1741352757 - Passmed UK

Question 1 - The most important difference between interstitial fluid and plasma is the: ...

Correct

The most important difference between interstitial fluid and plasma is the:

Your Answer: Protein concentration

Explanation:
Interstitial fluid (or tissue fluid or intercellular fluid) is a solution that surrounds the cells of multicellular animals. It is the main component of the extracellular fluid, which also includes plasma, lymph and transcellular fluid. Plasma, the major component in blood, communicates freely with interstitial fluid through pores and intercellular clefts in capillary endothelium. Interstitial fluid consists of a water solvent containing amino acids, sugars, fatty acids, coenzymes, hormones, neurotransmitters, salts, as well as waste products from the cells. Red blood cells, platelets and plasma proteins cannot pass through the walls of the capillaries. The resulting mixture that does pass through is essentially blood plasma without the plasma proteins. Tissue fluid also contains certain types of white blood cells. Once the extracellular fluid collects into small vessels it is considered to be lymph, and the vessels that carry it back to the blood are called the lymphatic vessels. The lymphatic system returns protein and excess interstitial fluid to the circulation.
This question is part of the following fields:
- Basic Sciences
- Physiology
4.8

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Question 2 - The superior rectal artery is a continuation of the: ...

Correct

The superior rectal artery is a continuation of the:

Your Answer: Inferior mesenteric artery

Explanation:
The superior rectal artery or superior haemorrhoidal artery is the continuation of the inferior mesenteric artery. It descends into the pelvis between the layers of the mesentery of the sigmoid colon, crossing the left common iliac artery and vein.
This question is part of the following fields:
- Anatomy
- Basic Sciences
4

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Question 3 - A 55-years-old man presented to the emergency department complaining of a squeezing sensation...

Correct

A 55-years-old man presented to the emergency department complaining of a squeezing sensation in his chest that has spread to his neck with associated worsening shortness of breath. Which of these laboratory tests would you ask for in this patient:

Your Answer: Creatine kinase-MB

Explanation:
Creatine kinase-MB is a test that usually is ordered when the patient has chest pain as a cardiac marker. When a heart attack is suspected and a troponin test (which is more specific for heart damage), is not available CK-MB is ordered. There are 3 forms of CK: CK-MM, CK-BB and CK-MB. CK-MB is commonly found in heart tissue, therefore injured heart muscle cells release CK-MB into the blood. Elevated CK-MB levels indicate that it is probable that a person has recently had a heart attack.
This question is part of the following fields:
- Basic Sciences
- Pathology
18.7

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Question 4 - After a car accident, a 30-year-old woman is alert and only has minor,...

Incorrect

After a car accident, a 30-year-old woman is alert and only has minor, superficial injuries. 2 hours later, she becomes unconscious and a CT scan reveals a convex, lens-shaped haemorrhage over the right parietal region. The most likely diagnosis is:

Your Answer: Subdural haematoma

Correct Answer: Epidural haematoma

Explanation:
Epidural haematomas are usually caused by arterial bleeding, classically due to damage to the middle meningeal artery by a temporal bone fracture. Symptoms develop within minutes to several hours after the injury and consist of increasing headache, decreased level of consciousness, hemiparesis and pupillary dilation with loss of light reactivity. Around 15–20% of epidural hematomas are fatal.
This question is part of the following fields:
- Basic Sciences
- Pathology
13.7

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Question 5 - A 30-year-old man presents to the A&E department after being shot in the...

Correct

A 30-year-old man presents to the A&E department after being shot in the back, in the lumbar region. On examination, he has increased tone and hyperreflexia of his right leg and hemianaesthesia of his left leg. What is the most likely diagnosis?

Your Answer: Brown-Sequard syndrome

Explanation:
This is a case of Brown-Sequard syndrome.

Brown-Sequard syndrome is caused by hemisection of the spinal cord following stab injuries or lateral vertebral fractures. It results in ipsilateral paralysis (pyramidal tract), and also loss of proprioception and fine discrimination(dorsal columns). Pain and temperature sensations are lost on the contralateral side. This is because the fibres of the spinothalamic tract have decussated below the level of the cord transection.
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
8

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Question 6 - A 21-year-old man is admitted to the hospital with diarrhoea and severe abdominal...

Incorrect

A 21-year-old man is admitted to the hospital with diarrhoea and severe abdominal pain for the past 18 hours. He was asymptomatic before that.Which of the following is the likely cause?

Your Answer: Salmonella gastroenteritis

Correct Answer: Campylobacter jejuni infection

Explanation:
Severe abdominal pain tends to favour infection with Campylobacter jejuni.

Infection with Campylobacter jejuni is one of the most common causes of gastroenteritis worldwide. In developed countries, the incidence of Campylobacter jejuni infections peaks during infancy and, again, during early adulthood. Most infections are acquired by the consumption and handling of poultry. A typical case is characterized by diarrhoea, fever, and severe abdominal cramps. Obtaining cultures of the organism from stool samples remains the best way to diagnose this infection. Complications of C. jejuni infections are rare, and most patients do not require antibiotics. Careful food preparation and cooking practices may prevent some Campylobacter infections.
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
9.7

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Question 7 - Which organs amongst these are the derivatives of the endoderm? ...

Incorrect

Which organs amongst these are the derivatives of the endoderm?

Your Answer:

Correct Answer: Epithelial part of the tympanic cavity

Explanation:
Endoderm derivatives include the epithelium of the following: gastrointestinal tract and its glands, glandular cells of the liver and pancreases, urachus and urinary bladder, pharynx, trachea and alveoli, part of the tonsils, thyroid and parathyroid, tympanic cavity and thymus and part of the anterior pituitary gland.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 8 - A 27 year old women works in a dry-cleaning shop. She was exposed...

Incorrect

A 27 year old women works in a dry-cleaning shop. She was exposed to massive amounts of carbon tetrachloride on her skin as well as inhaled. Which of the following organs is most susceptible to damage?

Your Answer:

Correct Answer: Liver

Explanation:
Carbon tetrachloride (CCl4) is a common agent used in the dry cleaning industry and is thought to cause the formation of free radicals. It causes rapid breakdown of the endoplasmic reticulum due to decomposition of lipids and severe liver cell injury. Within less than 30 mins, hepatic protein synthesis declines, lipid export is reduced due to lack of apoprotein and there is an influx of calcium and cell death.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 9 - A 4-year-old boy inserts a crayon into his external auditory meatus. Attempts to...

Incorrect

A 4-year-old boy inserts a crayon into his external auditory meatus. Attempts to remove it have not been successful. What is the best course of action?

Your Answer:

Correct Answer: Operate on the next emergency operating list

Explanation:
The removal of foreign bodies from the ear is a common procedure in the emergency department.
Abandon attempts to retrieve a foreign body if complications arise. If the object migrates farther into the canal or if bleeding, oedema, or increasing pain develops, consult an ENT specialist. Repeated attempts to remove a foreign body from the ear may result in infection, perforation, or another morbidity.
The presence of a tympanic membrane (TM) perforation, contact of a foreign body with the tympanic membrane, or incomplete visualization of the auditory canal are indications for urgent-emergent ENT consultation for removal by operative microscope and speculum.
Local anaesthesia is invasive and is not generally used for uncomplicated ear foreign body removal because of the complex innervations of the external ear canal.
This question is part of the following fields:
- Generic Surgical Topics
- Paediatric Surgery
0

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Question 10 - A 33 year old firefighter is recovering from an appendicectomy where the operation...

Incorrect

A 33 year old firefighter is recovering from an appendicectomy where the operation was complicated by the presence of perforation. On observation, he is seen to be vomiting and his urine output is decreasing. Which intravenous fluid should be initially administered, pending analysis of his urea and electrolyte levels?

Your Answer:

Correct Answer: Hartmann's solution

Explanation:
Compound Sodium Lactate (Hartmann’s) is used:
• for intravenous fluid and electrolyte replacement
• as a source of bicarbonate in the treatment of mild to moderate metabolic acidosis associated with dehydration or associated with potassium deficiency
• as a vehicle for intravenous drug delivery, if the drugs are compatible with the solutions

The total amount of electrolytes per litre are: sodium 131 mmol, potassium 5mmol, chloride 112 mmol, calcium 2mmol, bicarbonate (as lactate) 28 mmol.
The osmolality is approximately 255 mOsm/kg water. The solutions are isotonic, sterile, non-pyrogenic and do not contain antimicrobial agent or added buffers. The pH range is 5.0 to 7.0. Compound Sodium Lactate

Ringer’s lactate solution (RL), also known as sodium lactate solution and Hartmann’s solution, is a mixture of sodium chloride, sodium lactate, potassium chloride, and calcium chloride in water. It is used for replacing fluids and electrolytes in those who have low blood volume or low blood pressure.

Hartmann’s solution is often preferred over normal saline as it contains both fluids and electrolytes. The solution is also associated with fewer adverse effects and it can be administered to both adults and children.
This question is part of the following fields:
- Post-operative Management And Critical Care
- Principles Of Surgery-in-General
0

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Question 11 - A 40-year-old man has a tissue defect measuring 3 x 1 cm, following...

Incorrect

A 40-year-old man has a tissue defect measuring 3 x 1 cm, following the excision of a lipoma from the scapula. What should be the best option for managing the wound?

Your Answer:

Correct Answer: Direct primary closure

Explanation:
This wound should be managed by primary closure as there is minimal associated tissue loss and the surgery is minor and uncontaminated.

Primary wound closure is the fastest type of closures, and is also known as healing by primary intention. Wounds that heal by primary closure have a small, clean defect that minimizes the risk of infection and requires new blood vessels and keratinocytes to migrate only a small distance. Standard methods of suturing are usually sufficient for primary wound closure.
This question is part of the following fields:
- Principles Of Surgery-in-General
- Surgical Technique And Technology
0

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Question 12 - An anatomy instructor is giving a demonstration of the right lung. Which of...

Incorrect

An anatomy instructor is giving a demonstration of the right lung. Which of the statements about the right lung made by the demonstrator is correct?

Your Answer:

Correct Answer: Its upper lobar bronchus lies behind and above the right pulmonary artery

Explanation:
The root of the lungs on both sides are similar in that the pulmonary veins are anterior and inferior while the bronchus is posterior. However, on the right side, the pulmonary arteries are anterior to the bronchus while on the left side the pulmonary arteries are superior to the bronchus. The lingual is only found on the left lung. The mediastinum is the space in the thorax between the two pleural sacs and does not contain any lung. The right lung, having three lobes, is slightly larger than the left lung. On both sides, the phrenic nerves passes in front of the root of the lung.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 13 - A 46 year old woman is taken to the A&E department with a...

Incorrect

A 46 year old woman is taken to the A&E department with a full thickness burn on her chest which is well circumscribed. Her saturation was reduced to 92% on 15L of Oxygen, blood pressure of 104/63 mmHg and HR 106 bpm. What is the best management step?

Your Answer:

Correct 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.

Performing an escharotomy will therefore improve ventilation.
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
0

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Question 14 - A 35-year-old ultra marathon runner becomes severely dehydrated and collapses. This patient most...

Incorrect

A 35-year-old ultra marathon runner becomes severely dehydrated and collapses. This patient most likely has:

Your Answer:

Correct Answer: Decreased baroreceptor firing rate

Explanation:
Baroreceptors are sensors located in the blood vessels of all vertebrate animals. They sense the blood pressure and relay the information to the brain, so that a proper blood pressure can be maintained. Acute dehydration results in decreased plasma volume and increased plasma osmolarity, since more water than salt is lost in sweat. The decrease in plasma volume leads to an inhibition of the baroreceptors and a lower firing rate. The increase in plasma osmolarity leads to increased ADH secretion and high plasma ADH levels, which increases water permeability of collecting duct cells. Therefore more water is reabsorbed by the kidneys and renal water excretion is low.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 15 - A 55-year old patient with signs and symptoms of internal haemorrhage was brought...

Incorrect

A 55-year old patient with signs and symptoms of internal haemorrhage was brought in for emergency surgery to control the bleeding. Angiography results revealed an advanced duodenal tumour that had perforated the blood vessel immediately behind the first part of the duodenum. Which of the following is the most likely blood vessel that was ruptured by the cancer?

Your Answer:

Correct Answer: Gastroduodenal artery

Explanation:
The gastroduodenal artery is the artery that lies just behind the first portion of the duodenum. The gastroduodenal artery would be the most likely artery to be perforated by a cancer in this area. The perforation is as a result of the spillage of the acidic content of the chyme in the duodenum. All the other blood vessels in the list would less likely be affected by the gastric expellant from the duodenum. The coronary vein is located in the lesser curvature of the stomach. The inferior pancreaticoduodenal arcade is located inferiorly to the first part of the duodenum on the head of the pancreas. The hepatic artery proper is a branch of the common hepatic artery that is located superior to the first portion of the duodenum. The splenic vein arises from the spleen; it forms the portal vein by joining the superior mesenteric vein. It is laterally detached from the duodenum. Both the left gastric vein and the splenic vein are located superior to the first portion of the duodenum.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 16 - Which of the following is true about myasthenia gravis? ...

Incorrect

Which of the following is true about myasthenia gravis?

Your Answer:

Correct Answer: Response of skeletal muscle to nerve stimulation is weakened

Explanation:
An autoimmune disorder, myasthenia gravis leads to progressive muscle weakness. It occurs due to formation of antibodies against the nicotinic acetylcholine (ACh) receptor of the motor endplate, which leads to impaired neuromuscular transmission. Thus, nerve stimulation will lead to a weakened muscle response, but direct electrical stimulation will bring about a normal response. Diagnostic test includes improvement of muscle weakness by small doses of acetylcholinesterase inhibitors (physostigmine or edrophonium). However, a large dose of physostigmine worsens the weakness due to desensitisation of the endplate to persistent Ach. One of the investigative tools includes radiolabelled snake venom α-bungarotoxin. It is an in vitro study performed on muscle biopsy specimens and used to quantify the number of ACh receptors at the motor endplate.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 17 - A 75-year old patient is in atrial fibrallation but has never been on...

Incorrect

A 75-year old patient is in atrial fibrallation but has never been on anticoagulation therapy. To reduce the risk of future emboli, she would benefit from starting on long-term warfarin. Arterial emboli leading to acute limb ischaemia most commonly lodge at which one of the following sites?

Your Answer:

Correct Answer: Common femoral artery

Explanation:
The common femoral artery is the commonest site of arterial emboli causing acute limb ischemia. The treatment of choice is urgent femoral embolectomy.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 18 - A 32 year old woman with a history of Crohn's disease, presents with...

Incorrect

A 32 year old woman with a history of Crohn's disease, presents with a recurrent discharging anal fistula. Examination reveals a low anal fistula with involvement of a small area of the external anal sphincter muscle. Which of the following is the most appropriate management plan?

Your Answer:

Correct Answer: Insertion of a loose seton

Explanation:
Fistulotomy could achieve good results in terms of wound healing and incontinence in strictly selected patients with Crohn’s disease suffering from low-lying trans-sphincteric fistulae. For more high-lying or complicated fistulae, seton placement is more appropriate. For high transsphincteric fistulae, the only option is placement of loose seton.
Fistulae are classified into four main groups according to anatomical location and the degree of sphincter involvement. Simple uncomplicated fistulae are low and do not involve more than 30% of the external sphincter. Complex fistulae involve the sphincter, have multiple branches or are non cryptoglandular in origin
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
0

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Question 19 - During hysterectomy, the ureter is most likely to be ligated when a surgeon...

Incorrect

During hysterectomy, the ureter is most likely to be ligated when a surgeon is clamping the?

Your Answer:

Correct Answer: Uterine arteries

Explanation:
The ureter forms the posterior boundary of a shallow depression which lodges the ovary and then runs medially and forward on the lateral aspect of the uterine cervix and upper part of the vagina to reach the fundus of the bladder. It is also situated about 2cm from the side of the cervix of the uterus. The relationship of the ureters and uterine arteries is of clinical significance because the arteries are at risk of iatrogenic injury during hysterectomy.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 20 - What is the 5-year survival rate of carcinoma of the pancreas? ...

Incorrect

What is the 5-year survival rate of carcinoma of the pancreas?

Your Answer:

Correct Answer: 30 per cent

Explanation:
Pancreatic cancer typically has a poor prognosis, partly because the cancer usually initially remains symptomless, leading to locally advanced or metastatic disease at the time of diagnosis. Median survival from diagnosis is around 3–6 months. Even in those suitable for resectional surgery, 5-year survival rates are still only 30 per cent.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 21 - An 11 year old girl who is small for her age presents to...

Incorrect

An 11 year old girl who is small for her age presents to the clinic with hypermobile fingers and poor muscular development. Multiple fractures of the long bones and irregular patches of ossification are seen on the x-rays. What is her diagnosis?

Your Answer:

Correct Answer: Osteogenesis imperfecta

Explanation:
Answer: Osteogenesis imperfecta

Osteogenesis imperfecta (OI) is a disorder of bone fragility chiefly caused by mutations in the COL1A1 and COL1A2 genes that encode type I procollagen.

Type II – Perinatal lethal
Some providers who treat large numbers of patients with osteogenesis imperfecta suggest that the diagnosis of Type II OI be made in retrospect for patients who do not survive the perinatal period, and that even patients with very severe forms of OI who nonetheless are long term survivors be classified as Type III. Blue sclera may be present. Patients may have a small nose, micrognathia, or both. All patients have in utero fractures, which may involve the skull, long bones, and/or vertebrae. The ribs are beaded, and the long bones are severely deformed.
Causes of death include extreme fragility of the ribs, pulmonary hypoplasia, and malformations or haemorrhages of the CNS.

Type III – Severe, progressively deforming

Patients may have joint hyperlaxity, muscle weakness, chronic unremitting bone pain, and skull deformities (e.g., posterior flattening) due to bone fragility during infancy.

Deformities of upper limbs may compromise function and mobility. The presence of dentinogenesis imperfecta is independent of the severity of the osteogenesis imperfecta. The sclera have variable hues. In utero fractures are common. Limb shortening and progressive deformities can occur. Patients have a triangular face with frontal and temporal bossing. Malocclusion is common. Basilar invagination is an uncommon but potentially fatal occurrence in osteogenesis imperfecta.
Vertigo is common in patients with severe osteogenesis imperfecta. Hypercalciuria may be present in about 36% of patients with osteogenesis imperfecta, and adults may be at higher risk of renal calculi. Respiratory complications secondary to kyphoscoliosis are common in individuals with severe osteogenesis imperfecta.
Constipation and hernias are also common in people with osteogenesis imperfecta.

Obtain a radiographic skeletal survey after birth.

In mild (type I) osteogenesis imperfecta, images may reveal thinning of the long bones with thin cortices. Several wormian bones may be present. No deformity of long bones is observed.

In extremely severe (type II) osteogenesis imperfecta, the survey may reveal beaded ribs, broad bones, and numerous fractures with deformities of the long bones. Platyspondylia may also be revealed.

In moderate and severe (types III and IV) osteogenesis imperfecta, imaging may reveal cystic metaphysis, or a popcorn appearance of the growth cartilage. Normal or broad bones are revealed early, with thin bones revealed later. Fractures may cause deformities of the long bones. Old rib fractures may be present. Vertebral fractures are common.
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
0

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Question 22 - A 34 year old man arrives at the clinic due to a painless...

Incorrect

A 34 year old man arrives at the clinic due to a painless lump in his left teste. His blood tests and US point towards a teratoma. Which of the following is the most appropriate next step in the management of this patient?

Your Answer:

Correct Answer: Orchidectomy via an inguinal approach

Explanation:
Unlike other cancers for which a biopsy is performed, when testicular cancer is suspected the entire testicle is removed in a procedure called an orchiectomy through an incision in the groin and pulling the testicle up from the scrotum. A biopsy through the scrotum for testicular cancer runs the risk of spreading the cancer, and can complicate future treatment options. Removing the entire testicle out of the scrotum is the only safe way to diagnose for testicular cancer. Only the cancer-containing testicle is removed, and it is important to do so promptly.
If there is any uncertainty, the urologists can examine the testicle by pulling the testicle out of the scrotum; if a condition other than testis cancer is found, the testicle is placed back into the scrotum.

Testicular cancer is the most common malignancy in men aged 20-30 years. Around 95% of cases of testicular cancer are germ-cell tumours.
This question is part of the following fields:
- Generic Surgical Topics
- Urology
0

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Question 23 - A 56 year old gentleman, who is a chronic smoker presents to the...

Incorrect

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:

Correct 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 24 - In a splenectomy procedure, special care is emphasized on the preservation of the...

Incorrect

In a splenectomy procedure, special care is emphasized on the preservation of the tail of the pancreas that is closely associated with the spleen to avoid post operative pancreatic fistula. As a general surgeon conducting a splenectomy where are you most likely to find the tail of the pancreas in the abdominal cavity?

Your Answer:

Correct Answer: Splenorenal ligament

Explanation:
The tail of the pancreas is the only intraperitoneal part of the pancreas and is found contained in the splenorenal ligament of the peritoneal cavity. The splenorenal ligament is derived from the peritoneum where the wall of the general peritoneal cavity connects to the omental bursa between the spleen and the left kidney. This ligament contains the splenic vessels and the tail of the pancreas.
The gastrocolic ligament stretches from the greater curvature of the stomach to the transverse colon, connecting the two.
The gastrosplenic ligament is derived from the greater omentum and is the structure that connects the stomach to the hilum of the spleen. The gastrosplenic ligament continues from the splenic flexure of the colon to the diaphragm and acts as a support to the spleen.
The transverse colon is connected to the abdominal wall by the mesocolon ligament.
The falciform ligament on the other hand, attaches the liver to the ventral wall of the abdomen.
The hepatoduodenal ligament connects the porta hepatis of the liver to the superior part of the duodenum.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 25 - Anthrax is an infection caused by the bacterium Bacillus anthracis. Anthrax spores have been used...

Incorrect

Anthrax is an infection caused by the bacterium Bacillus anthracis. Anthrax spores have been used as a biological warfare weapon. What is the drug of choice in treating anthrax infection?

Your Answer:

Correct Answer: Ciprofloxacin

Explanation:
Early antibiotic treatment of anthrax is essential. A delay may significantly lessen the chances for survival of the patient. Treatment for anthrax infection include large doses of intravenous and oral antibiotics, such as fluoroquinolones (ciprofloxacin), doxycycline, erythromycin, vancomycin, or penicillin.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 26 - A 42 year old women presents with end stage renal failure and is...

Incorrect

A 42 year old women presents with end stage renal failure and is prepared to receive a kidney from her husband. HLA testing showed that they are not a 100% match and she is given immunosuppressant therapy for this. Three months later when her renal function tests were performed she showed signs of deteriorating renal function, with decreased renal output, proteinuria of +++ and RBCs in the urine. She was given antilymphocyte globulins and her condition reversed. What type of graft did this patient receive?

Your Answer:

Correct Answer: Allograft

Explanation:
Allograft describes a graft between two of the same species. As the donor and the recipients are history-incompatible, rejection of the graft is common and is controlled by immunosuppressive drug therapy. Isograft and syngraft are synonymous and referred to a graft transferred between genetically identical individuals e.g. identical twins. In this case rejection is rare as they are history-compatible.
Autograft refers to transfer of one part of the body to another location.
Xenograft is transfer of tissue from another species e.g. pig to human in valve replacement surgeries and rejection is very high.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 27 - A 45-year old male patient with a long history of alcoholism developed liver...

Incorrect

A 45-year old male patient with a long history of alcoholism developed liver cirrhosis that has led to portal hypertension. Which of the following plexuses of veins is most likely dilated in this patient?

Your Answer:

Correct Answer: Haemorrhoidal plexus

Explanation:
The haemorrhoidal plexus or also known as the rectal plexus is a venous plexus that surrounds the rectum. This venous plexus in males communicates anteriorly with the vesical plexus and uterovaginal plexus in females. This venous plexus forms a site of free communication between the portal and systemic venous systems. In the case of portal hypertension this plexus would most likely dilate due to the increased pressure.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 28 - Multiple, non-tender lymphadenopathy with biopsy showing several crowded follicles of small, monomorphic lymphocytes...

Incorrect

Multiple, non-tender lymphadenopathy with biopsy showing several crowded follicles of small, monomorphic lymphocytes and the absence of Reed-Sternberg cells is seen in which of the following?

Your Answer:

Correct Answer: Poorly differentiated lymphocytic lymphoma

Explanation:
Malignant lymphoma usually causes non-tender lymphadenopathy, unlike the tender lymphadenopathy caused by infections (including infectious mononucleosis caused by Epstein-Barr virus). Also, the lymphoid hyperplasia seen in infectious mononucleosis is benign and polyclonal.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 29 - An old man presented with atrophy of the thenar eminence despite the sensation...

Incorrect

An old man presented with atrophy of the thenar eminence despite the sensation over it still being intact. What is the injured nerve in this case?

Your Answer:

Correct Answer: Median nerve

Explanation:
Atrophy of the thenar muscles means injury to the motor supply of these muscles. The nerve that sends innervation to it is the median nerve. But the median nerve does not provide sensory innervation to the overlying skin so sensation is spared.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 30 - A 30 year old welder presents to his family doctor with symptoms of...

Incorrect

A 30 year old welder presents to his family doctor with symptoms of chronic ear discharge and a left-sided facial nerve palsy. On examination, he has foul smelling fluid draining from his left ear and a complete left-sided facial nerve palsy. What is the most likely cause?

Your Answer:

Correct Answer: Cholesteatoma

Explanation:
A cholesteatoma consists of squamous epithelium that is trapped within the skull base and that can erode and destroy important structures within the temporal bone. They often become infected and can result in chronically draining ears. Treatment almost always consists of surgical removal. The majority (98%) of people with cholesteatoma have ear discharge or conductive hearing loss or both in the affected ear.

Other more common conditions (e.g. otitis externa) may also present with these symptoms, but cholesteatoma is much more serious and should not be overlooked. If a patient presents to a doctor with ear discharge and hearing loss, the doctor should consider cholesteatoma until the disease is definitely excluded.

Other less common symptoms (all less than 15%) of cholesteatoma may include pain, balance disruption, tinnitus, earache, headaches and bleeding from the ear. There can also be facial nerve weakness. Balance symptoms in the presence of a cholesteatoma raise the possibility that the cholesteatoma is eroding the balance organs in the inner ear.
This question is part of the following fields:
- Generic Surgical Topics
- Head And Neck Surgery
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Question 31 - A 66 year old woman undergoes an emergency hip hemiarthroplasty. The procedure is...

Incorrect

A 66 year old woman undergoes an emergency hip hemiarthroplasty. The procedure is complicated by a fracture of the femoral shaft following the insertion of the prosthesis. She is seen postoperatively to be unsteady on her feet and she is depressed. She remains bedbound for 2 weeks and is slow to progress despite adequate physiotherapy. Which of the following physiological changes is not seen after prolonged immobilization?

Your Answer:

Correct Answer: Bradycardia

Explanation:
Answer: Bradycardia

Prolonged bed rest and immobilization inevitably lead to complications. Such complications are much easier to prevent than to treat. Musculoskeletal complications include loss of muscle strength and endurance, contractures and soft tissue changes, disuse osteoporosis, and degenerative joint disease. Cardiovascular complications include an increased heart rate (tachycardia), decreased cardiac reserve, orthostatic hypotension, and venous thromboembolism.
This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
0

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Question 32 - A 15 year old girl presented to the emergency with a history of...

Incorrect

A 15 year old girl presented to the emergency with a history of chronic cough, fever and weight loss. Her chest X-ray showed multiple nodules 1-4 cm in size and some of them with cavitation especially in the upper lobe. A sputum sample was positive for acid fast bacilli. Which of the following cells played a part in the development of the lung lesions?

Your Answer:

Correct Answer: Macrophage

Explanation:
The characteristic cells in granulomatous inflammation are giant cells, formed from merging macrophages and epithelioid cells elongated with granular eosinophilic cytoplasm. Granulomatous reactions are seen in patients with tuberculosis. A tuberculous/caseating granuloma is characterised by a zone of central necrosis lined with giant multinucleated giant cells (Langhans cells) and surrounded by epithelioid cells, lymphocytes and fibroblasts. The caseous zone is present due to the damaged and dead giant cells and epithelioid cells.
Mast cells are only few in number and fibroblasts lay down collagen.
Basophils are not present.
The giant cell made up of macrophages are the most abundant cells in this inflammatory process.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 33 - A 53-year-old female with a history of rheumatoid presents with a suspected septic...

Incorrect

A 53-year-old female with a history of rheumatoid presents with a suspected septic knee joint. A diagnostic aspiration is performed and sent to microbiology. Which of the organisms below is most likely to be responsible?

Your Answer:

Correct Answer: Staphylococcus aureus

Explanation:
Septic arthritis, also known as infectious arthritis, may represent a direct invasion of the joint space by various microorganisms, most commonly caused by bacteria.
Neisseria gonorrhoeae remains the most common pathogen (75% of cases) among younger sexually active individuals.
Staphylococcus aureus infection causes the vast majority of acute bacterial arthritis cases in adults and in children older than 2 years.
This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 34 - The line which divides the perineum into two triangles is connected to the?...

Incorrect

The line which divides the perineum into two triangles is connected to the?

Your Answer:

Correct Answer: Ischial tuberosities

Explanation:
The perineum has it’s deep boundaries in front of the pubic arch and the arcuate ligament of the pubis, behind the tip of the coccyx and on either side of the inferior rami of the pubis and ischium and the sacrotuberous ligament. It also corresponds to the outlet of the pelvis. A line drawn transversely across, in front of the ischial tuberosities divides the space into two portions, the posterior contains the termination of the anal canal and the anterior, contains the external urogenital organs.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 35 - A 5 year old boy accidentally spills boiling water over his legs and...

Incorrect

A 5 year old boy accidentally spills boiling water over his legs and is diagnosed with superficial partial thickness burns. Which of the following is least likely to occur?

Your Answer:

Correct Answer: Damage to sweat glands

Explanation:
Superficial burns are confined in the depth of the epidermis, and all dermal appendages and nerve endings are intact. Superficial burns generally heal in 3 to 5 days with minimal intervention and do not leave significant scarring as they typically heal by re epithelialization. Therefore the sweat glands will be intact.
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 36 - A 63 year old lawyer presents with marked agitation after undergoing a transurethral...

Incorrect

A 63 year old lawyer presents with marked agitation after undergoing a transurethral resection of the prostate which took one hour to perform. He has a heart rate of 105 beats per minute and his blood pressure is 170/100mmHg. He is suspected to be in a fluid overloaded state. Lab results reveal a sodium level of 120mmol/L. Which of the following is the most likely cause of this presentation?

Your Answer:

Correct Answer: TURP syndrome

Explanation:
Complications of Transurethral Resection: TURP
T URP syndrome
U rethral stricture/UTI
R etrograde ejaculation
P erforation of the prostate

TURP syndrome can cause a wide variety of symptoms that include asymptomatic hyponatremia, ECG changes, fatigue, vomiting, confusion, visual loss, coma and death. In a conscious and alert patient, changes in the mental state of may be the first sign of TURP syndrome and bladder perforation.
This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
0

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Question 37 - What is the most likely cause of bilateral gynaecomastia in a 55-year old...

Incorrect

What is the most likely cause of bilateral gynaecomastia in a 55-year old male?

Your Answer:

Correct Answer: Hepatic failure

Explanation:
Hypertrophy of breast tissue in males is known as gynaecomastia. It is normally due to proliferation of stroma and not of mammary ducts. Physiological gynaecomastia can occur during puberty and is often transient, bilateral, symmetrical and possibly tender. Gynaecomastia can occur during old age too, but is usually unilateral. Other causes include hepatic or renal failure, endocrinological disorders, drugs (anabolic steroids, antineoplastic drugs, calcium channel blockers, cimetidine, digitalis, oestrogens, isoniazid, ketoconazole, methadone, metronidazole, reserpine, spironolactone, theophylline), and marijuana. It should not be confused with malignancy which is often hard, asymmetric and fixed to the dermis or fascia. Treatment if indicated, includes withdrawal of the causative factor or treatment of the underlying disorder.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 38 - Calculate the stroke volume in an adult male with the following parameters: Heart...

Incorrect

Calculate the stroke volume in an adult male with the following parameters: Heart rate 70 beats/min, Arterial [O2] 0.24 ml O2/min, Venous [O2] 0.16 ml O2/min, Whole body O2 consumption 500 ml/min, Pulmonary diastolic pressure 15 mmHg, Pulmonary systolic pressure 25 mmHg, Wedge pressure 5 mmHg.

Your Answer:

Correct Answer: 90 ml

Explanation:
Fick’s principle states that, VO2 = (CO × CAO2) – (CO × CVO2) where VO2 = oxygen consumption, CO = cardiac output, CAO2 = oxygen concentration of arterial blood and CVO2 = oxygen concentration of venous blood. Thus, CO = VO2/CAO2– CVO2, CO = 500/0.24–0.16, CO = 500/0.8, CO = 6.25 l/min. Cardiac output is also given by product of stroke volume and heart rate. Thus, stroke volume = cardiac output / heart rate = 6.25/70 × 1000 stroke volume = 90 ml approximately.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 39 - A 30 year old female presented in the emergency with an irregular pulse....

Incorrect

A 30 year old female presented in the emergency with an irregular pulse. Her ECG showed absent P-waves with irregular RR interval. What is the most likely diagnosis?

Your Answer:

Correct Answer: Atrial fibrillation

Explanation:
Atrial fibrillation is one of the most common cardiac arrhythmias. It is often asymptomatic but may present with symptoms of palpitations, fainting, chest pain and heart failure. Characteristic findings are: absence of P-waves, unorganised electrical activity in their place, irregularity of RR interval due to irregular conduction of impulses to the ventricles and if paroxysmal AF is suspected, episodes may be documented with the use of Holter monitoring
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 40 - A 53 year old women with a history of atrial fibrillation developed an...

Incorrect

A 53 year old women with a history of atrial fibrillation developed an acute abdomen. On laparoscopic examination her bowels appeared to be dusky to red-purple in colour and her mesenteric veins appeared to be patent. Which of the following is most likely to occur in this situation?

Your Answer:

Correct Answer: Wet gangrene

Explanation:
Infarction of the small bowel following a sudden and complete occlusion of the mesenteric artery can involve any portion of the bowel, whether small or a large. The splenic flexure is at most risk for infarction as it is the watershed area between the superior and inferior mesenteric vessels. Regardless of whether the arterial or the venous blood vessels are occluded, because of the blood reflow into the damaged portion, it will appear haemorrhagic. The bowel appearing congested at first and then becoming oedematous. If the artery is occluded then there will be a clear cut demarcation and in venous occlusion the dusky colour fades with the rest of the normal bowel. Wet gangrene is characteristic of ischaemic injury to the gut.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 41 - A 56 year old man is scheduled for flexible sigmoidoscopy to investigate bright...

Incorrect

A 56 year old man is scheduled for flexible sigmoidoscopy to investigate bright red rectal bleeding. Which of the following would be the most appropriate preparation for this procedure?

Your Answer:

Correct Answer: Single phosphate enema 30 minutes pre procedure

Explanation:
Bowel preparation is a significant aspect of the flexible sigmoidoscopy procedure. Clear visibility of the bowel mucosa is critical for a thorough examination. The combination of a light breakfast in the morning and the application of 1 or 2 phosphate enemas a few hours before the examination is a safe and commonly used method of preparing a patient for a flexible sigmoidoscopy procedure.
This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
0

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Question 42 - Dicloxacillin is an antibiotic; the subclass that dicloxacillin belongs to is: ...

Incorrect

Dicloxacillin is an antibiotic; the subclass that dicloxacillin belongs to is:

Your Answer:

Correct Answer: Penicillin

Explanation:
Dicloxacillin is a narrow-spectrum beta-lactam antibiotic. It is used to treat infections caused by susceptible Gram-positive bacteria and most effective against beta-lactamase-producing organisms such as Staphylococcus aureus. To decrease the development of resistance, dicloxacillin is recommended to treat infections that are suspected or proven to be caused by beta-lactamase-producing bacteria.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 43 - A 40-year-old man presents to the acute surgical unit with acute pancreatitis. Over...

Incorrect

A 40-year-old man presents to the acute surgical unit with acute pancreatitis. Over the next few days, he becomes dyspnoeic and his saturations are 89% on air and CVP is 16 mmHg. CXR shows bilateral pulmonary infiltrates.What is the most likely diagnosis?

Your Answer:

Correct Answer: Acute respiratory distress syndrome

Explanation:
Acute pancreatitis is known to precipitate acute respiratory distress syndrome (ARDS) which is characterised by bilateral pulmonary infiltrates and severe hypoxaemia in the absence of evidence for cardiogenic pulmonary oedema. Pulmonary oedema is excluded by the CVP reading of <18 mmHg in this scenario. ARDS is subdivided into two stages. Early stage consists of an exudative phase of injury with associated oedema. The later stage is one of repair and consists of fibroproliferative changes. Subsequent scarring may result in poor lung function. ARDS can also lead to multiple organ failure. Various causes of ARDS include:
1. Sepsis
2. Direct lung injury
3. Trauma
4. Acute pancreatitis
5. Long bone fracture or multiple fractures (through fat embolism)
6. Head injury (sympathetic nervous stimulation which leads to acute pulmonary hypertension)

Management options are:
1. Treat the underlying cause
2. Antibiotics (if signs of sepsis)
3. Negative fluid balance, i.e. diuretics
4. Recruitment manoeuvres such as prone ventilation and use of positive end-expiratory pressure (PEEP)
5. Mechanical ventilation strategy using low tidal volumes, as conventional tidal volumes may cause lung injury (only treatment found to improve survival rates)
This question is part of the following fields:
- Post-operative Management And Critical Care
- Principles Of Surgery-in-General
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Question 44 - A 26-year-old man sustains a Holstein-Lewis fracture of the left arm. Which of...

Incorrect

A 26-year-old man sustains a Holstein-Lewis fracture of the left arm. Which of the following nerves is at risk of damage?

Your Answer:

Correct Answer: Radial

Explanation:
Holstein-Lewis fracture is a fracture of the distal third of the humerus resulting in entrapment of the radial nerve. The radial nerve is one of the major peripheral nerves of the upper limb. It innervates all the muscles in the extensor compartments of the arm.

Conservative treatment for this fracture includes reduction and use of a functional brace. However, vascular injury may require open surgery.
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 45 - The rotator cuff surrounds the shoulder joint and consists of the supraspinatus, infraspinatus,...

Incorrect

The rotator cuff surrounds the shoulder joint and consists of the supraspinatus, infraspinatus, subscapularis and which one other muscle?

Your Answer:

Correct Answer: Teres minor

Explanation:
The correct answer is the teres minor muscle. These group of muscles play an important role in protecting the shoulder joint and keeping the head of the humerus in the glenoid fossa of the scapula. This fossa is somehow shallow and needs support to allow for the full mobility that the shoulder joint has.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 46 - A patient with a long standing lower motor neuron lesion will have: ...

Incorrect

A patient with a long standing lower motor neuron lesion will have:

Your Answer:

Correct Answer: Muscle wasting

Explanation:
Lower motor neurons (LMNs) connect the brainstem and spinal cord to muscle fibres. Damage to lower motor neurons is indicated by abnormal electromyographic potentials, fasciculations, paralysis, weakening and wasting of skeletal muscles.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 47 - Streptokinase is used to break down clots in some cases of myocardial infarction,...

Incorrect

Streptokinase is used to break down clots in some cases of myocardial infarction, pulmonary embolism, and arterial thromboembolism; however, it is not recommended to use it again after 4 days from the first administration. Which complication could arise from repeated use?

Your Answer:

Correct Answer: Allergic reaction

Explanation:
Streptokinase belongs to a group of medications known as ‘fibrinolytics’ and is an extracellular metallo-enzyme produced by beta-haemolytic streptococci, used as an effective clot-dissolving medication in patients with myocardial infarction and pulmonary embolism. As Streptokinase is a bacterial product, the body has the ability to build up an immunity to it. Therefore, it is recommended that this medication should not be used again after four days from the first administration, as it may not be as effective and may also cause an allergic reaction.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 48 - A 22-year-old male presents with a 10-day history of right-sided abdominal pain. Prior...

Incorrect

A 22-year-old male presents with a 10-day history of right-sided abdominal pain. Prior to this, he was well. On examination, he has a low-grade fever and a palpable mass in the right iliac fossa. The rest of his abdomen is soft. An abdominal USS demonstrates matted bowel loops surrounding a thickened appendix. What is the best course of action?

Your Answer:

Correct Answer: Manage conservatively with antibiotics

Explanation:
The patient mostly has an appendicular mass.
At present, the treatment of choice for uncomplicated acute appendicitis in adults continues to be surgical. The inflammation in acute appendicitis may sometimes be enclosed by the patient’s own defence mechanisms, by the formation of an inflammatory phlegmon or a circumscribed abscess. The management of these patients is controversial. An immediate appendectomy may be technically demanding. The exploration often ends up in an ileocecal resection or a right-sided hemicolectomy. Recently, the conditions for conservative management of these patients have changed due to the development of computed tomography and ultrasound, which has improved the diagnosis of enclosed inflammation and made drainage of intra-abdominal abscesses easier. New efficient antibiotics have also given new opportunities for nonsurgical treatment of complicated appendicitis. The traditional management of these patients is nonsurgical treatment followed by interval appendectomy to prevent a recurrence. The need for interval appendectomy after successful nonsurgical treatment has recently been questioned because the risk of recurrence is relatively small.
In patients with suspicion of contained appendiceal inflammation, based on a palpable mass or long duration of symptoms, the diagnosis should be confirmed by imaging techniques, especially CT scan. The patient should receive primary nonsurgical treatment with antibiotics and abscess drainage as needed. After successful nonsurgical treatment, no interval appendectomy is indicated in some cases, but the patient should be informed about the risk of recurrence especially in the presence of appendicolith. The risk of missing another underlying condition (cancer or CD) is low, but motivates a follow-up with a colon examination and/or a CT scan or US, especially in patients above the age of 40 years.
This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 49 - Injury to this nerve will affect the function of the palatoglossus and levator...

Incorrect

Injury to this nerve will affect the function of the palatoglossus and levator veli palatini muscles:

Your Answer:

Correct Answer: Cranial nerve X

Explanation:
The vagus nerve (cranial nerve X) innervates both the palatoglossus and levator veli palatini muscles.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 50 - A middle aged man presented in OPD with a low grade fever and...

Incorrect

A middle aged man presented in OPD with a low grade fever and a persistent cough. His blood smear showed an increase in cells with large bi-lobed nuclei. Which of these cells represent the one seen on the smear?

Your Answer:

Correct Answer: Monocytes

Explanation:
Monocytes are white cells that protect the body against harmful pathogens. They are mobile and are produced in the bone marrow, mature there and circulate in the blood for about 1-3 days, where they enter the tissues and transform into macrophages. They are characteristically identified by their large bi-lobed nuclei.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 51 - A 4-year-old child was brought to a paediatrician for consult due to a...

Incorrect

A 4-year-old child was brought to a paediatrician for consult due to a palpable mass in his abdomen. The child has poor appetite and regularly complains of abdominal pain. The child was worked up and diagnosed with a tumour. What is the most likely diagnosis ?

Your Answer:

Correct Answer: Nephroblastoma

Explanation:
Nephroblastoma is also known as Wilms’ tumour. It is a cancer of the kidneys that typically occurs in children. The median age of diagnose is approximately 3.5 years. With the current treatment, approximately 80-90% of children with Wilms’ tumour survive.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 52 - A 17 year old girl presents with enlarged tonsils that meet in the...

Incorrect

A 17 year old girl presents with enlarged tonsils that meet in the midline. Examination confirms the finding and petechial haemorrhages affecting the oropharynx are observed. Splenomegaly is seen on systemic examination. Which of the following is the most likely cause?

Your Answer:

Correct Answer: Infection with Epstein Barr virus

Explanation:
Answer: Acute Epstein Barr virus infection

The Epstein–Barr virus is one of eight known human herpesvirus types in the herpes family, and is one of the most common viruses in humans. Infection with Epstein-Barr virus (EBV) is common and usually occurs in childhood or early adulthood.
EBV is the cause of infectious mononucleosis, an illness associated with symptoms and signs like:
fever,
fatigue,
swollen tonsils,
headache, and
sweats,
sore throat,
swollen lymph nodes in the neck, and
sometimes an enlarged spleen.
Although EBV can cause mononucleosis, not everyone infected with the virus will get mononucleosis. White blood cells called B cells are the primary targets of EBV infection.
Petechiae on the palate are characteristic of streptococcal pharyngitis but also can be seen in Epstein–Barr virus infection, Arcanobacterium haemolyticum pharyngitis, rubella, roseola, viral haemorrhagic fevers, thrombocytopenia, and palatal trauma.
This question is part of the following fields:
- Generic Surgical Topics
- Head And Neck Surgery
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Question 53 - A ‘claw hand’ is usually associated with injury to which of the following...

Incorrect

A ‘claw hand’ is usually associated with injury to which of the following nerves?

Your Answer:

Correct Answer: Ulnar nerve

Explanation:
A ‘claw hand’ is associated with injury to the ulnar nerve at the wrist affecting the interossei, lumbricals and hypothenar muscles of the hand. It is characterized by hypothenar eminence wasting, hyperextended metacarpophalangeal joints and flexed interphalangeal joints.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 54 - Which of the following is NOT a nutritional factor involved in wound healing:...

Incorrect

Which of the following is NOT a nutritional factor involved in wound healing:

Your Answer:

Correct Answer: Vitamin B3

Explanation:
Vitamin B6 is required for collagen cross-links.
Vitamin A is required for epithelial cell proliferation.
Zinc is required for RNA and DNA synthesis.
Copper is required for cross-linking of collagen.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 55 - What is the chief ligament preventing posterior sliding of the tibia on the...

Incorrect

What is the chief ligament preventing posterior sliding of the tibia on the femur ?

Your Answer:

Correct Answer: Posterior cruciate

Explanation:
The posterior cruciate ligament is attached to the posterior intercondyloid fossa of the tibia and the lateral and front part of the medial condyle of the femur. It resists sliding of the tibia posteriorly.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 56 - A 55-year-old male undergoes a laparotomy for perforated bowel after a colonoscopy. 2...

Incorrect

A 55-year-old male undergoes a laparotomy for perforated bowel after a colonoscopy. 2 days after surgery the nursing staff report there is pink, serous fluid discharging from the wound. What is the next most appropriate management step?

Your Answer:

Correct Answer: Examine the wound for separation of the rectus fascia

Explanation:
Surgical wound dehiscence (SWD) is the separation of the margins of a closed surgical incision that
has been made in the skin, with or without exposure or protrusion of underlying tissue, organs or implants. Separation may occur at single or multiple regions, or involve the full length of the incision, and may affect some or all tissue layers. A dehisced incision may, or may not, display clinical signs and symptoms of infection.
SWD can occur without warning. Incisions at risk of dehiscence may show signs of inflammation beyond the time and extent expected for normal healing, e.g. more exaggerated incisional redness, swelling, warmth and pain that extend beyond postoperative day 5. Palpation of the incision and surrounding area may reveal the warmth and a collection of fluid under some or all of the incision (a seroma, haematoma or abscess). A sudden increase in pain or discharge of serosanguineous fluid from the incision may herald SWD.

Prior to assessment of SWD, the events, if any, leading to the dehiscence, e.g. coughing, vomiting, trauma, suture/clip removal, purulent drainage, should be ascertained. The duration of the dehiscence should also be determined: SWD occurring very soon after surgery and of very recent occurrence may be suitable for re-suturing.
The entire length of an incision with SWD should be fully assessed: the factors that led to the SWD may also be affecting other regions of the incision that remain closed.
This question is part of the following fields:
- Post-operative Management And Critical Care
- Principles Of Surgery-in-General
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Question 57 - A 65-year-old man complains of headaches, weakness, cramps, and confusion; blood tests reveal...

Incorrect

A 65-year-old man complains of headaches, weakness, cramps, and confusion; blood tests reveal he has severe hyponatremia. The most likely cause is:

Your Answer:

Correct Answer: Severe diarrhoea or vomiting

Explanation:
Hyponatraemia occurs when the sodium level in the plasma falls below 135 mmol/l. Hyponatraemia is an abnormality that can occur in isolation or, more commonly as a complication of other medical illnesses. Severe hyponatraemia may cause osmotic shift of water from the plasma into the brain cells. Typical symptoms include nausea, vomiting, headache and malaise. As the hyponatraemia worsens, confusion, diminished reflexes, convulsions, stupor or coma may occur. The cause of hyponatremia is typically classified by a person’s fluid status into low volume, normal volume, and high volume. Low volume hyponatremia can occur from diarrhoea, vomiting, diuretics, and sweating.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 58 - A machine worker fractured the medial epicondyle of his right humerus resulting in...

Incorrect

A machine worker fractured the medial epicondyle of his right humerus resulting in damage to an artery running with the ulnar nerve posterior to the medial epicondyle. The artery injured is the?

Your Answer:

Correct Answer: Superior ulnar collateral

Explanation:
The superior ulnar collateral artery runs posterior to the medial epicondyle of the humerus, accompanied by the ulnar nerve. This artery arises from the brachial artery near the middle of the arm and ends under the flexor carpi ulnaris muscle by anastomosing with two arteries: the posterior ulnar recurrent and inferior ulnar collateral.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 59 - The middle meningeal artery is the largest among the arteries that supplies that...

Incorrect

The middle meningeal artery is the largest among the arteries that supplies that dura mater of the brain. What is the terminal branch of the middle meningeal artery?

Your Answer:

Correct Answer: Maxillary artery

Explanation:
The middle meningeal artery is the largest of the three (paired) arteries that supply the meninges. The middle meningeal artery is typically the third branch of the first part of the maxillary artery, one of the two terminal branches of the external carotid artery.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 60 - When does the heart rate decrease? ...

Incorrect

When does the heart rate decrease?

Your Answer:

Correct Answer: Pressure on the eyeball

Explanation:
Various vagotonic manoeuvres (e.g. Valsalva manoeuvre, carotid sinus massage, pressure on eyeballs, ice-water facial immersion, swallowing of ice-cold water) result in increased parasympathetic tone through the vagus nerve which results in a decrease in heart rate. These manoeuvres may be clinically useful in terminating supraventricular arrhythmias.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 61 - What percentage of the cardiac output is delivered to the brain? ...

Incorrect

What percentage of the cardiac output is delivered to the brain?

Your Answer:

Correct Answer: 15%

Explanation:
Among all body organs, the brain is most susceptible to ischaemia. Comprising of only 2.5% of total body weight, the brain receives 15% of the cardiac output. Oxygen extraction is also higher with venous oxygen levels approximating 13 vol%, and arteriovenous oxygen difference of 7 vol%.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 62 - A 32-year-old man presented with a metabolic acidosis and increased anion gap. What...

Incorrect

A 32-year-old man presented with a metabolic acidosis and increased anion gap. What is the most likely cause of the changes of the anion gap in this patient?

Your Answer:

Correct Answer: Lactic acidosis

Explanation:
High anion gap in metabolic acidosis is caused generally by the elevation of the levels of acids like ketones, lactate, sulphates in the body, which consume the bicarbonate ions. Other causes of a high anion gap include overdosing on salicylates, uraemia, rhabdomyolysis, hypocalcaemia, hypomagnesaemia, or ingestion of toxins such as ethylene glycol, methanol, propyl alcohol, cyanide and iron.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 63 - A 30 year old clerk who has had recurrent episodes of periductal mastitis...

Incorrect

A 30 year old clerk who has had recurrent episodes of periductal mastitis presents to the hospital with persistent green nipple discharge. Clinical examination reveals green nipple discharge, but no discrete lump. Her medical history shows that she has received multiple courses of antibiotics. Imaging with mammography and ultrasound is reassuring (U2, M2). Which of the following is the most appropriate course of action?

Your Answer:

Correct Answer: Undertake a Hadfields procedure

Explanation:
Duct ectasia is the cause of nipple discharge, with different percentages recorded in different articles (>10%, >30% and >50%). Duct ectasia differs from cystic disease since it is an inflammatory process, usually affecting the ducts below the nipple. It develops gradually, either through the ductal system or the breast lobes. The acute inflammation may be caused by epithelial rupture and diffusion of the contents into the fibrous duct-wall and the underlying structures. These contents consist of neutral fat and lipid crystals that are typical of duct ectasia. The chronic granulation-type reaction may develop foreign body-like giant cells and a multiform inflammatory cell population. Since the whole process in duct ectasia is long in duration, plasma cells are sometimes dominant in the inflammatory infiltrations. Other findings in duct ectasia include the following:
-Serous or green-white nipple discharge in 20% of cases;
-Nipple inversion that leads to fibrosis and development of ring or tubular calcification (this finding is typical in the mammogram and especially when the disease is in its advanced stages);
-Apocrine metaplasia with or without epithelial hyperplasia. The epithelial layer consists of widened atrophic cells.
The condition may be managed symptomatically and/or with antibiotics, but in persistent or recurrent cases it is managed with surgical excision of the ducts below the nipple. A focused excision is preferred to a complete subareolar excision since the later technique is associated with higher rates of seroma formation, nipple numbness and nipple inversion. The Hadfield’s procedure (major duct excision) is an option.
This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 64 - A 53 year old woman is admitted to the hospital with a femoral...

Incorrect

A 53 year old woman is admitted to the hospital with a femoral shaft fracture that occurred suddenly whilst running outside. On examination, there is no neurovascular deficit distal to the fracture site. However, there is a large firm nodule in the left lobe of the thyroid, with no associated lymphadenopathy. Which of the following is the most likely underlying cause?

Your Answer:

Correct Answer: Follicular thyroid cancer

Explanation:
Follicular thyroid cancer accounts for 15% of thyroid cancer and occurs more commonly in women over 50 years of age. Thyroglobulin (Tg) can be used as a tumour marker for well-differentiated follicular thyroid cancer. Follicular cells are the thyroid cells responsible for the production and secretion of thyroid hormones.

It is impossible to distinguish between follicular adenoma and carcinoma on cytological grounds. If fine needle aspiration cytology (FNAC) suggests follicular neoplasm, thyroid lobectomy should be performed to establish the histopathological diagnosis. Features for the diagnosis of follicular carcinoma are capsular invasion and vascular invasion by tumour cells. Capsular invasion should be carefully evaluated and discriminated from the capsular rupture due to FNA penetration resulting in WHAFFT (worrisome histologic alterations following FNA of thyroid).

– Follicular carcinoma tends to metastasize to lung and bone via the bloodstream.
– Papillary thyroid carcinoma commonly metastasizes to cervical lymph nodes.
– HMGA2 has been proposed as a marker to identify malignant tumours.
This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
0

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Question 65 - An infant, 5 weeks and 6 days old born with a large sub-aortic...

Incorrect

An infant, 5 weeks and 6 days old born with a large sub-aortic ventricular septal defect, is prepared for pulmonary artery banding through a left thoracotomy (the child is not fit for a surgical closure). The surgeon initially passes his index finger immediately behind two great arteries in the pericardial sac to mobilise the great arteries in order to pass the tape around the pulmonary artery. Into which space is the surgeon's finger inserted?

Your Answer:

Correct Answer: Transverse pericardial sinus

Explanation:
Cardiac notch: is an indentation on the left lung of the heart.
Coronary sinus: a venous sinus on the surface of the heart (the posterior aspect) that receives blood from the smaller veins that drain the heart.
Coronary sulcus: a groove on the heart between the atria and ventricles.
Transverse pericardial sinus: located behind the aorta and pulmonary trunk and anterior to the superior vena cava.
Oblique pericardial sinus: located behind the left atrium. Accessed from the inferior side (or the apex) of the heart upwards.
Horizontal pericardial sinus: this is a made-up term.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 66 - The following branch of the aorta is unpaired: ...

Incorrect

The following branch of the aorta is unpaired:

Your Answer:

Correct Answer: Coeliac artery

Explanation:
Branches that stem from the abdominal aorta can be divided into three: the visceral branches, parietal branches and terminal branches. Of the visceral branches, the suprarenal, renal, testicular and ovarian arteries are paired while the coeliac artery and superior and inferior mesenteric arteries are unpaired. Of the parietal branches the inferior phrenic and lumbar arteries are paired while the middle sacral artery is unpaired. The terminal branches i.e. the common iliac arteries are paired.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 67 - When at rest, which of the following will be higher in a marathon...

Incorrect

When at rest, which of the following will be higher in a marathon runner compared to an untrained individual?

Your Answer:

Correct Answer: Cardiac stroke volume

Explanation:
Cardiac muscle hypertrophy is seen in trained athletes as compared to the normal population. This hypertrophy results in higher stroke volume at rest and increased cardiac reserve (maximum cardiac output during exercise). However, the cardiac output at rest is almost the same in both trained and untrained people. This is because in trained athletes, the heart rate is slower, even up to 40-50 beats/min. There is minimal affect of athletic training on oxygen consumption and respiratory rate.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 68 - Which nuclei of the posterior grey column of the spinal cord are likely...

Incorrect

Which nuclei of the posterior grey column of the spinal cord are likely affected in a patient who has lost the sensation of pain and temperature?

Your Answer:

Correct Answer: Substantia gelatinosa

Explanation:
Substantia gelatinosa is one of the nuclei in the posterior grey column along side other posterior grey column nuclei like the nucleus dorsalis, nucleus proprius, and posteromarginal nucleus. These nuclei are a collection of cells in the posterior grey area found in throughout the spinal cord. The substantia gelatinosa receives direct input from the dorsal nerve roots (sensory), especially from thermoreceptors and nociceptors (receptors for temperature and pain).
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 69 - Arterial blood gas analysis of a man admitted with acute exacerbation of chronic...

Incorrect

Arterial blood gas analysis of a man admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD) showed the following: pH = 7.28, p(CO2) = 65.5 mmHg, p(O2)= 60 mmHg and standard bicarbonate = 30.5 mmol/l. This patient had:

Your Answer:

Correct Answer: Respiratory acidosis

Explanation:
Acidosis with high p(CO2) and normal standard bicarbonate indicates respiratory acidosis, commonly seen in acute worsening of COPD patients. Respiratory acidosis occurs due to alveolar hypoventilation which leads to increased arterial carbon dioxide concentration (p(CO2)). This in turn decreases the HCO3 –/p(CO2) and decreases pH. In acute respiratory acidosis, the p(CO2) is raised above the upper limit of normal (over 45 mm Hg) with a low pH. However, in chronic cases, the raised p(CO2) is accompanied with a normal or near-normal pH due to renal compensation and an increased serum bicarbonate (HCO3 – > 30 mmHg).
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 70 - A 55-year-old man underwent CT scan of the whole abdomen. The result showed...

Incorrect

A 55-year-old man underwent CT scan of the whole abdomen. The result showed renal cell carcinoma with a tumour size of 7cm and extension into the regional lymph. What is the clinical stage of his renal cell cancer?

Your Answer:

Correct Answer: Stage III

Explanation:
Renal cell carcinoma is a kidney cancer that originates in the lining of the proximal convoluted tubule. It is the most common type of kidney cancer in adults, responsible for approximately 90–95% of cases. Renal cell carcinomas can be staged by using the American Joint Committee on Cancer (AJCC) TNM (tumour-node-metastasis) classification, as follows: Stage I: tumours that are 7 cm or smaller and confined to the kidney, Stage II: tumours that are larger than 7 cm but still confined to the kidney, Stage III: tumours extending into the renal vein or vena cava, involving the ipsilateral adrenal gland and/or perinephric fat, or which have spread to one local lymph node and Stage IV: tumours extending beyond Gerota’s fascia, to more than one local node, or with distant metastases Recent literature has questioned whether the cut-off in size between stage I and stage II tumours should be 5 cm instead of 7 cm. The patient’s cancer in this case is stage III.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 71 - A 44 year old woman suffers 20% partial and full thickness burns in...

Incorrect

A 44 year old woman suffers 20% partial and full thickness burns in a garage fire. There is also an associated inhalational injury. Her doctors have decided to administer intravenous fluids to replace fluid loss. Which of the following intravenous fluids should be used for initial resuscitation?

Your Answer:

Correct Answer: Hartmann's solution

Explanation:
The goal of fluid management in major burn injuries is to maintain the tissue perfusion in the early phase of burn shock, in which hypovolemia finally occurs due to steady fluid extravasation from the intravascular compartment.

Burn injuries of less than 20% are associated with minimal fluid shifts and can generally be resuscitated with oral hydration, except in cases of facial, hand and genital burns, as well as burns in children and the elderly. As the total body surface area (TBSA) involved in the burn approaches 15–20%, the systemic inflammatory response syndrome is initiated and massive fluid shifts, which result in burn oedema and burn shock, can be expected.

The ideal burn resuscitation is the one that effectively restores plasma volume, with no adverse effects. Isotonic crystalloids, hypertonic solutions and colloids have been used for this purpose, but every solution has its advantages and disadvantages. None of them is ideal, and none is superior to any of the others.
Crystalloids are readily available and cheaper than some of the other alternatives. RL solution, Hartmann solution (a solution similar to RL solution) and normal saline are commonly used. There are some adverse effects of the crystalloids: high volume administration of normal saline produces hyperchloremic acidosis, RL increases the neutrophil activation after resuscitation for haemorrhage or after infusion without haemorrhage. d-lactate in RL solution containing a racemic mixture of the d-lactate and l-lactate isomers has been found to be responsible for increased production of ROS. RL used in the majority of hospitals contains this mixture. Another adverse effect that has been demonstrated is that crystalloids have a substantial influence on coagulation. Recent studies have demonstrated that in vivo dilution with crystalloids (independent of the type of the crystalloid) resulted in a hypercoagulable state.
Despite these adverse effects, the most commonly used fluid for burn resuscitation in the UK and Ireland is Hartmann’s solution (adult units 76%, paediatric units 75%). Another study has revealed that RL is the most popular type of fluid in burn units located in USA and Canada.
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 72 - A 30-year-old woman feels thirsty. This thirst is probably due to: ...

Incorrect

A 30-year-old woman feels thirsty. This thirst is probably due to:

Your Answer:

Correct Answer: Increased level of angiotensin II

Explanation:
Thirst is the basic need or instinct to drink. It arises from a lack of fluids and/or an increase in the concentration of certain osmolites such as salt. If the water volume of the body falls below a certain threshold or the osmolite concentration becomes too high, the brain signals thirst. Excessive thirst, known as polydipsia, along with excessive urination, known as polyuria, may be an indication of diabetes. Angiotensin II is a hormone that is a powerful dipsogen (i.e. it stimulates thirst) that acts via the subfornical organ. It increases secretion of ADH in the posterior pituitary and secretion of ACTH in the anterior pituitary.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 73 - What causes a reduction in pulmonary functional residual capacity? ...

Incorrect

What causes a reduction in pulmonary functional residual capacity?

Your Answer:

Correct Answer: Pulmonary fibrosis

Explanation:
Pulmonary functional residual capacity (FRC) is = volume of air present in the lungs at the end of passive expiration.
Obstructive diseases (e.g. emphysema, chronic bronchitis, asthma) = an increase in FRC due to an increase in lung compliance and air trapping.
Restrictive diseases (e.g. pulmonary fibrosis) result in stiffer, less compliant lungs and a reduction in FRC.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 74 - An amateur body-builder complains of increasing pain in his right shoulder after a...

Incorrect

An amateur body-builder complains of increasing pain in his right shoulder after a few days of intense training. A surgeon aspirates clear fluid from his subdeltoid region. What's the most likely diagnosis?

Your Answer:

Correct Answer: Bursitis

Explanation:
Bursae are potential cavities that contain synovial fluid, found in areas where friction occurs. Their function is to minimise friction and facilitate movement. Bursitis is the inflammation of one or more bursae, and they can occur in the shoulder, elbow, knee, ischium, amongst other joints. Acute bursitis can appear after strenuous exercise or activity, and chronic bursitis can develop following previous bursitis or trauma. Acute bursitis causes pain, tenderness, and swelling.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 75 - As per the Poiseuille-Hagen formula, doubling the diameter of a vessel will change...

Incorrect

As per the Poiseuille-Hagen formula, doubling the diameter of a vessel will change the resistance of the vessel from 16 peripheral resistance units (PRU) to:

Your Answer:

Correct Answer: 1 PRU

Explanation:
Poiseuille-Hagen formula for flow in along narrow tube states that F = (PA– PB) × (Π/8) × (1/η) × (r4/l) where F = flow, PA– PB = pressure difference between the two ends of the tube, η = viscosity, r = radius of tube and L = length of tube. Also, flow is given by pressure difference divided by resistance. Hence, R = 8ηL ÷ Πr4. Hence, the resistance of the vessel changes in inverse proportion to the fourth power of the diameter. So, if the diameter of the vessel is increased to twice the original, it will lead to decrease in resistance to one-sixteenth its initial value.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 76 - How are amino acids transported across the luminal surface of the small intestinal...

Incorrect

How are amino acids transported across the luminal surface of the small intestinal epithelium?

Your Answer:

Correct Answer: Co-transport with sodium ions

Explanation:
Once complex peptides are broken down into amino acids by the peptidases present in the brush border of small intestine, they are ready for absorption by at least four sodium-dependent amino acid co-transporters – one each for acidic, basic, neutral and amino acids, present on the luminal plasma membrane. These transporters first bind sodium and can then bind the amino acids. Thus, amino acid absorption is totally dependent on the electrochemical gradient of sodium across the epithelium. The basolateral membrane in contrast, possesses additional transporters to carry amino acids from the cell into the blood, but these are sodium-independent.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 77 - An alcoholic patient was found to have hypomagnesaemia on blood tests. Which of...

Incorrect

An alcoholic patient was found to have hypomagnesaemia on blood tests. Which of the following clinical features will have prompted the doctor to check the serum magnesium level in this patient?

Your Answer:

Correct Answer: Seizures

Explanation:
Hypomagnesaemia is a condition characterised by a low level of magnesium in the blood. The normal range for serum magnesium level is 0.75-1.05 mmol/l. In hypomagnesaemia serum levels of magnesium are less than 0.75 mmol/l. The cardiovascular and nervous systems are the most commonly affected. Neuromuscular manifestations include symptoms like tremor, tetany, weakness, apathy, delirium, a positive Chvostek and Trousseau sign, nystagmus and seizures. Cardiovascular manifestations include electrocardiographic abnormalities and arrhythmias e.g. ventricular fibrillation.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 78 - A surgeon performing a laparoscopic repair of an inguinal hernia visualizes a loop...

Incorrect

A surgeon performing a laparoscopic repair of an inguinal hernia visualizes a loop of bowel protruding through the abdominal wall to form a direct inguinal hernia. When this is viewed from the side of the abdomen with a laparoscope, in which region would the hernial sac be?

Your Answer:

Correct Answer: Medial inguinal fossa

Explanation:
In a direct inguinal hernia, visceral contents exit the abdomen through a weak point in the fascia in the medial inguinal fossa i.e. the area between the medial and lateral umbilical folds. Such a hernia doesn’t pass through the deep inguinal ring or the lateral inguinal fossa. Note that direct hernias can go through the superficial inguinal ring, although rarely. The supravesical fossa, between the median and medial umbilical folds, is formed by a peritoneal reflection from the anterior abdominal wall onto the bladder and the retrovesical fossa is the region behind the urinary bladder.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 79 - A 2-day old baby develops dyspnoea. A chest x-ray is performed and shows...

Incorrect

A 2-day old baby develops dyspnoea. A chest x-ray is performed and shows a radio-opaque shadow with an air-fluid level in the chest. It is located immediately anterior to the 6th hemivertebra. Which of the following is the most likely underlying diagnosis?

Your Answer:

Correct Answer: Bronchogenic cyst

Explanation:
Bronchogenic cysts, although relatively rare, represent the most common cystic lesion of the mediastinum.
Bronchogenic cysts are the result of anomalous development of the ventral foregut; they are usually single but may be multiple and can be filled with fluid or mucus. They have been found all along the tracheoesophageal course, in perihilar or intraparenchymal sites, with a predilection for the area around the carina. Those in the mediastinum frequently attach to but do not communicate with the tracheobronchial tree. Bronchogenic cysts have also been described in more remote locations, including the interatrial septum, neck, abdomen, and retroperitoneal space.
With the advent of improved antenatal diagnosis, many infants are identified before the development of symptoms:
Chest pain and dysphagia are the most common symptoms in adults with bronchogenic cysts.
Recurrent infections may be the clinical presentation in some children
In infants, symptoms are most often produced as a result of airway or oesophageal compression.

Oesophageal duplication cysts are rare inherited lesions usually diagnosed in early childhood. Most of them are found in the mediastinum and manifest themselves as separate masses along or in continuity with the native oesophagus
This question is part of the following fields:
- Generic Surgical Topics
- Paediatric Surgery
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Question 80 - Which of the following coagulation factors is responsible for the formation of a...

Incorrect

Which of the following coagulation factors is responsible for the formation of a complex with tissue factor to activate factors IX and X?

Your Answer:

Correct Answer: Factor VII

Explanation:
Factor VII, also known as proconvertin or stable factor, is a vitamin K–dependent protein that plays a central role in haemostasis and coagulation. Tissue factor is a protein that is normally not exposed on the surface of intact blood vessels. Damage to the vascular lumen leads to tissue factor exposure. The exposed tissue factor binds to factor VII. This facilitates the activation of factor VII to factor VIIa.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 81 - A 30 year old mother presents with a tender indurated mass in her...

Incorrect

A 30 year old mother presents with a tender indurated mass in her left breast which developed 6 days after giving birth and breastfeeding the baby. Which organism is most likely to have caused this infection?

Your Answer:

Correct Answer: Staphylococcus aureus

Explanation:
Answer: Staphylococcus aureus

Mastitis is defined as inflammation of the breast. Although it can occur spontaneously or during lactation, this discussion is limited to mastitis in breastfeeding women, with mastitis defined clinically as localized, painful inflammation of the breast occurring in conjunction with flu-like symptoms (e.g., fever, malaise). Mastitis is especially problematic because it may lead to the discontinuation of breast-feeding, which provides optimal infant nutrition. Mastitis occurs in approximately 10 percent of U.S. mothers who are breastfeeding, and it can lead to the cessation of breastfeeding. The risk of mastitis can be reduced by frequent, complete emptying of the breast and by optimizing breastfeeding technique. Sore nipples can precipitate mastitis. The differential diagnosis of sore nipples includes mechanical irritation from a poor latch or infant mouth anomalies, such as cleft palate or bacterial or yeast infection. The diagnosis of mastitis is usually clinical, with patients presenting with focal tenderness in one breast accompanied by fever and malaise. Treatment includes changing breastfeeding technique, often with the assistance of a lactation consultant. When antibiotics are needed, those effective against Staphylococcus aureus (e.g., dicloxacillin, cephalexin) are preferred. As methicillin-resistant S. aureus becomes more common, it is likely to be a more common cause of mastitis, and antibiotics that are effective against this organism may become preferred. Continued breastfeeding should be encouraged in the presence of mastitis and generally does not pose a risk to the infant. Breast abscess is the most common complication of mastitis. It can be prevented by early treatment of mastitis and continued breastfeeding. Once an abscess occurs, surgical drainage or needle aspiration is needed. Breastfeeding can usually continue in the presence of a treated abscess.
This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 82 - Following an accident, a man was unable to extend the wrist and metacarpophalangeal...

Incorrect

Following an accident, a man was unable to extend the wrist and metacarpophalangeal joints, despite sensation being intact. Which nerve was likely damaged?

Your Answer:

Correct Answer: Posterior interosseous nerve

Explanation:
The posterior interosseous nerve which causes, what is known as the posterior interosseous nerve syndrome. The nerve is compressed before it bifurcates to form the medial and lateral branches. The compression is beyond the origin of the branches to the radial wrist extensors and the radial sensory nerve. The result of such a case is paralysis of the digital extensors and the extensor carpi ulnaris, resulting in dorsoradial deviation of the wrist.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 83 - An experiment is carried out to observe engulfment and phagocytosis of microbes. Strep...

Incorrect

An experiment is carried out to observe engulfment and phagocytosis of microbes. Strep pneumoniae are added to a solution of leukocytes with a substance added to enhance the process of phagocytosis. What is this substance?

Your Answer:

Correct Answer: Complement C3b

Explanation:
C3b is cleaved from C3 complement with the help of the enzyme C3- convertase. It binds to the cell surface of the offending substance and opsonizes it. This makes it easy for the phagocytes to detect and eliminate them.
IgM does not act as an opsonin but igG does.
Selectins aid leukocytes to bind to the endothelial surfaces.
C5a is a chemo-attractant and histamine a vasodilator.
NADPH oxidises offending substance after phagocytosis within the macrophage.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 84 - A 62-year-old male smoker, presented with shortness of breath, chronic cough and haemoptysis...

Incorrect

A 62-year-old male smoker, presented with shortness of breath, chronic cough and haemoptysis over the last three months. He has developed a fat pad in the base of his neck, rounded face, acne and osteoporosis. Which of the following is the most likely pulmonary disease that is causing these symptoms and findings?

Your Answer:

Correct Answer: Small-cell anaplastic carcinoma

Explanation:
Small cell lung cancer is a highly aggressive form of lung cancer. It is thought to originate from neuroendocrine cells in the bronchus called Feyrter cells and is often associated to ectopic production of hormones like ADH and ACTH that result in paraneoplastic syndromes and Cushing’s syndrome.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 85 - Pseudomonas aeruginosa is a multidrug resistant pathogen that causes hospital-acquired infections. It is...

Incorrect

Pseudomonas aeruginosa is a multidrug resistant pathogen that causes hospital-acquired infections. It is usually treated with piperacillin or another antibiotic. Which of the following is the other antibiotic?

Your Answer:

Correct Answer: Azlocillin

Explanation:
Azlocillin, like piperacillin, is an acylampicillin antibiotic with an extended spectrum of activity and greater in vitro potency than the carboxypenicillins. Azlocillin is similar to mezlocillin and piperacillin. It demonstrates antibacterial activity against a broad spectrum of bacteria, including Pseudomonas aeruginosa.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 86 - A 17-year-old female was given an antibiotic for a urinary tract infection. After...

Incorrect

A 17-year-old female was given an antibiotic for a urinary tract infection. After taking the medication the patient developed Steven-Johnson syndrome. Which particular antibiotic usually causes Steven-Johnson syndrome?

Your Answer:

Correct Answer: Sulphonamides

Explanation:
Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulphonamide antibiotics, and nevirapine.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 87 - A 20-year-old woman presents with a posteriorly-sited anal fissure. Treatment with stool softeners...

Incorrect

A 20-year-old woman presents with a posteriorly-sited anal fissure. Treatment with stool softeners and topical GTN have failed to improve the condition. Which of the following would be the most appropriate next step of management?

Your Answer:

Correct Answer: Injection of botulinum toxin

Explanation:
The most appropriate management option to consider, after GTN or other topical nitrates have failed, is botulinum toxin injection. In males, a lateral internal sphincterotomy would be an acceptable alternative. In a female who has yet to conceive, this may predispose to an increased risk of sphincter dysfunction. Moreover, division of the external sphincter would result in faecal incontinence and is not a justified treatment for anal fissure.

Anal fissures are a common cause of painful, bright red rectal bleeding. Most fissures are idiopathic and present as a painful mucocutaneous defect in the posterior midline (90% cases). Fissures are more likely to be anteriorly located in females, particularly if they are multiparous. Diseases associated with fissure-in-ano include:
1. Crohn’s disease
2. Tuberculosis
3. Internal rectal prolapse

Diagnostic options are as follows:
In most cases, the defect can be visualised as a posterior midline epithelial defect. Where symptoms are highly suggestive of the condition and examination findings are unclear, an examination under anaesthesia may be helpful. Atypical disease presentation should be investigated by colonoscopy and EUA, with biopsies of the area.

For management of anal fissure:
1. Stool softeners are important as hard stools may tear the epithelium and result in recurrent symptoms. The most effective first-line agents are topically applied GTN (0.2%) or Diltiazem (2%) paste.
2. Resistant cases may benefit from injection of botulinum toxin or lateral internal sphincterotomy. Advancement flaps may be used to treat resistant cases.
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 88 - A 31 year old banker with known multiple gastric ulcers visits the surgical...

Incorrect

A 31 year old banker with known multiple gastric ulcers visits the surgical clinic for a review. She has not improved despite taking proton pump inhibitors for two months. Tests show that she now has a gastrinoma. Which statement is false in relation to her diagnosis?

Your Answer:

Correct Answer: Most commonly found in the pancreas

Explanation:
A gastrinoma is a gastrin-secreting tumour that can occur in the pancreas, although it is most commonly found in the duodenum. Duodenal wall gastrinomas have been identified in 40-50% of patients. These duodenal wall tumours are frequently small and multiple. Sporadic tumours occurring in the pancreas tend to be solitary and have a greater malignant potential as compared to duodenal gastrinomas.

Primary tumours also occur in a variety of ectopic sites, including the body of the stomach, jejunum, peripancreatic lymph nodes, splenic hilum, omentum, liver, gallbladder, common bile duct, and the ovary. Over 50% of gastrinomas are malignant and can metastasize to the regional lymph nodes and the liver. One fourth of gastrinomas are related to multiple endocrine neoplasia (MEN) type I and are associated with hyperparathyroidism and pituitary adenomas.

The symptoms in 90-95% of patients with gastrinomas are similar to the symptoms of common peptic ulcer disease. Usually, persistent abdominal pain exists that is less responsive to medical treatment.
Sometimes, symptoms may relate to a complication of peptic ulcer disease, such as bleeding (e.g., melena, hematemesis), gastric outlet obstruction (e.g., vomiting), and perforation (e.g., peritoneal irritation).
Other symptoms include gastroesophageal reflux, diarrhoea, steatorrhea, and weight loss, all of which are secondary to acid hypersecretion. Vitamin B-12 malabsorption, which is not correctable by oral intrinsic factor, may also be observed.

Somatostatin receptor scintigraphy (SRS) is very useful to identify the primary lesions preoperatively. SRS is the most sensitive non-invasive method for localizing the primary tumours and metastases. It also is helpful for detecting the presence of liver or bone metastasis.
This question is part of the following fields:
- Generic Surgical Topics
- Upper Gastrointestinal Surgery
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Question 89 - Out of the following options, which malignancy has the highest potential for multicentricity?...

Incorrect

Out of the following options, which malignancy has the highest potential for multicentricity?

Your Answer:

Correct Answer: Transitional cell carcinoma

Explanation:
Transitional cell carcinomas can arise anywhere in the urothelium lining the urinary tract; and hence are known to be multicentric and recur commonly. Prostatic adenocarcinoma most commonly involves the posterior lobe of the prostate gland. Although renal cell carcinomas occasionally show multicentricity, it is not common. Penile carcinomas are usually locally infiltrative lesions. Wilm’s tumours are usually solitary, but can be bilateral or multicentric in 10% cases. Small cell carcinoma of lung and teratomas are usually solitary.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 90 - A 27-year-old ski instructor who falls off a ski lift and sustains a...

Incorrect

A 27-year-old ski instructor who falls off a ski lift and sustains a spiral fracture of the midshaft of the tibia. Attempts to achieve a satisfactory position in plaster have failed. Overlying tissues are healthy. What is the most appropriate course of action?

Your Answer:

Correct Answer: Intramedullary nail

Explanation:
Initially, all tibial shaft fractures should be stabilized with a long posterior splint with the knee in 10-15° of flexion and the ankle flexed at 90°
Closed fractures with minimal displacement or stable reduction may be treated nonoperatively with a long leg cast, but cast application should be delayed for 3-5 days to allow early swelling to diminish. The cast should extend from the midthigh to the metatarsal heads, with the ankle at 90° of flexion and the knee extended. The cast increases tibial stability and can decrease pain and swelling.
Despite proper casting techniques and adequate follow-up, not all nonoperatively treated tibial shaft fractures heal successfully.
Operative fixation is required when fractures are unstable. Surgical options include plating, external fixation, intramedullary nailing, and, in some cases, amputation.
Intramedullary nailing with locking screws (see the image below) has become the treatment of choice for most tibial shaft fractures. The prevalence of non-union and malunion is greatly decreased in comparison with the other methods of fixation. Patients are also able to return to low-impact activities much sooner than they can with the other treatments.
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 91 - When inserting a chest drain anteriorly into the second intercostal space, one must...

Incorrect

When inserting a chest drain anteriorly into the second intercostal space, one must identify the second costal cartilage by palpating which landmark?

Your Answer:

Correct Answer: Sternal angle

Explanation:
The sternal angle is the site for identification of the second rib as the second rib is attached to the sternum at this point.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 92 - The following joint has an anastomotic circulation that is provided by branches of...

Incorrect

The following joint has an anastomotic circulation that is provided by branches of the brachial artery:

Your Answer:

Correct Answer: Elbow joint

Explanation:
The arterial anastomoses of the elbow joint is contributed by branches of the brachial artery and the Profunda brachii artery. The brachial artery gives off the superior ulnar collateral artery and the inferior collateral artery. On the other hand, the Profunda brachii gives off the radial and medial recurrent arteries.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 93 - Investigations in a 40-year old gentleman with splenomegaly reveal the following: haemoglobin 21.5...

Incorrect

Investigations in a 40-year old gentleman with splenomegaly reveal the following: haemoglobin 21.5 g/dl, haematocrit 66%, mean corpuscular volume (MCV) 86 fl, mean cell haemoglobin concentration 34 g/dl, mean corpuscular haemoglobin 34.5 pg, platelet count 450 × 109/l, and white blood cell count 12 × 109/l, with 81% polymorphonuclear leukocytes, 4% bands, 3% monocytes, and 7% lymphocytes. What is the likely diagnosis?

Your Answer:

Correct Answer: Polycythaemia vera

Explanation:
The markedly increased haematocrit, along with thrombocytosis and the leucocytosis suggest a myeloproliferative disorder.
Polycythaemia vera is the commonest myeloproliferative disorders occurring more often in males (about 1.4 to 1). The mean age at diagnosis is 60 years (range 15–90 years) with 5% of patients below 40 years at onset. It involves increased production of all cell lines, including red blood cells (independent of erythropoietin), white blood cells and platelets. If confined only to red blood cells, it is known as ‘primary erythrocytosis’. There is an increase in blood volume and hyperviscosity occurs, predisposing to thrombosis. Increased bleeding occurs due to abnormal functioning of platelets. Patients become hypermetabolic, and increased cell turnover leads to hyperuricaemia.
Usually asymptomatic, occasionally symptoms include weakness, pruritus, headache, light-headedness, visual disturbances, fatigue and dyspnoea. Face appears red with engorged retinal veins. Lower extremities appear red and painful, along with digital ischaemia (erythromelalgia). Hepatomegaly is common and massive splenomegaly is seen in 75% patients. Thrombosis can lead to stroke, deep venous thrombosis, myocardial infarction, retinal artery or vein occlusion, splenic infarction (often with a friction rub) or Budd–Chiari syndrome. Gastrointestinal bleeding is seen in 10-20% patients. Hypermetabolism can lead to low-grade fevers and weight loss. Late features include complications of hyperuricaemia (e.g. gout, renal calculi). 1.5% to 10% cases transform to acute leukaemia.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 94 - What is the most likely cause of prolonged bleeding time in a 40...

Incorrect

What is the most likely cause of prolonged bleeding time in a 40 year old women admitted for a laparoscopic cholecystectomy?

Your Answer:

Correct Answer: Thrombocytopaenia

Explanation:
Bleeding time is related to platelet function, thus a decrease in platelet function, as seen in thrombocytopenia, DIC and von Willebrand disease in which platelet aggregation is defective, leads to an increase in bleeding time. It is not affected by a decrease or deficiency of any other clotting factors. Aspirin and other COX inhibitors prolong bleeding time along with warfarin and heparin.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 95 - A 33-year old lady presented to the gynaecology clinic with amenorrhoea for 6...

Incorrect

A 33-year old lady presented to the gynaecology clinic with amenorrhoea for 6 months and a recent-onset of milk discharge from her breasts. She was not pregnant or on any medication. On enquiry, she admitted to having frequent headaches the last 4 months. Which of the following findings would you expect to see in her condition?

Your Answer:

Correct Answer: Hyperprolactinaemia

Explanation:
Excessively high levels of prolactin in the blood is called hyperprolactinaemia. Normally, prolactin levels are less than 580 mIU/l in females and less than 450 mIU/l in men. The biologically inactive macroprolactin can lead to a false high reading. However, the patient remains asymptomatic. Dopamine down-regulates prolactin whereas oestrogen upregulates it. Hyperprolactinaemia can be caused due to lack of inhibition (compression of pituitary stalk or low dopamine levels), or increased production due to a pituitary adenoma (prolactinoma). Either of these causes can lead to a prolactin level of 1000-5000 mIU/l. However, levels more than 5000mIU/l are usually associated due to an adenoma and >100,000 mIU/l are seen in macroadenomas (tumours < 1cm in diameter). Increased prolactin causes increased dopamine release from the arcuate nucleus of hypothalamus. This increased dopamine in turn, inhibits the GnRH (Gonadotrophin Releasing Hormone) thus blocking gonadal steroidogenesis resulting in the symptoms of hyperprolactinaemia. In women, it includes hypoestrogenism, anovulatory infertility, decreased or irregular menstruation or complete amenorrhoea. It can even cause production of breast milk, loss of libido, vaginal dryness and osteoporosis. In men, the symptoms include impotence, decreased libido, erectile dysfunction and infertility. In men, treatment can be delayed due to late diagnosis as they have no reliable indicator such as menstruation that might indicate a problem. Most of the male patients seek help only when headaches and visual defects start to surface.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 96 - What is the normal amount of oxygen that is carried in the blood?...

Incorrect

What is the normal amount of oxygen that is carried in the blood?

Your Answer:

Correct Answer: 20 ml oxygen/100 ml blood

Explanation:
Normally, 100 ml of blood contains 15g haemoglobin and a single gram of haemoglobin can bind to 1.34 ml oxygen when 100% saturated. Thus, 15 × 1.34 = 20 ml O2/100 ml blood. The haemoglobin in venous blood that is leaving the tissues is about 75% saturated with oxygen, and hence it carries about 15 ml O2/100 ml venous blood. This implies that for each 10 ml of blood, 5 ml oxygen is transported to the tissues. With a p(O2) > 100 mm Hg, only 3 ml of oxygen is dissolved in every one litre of plasma. By increasing the pA(O2) by breathing 100% oxygen, one can add an extra amount of oxygen in the plasma, but the amount of oxygen carried by haemoglobin will not increase significantly as it is already > 95% saturated.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 97 - A 65-year old gentleman presents to the clinic with chronic back pain and...

Incorrect

A 65-year old gentleman presents to the clinic with chronic back pain and weight loss. His blood count shows a white blood cell count of 10 × 109/l, with a differential count of 66 polymorphonuclear leukocytes, 7 bands, 3 metamyelocytes, 3 myelocytes, 14 lymphocytes, 7 monocytes, and 5 nucleated red blood cells. The haemoglobin is 13 g/dl with a haematocrit of 38.1%, a mean corpuscular volume of 82 fl, and a platelet count of 126 × 109/l. What is the likely diagnosis?

Your Answer:

Correct Answer: Metastatic carcinoma

Explanation:
The peripheral blood findings suggest a leucoerythroblastic picture, the common causes of which in a 65-year old gentleman includes prostatic or lung malignancy.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 98 - In which of the following situations will fat necrosis occur? ...

Incorrect

In which of the following situations will fat necrosis occur?

Your Answer:

Correct Answer: Trauma to the breast

Explanation:
Fat necrosis is necrosis of adipose tissue with subsequent deposition of calcium, giving it a white chalky appearance. It is seen characteristically in trauma to the breast and the pancreas with subsequent involvement of the peripancreatic fat. In the breast it may present as a palpable mass with is usually painless or as an incidental finding on mammogram. Fatty acids are released from the traumatic tissue which combine with calcium in a process known as saponification, this is an example of dystrophic calcification in which calcium binds to dead tissue. The central focus is surrounded by macrophages and neutrophils initially, followed by proliferation of fibroblasts, neovascularization and lymphocytic migration to the site of the insult.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 99 - Choose the most correct answer regarding the obturator internus muscle. ...

Incorrect

Choose the most correct answer regarding the obturator internus muscle.

Your Answer:

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.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 100 - The majority of gallstones are mainly composed of: ...

Incorrect

The majority of gallstones are mainly composed of:

Your Answer:

Correct Answer: Cholesterol

Explanation:
Bile salts are formed out of cholesterol in the liver cells. Occasionally, precipitation of cholesterol occurs resulting into cholesterol stones developing in the gall bladder.
These cholesterol gallstones are the most common type and account for 80% of all gallstones. Another type, accounting for 20% gallstones is pigment stones which are composed of bilirubin and calcium salts. Occasionally, stones of mixed origin are also seen.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 101 - Cancer of the testis most likely metastases to which set of lymph nodes?...

Incorrect

Cancer of the testis most likely metastases to which set of lymph nodes?

Your Answer:

Correct Answer: Aortic

Explanation:
The lymphatic drainage of an organ is related to its blood supply. The lymphatic drainage of the testis drains along the testicular artery to reach the lymph nodes along the aorta.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 102 - A 42-year-old woman is admitted with sepsis and right flank pain. Twenty-four hours...

Incorrect

A 42-year-old woman is admitted with sepsis and right flank pain. Twenty-four hours ago, she was started on trimethoprim, by the GP, for a urinary tract infection (UTI).Which of the following organisms is the most likely causative agent?

Your Answer:

Correct Answer: E. coli

Explanation:
Ascending infection of the urinary tract is most commonly caused by Escherichia coli (E.coli). Other organisms may be accountable. However, these are less common.

E. coli are gram-negative rods. They have a wide range of subtypes and some are normal gut commensals. Most varieties of E. coli are harmless or cause relatively brief diarrhoea. But a few nasty strains, such as E. coli O157:H7, can cause severe abdominal cramps, bloody diarrhoea, and vomiting. Some strains of E. coli are also resistant to a large number of antibiotics used to treat gram-negative infections.
This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 103 - A 34-year old gentleman presented with acute pancreatitis to the emergency department. On...

Incorrect

A 34-year old gentleman presented with acute pancreatitis to the emergency department. On enquiry, there was found to be a history of recurrent pancreatitis, eruptive xanthomas and raised plasma triglyceride levels associated with chylomicrons. Which of the following will be found deficient in this patient?

Your Answer:

Correct Answer: Lipoprotein lipase

Explanation:
The clinical features mentioned here suggest the diagnosis of hypertriglyceridemia due to lipoprotein lipase (LPL) deficiency. LPL aids in hydrolysing the lipids in lipoproteins into free fatty acids and glycerol. Apo-CII acts as a co-factor. Deficiency of this enzyme leads to hypertriglyceridemia.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 104 - An 11 month old baby boy is taken to the clinic with a...

Incorrect

An 11 month old baby boy is taken to the clinic with a history of a right groin swelling. A photograph on the father's mobile phone, shows what looks like an inguinal hernia. What is the most appropriate course of action?

Your Answer:

Correct Answer: Undertake an open inguinal herniotomy

Explanation:
Answer: Undertake an open inguinal herniotomy

Inguinal hernia is a type of ventral hernia that occurs when an intra-abdominal structure, such as bowel or omentum, protrudes through a defect in the abdominal wall. Inguinal hernias do not spontaneously heal and must be surgically repaired because of the ever-present risk of incarceration. Generally, a surgical consultation should be made at the time of diagnosis, and repair (on an elective basis) should be performed very soon after the diagnosis is confirmed.

The infant or child with an inguinal hernia generally presents with an obvious bulge at the internal or external ring or within the scrotum. The parents typically provide the history of a visible swelling or bulge, commonly intermittent, in the inguinoscrotal region in boys and inguinolabial region in girls. The swelling may or may not be associated with any pain or discomfort.

Open herniotomy is its standard treatment against which all alternative modalities of treatment are evaluated. It is credited with being easy to perform, having a high success rate, and low rate of complications.
The use of prosthetic mesh in these patients is rare, however not uncalled for. Laparoscopic inguinal herniotomy is significantly associated with longer operative time for unilateral cases and a reduction in metachronous hernia development when compared to open inguinal herniotomy. There was a trend towards higher recurrence rate for laparoscopic repairs and shorter operative time for bilateral cases. A well conducted randomized controlled trial is warranted to compare both approaches.
This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 105 - From which branchial (pharyngeal) pouch does the inferior parathyroid gland arise? ...

Incorrect

From which branchial (pharyngeal) pouch does the inferior parathyroid gland arise?

Your Answer:

Correct Answer: 3rd

Explanation:
The following structures arise from each branchial pouch:
1st pouch – eustachian tube, middle ear, mastoid, and inner layer of the tympanic membrane
2nd pouch – middle ear, palatine tonsils
3rd pouch – inferior parathyroid glands, thymus
4th pouch – superior parathyroid glands, ultimobranchial body which forms the parafollicular C-cells of the thyroid gland, musculature and cartilage of larynx (along with the sixth pharyngeal pouch)
5th pouch – rudimentary structure
6th pouch – along with the fourth pouch, contributes to the formation of the musculature and cartilage of the larynx.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 106 - Difficulty in retracting the foreskin of the penis in an uncircumcised male is...

Incorrect

Difficulty in retracting the foreskin of the penis in an uncircumcised male is known as:

Your Answer:

Correct Answer: Phimosis

Explanation:
Phimosis is the inability to fully retract the foreskin of the penis in an uncircumcised male. It can be physiological in infancy, in which it could be referred to as ‘developmental non-retractility of the foreskin. However, it is almost always pathological in older children and men. Causes include chronic inflammation (e.g. balanoposthitis), multiple catheterisations, or forceful foreskin retraction. One of the causes is chronic balanitis xerotica obliterans. It leads to development of a ring of indurated tissue near the tip of the prepuce, which prevents retraction. Contributory factors include infections, hormonal and inflammatory factors. The recommended treatment includes circumcision.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 107 - The pleural cavity is the space between the two pulmonary pleurae which cover...

Incorrect

The pleural cavity is the space between the two pulmonary pleurae which cover the lungs. What is the normal amount of pleural fluid?

Your Answer:

Correct Answer: 10 ml

Explanation:
Pleural fluid is a serous fluid produced by the serous membrane covering normal pleurae. Most fluid is produced by the parietal circulation (intercostal arteries) via bulk flow and reabsorbed by the lymphatic system. The total volume of fluid present in the intrapleural space is estimated to be only 2–10 ml. A small amount of protein is present in intrapleural fluid. Normally, the rate of reabsorption increases as a physiological response to accumulating fluid.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 108 - A three week old baby is referred to surgery by his paediatrician because...

Incorrect

A three week old baby is referred to surgery by his paediatrician because she has a painful area of macerated tissue at the site of the umbilicus. When he cries, a clear-yellowish fluid is seen to be draining from the umbilicus. Which of the following would be the correct diagnosis?

Your Answer:

Correct Answer: Patent urachus

Explanation:
A patent urachus is one of the spectrum of congenital urachal anomalies. It has occasionally been termed urachal fistula. In an open (or patent) urachus, there is an opening between the bladder and the belly button (navel). The urachus is a tube between the bladder and the belly button that is present before birth. In most cases, it closes along its full length before the baby is born. An open urachus occurs mostly in infants. A patent urachus is often diagnosed in neonates when urine is noted leaking from the umbilicus. The umbilicus may also have an abnormal appearance on physical exam.

A patent urachus predisposes to infection. If the urachal disorder presents with an infection, the infection is treated first. This requires antibiotics, possible admission for intravenous antibiotics, and occasional surgical drainage of any infected cyst or poorly draining cavity. Once the infection is under control, excision of the urachus is usually performed. This can usually be done laparoscopically or with a small incision on the lower abdomen. Patients usually stay in the hospital 1-2 days after the surgery. The urachus can be excised because in normal development it usually obliterates anyway. The umbilicus is not removed.

Omphalitis is an infection of the umbilicus and/or surrounding tissues, occurring primarily in the neonatal period. Omphalitis is primarily a disease of the neonate and is characterized by tenderness, erythema, and induration of the umbilicus and surrounding tissues. Early on, patients may only have superficial cellulitis but, if untreated, this can progress to involve the entire abdominal wall. Patients may also have purulent drainage or be bleeding from the umbilical cord stump. Foul-smelling drainage should raise the suspicion of anaerobic infection.

Patent vitellointestinal or persistent omphalomesenteric duct is a very unusual congenital anomaly which occurs in 2% of population related with the embryonic yolk stalk. A persistent vitellointestinal duct can induce abdominal pain, bowel obstruction, intestinal haemorrhage and umbilical sinus, fistula or hernia which commonly occurs in children.

An umbilical granuloma is a moist, red lump of tissue that can form on a baby’s navel (belly button). It can be seen in the first few weeks of life, after the umbilical cord has dried and fallen off. It’s usually a minor problem that looks worse than it is. An umbilical granuloma does not cause pain. It may ooze a small amount of fluid that can make the skin around it red and irritated.
This question is part of the following fields:
- Generic Surgical Topics
- Paediatric Surgery
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Question 109 - A 30-year-old male has had a sore throat for the past 5 days....

Incorrect

A 30-year-old male has had a sore throat for the past 5 days. Over the past 24 hours, he has noticed increasing and severe throbbing pain in the region of his right tonsil. He has pyrexia and on examination, he is noted to have swelling of this area. What is the most likely cause?

Your Answer:

Correct Answer: Quinsy

Explanation:
Patients with a Quinsy or peritonsillar abscess (PTA) typically present with a history of acute pharyngitis accompanied by tonsillitis and worsening unilateral pharyngeal discomfort. Patients also may experience malaise, fatigue, and headaches. They often present with a fever and asymmetric throat fullness. Associated halitosis, odynophagia, dysphagia, and a hot potato–sounding voice occurs.
The presentation may range from acute tonsillitis with unilateral pharyngeal asymmetry to dehydration and sepsis. Most patients have severe pain. Examination of the oral cavity reveals marked erythema, asymmetry of the soft palate, tonsillar exudation, and contralateral displacement of the uvula.
Indications for considering the diagnosis of a PTA include the following:
Unilateral swelling of the peritonsillar area
Unilateral swelling of the soft palate, with anterior displacement of the ipsilateral tonsil
Nonresolution of acute tonsillitis, with persistent unilateral tonsillar enlargement
A PTA ordinarily is unilateral and located at the superior pole of the affected tonsil, in the supratonsillar fossa. At the level of the supratonsillar fold, the mucosa may appear pale and even show a small pimple. Palpation of the soft palate often reveals an area of fluctuance. Flexible nasopharyngoscopy and laryngoscopy are recommended in patients experiencing airway distress. The laryngoscopy is key to ruling out epiglottitis and supraglottitis, as well as vocal cord pathology.
This question is part of the following fields:
- Generic Surgical Topics
- Head And Neck Surgery
0

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Question 110 - Injury to the supraspinatus muscle will affect: ...

Incorrect

Injury to the supraspinatus muscle will affect:

Your Answer:

Correct Answer: Initiation of abduction of the humerus

Explanation:
This muscle arises from the medial two-thirds of the supraspinatus fossa and from the supraspinatus fascia. It is inserted into the highest impression on the greater tubercle of the humerus after passing over the upper part of the shoulder joint. It works with the deltoid to raise the arm from the side of the trunk and initiate abduction. It also assists in fixation of the head of the humerus in the glenoid cavity.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 111 - A neonate with failure to pass meconium is being evaluated. His abdomen is...

Incorrect

A neonate with failure to pass meconium is being evaluated. His abdomen is distended and X-ray films of the abdomen show markedly dilated small bowel and colon loops. The likely diagnosis is:

Your Answer:

Correct Answer: Aganglionosis in the rectum

Explanation:
Hirschsprung’s disease (also known as aganglionic megacolon) leads to colon enlargement due to bowel obstruction by an aganglionic section of bowel that starts at the anus. A blockage is created by a lack of ganglion cells needed for peristalsis that move the stool. 1 in 5000 children suffer from this disease, with boys affected four times more commonly than girls. It develops in the fetus in early stages of pregnancy. Symptoms include not having a first bowel movement (meconium) within 48 hours of birth, repeated vomiting and a swollen abdomen. Two-third of cases are diagnosed within 3 months of birth. Some children may present with delayed toilet training and some might not show symptoms till early childhood. Diagnosis is by barium enema and rectal biopsy (showing lack of ganglion cells).
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 112 - A 27-yeaar-old woman is diagnosed with candidiasis and prescribed fluconazole. What is the...

Incorrect

A 27-yeaar-old woman is diagnosed with candidiasis and prescribed fluconazole. What is the mechanism of action of fluconazole?

Your Answer:

Correct Answer: Inhibits cytochrome P450

Explanation:
Fluconazole is a triazole antifungal drug used in the treatment and prevention of superficial and systemic fungal infections. Like other imidazole- and triazole-class antifungals, fluconazole inhibits the fungal cytochrome P450 enzyme, 14-demethylase. It is used to treat candidiasis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, dermatophytosis, and pityriasis versicolor.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 113 - Which of the following will be affected by a lesion in the posterior...

Incorrect

Which of the following will be affected by a lesion in the posterior column-medial lemniscus system?

Your Answer:

Correct Answer: Fine touch

Explanation:
The posterior column–medial lemniscus (PCML) pathway is a sensory pathway that transmits fine touch and conscious proprioceptive information from the body to the brain. As the posterior columns are also known as dorsal columns, the pathway is also called the dorsal column–medial lemniscus system or DCML.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 114 - An 26-year-old man sought admission due to persistent non-bloody diarrhoea. The patient is...

Incorrect

An 26-year-old man sought admission due to persistent non-bloody diarrhoea. The patient is HIV-positive. Examination of stool sample showed numerous acid-fast cysts. Which of the following organism is the most likely cause of diarrhoea?

Your Answer:

Correct Answer: Cryptosporidium parvum

Explanation:
Cryptosporidium parvum is one of several species that causes cryptosporidiosis, a parasitic disease of the mammalian intestinal tract. Primary symptoms of C. parvum infection are acute, watery, and non-bloody diarrhoea. C. parvum infection is of particular concern in immunocompromised patients, where diarrhoea can reach 10–15 l per day.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 115 - Which condition presents with a positive urine dipstick test for blood, but no...

Incorrect

Which condition presents with a positive urine dipstick test for blood, but no blood cells on urine microscopy?

Your Answer:

Correct Answer: Myoglobinuria

Explanation:
Myoglobinuria, or presence of myoglobulin in the urine is seen due to rhabdomyolysis (muscle destruction). Common causes of rhabdomyolysis include trauma, electrical injuries, burns, venom and drugs. Damaged muscle leads to release of myoglobin in the blood. Ideally, the released myoglobin gets filtered and excreted by the kidneys. However, excess myoglobin can occlude the renal filtration system leading to acute tubular necrosis and acute renal dysfunction.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 116 - Which of the following structure forms the floor of the posterior triangle of...

Incorrect

Which of the following structure forms the floor of the posterior triangle of the neck:

Your Answer:

Correct Answer: Prevertebral fascia

Explanation:
The posterior triangle (or lateral cervical region) is a region of the neck which has the following boundaries:
Apex: Union of the sternocleidomastoid and the trapezius muscles at the superior nuchal line of the occipital bone
Anterior: Posterior border of the sternocleidomastoid muscle
Posterior: Anterior border of the trapezius
Base: Middle one third of the clavicle
Roof: Investing layer of the deep cervical fascia
Floor: The anterolateral portion of prevertebral fascia
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 117 - Which among the following vertebrae marks the lowest extent of the superior mediastinum?...

Incorrect

Which among the following vertebrae marks the lowest extent of the superior mediastinum?

Your Answer:

Correct Answer: Fourth thoracic

Explanation:
The superior mediastinum lies between the manubrium anteriorly and the upper vertebrae of the thorax posteriorly. Below, it is bound by a slightly oblique plane that passes backward from the sternal angle to the lower part of the body of T4 and laterally by the pleura.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 118 - During cardiac catheterisation, if the blood sample from the catheter shows an oxygen...

Incorrect

During cardiac catheterisation, if the blood sample from the catheter shows an oxygen saturation of 70%, and the pressure ranging from 12 to 24 mm Hg, it implies that the catheter tip is located in the:

Your Answer:

Correct Answer: Pulmonary artery

Explanation:
Normal values for various parameters are as follows:
Systolic arterial blood pressure (SBP): 90–140 mmHg.
Diastolic arterial blood pressure: 60–90 mmHg.
Mean arterial blood pressure (MAP): SBP + (2 × DBP)/3 (normal range: 70-105 mmHg).
Right atrial pressure (RAP): 2–6 mmHg.
Systolic right ventricular pressure (RVSP): 15–25 mmHg.
Diastolic right ventricular pressure (RVDP): 0–8 mmHg.
Pulmonary artery pressure (PAP): Systolic (PASP) is 15-25 mmHg and Diastolic (PADP) is 8–15 mmHg.
Pulmonary artery wedge pressure (PAWP): 6–12 mmHg.
Left atrial pressure (LAP): 6–12 mmHg.
Thus, the given value indicates that the position of catheter tip is likely to be in the pulmonary artery.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 119 - A 59 year old woman presents to the hospital with a 2.1cm mobile...

Incorrect

A 59 year old woman presents to the hospital with a 2.1cm mobile breast mass. A mammogram is indeterminate (M3), an ultrasound scan shows benign changes (U2), and clinical examination is also indeterminate (P3). What is the next best course of action?

Your Answer:

Correct Answer: Image guided core biopsy

Explanation:
Image guided core biopsy (US-directed biopsy) is performed for lesions that are palpable, but also for non-palpable, mammogram-detected lesions with a corresponding abnormality visualized on US. US-guided core biopsy is technically easier than stereotactic-guided biopsy as real-time imaging allows the surgeon to visualize the biopsy as it occurs. Using sterile technique and local anaesthesia, a small puncture is made with an 11-knife blade and the needle is placed near the edge of the lesion and fired, which inserts it into the lesion for a sample to be retrieved. When placed parallel to the needle the position of the needle can be visualized on US.

If the core biopsy result is benign and is concordant with imaging findings, continued surveillance is acceptable. If the result is indeterminate or image-discordant, surgical excision is indicated to rule out malignancy. In order to determine the appropriate management and surveillance of a lesion, the histologic, imaging, and clinical findings must be taken into account for an assessment of concordance to be performed. In addition, surgical excision is indicated for a core biopsy that demonstrates atypical hyperplasia (lobular or ductal) or lobular carcinoma in situ or neoplasia as the incidence of coexisting ductal carcinoma in situ or invasive carcinoma may be as high as 30% due to potential sampling error.
This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
0

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Question 120 - A 30-year-old male is playing tennis when he suddenly collapses and has a...

Incorrect

A 30-year-old male is playing tennis when he suddenly collapses and has a GCS of 4 when examined. What is the most likely cause?

Your Answer:

Correct Answer: Subarachnoid haemorrhage

Explanation:
The term subarachnoid haemorrhage (SAH) refers to extravasation of blood into the subarachnoid space between the pial and arachnoid membranes. SAH constitutes half of all spontaneous atraumatic intracranial haemorrhages; the other half consists of bleeding that occurs within the brain parenchyma.
Intracranial saccular aneurysms (“berry aneurysms”) represent the most common aetiology of nontraumatic SAH; about 80% of cases of SAH result from ruptured aneurysms.
This question is part of the following fields:
- Generic Surgical Topics
- Surgical Disorders Of The Brain
0

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Question 121 - A 63-year old lady presents with pain in multiple bones and renal failure....

Incorrect

A 63-year old lady presents with pain in multiple bones and renal failure. On enquiry, there is history of recurrent pneumonia in the past. What will be the likely finding on her bone marrow biopsy?

Your Answer:

Correct Answer: Plasma cells

Explanation:
Multiple myeloma is a plasma cell malignancy that produce excessive monoclonal immunoglobulins. The disease presents with bone pains, renal dysfunction, increased calcium, anaemia and recurrent infections. Diagnosis is by demonstrating the presence of M-protein in urine or serum, lytic bone lesions, light chain proteinuria or excessive plasma cells on marrow biopsy.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 122 - Regarding the coagulation cascade, Factor VII: ...

Incorrect

Regarding the coagulation cascade, Factor VII:

Your Answer:

Correct Answer: Is mainly synthesised by the vascular endothelium

Explanation:
Factor VII is an important part of the coagulation cascade. Deficiency causes haemophilia A. It is synthesised predominantly by the vascular endothelium and is not affect by liver disease. In the circulation it is bound to von Willebrand factor and it forms a stable complex. It is activated by thrombin or factor Xa and acts as a co-factor to factor IXa to activate factor X.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 123 - If the blood flow is constant, oxygen extraction by tissues will show the...

Incorrect

If the blood flow is constant, oxygen extraction by tissues will show the greatest decrease due to which of the following interventions?

Your Answer:

Correct Answer: Tissue cooling

Explanation:
With a constant blood flow to a given tissue bed, there will be an increase in oxygen extraction by the tissue with the following; an increase in tissue metabolism and oxygen requirements: warming (or fever), exercise, catecholamines and thyroxine. With cooling, the demand for oxygen decreases, leading to decreased oxygen extraction.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 124 - Which of these foramen is located at the base of the skull and...

Incorrect

Which of these foramen is located at the base of the skull and transmits the accessory meningeal artery?

Your Answer:

Correct Answer: Foramen ovale

Explanation:
At the base of the skull the foramen ovale is one of the larger of the several holes that transmit nerves through the skull. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery, lesser petrosal nerve, a branch of the glossopharyngeal nerve, emissary vein connecting the cavernous sinus with the pterygoid plexus of veins and occasionally the anterior trunk of the middle meningeal vein.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 125 - A patient had sudden complete loss of vision of the right eye. Fundoscopy...

Incorrect

A patient had sudden complete loss of vision of the right eye. Fundoscopy showed the distinct cherry red spot on the retina. Which of the following arteries was occluded?

Your Answer:

Correct Answer: Central artery of the retina

Explanation:
The central retinal artery supplies all the nerve fibres that form the optic nerve, which carries the visual information to the lateral geniculate nucleus of the thalamus. Thus if the central retinal artery gets occluded, there is complete loss of vision in that eye and the entire retina (with the exception of the fovea) becomes pale, swollen and opaque while the central fovea still appears reddish (this is because the choroid colour shows through). This is the basis of the famous Cherry red spot seen on examination of the retina on fundoscopy of a central retinal artery occlusion (CRAO).
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 126 - A 67 year old man brought to the emergency department with acute pancreatitis...

Incorrect

A 67 year old man brought to the emergency department with acute pancreatitis is immediately intubated and put on a ventilator. His intra-abdominal pressure is measured using a bladder catheter connected to manometry. Which of the following would most likely represent the pressure effect seen in abdominal compartment syndrome?

Your Answer:

Correct Answer: Bladder pressure of 16–25 mmHg does not require decompression

Explanation:
Bladder pressures below 5mm Hg are expected in healthy patients. Pressures between 10 to 15 mmHg can be expected following abdominal surgery and in obese patients. Bladder pressures over 25 mmHg are highly suspicious of abdominal compartment syndrome and should be correlated clinically. It is recommended that pressure measurements be trended to show and recognize the worsening of intra-abdominal hypertension. Recommended management at this stage includes fluid resuscitation and if the pressure rises beyond the critical threshold of 25 mmHg, abdominal decompression is required.
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
0

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Question 127 - The petrous part of the internal carotid artery is located inside of which...

Incorrect

The petrous part of the internal carotid artery is located inside of which cranial bone?

Your Answer:

Correct Answer: Temporal

Explanation:
The petrous segment, or C2, of the internal carotid is that which is inside the petrous part of the temporal bone. This segment extends until the foramen lacerum. The petrous portion classically has three sections: an ascending, or vertical portion; the genu, or bend; and the horizontal portion.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 128 - A 30-year-old female was alarmed when she started to experience hair loss and...

Incorrect

A 30-year-old female was alarmed when she started to experience hair loss and balding, however, she also noted increased hair on her face and body and developed an acne breakout. Deepening of her voice also became prominent. She was referred to an oncologist and was diagnosed with a hormone-producing tumour. What is the most likely diagnosis ?

Your Answer:

Correct Answer: Arrhenoblastoma

Explanation:
Arrhenoblastoma, known as ‘Sertoli–Leydig tumour’ is a rare ovarian stromal neoplasm that secretes testosterone. It is mostly seen in women in the reproductive years. The key clinical features of this tumour is due to excessive production of testosterone which leads to progressive masculinisation in a woman who was typical normal beforehand. The lesion tends to grow slowly and rarely metastasises. Treatment is surgical removal of the tumour and the prognosis is generally good.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 129 - A 20-year old involved in a brawl was stabbed in the anterior chest...

Incorrect

A 20-year old involved in a brawl was stabbed in the anterior chest in a structure that is in close proximity to where the first rib articulates with the sternum. What is the structure that was most likely injured?

Your Answer:

Correct Answer: Sternoclavicular joint

Explanation:
The first rib articulates with the sternum right below the sternoclavicular joint.
The sternal angle articulates with the costal cartilage of the second rib.
The nipple is found between the fourth and the fifth ribs, in the fourth intercostal space.
The xiphoid process is located right below the point of articulation of the costal cartilage of rib 7 with the sternum.
The root of the lung is the part of the lung where neurovascular structures enter and leave the lung.
Acromioclavicular joint is the point of articulation between the acromion process and the clavicle, near the shoulder.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 130 - What's the nodal stage of a testicular seminoma if several lymph nodes between...

Incorrect

What's the nodal stage of a testicular seminoma if several lymph nodes between 2cm and 5cm are found?

Your Answer:

Correct Answer: N2

Explanation:
According to the American Joint Committee on Cancer (AJCC) 2002 guidelines, the nodal staging of testicular seminoma is the following:
N0: no regional lymph node metastases
N1: metastasis with lymph nodes 2 cm or less in their greatest dimension or multiple lymph nodes, none more than 2 cm
N2: metastasis with lymph nodes greater than 2 cm but not greater than 5 cm in their greatest dimension, or multiple lymph nodes, any one mass greater than 2 cm, but not more than 5 cm
N3: metastasis with lymph nodes greater than 5 cm in their greatest dimension.
The patient in this case has N2 testicular seminoma. This TNM staging is extremely important because treatment options are decided depending on this classification.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 131 - Which of the following nerves has its terminal branch at the supratrochlear nerve?...

Incorrect

Which of the following nerves has its terminal branch at the supratrochlear nerve?

Your Answer:

Correct Answer: Frontal

Explanation:
The supratrochlear nerve is a branch of the frontal nerve which comes from the ophthalmic division of cranial nerve V (trigeminal nerve). It passes above the superior oblique nerve and its descending filaments join the infratrochlear branch of the nasociliary nerve. From the orbit, it exits between the supraorbital foramen and the pulley of the superior oblique. It then curves up to the forehead beneath the corrugator supercilli and frontalis muscle. It further divides into branches that supply sensory innervation to the bridge of the nose, medial part of the upper eyelid and medial forehead.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 132 - A 38-year-old woman with end-stage renal disease, is undergoing haemodialysis. She has normocytic...

Incorrect

A 38-year-old woman with end-stage renal disease, is undergoing haemodialysis. She has normocytic normochromic anaemia. What is the best treatment for her?

Your Answer:

Correct Answer: Erythropoietin

Explanation:
E erythropoietin (EPO) is a hormone that is released by the kidney. It is responsible for the regulation of red blood cell production in the body. It can be made using recombinant technology and is used in the treatment of anaemia of chronic renal failure and in patients under going chemotherapy
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 133 - A 38 year old teacher presents with a mass lesion in her left...

Incorrect

A 38 year old teacher presents with a mass lesion in her left breast. A biopsy and imaging confirmed a 2.5cm lesion in the upper inner quadrant of her left breast and a 1.5cm lesion at the central aspect of the same breast. Examination of her axilla revealed lymphadenopathy and a fine needle aspirate from the node showed malignant cells. Which of the following would be the best course of action?

Your Answer:

Correct Answer: Simple mastectomy and axillary node clearance

Explanation:
Indications for a simple mastectomy with a concomitant axillary procedure, which may be either a sentinel node biopsy or an axillary clearance, are as follows:

– Locally advanced breast cancer
– Multifocal breast cancer
– Large tumour relative to the size of the breast, excision of which may compromise final cosmesis
– Extensive ductal carcinoma in situ (DCIS)

Multifocality and multicentricity (MFMC) are frequently used descriptors to assess the extent of disease in patients presenting breast cancer. The presence of two or more foci of cancer within the same breast quadrant is defined as multifocal, while the presence of two or more foci of cancer in different quadrants of the same breast is defined as multicentric. A simple mastectomy involves removing the breast along with an ellipse of skin that encompasses the nipple-areola complex. Unlike a radical mastectomy, it does not involve removal of the underlying muscles and uninvolved lymph nodes.

Patient unsuitability for breast-conserving approaches as a result of contraindications for radiation therapy – Such contraindications include a previous history of chest wall irradiation, either after previous breast-conserving therapy or in mantle field radiation therapy for lymphoma; severe skin disorders, such as scleroderma and psoriasis; and severe pulmonary dysfunction

Patient preference for mastectomy – A patient who is a suitable candidate for breast conservation may opt for a mastectomy instead.
This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 134 - You observe a procedure to harvest the left internal thoracic (mammary) artery to...

Incorrect

You observe a procedure to harvest the left internal thoracic (mammary) artery to be used as a graft for coronary artery bypass surgery. The left internal thoracic artery is mobilised from the inside of the chest wall and divided near the caudal end of the sternum. After dividing the internal thoracic artery at its distal end, the specialist registrar asks you to name the artery that will now have increased blood supply so that adequate blood flow is maintained to the rectus abdominis on the left side. What would your answer be?

Your Answer:

Correct Answer: Inferior epigastric artery

Explanation:
The rectus abdominis muscle is supplied by the superior epigastric artery which is a branch of the internal thoracic artery. If the internal thoracic artery is thus ligated, blood would no longer flow to it. However, the superior epigastric artery communicates with the inferior epigastric artery (a branch of the external iliac artery). This means that blood could flow from the external iliac, to the inferior epigastric, to the superior epigastric to the rectus abdominis.
The superficial circumflex iliac artery and the superficial epigastric are two superficial branches of the femoral artery and do not supply the deep branches of the abdomen.
The deep circumflex iliac artery travels along the iliac crest on the inner surface of the abdominal wall; being too lateral it doesn’t supply blood to the rectus abdominis.
The distal portions of the umbilical arteries are obliterated in adults to form the medial umbilical folds.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 135 - A 55-year-old male chronic smoker is diagnosed with non-small-cell cancer. His right lung...

Incorrect

A 55-year-old male chronic smoker is diagnosed with non-small-cell cancer. His right lung underwent complete atelectasis and he has a 7cm tumour involving the chest wall. What is the stage of the lung cancer of this patient?

Your Answer:

Correct Answer: T3

Explanation:
Non-small-cell lung cancer is staged through TNM classification. The stage of this patient is T3 because based on the TNM classification the tumour is staged T3 if > 7 cm or one that directly invades any of the following: Chest wall (including superior sulcus tumours), diaphragm, phrenic nerve, mediastinal pleura, or parietal pericardium; or the tumour is in the main bronchus < 2 cm distal to the carina but without involvement of the carina, Or it is associated with atelectasis/obstructive pneumonitis of the entire lung or separate tumour nodule(s) in the same lobe.
This question is part of the following fields:
- Basic Sciences
- Pathology
0

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Question 136 - What is the nerve supply of the muscle that is inserted onto the...

Incorrect

What is the nerve supply of the muscle that is inserted onto the crest of the lesser tubercle of the humerus?

Your Answer:

Correct Answer: Lower subscapular

Explanation:
The muscle is the subscapularis muscle which is supplied by the lower subscapular nerve.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 137 - The third branch of the maxillary artery lies in which fossa? ...

Incorrect

The third branch of the maxillary artery lies in which fossa?

Your Answer:

Correct Answer: Pterygopalatine fossa

Explanation:
The maxillary artery supplies deep structures of the face. It branches from the external carotid artery just deep to the neck of the mandible. It is divided into three portions:
– The first or mandibular portion (or bony portion) passes horizontally forward, between the neck of the mandible and the sphenomandibular ligament.
– The second or pterygoid portion (or muscular portion) runs obliquely forward and upward under cover of the ramus of the mandible, on the surface of the lateral pterygoid muscle; it then passes between the two heads of origin of this muscle and enters the fossa.
– The third portion lies in the pterygopalatine fossa in relation to the pterygopalatine ganglion. This is considered the terminal branch of the maxillary artery. Branches from the third portion includes: the sphenopalatine artery, descending palatine artery, infraorbital artery, posterior superior alveolar artery, artery of pterygoid canal, pharyngeal artery, middle superior alveolar artery and anterior superior alveolar artery.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 138 - A 44 year old actor presents with an attack of mild acute pancreatitis....

Incorrect

A 44 year old actor presents with an attack of mild acute pancreatitis. Imaging identifies gallstones but a normal calibre bile duct, and a peripancreatic fluid collection. Which management option would be the most appropriate?

Your Answer:

Correct Answer: Cholecystectomy once the attack has settled

Explanation:
Pancreatitis is inflammation of the pancreas with variable involvement of regional tissues or remote organ systems. Acute pancreatitis (AP) is characterized by severe pain in the upper abdomen and elevation of pancreatic enzymes in the blood. In the majority of patients,
Biliary pancreatitis should always be treated eventually with a cholecystectomy after the process has subsided.
Feeding should be introduced enterally as the patient’s anorexia and pain resolves.
The use of nasogastric aspiration offers no clear advantage in patients with mild AP, but is beneficial in patients with profound pain, severe disease, paralytic ileus, and intractable vomiting.
AP is a mild, self-limiting disease that resolves spontaneously without complications. Patients can be initiated on a low-fat diet initially and need not invariably start their dietary advancement using a clear liquid diet. Systematic reviews and meta-analyses have shown that administration of enteral nutrition may reduce mortality and infectious complications compared with parenteral nutrition. Although the ideal timing to initiate enteral feeding remains undetermined, administration within 48 hours appears to be safe and tolerated.
This question is part of the following fields:
- Generic Surgical Topics
- Hepatobiliary And Pancreatic Surgery
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Question 139 - A 43-year-old female with liver cirrhosis is recovering following an emergency paraumbilical hernia...

Incorrect

A 43-year-old female with liver cirrhosis is recovering following an emergency paraumbilical hernia repair. She has been slow to resume oral intake and has been receiving regular boluses of normal saline for oliguria. Which of the following intravenous fluids should be considered?

Your Answer:

Correct Answer: Human albumin solution 4.5%

Explanation:
In a surgical patient, hepatic dysfunction translates into an increased risk of infection, haemorrhage, thrombosis, and a prolonged half-life of numerous drugs (e.g., opioids and benzodiazepines). The associated imbalance of neuroendocrine mediators (e.g., vasopressin, renin-angiotensin-aldosterone system, and nitric oxide) also potentiates sodium and fluid retention, resulting in a background hyperdynamic circulation with splanchnic venous congestion and systemic vasodilation.
In emergency surgery, stress response to the underlying condition, anaesthesia, and surgical trauma increase the risk of hepatic decompensation and associated multi-system failure. Changes in hepatic perfusion with shock and fluid shifts further compromise hepatocellular synthetic and excretory functions. In addition, endotoxemia from gram-negative sepsis potentiates platelet aggregation and creates a state of low-grade disseminated intravascular coagulation.
Activation of the renin-angiotensin-aldosterone system with hypersecretion of vasopressin acts as compensatory mechanisms to preserve arterial pressure and replenish effective circulating volume when blood is pooled in the splanchnic territory. With the progression of cirrhosis, avidity for water and sodium increases, and dilutional hyponatremia results from water retention. In advanced cases, exacerbation of these abnormalities leads to hepatorenal syndrome (HRS). HRS is characterized by a rapid decline in renal function with low urinary excretion of sodium due to severe renal vasoconstriction and diminished or absent cortical perfusion. This syndrome is potentially reversible but carries an extremely poor prognosis.

Owing to raised intra-abdominal pressure due to ascites and muscle weakness from decreased muscle mass and malnutrition, umbilical and inguinal hernia incidence is higher in patients with cirrhosis.
If the patient with cirrhosis has umbilical hernia with obstructive symptoms such as intermittent incarceration or trophic skin changes, surgical repair should be considered.

Euvolemia and electrolyte homeostasis should be maintained under strict clinical and laboratory monitoring. Acute kidney injury in the absence of hemodynamic instability, use of nephrotoxic drugs, or parenchymal renal disease suggests the diagnosis of hepatorenal syndrome. Additional diagnostic criteria include no improvement in renal function after volume expansion with albumin and diuretic withdrawal. Treatment of hepatorenal syndrome requires the use of splanchnic vasoconstrictors (terlipressin, noradrenalin, or midodrine) and albumin infusion. Improved renal function has been demonstrated with medical treatment, but a mortality benefit is only ultimately achieved with liver transplantation. TIPS placement and renal and hepatic replacement therapies can be indicated as bridging strategies.
This question is part of the following fields:
- Post-operative Management And Critical Care
- Principles Of Surgery-in-General
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Question 140 - A man came to the hospital complaining of a sensation of pins and...

Incorrect

A man came to the hospital complaining of a sensation of pins and needles in the dorsum of the thumb and digits 1 and 2. On further examination they found that he had weakness in wrist dorsiflexion and finger extension. Which nerve do you think is injured in this case?

Your Answer:

Correct Answer: Radial

Explanation:
The radial nerve can be injured in multiple sites along its course in the upper limb, and each site has its own presentation. The major complaint is wrist drop which if high above the elbow, can cause numbness of the forearm and hand. It can last for several days or weeks. The most common site of compression for the radial nerve is at the proximal forearm in the area of the supinator muscles.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 141 - A 40-year-old man is brought to the A&E department in an unconscious state,...

Incorrect

A 40-year-old man is brought to the A&E department in an unconscious state, following a car collision. He was driving at a high speed of 140 km/hr, wearing a seat belt, when his car collided with a brick wall. CT scan of the brain appears to be normal. However, he remains in a persistent vegetative state. What is the most likely underlying cause?

Your Answer:

Correct Answer: Diffuse axonal injury

Explanation:
This is a case of diffuse axonal injury (DAI) which occurs when the head is rapidly accelerated or decelerated.

DAI is a form of traumatic brain injury which occurs when the brain rapidly shifts inside the skull as an injury is occurring. The long connecting fibres in the brain called axons are sheared as the brain rapidly accelerates and decelerates inside the hard bone of the skull. There are two components of DAI:
1. Multiple haemorrhages
2. Diffuse axonal damage in the white matter

Up to two-thirds of the changes occurs at the junction of the grey and white matter due to the different densities of the tissue. These are mainly histological and axonal damage is secondary to biochemical cascades. Often, there are no signs of a fracture or contusion. DAI typically causes widespread injury to the brain leading to loss of consciousness. The changes in the brain are often very tiny and can be difficult to detect using CT or MRI scans.
This question is part of the following fields:
- Generic Surgical Topics
- Surgical Disorders Of The Brain
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Question 142 - What is correct regarding the obturator artery? ...

Incorrect

What is correct regarding the obturator artery?

Your Answer:

Correct Answer: It is found in the medial compartment of the thigh

Explanation:
The obturator artery is a branch of the internal iliac artery, which passes antero-inferiorly on the lateral wall of the pelvis, to the upper part of the obturator foramen. The posterior branch follows the posterior margin of the foramen and turns forward on the inferior ramus of the ischium. It also supplies an articular branch, which enters the hip joint through the acetabular notch, sending a branch along the ligamentum teres to the head of the femur. It is the main source of arterial supply to the medial compartment of the thigh
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 143 - A 17-year-old boy, who had developed shortness of breath and a loss of...

Incorrect

A 17-year-old boy, who had developed shortness of breath and a loss of appetite over the last month, was referred to a haematologist because he presented with easy bruising and petechiae. His prothrombin time, platelet count, partial thromboplastin and bleeding time were all normal. Which of the following would explain the presence of the petechiae and easy bruising tendency?

Your Answer:

Correct Answer: Scurvy

Explanation:
Scurvy is a condition caused by a dietary deficiency of vitamin C, also known as ascorbic acid. Humans are unable to synthesize vitamin C, therefore the quantity of it that the body needs has to come from the diet. The presence of an adequate quantity of vitamin C is required for normal collagen synthesis. In scurvy bleeding tendency is due to capillary fragility and not coagulation defects, therefore blood tests are normal.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 144 - A 65 year old man is brought to the emergency department after he...

Incorrect

A 65 year old man is brought to the emergency department after he collapsed at the bus station. Clinical examination is significant for a ruptured abdominal aortic aneurysm. On arrival he is hypotensive and moribund. Which of the following is most likely to be his ASA?

Your Answer:

Correct Answer: 5

Explanation:
ASA-V: A moribund patient who is not expected to survive without the operation. Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction

ASA Grading
1 – No organic physiological, biochemical or psychiatric disturbance. The surgical pathology is localised and has not invoked systemic disturbance
2 – Mild or moderate systemic disruption caused either by the surgical disease process or though underlying pre-existing disease
3 – Severe systemic disruption caused either by the surgical pathology or pre-existing disease
4 – Patient has severe systemic disease that is a constant threat to life
5 – A patient who is moribund and will not survive without surgery
This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
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Question 145 - Whilst snorkelling, a 30-year old gentleman has the respiratory rate of 10/min, tidal...

Incorrect

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. Which of the following will bring about a maximum increase in his alveolar ventilation?

Your Answer:

Correct Answer: A 2x increase in tidal volume and a shorter snorkel

Explanation:
Alveolar ventilation = respiratory rate × (tidal volume − anatomical dead space volume). Increase in respiratory rate simply causes movement of air in the anatomical dead space, with no contribution to the alveolar ventilation. By use of a shorter snorkel, the effective anatomical dead space will decrease and will cause a maximum rise in alveolar ventilation along with doubling of tidal volume.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 146 - Which of the following brings about a reduction in gastric blood flow? ...

Incorrect

Which of the following brings about a reduction in gastric blood flow?

Your Answer:

Correct Answer: Vasopressin

Explanation:
Gastric blood flow is increased by vagal stimulation, gastrin, histamine and acetylcholine as they stimulate gastric section and the production of vasodilator metabolites. Acetylcholine and histamine also have a direct action on the gastric arterioles. Similarly, gastric blood flow is reduced by inhibitors of secretion – catecholamines, secretin and vasopressin.
This question is part of the following fields:
- Basic Sciences
- Physiology
0

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Question 147 - A 62 year old man presents with sudden onset of palpitations. ECG shows...

Incorrect

A 62 year old man presents with sudden onset of palpitations. ECG shows broad complex tachycardia at a rate of 150 beats per minute. The blood pressure is 120/82 mmHg and there is no evidence of heart failure. The doctor wants to prescribe a rate controlling medication. Which of the following should be avoided in this case?

Your Answer:

Correct Answer: Verapamil

Explanation:
The use of intravenous diltiazem or verapamil is contraindicated in patients with ventricular tachycardia. The IV administration of a calcium channel blocker can precipitate cardiac arrest in such patients.
Marked hemodynamic deterioration and ventricular fibrillation have occurred in patients with wide-complex ventricular tachycardia (QRS >= 0.12 seconds) treated with IV verapamil.
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 148 - A 45-year-old-female is suspected to have a pulmonary mass. Supposing that she has...

Incorrect

A 45-year-old-female is suspected to have a pulmonary mass. Supposing that she has a neoplasm, which of the following are most commonly found to involve the lung:

Your Answer:

Correct Answer: Pulmonary metastases

Explanation:
Lung metastases occur when a cancer started in another part of the body (primary site) spreads to the lungs. The lungs are among the most common site where cancer can spread due to its rich systemic venous drainage, almost every type of cancer can spread to the lung. The most common types of cancer that spread to the lung are breast, colorectal, kidney, testicular, bladder, prostate, head and neck cancers.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 149 - A 30-year-old male is reviewed in the clinic. He has suffered from Crohn's...

Incorrect

A 30-year-old male is reviewed in the clinic. He has suffered from Crohn's disease for many years, he has recently undergone a subtotal colectomy. However, he has residual Crohns in his rectum causing the ongoing symptoms. Medical therapy is ineffective. What is the best course of action?

Your Answer:

Correct Answer: Proctectomy

Explanation:
Treatment of Crohn’s disease is based on the disease site, pattern, activity, and severity. The general goals of treatment for Crohn’s disease are as follows:
To achieve the best possible clinical, laboratory, and histologic control of the inflammatory disease with the least adverse effects from medication.
To permit the patient to function as normally as possible.
Therapy for mild Crohn’s disease is typically administered in a sequential “step-up” approach, in which less aggressive and less toxic treatments are initiated first, followed by more potent medications or procedures if the initial therapy fails.
Patients are treated with preparations of 5-aminosalicylic acid (5-ASA), antibiotics, and nutritional therapy. However, the use of 5-ASA for the treatment of Crohn’s disease is controversial; only a small subset of patients may benefit from this agent. Although 5-ASA is effective for reducing disease activity in active Crohn’s disease, it typically has a lower efficacy for Crohn’s disease than for ulcerative colitis, and its efficacy for maintenance of remission remains unproven.

If no response occurs or if the disease is more severe than initially thought, corticosteroids and inhibitors of DNA synthesis (i.e., immunomodulators) with 6-mercaptopurine (6-MP)/azathioprine or methotrexate are administered. Finally, biologic agents (infliximab, adalimumab, certolizumab pegol, and natalizumab) and surgical therapies can be useful.

For the treatment of moderate to severe Crohn’s disease, current recommendations include the “top-down” approach, which differs from the conventional step-up approach in that more potent agents are administered initially. Top-down therapies include biologic agents and steroids as needed versus combination therapy with both biologic drugs and immunomodulatory agents.

Azathioprine or 6-MP is effective for maintenance of remission in Crohn’s disease; each is effective for avoiding surgery and for preventing postoperative and endoscopic relapse. Both agents can be used in combination with infliximab.

If medical therapy for active Crohn’s disease fails, surgical resection of the inflamed bowel, with the restoration of continuity, is indicated.

Recommended indications for surgical intervention include the following:
Failed medical therapy
Persistent symptoms despite high-dose corticosteroid therapy
Treatment-related complications, including intra-abdominal abscesses
Medically intractable fistulae
Fibrotic strictures with obstructive symptoms
Toxic megacolon
Intractable haemorrhage
Perforation
Cancer

For Rectal Crohn’s: Proctectomy is appropriate, and in published series, it is required in 10 to 20% of cases. Unfortunately, proctectomy can be complicated by poor wound healing and perineal sinus formation in up to 25 to 50% of patients. A gracillis flap can be helpful.
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 150 - A urologist makes a transverse suprapubic incision to retrieve a stone from the...

Incorrect

A urologist makes a transverse suprapubic incision to retrieve a stone from the urinary bladder. Which of the following abdominal wall layers will the surgeon NOT traverse?

Your Answer:

Correct Answer: Posterior rectus sheath

Explanation:
Pfannenstiel incision (a transverse suprapubic incision) is made below the arcuate line. Thus, there is no posterior layer of the rectus sheath here, only the transversalis fascia lines the inner layer of the rectus abdominis. The layers traversed include: skin, superficial fascia (fatty and membranous), deep fascia, anterior rectus sheath, rectus abdominis muscle, transversalis fascia, extraperitoneal connective tissue and peritoneum.
This question is part of the following fields:
- Anatomy
- Basic Sciences
0

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Question 151 - Following a fracture in the fibula, an artery contained in a fibrous canal...

Incorrect

Following a fracture in the fibula, an artery contained in a fibrous canal between tibialis posterior and flexor hallucis longus was lacerated. Which of the following arteries was injured?

Your Answer:

Correct Answer: Peroneal

Explanation:
The peroneal artery is deeply seated at the back of the fibular side of the leg, contained in a fibrous canal between the tibialis posterior and the flexor hallucis longus.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 152 - A syndrome responsible for failure to absorb vitamin B12 from the GIT is...

Incorrect

A syndrome responsible for failure to absorb vitamin B12 from the GIT is called?

Your Answer:

Correct Answer: Pernicious anaemia

Explanation:
Pernicious anaemia is a type of autoimmune disease in which antibodies form against the parietal cells or intrinsic factor. Intrinsic factor is required for the absorption of vitamin B12. Blood testing typically shows a macrocytic, normochromic anaemia and low levels of serum vitamin B12. A Schilling test can then be used to distinguish between pernicious anaemia, vitamin B12 malabsorption and vitamin B12 deficiency. Symptoms include shortness of breath, pallor and diarrhoea etc.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 153 - A 45 year old lady has been diagnosed with Friedreich's ataxia that has...

Incorrect

A 45 year old lady has been diagnosed with Friedreich's ataxia that has affected her medial group of nuclei in the anterior horn of the spinal cord. Which of the following structures will have their muscles affected?

Your Answer:

Correct Answer: Axial muscles

Explanation:
The cells in the anterior horn can be arranged in the following three main groups: medial, lateral and central. The medial group of nuclei in the anterior horn of the spinal cord are located along the entire length of the spinal cord and are responsible for the innervation of the axial muscles of the body ( muscles of the head and neck region). Thus this disease will most likely affect the functioning of the muscles of the head and neck.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 154 - An 18 year old 100m athlete presents with knee pain which worsens on...

Incorrect

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:

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 155 - A 20-year-old African man is admitted to the hospital with acute severe abdominal...

Incorrect

A 20-year-old African man is admitted to the hospital with acute severe abdominal pain. He has just flown to UK after a long-haul flight, and the pain developed mid-flight. On examination, there is tenderness in the left upper abdominal quadrant. His blood tests, done on his arrival, show:Hb: 5 g/dLWCC: 20 x 10^9/LRetic count: 30% What is the most likely underlying cause?

Your Answer:

Correct Answer: Sickle cell anaemia

Explanation:
The combination of a high reticulocyte count and severe anaemia indicates aplastic crisis in patients with sickle cell anaemia. Another differential can be that of a transient aplastic crisis due to parvovirus. This is less likely as it causes reticulocytopenia rather than reticulocytosis.

Parvovirus B19 infects erythroid progenitor cells in the bone marrow and causes temporary cessation of red blood cell production. People who have underlying haematologic abnormalities such as sickle cell anaemia are at risk of cessation of red blood cell production if they become infected. This can result in a transient aplastic crisis. It is more common in people of African, Indian, and Middle Eastern backgrounds. Typically, these patients have a viral prodrome followed by anaemia, often with haemoglobin concentrations falling below 5.0 g/dL and reticulocytosis.
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 156 - A 21-year-old woman is admitted with loin pain and fever. She has given...

Incorrect

A 21-year-old woman is admitted with loin pain and fever. She has given a history of haematuria for the past one week with associated dysuria, for which she was started on trimethoprim as an empirical outpatient treatment.What is the most likely diagnosis?

Your Answer:

Correct Answer: Pyelonephritis

Explanation:
This is most likely a case of pyelonephritis.

Acute pyelonephritis is a common bacterial infection of the renal pelvis and kidneys most often seen in young adult women. History and physical examination are the most important tools for diagnosis. Most patients have fever, although it may be absent early in the illness. E. coli is the most common pathogen in acute pyelonephritis.

For diagnosing the disease:
1. A positive urinalysis confirms the diagnosis in patients with a compatible history and physical examination.
2. Urine culture should be obtained in all patients to guide antibiotic therapy if the patient does not respond to initial empirical antibiotic regimens.
3. Imaging, usually with contrast-enhanced CT scan, is not necessary unless there is no improvement in the patient’s symptoms or if there is recurrence of symptoms after initial improvement.

Outpatient treatment is appropriate for most patients. Inpatient therapy is recommended for patients who have severe illness or in whom a complication is suspected. Oral beta-lactam antibiotics and trimethoprim/sulfamethoxazole are generally inappropriate for outpatient therapy because of high resistance rates. Several antibiotic regimens can be used for inpatient treatment, including fluoroquinolones, aminoglycosides, and cephalosporins.
This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 157 - The posterior boundary of the carotid triangle is bounded by which of the...

Incorrect

The posterior boundary of the carotid triangle is bounded by which of the following muscles?

Your Answer:

Correct Answer: Sternocleidomastoid

Explanation:
The carotid triangle is a portion of the anterior triangle of the neck. It is bounded superiorly by the posterior belly of the digastric muscle, antero-inferiorly by the superior belly of omohyoid and posteriorly by the sternocleidomastoid. The floor is formed by the thyrohyoid, hyoglossus, middle and inferior pharyngeal constrictors and the roof is formed by the skin, superficial fascia, platysma and deep fascia.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 158 - In a young, sexually active male, what is the most common cause of...

Incorrect

In a young, sexually active male, what is the most common cause of non-gonococcal urethritis?

Your Answer:

Correct Answer: Chlamydia

Explanation:
Non-gonococcal urethritis is most commonly caused by Chlamydia trachomatis (50% cases). Less common organisms include Mycoplasma genitalium, Urea urealyticum and Trichomonas vaginalis. Chlamydia is also the commonest cause of non-gonococcal cervicitis in women and proctitis in both sexes.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 159 - upon stroking the plantar surface of a patient's foot, extension of toes was...

Incorrect

upon stroking the plantar surface of a patient's foot, extension of toes was noted. This is likely to be accompanied with:

Your Answer:

Correct Answer: Spasticity

Explanation:
An upper motor neuron lesion affects the neural pathway above the anterior horn cell or motor nuclei of the cranial nerves, whereas a lower motor neurone lesion affects nerve fibres travelling from the anterior horn of the spinal cord to the relevant muscles. An upper motor neurone lesions results in the following:
– Spasticity in the extensor muscles (lower limbs) or flexor muscles (upper limbs).
– ‘clasp-knife’ response where initial resistance to movement is followed by relaxation
– Weakness in the flexors (lower limbs) or extensors (upper limbs) with no muscle wasting
– Brisk tendon jerk reflexes
– Positive Babinski sign (on stimulation of the sole of the foot, the big toe is raised rather than curled downwards)
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 160 - What is a major source of fuel being oxidised by the skeletal muscles...

Incorrect

What is a major source of fuel being oxidised by the skeletal muscles of a man who has undergone starvation for 7 days?

Your Answer:

Correct Answer: Serum fatty acids

Explanation:
Starvation is the most extreme form of malnutrition. Prolonged starvation can lead to permanent organ damage and can be fatal. Starved individuals eventually lose significant fat and muscle mass as the body uses these for energy.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 161 - A 40 year old male presents with jaundice and is diagnosed as having...

Incorrect

A 40 year old male presents with jaundice and is diagnosed as having a carcinoma of the head of the pancreas. Despite being deeply jaundiced, his staging investigations are negative for metastatic disease. What is the best method of biliary decompression in this case?

Your Answer:

Correct Answer: ERCP and placement of stent

Explanation:
ERCP is a highly sensitive means of detecting pancreatic and/or biliary ductal abnormalities in pancreatic carcinoma. Among patients with pancreatic adenocarcinoma, 90-95% have abnormalities on ERCP findings.
ERCP is more invasive than the other diagnostic imaging modalities available for pancreatic carcinoma. ERCP also carries a 5-10% risk of significant complications. Because of this morbidity, it is usually reserved as a therapeutic procedure for biliary obstruction or for the diagnosis of unusual pancreatic neoplasms, such as intraductal pancreatic mucinous neoplasms (IPMN).
ERCP findings provide only limited staging information, but ERCP does have the advantage of allowing for therapeutic palliation of obstructive jaundice with either a plastic or metal biliary stent.
This question is part of the following fields:
- Generic Surgical Topics
- Hepatobiliary And Pancreatic Surgery
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Question 162 - An 18-year-old male is admitted with a three-month history of intermittent pain in...

Incorrect

An 18-year-old male is admitted with a three-month history of intermittent pain in the right iliac fossa. He suffers from episodic diarrhoea and has lost two kilograms of weight. On examination, he is febrile and has right iliac fossa tenderness.What is the most likely diagnosis?

Your Answer:

Correct Answer: Inflammatory bowel disease

Explanation:
A history of weight loss and intermittent diarrhoea makes inflammatory bowel disease (IBD) the most likely diagnosis. Conditions such as appendicitis and infections have a much shorter history. Although Meckel’s diverticulum can bleed and cause inflammation, it seldom causes marked weight loss. Irritable bowel syndrome (IBS) presents with alternating episodes of constipation and diarrhoea along with abdominal pain, bloating, and gas.
This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 163 - A 25 year old man is taken to the A&E department after being...

Incorrect

A 25 year old man is taken to the A&E department after being hit in the head with a batton. He opens his eyes to pain and groans or grunts. He extends his hands at the elbow on application of painful stimulus. What is his Glasgow coma score?

Your Answer:

Correct Answer: 6

Explanation:
Answer: 6

Eye Opening Response
Spontaneous–open with blinking at baseline – 4 points
Opens to verbal command, speech, or shout – 3 points
Opens to pain, not applied to face – 2 point
None – 1 point

Verbal Response
Oriented – 5 points
Confused conversation, but able to answer questions – 4 points
Inappropriate responses, words discernible – 3 points
Incomprehensible speech – 2 points
None – 1 point

Motor Response
Obeys commands for movement – 6 points
Purposeful movement to painful stimulus – 5 points
Withdraws from pain – 4 points
Abnormal (spastic) flexion, decorticate posture – 3 points
Extensor (rigid) response, decerebrate posture – 2 points
None – 1 point

He opens his eyes to pain and groans or grunts. He extends his hands at the elbow on application of painful stimulus. This gives him a Glasgow score of 6: eye opening response of 2, verbal response 2 and motor response 2.
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 164 - A 30-year-old man who is a known case of von Willebrand disease has...

Incorrect

A 30-year-old man who is a known case of von Willebrand disease has started bleeding following the excision of a sebaceous cyst.Administration of which of the following agents is most likely to be beneficial?

Your Answer:

Correct Answer: Desmopressin

Explanation:
Desmopressin is useful in managing mild to moderate episodes of bleeding in von Willebrand disease (vWD).

vWD is the most common hereditary coagulopathy resulting from the deficiency or abnormal function of von Willebrand factor (vWF). vWF promotes platelet adhesion to damaged endothelium and other platelets and is also involved in the transport and stabilization of factor VIII.

There are seven subtypes of vWD. Type 1 vWD (autosomal dominant) is the most common and accounts for 80% of the cases. Type 2 vWD (autosomal dominant or recessive) accounts for 15% of the cases. There is a significant spectrum of severity ranging from spontaneous bleeding and epistaxis through to troublesome excessive bleeding following minor procedures.

Bleeding time is mostly used as a diagnostic test for vWD. Treatment options include administration of tranexamic acid for minor cases undergoing minor procedures. More significant bleeding or procedures respond well to desmopressin (DDAVP). It is most effective in type 1 vWD, less effective in type 2 and contraindicated in type 2B. Individuals who cannot have desmopressin or in whom it is contraindicated usually receive factor VIII concentrates containing vWF.
This question is part of the following fields:
- Post-operative Management And Critical Care
- Principles Of Surgery-in-General
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Question 165 - A 40-year-old chef presents to the hospital with profuse bloody diarrhoea. He also...

Incorrect

A 40-year-old chef presents to the hospital with profuse bloody diarrhoea. He also complains of frequent urge to defecate and pain before and during defecation. A sigmoidoscopy is arranged which reveals necrosis and ulceration of the descending colon mucosa. What is the most likely underlying cause?

Your Answer:

Correct Answer: Infection with enteroinvasive E. coli

Explanation:
Necrosis and ulcers of the colon are a feature of infection with enteroinvasive E. coli (EIEC). It presents with a dysentery-type illness similar to shigellosis.

E. coli have different strains that cause a wide range of conditions. The four main types are:

1. Enteropathogenic E. coli—cause watery diarrhoea, vomiting, and low-grade fever

2. Enteroinvasive E. coli—cause dysentery, large bowel necrosis, and ulcers

3. Enterotoxigenic E. coli—cause traveller’s diarrhoea

4. Enterohaemorrhagic E. coli 0157:H7—cause haemorrhagic colitis, haemolytic uremic syndrome, and thrombotic thrombocytopenic purpura
This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 166 - Different portions of the renal tubule have varying degrees of water permeability. Which...

Incorrect

Different portions of the renal tubule have varying degrees of water permeability. Which of the following renal sites is characterised by low water permeability under normal circumstances?

Your Answer:

Correct Answer: Thick ascending limb of the loop of Henlé

Explanation:
Within the nephron of the kidney, the ascending limb of the loop of Henle is a segment of the loop of Henle downstream of the descending limb, after the sharp bend of the loop. Both the thin and the thick ascending limbs of the loop of Henlé have very low permeability to water. Since there are no regulatory mechanisms to alter its permeability, it remains poorly permeable to water under all circumstances. Sodium and chloride are transported out of the luminal fluid into the surrounding interstitial spaces, where they are reabsorbed. Water must remain behind because it is not reabsorbed, so the solute concentration becomes less and less (the luminal fluid becomes more dilute). This is one of the principal mechanisms (along with diminution of ADH secretion) for the production of a dilute, hypo-osmotic urine (water diuresis).
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 167 - The muscle that stabilizes the stapes is innervated by which of the following...

Incorrect

The muscle that stabilizes the stapes is innervated by which of the following nerves?

Your Answer:

Correct Answer: Facial nerve

Explanation:
The stapedius is the smallest skeletal muscle in the human body. At just over one millimetre in length, its purpose is to stabilize the smallest bone in the body, the stapes and is innervated by a branch of the facial nerve.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 168 - Which of these structures does NOT pass posterior to the medial malleolus? ...

Incorrect

Which of these structures does NOT pass posterior to the medial malleolus?

Your Answer:

Correct Answer: Saphenous vein

Explanation:
The saphenous vein passes anterior to the medial malleolus. The structures passing posterior, from nearest to furthest include: tibial, posterior tendon, flexor digitorum longus tendon, posterior tibial artery, posterior tibial vein, posterior tibial nerve and the flexor hallucis longus tendon.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 169 - A 43 year old construction worker is rushed to the A&E department after...

Incorrect

A 43 year old construction worker is rushed to the A&E department after complaining of chest pain after an episode of severe vomiting. He was found to be in shock. What would be his diagnosis?

Your Answer:

Correct Answer: Boerhaave’s syndrome

Explanation:
Boerhaave syndrome refers to an oesophageal rupture secondary to forceful vomiting and retching. They are often associated with the clinical triad (Mackler’s triad) of vomiting, chest pain and subcutaneous emphysema. Other symptoms include epigastric pain, back pain, dyspnoea and shock. This condition was universally fatal before the age of surgery.

Ideal management for Boerhaave syndrome involves a combination of both conservative and surgical interventions.

Mainstays of therapy include the following:
– Intravenous volume resuscitation
– Administration of broad-spectrum antibiotics
– Prompt endoscopic and/or surgical intervention
This question is part of the following fields:
- Generic Surgical Topics
- Upper Gastrointestinal Surgery
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Question 170 - A teenager presents with pain and swelling in a limb which increases after...

Incorrect

A teenager presents with pain and swelling in a limb which increases after activity. X-rays reveal an expansible, eccentric, lytic lesion in the metaphysis distally in the affected bone surrounded by new bone. What is the most likely diagnosis?

Your Answer:

Correct Answer: Aneurysmal bone cyst

Explanation:
Aneurysmal bone cysts tend to develop in patients younger than 20 years old. They usually occur in the metaphyseal region of long bones, and are cystic lesions composed of numerous blood filled channels that grow slowly. In X-rays, they show up as circumscribed lesions, sometimes surrounded by new bone.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 171 - A 39 year old female presents with a 4 day history of a...

Incorrect

A 39 year old female presents with a 4 day history of a painful purple lesion on her ring finger. A tender red/purple lesion is seen on her ring finger on examination and medical history states that she has systemic lupus erythematosus (SLE). Which of the following would be her diagnosis?

Your Answer:

Correct Answer: Oslers nodes

Explanation:
Osler nodes are small, usually raised, purplish red lesions, which are always tender, appear suddenly, and last 4 to 5 days. Painful fingers may be the earliest complaint or the chief complaint as with this patient. The nodes can appear on the dorsa of the feet and elsewhere. Osler nodes sometimes also accompany bacteraemia without endocarditis as well as septic endarteritis, typhoid fever, gonococcemia, systemic lupus erythematosus, and nonbacterial thrombotic endocarditis.
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 172 - After a total colectomy and ileotomy, a 50-year old diabetic man who was...

Incorrect

After a total colectomy and ileotomy, a 50-year old diabetic man who was a known case of diabetic nephropathy had persistent metabolic acidosis. The patient appeared well perfused, with normal vital signs and normal fluid balance. Investigations revealed:Sodium = 132 mmol/l, Potassium = 6.6 mmol/l, Creatinine = 185 μmol/l (2.16 mg/dl), Chloride = 109 μmol/l, 8am cortisol = 500 nmol/l (18 μg/dl), pH = 7.29, p(CO2) = 27 mmHg, p(O2) = 107 mmHg, standard bicarbonate = 12 mmol/l. What is the likely causes of his acidosis?

Your Answer:

Correct Answer: Renal tubular acidosis

Explanation:
Acidosis here is due to low bicarbonate. The low p(CO2) is seen in compensation. The anion gap is normal, ruling out intra-abdominal ischaemia (which leads to metabolic acidosis). If it was a gastrointestinal aetiology, low potassium would be seen. The history of diabetic nephropathy predisposes to renal tubular acidosis. Type 4 (hyporeninaemic hypoaldosteronism) is associated with high potassium and is found in diabetic and hypertensive renal disease.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 173 - Mallory bodies are characteristic of which of the following conditions? ...

Incorrect

Mallory bodies are characteristic of which of the following conditions?

Your Answer:

Correct Answer: Alcoholic hepatitis

Explanation:
Mallory bodies (or ‘alcoholic hyaline’) are inclusion bodies in the cytoplasm of liver cells, seen in patients of alcoholic hepatitis; and also in Wilson’s disease. These pathological bodies are made of intermediate keratin filament proteins that are ubiquinated or bound by proteins like heat chock protein. Being highly eosinophilic, they appear pink on haematoxylin and eosin staining.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 174 - A 50 year old man presents to the hospital with an episode of...

Incorrect

A 50 year old man presents to the hospital with an episode of alcoholic pancreatitis. He makes progress slowly but steadily. He is reviewed clinically at 7 weeks following admission. On examination, he is seen with a diffuse fullness of his upper abdomen and on imaging, a collection of fluid is found to be located behind the stomach. Tests show that his serum amylase is mildly elevated. Which of the following is the most likely explanation?

Your Answer:

Correct Answer: Pseudocyst

Explanation:
A pancreatic pseudocyst is a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue, typically located in the lesser sac of the abdomen. Pancreatic pseudocysts are usually complications of pancreatitis, although in children they frequently occur following abdominal trauma. Pancreatic pseudocysts account for approximately 75% of all pancreatic masses.
Signs and symptoms of pancreatic pseudocyst include abdominal discomfort and indigestion.

Diagnosis of Pancreatic pseudocyst can be based on cyst fluid analysis:
Carcinoembryonic antigen (CEA) and CEA-125 (low in pseudocysts and elevated in tumours);
Fluid viscosity (low in pseudocysts and elevated in tumours);
Amylase (usually high in pseudocysts and low in tumours)

The most useful imaging tools are:

-Ultrasonography – the role of ultrasonography in imaging the pancreas is limited by patient habitus, operator experience and the fact that the pancreas lies behind the stomach (and so a gas-filled stomach will obscure the pancreas).
-Computerized tomography – this is the gold standard for initial assessment and follow-up.
-Magnetic resonance cholangiopancreatography (MRCP) – to establish the relationship of the pseudocyst to the pancreatic ducts, though not routinely used.
This question is part of the following fields:
- Generic Surgical Topics
- Hepatobiliary And Pancreatic Surgery
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Question 175 - A 1 day old baby girl is born with severe respiratory compromise. She...

Incorrect

A 1 day old baby girl is born with severe respiratory compromise. She is seen to have a scaphoid abdomen and an absent apex beat. Which anomaly does this baby have?

Your Answer:

Correct Answer: Bochdalek hernia

Explanation:
Answer: Bochdalek hernia

A Bochdalek hernia is one of two forms of a congenital diaphragmatic hernia, the other form being Morgagni hernia. A Bochdalek hernia is a congenital abnormality in which an opening exists in the infant’s diaphragm, allowing normally intra-abdominal organs (particularly the stomach and intestines) to protrude into the thoracic cavity. In the majority of patients, the affected lung will be deformed, and the resulting lung compression can be life-threatening. Bochdalek hernias occur more commonly on the posterior left side (85%, versus right side 15%).

In normal Bochdalek hernia cases, the symptoms are often observable simultaneously with the baby’s birth. A few of the symptoms of a Bochdalek Hernia include difficulty breathing, fast respiration and increased heart rate. Also, if the baby appears to have cyanosis (blue-tinted skin) this can also be a sign. Another way to differentiate a healthy baby from a baby with Bochdalek Hernia, is to look at the chest immediately after birth. If the baby has a Bochdalek Hernia it may appear that one side of the chest cavity is larger than the other and or the abdomen seems to be scaphoid (caved in).

Situs inversus (also called situs transversus or oppositus) is a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions. The normal arrangement of internal organs is known as situs solitus while situs inversus is generally the mirror image of situs solitus. Although cardiac problems are more common than in the general population, most people with situs inversus have no medical symptoms or complications resulting from the condition, and until the advent of modern medicine it was usually undiagnosed. In the absence of congenital heart defects, individuals with situs inversus are homeostatically normal, and can live standard healthy lives, without any complications related to their medical condition. There is a 5–10% prevalence of congenital heart disease in individuals with situs inversus totalis, most commonly transposition of the great vessels. The incidence of congenital heart disease is 95% in situs inversus with levocardia.

Cystic fibrosis is a progressive, genetic disease that causes persistent lung infections and limits the ability to breathe over time. In people with CF, mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene cause the CFTR protein to become dysfunctional. When the protein is not working correctly, it’s unable to help move chloride — a component of salt — to the cell surface. Without the chloride to attract water to the cell surface, the mucus in various organs becomes thick and sticky. In the lungs, the mucus clogs the airways and traps germs, like bacteria, leading to infections, inflammation, respiratory failure, and other complications.

Necrotizing enterocolitis (NEC) is a medical condition where a portion of the bowel dies. It typically occurs in new-borns that are either premature or otherwise unwell. Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, or vomiting of bile.
The exact cause is unclear. Risk factors include congenital heart disease, birth asphyxia, exchange transfusion, and premature rupture of membranes. The underlying mechanism is believed to involve a combination of poor blood flow and infection of the intestines. Diagnosis is based on symptoms and confirmed with medical imaging.

Morgagni hernias are one of the congenital diaphragmatic hernias (CDH), and is characterized by herniation through the foramen of Morgagni. When compared to Bochdalek hernias, Morgagni hernias are:
-anterior
-more often right-sided (,90%)
-small
-rare (,2% of CDH)
-at low risk of prolapse

Only ,30% of patients are symptomatic. New-borns may present with respiratory distress at birth similar to a Bochdalek hernia. Additionally, recurrent chest infections and gastrointestinal symptoms have been reported in those with previously undiagnosed Morgagni hernia.
The image of the transverse colon is herniated into the thoracic cavity, through a mid line defect and this indicates that it is a Morgagni hernia since the foramen of a Morgagni hernia occurs in the anterior midline through the sternocostal hiatus of the diaphragm, with 90% of cases occurring on the right side.

Clinical manifestations of congenital diaphragmatic hernia (CDH) include the following:

Early diagnosis – Right-side heart; decreased breath sounds on the affected side; scaphoid abdomen; bowel sounds in the thorax, respiratory distress, and/or cyanosis on auscultation; CDH can often be diagnosed in utero with ultrasonography (US), magnetic resonance imaging (MRI), or both
Late diagnosis – Chest mass on chest radiography, gastric volvulus, splenic volvulus, or large-bowel obstruction
Congenital hernias (neonatal onset) – Respiratory distress and/or cyanosis occurs within the first 24 hours of life; CDH may not be diagnosed for several years if the defect is small enough that it does not cause significant pulmonary dysfunction
Congenital hernias (childhood or adult onset) – Obstructive symptoms from protrusion of the colon, chest pain, tightness or fullness the in chest, sepsis following strangulation or perforation, and many respiratory symptoms occur.
This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 176 - A 66 year old retired judge has recently undergone a wide local excision...

Incorrect

A 66 year old retired judge has recently undergone a wide local excision and sentinel lymph node biopsy for breast cancer. Which of the factors listed below will provide the most important prognostic information?

Your Answer:

Correct Answer: Nodal status

Explanation:
Even in the era of gene-expression profiling, the nodal status still remains the primary prognostic discriminant in breast cancer patients. The exclusion of node involvement using non-invasive methods could reduce the rate of axillary surgery, thereby preventing from suffering complications.

Lymph node status is highly related to prognosis (chances for survival).
This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 177 - A 25 year old women is pregnant with her second child. She is...

Incorrect

A 25 year old women is pregnant with her second child. She is A- blood group. Her first child was Rh+ and the father is also Rh+. The second child is at a risk of developing which condition?

Your Answer:

Correct Answer: Haemolytic disease of the new-born

Explanation:
This infant is at risk for haemolytic disease of the new born also known as erythroblastosis fetalis. In the pregnancy, Rh-positive RBC’s cross the placenta and enter the mothers blood system. She then becomes sensitised and forms IgG antibodies/anti-Rh antibodies against them. The second child is at a greater risk for this disease than the first child with Rh-positive blood group as during the second pregnancy, a more powerful response is produced. IgG has the ability to cross the placenta and bind to the fetal RBCs (type II hypersensitivity reaction) which are phagocytosed by the macrophages.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 178 - A young girl injured her arm following a fall down the steps On...

Incorrect

A young girl injured her arm following a fall down the steps On examination, it was found that her left proximal radioulnar joint had dislocated and the annular ligament was stretched. This will make which movement extremely painful?

Your Answer:

Correct Answer: Supination

Explanation:
Supination is the rotation of the forearm so that the palm of the hand faces anteriorly. This is performed by the biceps brachii and supinator of the extensor muscles of the thumb. The opposite action of moving the palm from an anterior-facing position to a posterior-facing position is called pronation. Pronation is performed by the pronator teres and pronator quadratus.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 179 - A football player sustained an injury to his ankle. The wound went through...

Incorrect

A football player sustained an injury to his ankle. The wound went through the skin, subcutaneous tissue and flexor retinaculum. Which other structure passing under the retinaculum may be injured?

Your Answer:

Correct Answer: Tibial nerve

Explanation:
The flexor retinaculum is immediately posterior to the medial malleolus. The structures that pass under the flexor retinaculum from anterior to posterior are: tendon of the tibialis posterior, flexor digitorum longus, posterior tibial artery (and vein), tibial nerve and tendon of flexor hallucis longus. The tibial nerve is the only one which lies behind the flexor retinaculum.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 180 - A 38 year-old man falls on an outstretched hand. X-rays indicate an anterior...

Incorrect

A 38 year-old man falls on an outstretched hand. X-rays indicate an anterior dislocation of one of the carpal bones. Which carpal bone is most commonly dislocated?

Your Answer:

Correct Answer: Lunate

Explanation:
The scaphoid bone is the most commonly fractured carpal bone and has an increased risk of avascular necrosis.
The lunate is the most commonly dislocated carpal bone. The displaced bone may compress the median nerve in the carpal tunnel.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 181 - A 66 year old male, was involved in a MVA. He sustained third...

Incorrect

A 66 year old male, was involved in a MVA. He sustained third degree burns to his abdomen and open bleeding wound to his left leg. The patient complains of dizziness. He is a known hypertensive but during examination was found to be hypotensive. His heart rate is 120/min, with regular rhythm. What is the possible cause of his hypotension?

Your Answer:

Correct Answer: Hypovolaemia

Explanation:
Hypovolemia can be recognized by tachycardia, diminished blood pressure, and the absence of perfusion as assessed by skin signs (skin turning pale) and/or capillary refill time. The patient may feel dizzy, faint, nauseated, or very thirsty. Common causes of hypovolemia are loss of blood, loss of plasma which occurs in severe burns and lesions discharging fluid, loss of body sodium and consequent intravascular water which may occur in cases of diarrhoea and vomiting. In this case the cause of patients hypotension is due to hypovolemia from both loss of plasma and blood.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 182 - An 18 -year-old female is diagnosed with folliculitis in the left axilla. What...

Incorrect

An 18 -year-old female is diagnosed with folliculitis in the left axilla. What is the most likely organism that could cause this condition?

Your Answer:

Correct Answer: Staphylococcus aureus

Explanation:
Folliculitis is the inflammation of the hair follicles. It is usually caused by Staphylococcus infection.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 183 - Which of the following structure contains the parasympathetic pre-ganglionic nucleus that innervates the...

Incorrect

Which of the following structure contains the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle?

Your Answer:

Correct Answer: Edinger–Westphal nucleus

Explanation:
The Edinger–Westphal nucleus (accessory oculomotor nucleus) is the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 184 - A 39-year-old man is admitted with a tender mass in the right groin,...

Incorrect

A 39-year-old man is admitted with a tender mass in the right groin, fever, and sweating. He is on multi-drug therapy for HIV infection. On examination, a tender swelling is noted in his right groin. The pain is exacerbated by hip extension. What is the most likely diagnosis?

Your Answer:

Correct Answer: Psoas abscess

Explanation:
The patient has a primary psoas abscess.

Psoas (or iliopsoas) abscess is a collection of pus in the iliopsoas muscle compartment. It may arise via contiguous spread from adjacent structures or by the haematogenous route from a distant site. Psoas abscesses may be either primary or secondary. Primary cases often develop in the immunosuppressed and may occur as a result of haematogenous spread. Secondary cases may occur as a complication of intra-abdominal diseases such as Crohn’s disease.

Patients usually present with lower back pain and if the abscess is extensive, a mass that may be localised to the inguinal region or femoral triangle. In most cases, the diagnosis can be made clinically. Where it is not clear, an ultrasound scan is often the most convenient investigation.

Smaller collections may be percutaneously drained. If the collection is larger, or the percutaneous route fails, then surgery (via a retroperitoneal approach) should be performed.
This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 185 - Which cells are most commonly seen in a granulomatous lesion that suggests an...

Incorrect

Which cells are most commonly seen in a granulomatous lesion that suggests an underlying chronic inflammation?

Your Answer:

Correct Answer: Lymphocytes

Explanation:
Lymphocytes and monocytes are commonly and characteristically recognised in a case of chronic inflammation.
Eosinophils and neutrophils are seen with acute inflammation.
Mast cells release histamine in early inflammation.
Basophils are seen with allergies.
Plasma cells are seen with viral infection.
Platelets are not characteristic of any type of inflammation.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 186 - A 35 year-old man presents with high grade fever for 7 days after...

Incorrect

A 35 year-old man presents with high grade fever for 7 days after returning from a trip to India. He tested positive for widal test. What is the most likely organism that caused his fever?

Your Answer:

Correct Answer: Salmonella typhi

Explanation:
Typhoid fever is caused by virulent bacteria called Salmonella typhi. Salmonella typhi spread through contaminated food or water and occasionally through direct contact with someone who is infected.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 187 - An 8 year old boy presents with bleeding from the nose. From which...

Incorrect

An 8 year old boy presents with bleeding from the nose. From which area did the bleeding most likely originate?

Your Answer:

Correct Answer: Kiesselbach's plexus

Explanation:
Answer: Kiesselbach’s plexus

Epistaxis is defined as acute haemorrhage from the nostril, nasal cavity, or nasopharynx. The source of 90% of anterior nosebleeds within the Kiesselbach’s plexus (also known as Little’s area) on the anterior nasal septum.

Kiesselbach’s plexus (Kiesselbach’s area or Little’s area) is a vascular region of the anteroinferior nasal septum that comprises four arterial anastomoses:
1)anterior ethmoidal artery – a branch of the ophthalmic artery
2)sphenopalatine artery
This question is part of the following fields:
- Generic Surgical Topics
- Head And Neck Surgery
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Question 188 - Which muscle is responsible for directing the gaze downward when the eye is...

Incorrect

Which muscle is responsible for directing the gaze downward when the eye is abducted?

Your Answer:

Correct Answer: Inferior rectus muscle

Explanation:
The inferior rectus muscle is a muscle in the orbit. As with most of the muscles of the orbit, it is innervated by the inferior division of oculomotor nerve (Cranial Nerve III). It depresses, adducts, and helps laterally rotate the eye.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 189 - Loperamide is a drug used to treat diarrhoea. What is the mechanism of...

Incorrect

Loperamide is a drug used to treat diarrhoea. What is the mechanism of action of loperamide?

Your Answer:

Correct Answer: Opiate agonist

Explanation:
Loperamide is an opioid-receptor agonist and acts on the mu opioid receptors in the myenteric plexus of large intestine. It works by decreasing the motility of the circular and longitudinal smooth muscles of the intestinal wall. It is often used for this purpose in gastroenteritis, inflammatory bowel disease, and short bowel syndrome.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 190 - Endometrial hyperplasia is most likely to be associated with which of the following...

Incorrect

Endometrial hyperplasia is most likely to be associated with which of the following conditions?

Your Answer:

Correct Answer: Fibrothecoma

Explanation:
A benign tumour arising from the ovarian stroma, fibrothecoma are bilateral in 10% cases. The thecoma component of the tumour can produce oestrogen leading to endometrial hyperplasia. The thecoma is rich in lipid content and is responsible for the yellowish appearance of the tumour. Meig’s syndrome is the presence of fibrothecoma with a right-sided hydrothorax.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 191 - A 36 year old man with severe treatment refractory ulcerative colitis arrives at...

Incorrect

A 36 year old man with severe treatment refractory ulcerative colitis arrives at the clinic in a state of hypotension and tachycardia with peritonitis. Which of the following is the most appropriate treatment strategy for this patient?

Your Answer:

Correct Answer: Emergency subtotal colectomy and ileostomy

Explanation:
Subtotal colectomy with ileostomy remains a safe and effective treatment for patients requiring urgent surgery for severe inflammatory bowel disease. As the patient is not hemodynamically stable, any anastomosis like ileorectal or ileoanal should not be done. The patient should be fully resuscitated and given antibiotics and thromboprophylaxis preoperatively.
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 192 - A 40-year old lady with a flail chest due to trauma was breathing...

Incorrect

A 40-year old lady with a flail chest due to trauma was breathing with the help of a mechanical ventilator in the ICU, and was heavily sedated on muscle relaxants. Due to sudden power failure, a nurse began to hand-ventilate the patient with a Ambu bag. What change will occur in the following parameters in the intervening period between power failure and hand ventilation? Arterial p(CO2), pH

Your Answer:

Correct Answer: Increase, Decrease

Explanation:
Respiratory acidosis occurs due to alveolar hypoventilation which leads to increased arterial carbon dioxide concentration (p(CO2)). This in turn decreases the HCO3 –/p(CO2) and decreases pH. Respiratory acidosis can be acute or chronic. In acute respiratory acidosis, the p(CO2) is raised above the upper limit of normal (over 45 mm Hg) with low pH. However, in chronic cases, the raised p(CO2) is accompanied with a normal or near-normal pH due to renal compensation and an increased serum bicarbonate (HCO3 – > 30 mmHg). The given problem represents acute respiratory acidosis and thus, will show a increase in arterial p(CO2) and decrease in pH.
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 193 - A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for...

Incorrect

A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for the last 5 days. A CT scan reveals an oedematous mass with ring enhancement in the left temporal region. It is biopsied, revealing glial cells, necrosis, neutrophils and lymphocytes. What is the most likely diagnosis?

Your Answer:

Correct Answer: Cerebral abscess

Explanation:
A cerebral abscess can result from direct extension of cranial infections, penetrating head trauma, haematogenous spread, or for unknown causes. An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts. Oedema around the abscess can increase the intracranial pressure. Symptoms result from increased intracranial pressure and mass effects. It is most frequent in the third decade of life, and when it occurs in children, it is usually associated with congenital heart disease.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 194 - A histological examination of a lump showed an abnormal amount and arrangement of...

Incorrect

A histological examination of a lump showed an abnormal amount and arrangement of normal tissue in an otherwise normal area. This condition is known as?

Your Answer:

Correct Answer: Hamartoma

Explanation:
A hamartoma is a condition best described as tissue normally present in an area arranged haphazardly in an disorganized, abnormal fashion. They are never malignant and do not metastasis.
All the neoplastic, cancerous lesions comprise of a mixture of different cells that are not normal to that area.
Metaplasia is a change in the type of the epithelium.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 195 - A 68 year old man who is scheduled for an amputation suddenly presents...

Incorrect

A 68 year old man who is scheduled for an amputation suddenly presents to the physician with episodes of vertigo and dysarthria. After a while he collapses and his GCS is recorded to be 3. Which of the following is the most likely diagnosis of this presentation?

Your Answer:

Correct Answer: Basilar artery occlusion

Explanation:
The clinical presentation of basilar artery occlusion (BAO) ranges from mild transient symptoms to devastating strokes with high fatality and morbidity. Often, non-specific prodromal symptoms such as vertigo or headaches are indicative of BAO, and are followed by the hallmarks of BAO, including decreased consciousness, quadriparesis, pupillary and oculomotor abnormalities, dysarthria, and dysphagia. When clinical findings suggest an acute brainstem disorder, BAO has to be confirmed or ruled out as a matter of urgency. If BAO is recognised early and confirmed with multimodal CT or MRI, intravenous thrombolysis or endovascular treatment can be undertaken. The goal of thrombolysis is to restore blood flow in the occluded artery and salvage brain tissue; however, the best treatment approach to improve clinical outcome still needs to be ascertained.
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 196 - A premenopausal woman has an ovarian tumour. Which is the most common benign...

Incorrect

A premenopausal woman has an ovarian tumour. Which is the most common benign germ-cell tumour that could occur in a premenopausal woman?

Your Answer:

Correct Answer: Dermoid cyst

Explanation:
A dermoid cyst is a teratoma of a cystic nature that contains an array of developmentally mature and solid tissues. Dermoid cysts grow slowly and this type of cystic teratoma is nearly always benign.
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 197 - What best describes the muscles of the posterior compartment of the leg? ...

Incorrect

What best describes the muscles of the posterior compartment of the leg?

Your Answer:

Correct Answer: One of the posterior compartment leg muscles laterally rotates the femur

Explanation:
The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris and are the chief extensors of the foot at the ankle joint. Deep muscles include the tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 198 - A 26-year-old male falls and hits his head against a wall. There is...

Incorrect

A 26-year-old male falls and hits his head against a wall. There is a brief loss of consciousness. When assessed in accident and emergency he is alert and orientated with a GCS of 15. Imaging shows no fracture of the skull. What is his risk of having an intracranial haematoma that requires removal?

Your Answer:

Correct Answer: 1 in 6000

Explanation:
Risk of haematoma (requiring removal) in adults attending accident and emergency units following head injury.

Risk Factor Risk of haematoma
Oriented, no skull fracture 1 in 5983
Not oriented, no skull fracture 1 in 121
Skull fracture, Orientated 1 in 32
Skull fracture, Not orientated 1 in 4
This question is part of the following fields:
- Generic Surgical Topics
- Surgical Disorders Of The Brain
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Question 199 - A mechanic sustained a deep laceration to his right cubital fossa which resulted...

Incorrect

A mechanic sustained a deep laceration to his right cubital fossa which resulted in him unable to move the proximal radioulnar joint of his right arm. Which muscles was affected?

Your Answer:

Correct Answer: Pronator teres

Explanation:
The correct answer is the pronator teres muscle. This muscle arises from 2 heads of origin: the humerus and ulnar. Between the 2 heads is the site of entrance of median nerve to the forearm. This muscle acts on the proximal radio-ulnar joint to rotate the radius on the ulna, otherwise known as pronation. It also assists in forearm flexion if the radius is fixed.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 200 - A young man in a motor vehicle accident sustained a spinal injury at...

Incorrect

A young man in a motor vehicle accident sustained a spinal injury at C8 level. What would likely be seen in this patient?

Your Answer:

Correct Answer: The hypothenar muscles would be completely paralysed

Explanation:
The eighth cervical nerve is one of the contributors of the ulnar nerve. The ulnar nerve supplies the hypothenar muscles which include the opponens digiti minimi, abductor digiti minimi, flexor digiti minimi brevis, and palmaris brevis.
This question is part of the following fields:
- Anatomy
- Basic Sciences
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