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  • Question 1 - Driving pressure is considered to be a strong predictor of mortality in patients...

    Incorrect

    • Driving pressure is considered to be a strong predictor of mortality in patients with ARDS. What is the normal mean intravascular driving pressure for the respiratory circulation?

      Your Answer: 30 mmHg

      Correct Answer: 10 mmHg

      Explanation:

      Driving pressure is the difference between inflow and outflow pressure. For the pulmonary circulation, this is the difference between pulmonary arterial (pa) and left atrial pressure (pLA). Normally, mean driving pressure is about 10 mmHg, computed by subtracting pLA (5 mmHg) from pA (15 mmHg). This is in contrast to a mean driving pressure of nearly 100 mmHg in the systemic circulation.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      151.9
      Seconds

  • Question 2 - A 20-year old cyclist falls off a speeding bike and fractures a structure...

    Incorrect

    • A 20-year old cyclist falls off a speeding bike and fractures a structure that articulates with the tubercle of the 7th rib. Which structure is fractured?

      Your Answer: Transverse process of vertebra T6

      Correct Answer: Transverse process of vertebra T7

      Explanation:

      A rib tubercle is a projection that is postero-inferior and lateral to the neck of a rib which articulates with the transverse process of the corresponding vertebra i.e. of the same number. Therefore, the tubercle of rib 7 articulates with the transverse process of T7 vertebra. The head of the rib 7, on the other hand, articulates with the 6th vertebra superiorly and the 7th vertebra inferiorly.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      37.8
      Seconds

  • Question 3 - A 4-month-old boy is brought to the clinic by his mother who has...

    Incorrect

    • A 4-month-old boy is brought to the clinic by his mother who has noticed a swelling in the right hemiscrotum. On examination, there is a firm mass affecting the right spermatic cord distally, the testis is felt separately from it. What is the most likely diagnosis?

      Your Answer: Leydig cell tumour

      Correct Answer: Rhabdomyosarcoma

      Explanation:

      Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children.
      Rhabdomyosarcoma usually manifests as an expanding mass. Tumours in superficial locations may be palpable and detected relatively early, but those in deep locations (e.g., retroperitoneum) may grow large before causing symptoms.
      Symptoms depend on the location of the tumour, and pain may be present. Typical presentations of nonmetastatic disease, by location, are as follows:
      Orbit: Proptosis or dysconjugate gaze
      Paratesticular: Painless scrotal mass, testes are felt separately
      Prostate: Bladder or bowel difficulties
      Uterus, cervix, bladder: Menorrhagia or metrorrhagia
      Vagina: Protruding polypoid mass (botryoid, meaning a grapelike cluster)
      Extremity: Painless mass
      Parameningeal (ear, mastoid, nasal cavity, paranasal sinuses, infratemporal fossa, pterygopalatine fossa): Upper respiratory symptoms or pain

      In the international classification of rhabdomyosarcoma, there are 5 recognized variants: embryonal, alveolar, botryoid embryonal, spindle cell embryonal and anaplastic. The most common variant is embryonal, most associated with tumours of the genitourinary tract and the head and neck. Histologically, the embryonal subtype resembles that of a 6- to an 8-week old embryo.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
      48.3
      Seconds

  • Question 4 - A football player sustained an injury to his ankle. The wound went through...

    Correct

    • 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: 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
      20.5
      Seconds

  • Question 5 - Which of the following will increase blood pressure and cause hypokalaemia? ...

    Correct

    • Which of the following will increase blood pressure and cause hypokalaemia?

      Your Answer: Angiotensin II

      Explanation:

      Angiotensin is a peptide that is released in response to a decrease in blood volume and blood pressure. It has multiple functions but mainly acts to cause vasoconstriction, increase BP and release aldosterone from the adrenal cortex. It is a powerful vasoconstrictor and release of aldosterone causes increased retention of sodium and excretion of potassium.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      17.2
      Seconds

  • Question 6 - 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: Formation of vesicles or bullae

      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
      23.4
      Seconds

  • Question 7 - Which is a feature of the action of insulin? ...

    Incorrect

    • Which is a feature of the action of insulin?

      Your Answer: Promotes phosphate release from bone

      Correct Answer: Promotes protein synthesis

      Explanation:

      Insulin is produced by the beta-cells of the islets of Langerhans in the pancreas. Its actions include:
      – promoting uptake of glucose into cells
      – glycogen synthesis (glycogenesis)
      – protein synthesis
      – stimulation of lipogenesis (fat formation).
      – driving potassium into cells – used to treat hyperkaelamia.
      Parathyroid hormone and activated vitamin D are the principal hormones involved in calcium/phosphate metabolism, rather than insulin.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      74.8
      Seconds

  • Question 8 - A 32 year old man is suffering from recurrent bouts of severe pain...

    Incorrect

    • A 32 year old man is suffering from recurrent bouts of severe pain that is localized to the anus. The pain lasts momentarily for a few seconds and completely resolves between attacks. Which of the following would be the most suitable approach to this patient's management?

      Your Answer: Topical glyceryl trinitrate 0.2%

      Correct Answer: Reassurance

      Explanation:

      Proctalgia fugax (PF) is a benign painful rectal condition that is defined as intermittent, recurring, and self-limiting pain in the anorectal region in the absence of organic pathology. The pain of proctalgia fugax is sharp or gripping and severe. Similar to other urogenital focal pain syndromes, such as vulvodynia and proctodynia, the causes remain obscure. Stress and sitting for prolonged periods often increase the frequency and intensity of attacks of proctalgia fugax. Patients often feel an urge to defecate with the onset of the paroxysms of pain . Depression often accompanies the pain of proctalgia fugax but is not thought to be the primary cause. The symptoms of proctalgia fugax can be so severe as to limit the patient’s ability to perform activities of daily living. Reassurance has proven to help in many cases as the condition has been linked to stress.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
      20
      Seconds

  • Question 9 - A 27 year-old male patient was admitted to the hospital due to recurrent...

    Correct

    • A 27 year-old male patient was admitted to the hospital due to recurrent fever for the past 2 weeks. The patient claimed that he is an intravenous drug user. Following work up, the patient was diagnosed with infective endocarditis. Which is the most likely organism responsible for this diagnosis?

      Your Answer: Staphylococcus aureus

      Explanation:

      Acute bacterial endocarditis is a fulminant illness lasting over days to weeks (<2weeks). It is most likely due to Staphylococcus aureus especially in intravenous drug abusers.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      9.9
      Seconds

  • Question 10 - A 46 year old policeman was admitted with peritonitis secondary to a perforated...

    Incorrect

    • A 46 year old policeman was admitted with peritonitis secondary to a perforated appendix. A laparoscopic appendicectomy was done but he had a stormy post operative course. He has now started to develop increasing abdominal pain and has been vomiting. A laparotomy is performed and at operation a large amount of small bowel shows evidence of patchy areas of infarction. Which of the following is the most likely cause?

      Your Answer: Acute on chronic mesenteric ischaemia

      Correct Answer: Mesenteric venous thrombosis

      Explanation:

      Mesenteric venous thrombosis (MVT) is a blood clot in one or more of the major veins that drain blood from the intestine. The superior mesenteric vein is most commonly involved. The exact cause of MVT is unknown. However, there are many diseases that can lead to MVT. Many of the diseases cause swelling (inflammation) of the tissues surrounding the veins, and include:
      Appendicitis
      Cancer of the abdomen
      Diverticulitis
      Liver disease with cirrhosis
      High blood pressure in the blood vessels of the liver
      Abdominal surgery or trauma
      Pancreatitis
      Inflammatory bowel disorders
      Heart failure
      Protein C or S deficiencies
      Polycythaemia vera
      Essential thrombocythemia
      People who have disorders that make the blood more likely to stick together (clot) have a higher risk for MVT. Birth control pills and oestrogen medicines also increase risk.

      MVT is more common in men than women. It mainly affects middle aged or older adults. Symptoms may include any of the following:
      Abdominal pain, which may get worse after eating and over time; Bloating; Constipation; Bloody diarrhoea; Fever; Septic shock; Lower gastrointestinal bleeding; Vomiting and nausea.
      Blood thinners (most commonly heparin or related medicines) are used to treat MVT when there is no associated bleeding. In some cases, medicine can be delivered directly into the clot to dissolve it. This procedure is called thrombolysis. Less often, the clot is removed by thrombectomy.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Vascular
      69.8
      Seconds

  • Question 11 - A patient in the intensive care unit developed hyperphosphatemia. The phosphate level is...

    Incorrect

    • A patient in the intensive care unit developed hyperphosphatemia. The phosphate level is 160 mmol/L. Which of the following is most likely responsible for this abnormality?

      Your Answer:

      Correct Answer: Renal insufficiency

      Explanation:

      Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood. It is caused by conditions that impair renal phosphate excretion (ex: renal insufficiency, hypoparathyroidism, parathyroid suppression) and conditions with massive extracellular fluid phosphate loads (ex: rapid administration of exogenous phosphate, extensive cellular injury or necrosis, transcellular phosphate shifts).

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 12 - 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
      Seconds

  • Question 13 - A 62 year old retired teacher is diagnosed as having a malignant lesion...

    Incorrect

    • A 62 year old retired teacher is diagnosed as having a malignant lesion in the inferior aspect of her left breast. On examination, there is palpable axillary lymphadenopathy. Which of the following is the best course of action?

      Your Answer:

      Correct Answer: Image guided fine needle aspiration of the axillary nodes

      Explanation:

      Fine-needle aspiration (FNA) cytology of axillary lymph nodes is a simple, minimally invasive technique that can be used to improve preoperative determination of the status of the axillary lymph nodes in patients with breast cancer, thereby serving as a tool with which to triage patients for sentinel versus full lymph node dissection procedures. FNA of axillary lymph nodes is a sensitive and very specific method with which to detect metastasis in breast cancer patients. Because of its excellent positive predictive value, full axillary lymph node dissection can be planned safely instead of a sentinel lymph node dissection when a preoperative positive FNA result is rendered.

    • This question is part of the following fields:

      • Breast And Endocrine Surgery
      • Generic Surgical Topics
      0
      Seconds

  • Question 14 - A 46-year-old male complains of sharp chest pain. He is due to have...

    Incorrect

    • A 46-year-old male complains of sharp chest pain. He is due to have elective surgery to replace his left hip. He has been bed-bound for 3 months. He suddenly collapses; his blood pressure is 70/40mmHg, heart rate 120 bpm and his saturations are 74% on air. He is deteriorating in front of you. What is the next best management plan?

      Your Answer:

      Correct Answer: Thrombolysis with Alteplase

      Explanation:

      The patient has Pulmonary embolism (PE).
      PE is when a thrombus becomes lodged in an artery in the lung and blocks blood flow to the lung. Pulmonary embolism usually arises from a thrombus that originates in the deep venous system of the lower extremities; however, it rarely also originates in the pelvis, renal, upper extremity veins, or the right heart chambers. After travelling to the lung, large thrombi can lodge at the bifurcation of the main pulmonary artery or the lobar branches and cause hemodynamic compromise.
      The classic presentation of PE is the abrupt onset of pleuritic chest pain, shortness of breath, and hypoxia. However, most patients with pulmonary embolism have no obvious symptoms at presentation. Rather, symptoms may vary from sudden catastrophic hemodynamic collapse to gradually progressive dyspnoea.
      Physical signs of pulmonary embolism include the following:
      Tachypnoea (respiratory rate >16/min): 96%
      Rales: 58%
      Accentuated second heart sound: 53%
      Tachycardia (heart rate >100/min): 44%
      Fever (temperature >37.8°C [100.04°F]): 43%
      Diaphoresis: 36%
      S3 or S4 gallop: 34%
      Clinical signs and symptoms suggesting thrombophlebitis: 32%
      Lower extremity oedema: 24%
      Cardiac murmur: 23%
      Cyanosis: 19%
      Management
      Anticoagulation and thrombolysis
      Immediate full anticoagulation is mandatory for all patients suspected of having DVT or PE. Diagnostic investigations should not delay empirical anticoagulant therapy.
      Thrombolytic therapy should be used in patients with acute pulmonary embolism who have hypotension (systolic blood pressure< 90 mm Hg) who do not have a high bleeding risk and in selected patients with acute pulmonary embolism not associated with hypotension who have a low bleeding risk and whose initial clinical presentation or clinical course suggests a high risk of developing hypotension.
      Long-term anticoagulation is critical to the prevention of recurrence of DVT or pulmonary embolism because even in patients who are fully anticoagulated, DVT and pulmonary embolism can and often do recur.
      Thrombolytic agents used in managing pulmonary embolism include the following:
      – Alteplase
      – Reteplase

      Heparin should be given to patients with intermediate or high clinical probability before imaging.
      Unfractionated heparin (UFH) should be considered (a) as a first dose bolus, (b) in massive PE, or (c) where rapid reversal of effect may be needed.
      Otherwise, low molecular weight heparin (LMWH) should be considered as preferable to UFH, having equal efficacy and safety and being easier to use.
      Oral anticoagulation should only be commenced once venous thromboembolism (VTE) has been reliably confirmed.
      The target INR should be 2.0–3.0; when this is achieved, heparin can be discontinued.
      The standard duration of oral anticoagulation is: 4–6 weeks for temporary risk factors, 3 months for first idiopathic, and at least 6 months for other; the risk of bleeding should be balanced with that of further VTE.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      0
      Seconds

  • Question 15 - Which lymph nodes are likely to be enlarged in a patient who has...

    Incorrect

    • Which lymph nodes are likely to be enlarged in a patient who has malignant growth involving the anus?

      Your Answer:

      Correct Answer: Superficial inguinal

      Explanation:

      The lymphatics from the anus, skin of the perineum and the scrotum end in the superficial inguinal nodes. In case of a malignant growth of the anus, the superficial inguinal lymph nodes would most likely be enlarge.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 16 - In a study, breast lumps were analysed to determine the characteristic of malignant...

    Incorrect

    • In a study, breast lumps were analysed to determine the characteristic of malignant neoplasm on biopsy. What microscopic findings are suggestive of malignancy?

      Your Answer:

      Correct Answer: Invasion

      Explanation:

      Invasion is suggestive of malignancy and an even better option would have been metastasis. Pleomorphism is found in both benign and malignant neoplasms along with atypia and anaplasia. A height nuclear/cytoplasmic ratio is suggestive of malignancy but not the best indicator. Malignant tumours are aggressive and growth rapidly. Necrosis can be seen in benign tumours if they deplete their blood supply.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 17 - In multiple myeloma, which of these cell types confirms the diagnosis when found...

    Incorrect

    • In multiple myeloma, which of these cell types confirms the diagnosis when found in a smear of bone marrow aspirate?

      Your Answer:

      Correct Answer: Plasma cells

      Explanation:

      A bone marrow aspiration is the diagnostic test for multiple myeloma, which is a malignant bone tumour that usually affects older adults. The smear reveals clusters of plasma cells, while X-rays tend to show circumscribed lytic lesions or diffuse demineralisation.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 18 - QT interval in the electrocardiogram of a healthy individual is normally: ...

    Incorrect

    • QT interval in the electrocardiogram of a healthy individual is normally:

      Your Answer:

      Correct Answer: 0.40 s

      Explanation:

      QT interval extends from beginning of the QRS complex till the end of he T-wave and normally lasts for 0.40 s. It is important in the diagnosis of long-QT and short-QT syndrome. The QT interval varies on the basis of heart rate and may need to be corrected.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 19 - Nephrotic syndrome is a condition that causes proteinuria, hypoalbuminemia and oedema. Which of...

    Incorrect

    • Nephrotic syndrome is a condition that causes proteinuria, hypoalbuminemia and oedema. Which of the following is the cause of the oedema in these patients?

      Your Answer:

      Correct Answer: Decreased oncotic pressure

      Explanation:

      The glomeruli of the kidneys are the parts that normally filter the blood. They consist of capillaries that are fenestrated and allow fluid, salts and other small solutes to flow through, but normally not proteins. In nephrotic syndrome, the glomeruli become damaged allowing small proteins, such as albumin to pass through the kidneys into urine. Oedema usually occurs due to salt and water retention by the diseased kidneys as well as due to the reduced colloid oncotic pressure (because of reduced albumin in the plasma). Lower serum oncotic pressure causes fluid to accumulate in the interstitial tissues.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 20 - The periphery of a haematoma is infiltrated by fibroblasts, collagen and new vasculature....

    Incorrect

    • The periphery of a haematoma is infiltrated by fibroblasts, collagen and new vasculature. This process is best described as?

      Your Answer:

      Correct Answer: Organisation of the haematoma

      Explanation:

      Formation of granulation tissue at the periphery of the hematoma is a normal process leading to resolution. This granulation tissue is composed of new capillaries, fibroblasts and collagen. Lysis of a blood clot can occur, but the actual process of this response is known as organization, wherein the scar tissue will become part of the vessels. This is followed by recanalization and embolization which can lead to eventual complications. Proliferation of a clot will occur due to an imbalance in the clotting and lysing systems. Thrombosis has nothing to do with the process described above.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Basic Sciences (3/6) 50%
Physiology (1/3) 33%
Anatomy (1/2) 50%
Generic Surgical Topics (0/3) 0%
Urology (0/1) 0%
Emergency Medicine And Management Of Trauma (0/1) 0%
Principles Of Surgery-in-General (0/1) 0%
Colorectal Surgery (0/1) 0%
Pathology (1/1) 100%
Vascular (0/1) 0%
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