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  • Question 1 - Which of the following cells would be increased in a patient suffering from...

    Incorrect

    • Which of the following cells would be increased in a patient suffering from a hydatid cyst in the liver?

      Your Answer: Lymphocytes

      Correct Answer: Eosinophils

      Explanation:

      Eosinophils are granulocytes that respond to parasitic infections. They are also involved in allergy response and asthma. They contain granules which stain red with Romanowsky’s method and contain peroxidase, Rnase, Dnase, histamine, lipase and major basic proteins that are toxic to the parasite as well as the hosts tissue. They are about 1-5% of the total WBC population and persist in the blood for 6-12 hours.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      43.6
      Seconds

  • Question 2 - The posterior cord contains nerve fibres from which of the following levels of...

    Incorrect

    • The posterior cord contains nerve fibres from which of the following levels of the spinal cord?

      Your Answer: C7, C8 and T1

      Correct Answer: C5, C6, C7, C8 and T1

      Explanation:

      THE correct answer is A. The posterior cord derives its fibres from the spinal nerves C5,C6,C7,C8,T1. This cord is formed from the fusion of the posterior divisions of the upper, lower, and middle trunks.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      15.6
      Seconds

  • Question 3 - To reach the oral vestibule, the parotid duct must pierce this muscle: ...

    Incorrect

    • To reach the oral vestibule, the parotid duct must pierce this muscle:

      Your Answer: Superior pharyngeal constrictor muscle

      Correct Answer: Buccinator muscle

      Explanation:

      The parotid duct or Stensen duct is a duct and the route that saliva takes from the major salivary gland, the parotid gland into the mouth. The parotid duct is formed when several interlobular ducts—the largest ducts inside the parotid gland join. It emerges from the gland and runs forward along the lateral side of the masseter muscle. In this course, the duct is surrounded by the buccal fat pad. It takes a steep turn at the border of the masseter and passes through the buccinator muscle, opening into the vestibule of the mouth, between the cheek and the gums, at the parotid papilla, which lies across the second superior molar tooth.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      12.5
      Seconds

  • Question 4 - A patient underwent surgical excision of mass in the right carotid triangle. One...

    Incorrect

    • A patient underwent surgical excision of mass in the right carotid triangle. One day after the surgery patient complained of numbness of the skin over the right side of the neck. Injury to the cervical plexus of nerves is suspected. What is the possible nerve affected in this patient?

      Your Answer:

      Correct Answer: Transverse cervical

      Explanation:

      The transverse cervical nerve (superficial cervical or cutaneous cervical) arises from the second and third spinal nerves, turns around the posterior border of the sternocleidomastoid and, passing obliquely forward beneath the external jugular vein to the anterior border of the muscle, it perforates the deep cervical fascia, and divides beneath the platysma into the ascending and descending branches. It provides cutaneous innervation to this area.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 5 - 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
      0
      Seconds

  • Question 6 - A 15 year old girl is diagnosed with familial adenomatous polyposis. Which of...

    Incorrect

    • A 15 year old girl is diagnosed with familial adenomatous polyposis. Which of the following is the most appropriate recommended step in management?

      Your Answer:

      Correct Answer: Surveillance annual flexible sigmoidoscopy from age 13 years until age 30 years

      Explanation:

      Answer: Surveillance annual flexible sigmoidoscopy from age 13 years until age 30 years.

      Familial adenomatous polyposis (FAP) is the most common adenomatous polyposis syndrome. It is an autosomal dominant inherited disorder characterized by the early onset of hundreds to thousands of adenomatous polyps throughout the colon. If left untreated, all patients with this syndrome will develop colon cancer by age 35-40 years. In addition, an increased risk exists for the development of other malignancies.
      Most patients with FAP are asymptomatic until they develop cancer. As a result, diagnosing presymptomatic patients is essential.

      Of patients with FAP, 75%-80% have a family history of polyps and/or colorectal cancer at age 40 years or younger.

      Nonspecific symptoms, such as unexplained rectal bleeding (haematochezia), diarrhoea, or abdominal pain, in young patients may be suggestive of FAP.

      In a minority of FAP families a mutation cannot be identified and so annual flexible sigmoidoscopy should be offered to at risk family members from age 13–15 years until age 30, and at three to five year intervals thereafter until age 60 years.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
      0
      Seconds

  • Question 7 - A 52-year-old female presents with pain in her proximal femur. Imaging demonstrates a...

    Incorrect

    • A 52-year-old female presents with pain in her proximal femur. Imaging demonstrates a bone metastasis from an unknown primary site. CT scanning with arterial phase contrast shows that the lesion is hypervascular. From which of the following primary sites is the lesion most likely to have originated?

      Your Answer:

      Correct Answer: Renal

      Explanation:

      In females, the breasts and lungs are the most common primary disease sites; approximately 80% of cancers that spread to bone arise in these locations. In males, cancers of the prostate and lungs make up 80% of the carcinomas that metastasize to bone. The remaining 20% of primary disease sites in patients of both sexes are the kidney, gut, and thyroid, as well as sites of unknown origin.

      On contrast-enhanced CT scans, RCC is usually solid, and decreased attenuation suggestive of necrosis is often present. Sometimes, RCC is a predominantly cystic mass, with thick septa and wall nodularity.
      RCC may also appear as a completely solid and highly enhancing mass

    • This question is part of the following fields:

      • Oncology
      • Principles Of Surgery-in-General
      0
      Seconds

  • Question 8 - This structure divides the space between the lens and the cornea into the...

    Incorrect

    • This structure divides the space between the lens and the cornea into the anterior and posterior chambers of the eye:

      Your Answer:

      Correct Answer: The iris

      Explanation:

      The iris divides the space between the lens and the cornea into an anterior and a posterior chamber. The anterior cavity is filled with watery aqueous fluid, and the posterior cavity with a gel-like vitreous fluid. The anterior chamber of the eye is bounded in front by the posterior surface of the cornea; behind by the front of the iris and the central part of the lens. The posterior chamber is a narrow gap behind the peripheral part of the iris and in front of the suspensory ligament of the lens and the ciliary processes.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 9 - A 27-year-old man presents to the A&E department with a headache and odd...

    Incorrect

    • A 27-year-old man presents to the A&E department with a headache and odd behaviour after being hit on the side of his head by a bat. Whilst waiting for a CT scan, he becomes drowsy and unresponsive. What is the most likely underlying injury?

      Your Answer:

      Correct Answer: Extradural haematoma

      Explanation:

      Extradural haematoma is the most likely cause of this patient’s symptomology. The middle meningeal artery is prone to damage when the temporal side of the head is hit.

      Patients who suffer head injuries should be managed according to ATLS principles and extracranial injuries should be managed alongside cranial trauma. Inadequate cardiac output compromises the CNS perfusion, irrespective of the nature of cranial injury.

      An extradural haematoma is a collection of blood in the space between the skull and the dura mater. It often results from acceleration-deceleration trauma or a blow to the side of the head. The majority of extradural haematomas occur in the temporal region where skull fractures cause a rupture of the middle meningeal artery. There is often loss of consciousness following a head injury, a brief regaining of consciousness, and then loss of consciousness again—lucid interval. Other symptoms may include headache, confusion, vomiting, and an inability to move parts of the body. Diagnosis is typically by a CT scan or MRI, and treatment is generally by urgent surgery in the form of a craniotomy or burr hole.

    • This question is part of the following fields:

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

  • Question 10 - A 40-year-old man has been diagnosed with anal fissure, which has failed to...

    Incorrect

    • A 40-year-old man has been diagnosed with anal fissure, which has failed to respond to first-line treatment. What should be the next most appropriate treatment?

      Your Answer:

      Correct Answer: 15–30 units of botulinum toxin injected into the internal anal sphincter

      Explanation:

      The next appropriate step would be to perform an examination under anaesthesia and inject 15–30 units of botulinum toxin into the internal anal sphincter.

      Anal fissures are commonly seen in the colorectal clinic and 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 (however, up to 25% of the patients fail to respond). 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
      0
      Seconds

  • Question 11 - The LEAST mobile structure in the peritoneal cavity is the: ...

    Incorrect

    • The LEAST mobile structure in the peritoneal cavity is the:

      Your Answer:

      Correct Answer: Pancreas

      Explanation:

      The presence or absence of the mesentery determines mobility of abdominal contents. Structures like the stomach, transverse colon and appendix have mesenteries and thus are relatively mobile. In contrast, the pancreas is a retroperitoneal (behind the peritoneum) structure and therefore is fixed. The greater omentum is a large mobile fold of omentum that hangs down from the stomach .

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 12 - Which of the following proteins prevents red blood cells (RBCs) from bursting when...

    Incorrect

    • Which of the following proteins prevents red blood cells (RBCs) from bursting when they pass through capillaries?

      Your Answer:

      Correct Answer: Spectrin

      Explanation:

      Spectrin is a structural protein found in the cytoskeleton that lines the intercellular side of the membrane of cells which include RBCs. They maintain the integrity and structure of the cell. It is arranged into a hexagonal arrangement formed from tetramers of spectrin and associated with short actin filaments that form junctions allowing the RBC to distort its shape.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 13 - Lung compliance is increased by: ...

    Incorrect

    • Lung compliance is increased by:

      Your Answer:

      Correct Answer: Emphysema

      Explanation:

      Lung compliance is increased by emphysema, acute asthma and increasing age and decreased by alveolar oedema, pulmonary hypertension, atelectasis and pulmonary fibrosis.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 14 - Where do the cells belonging to the mononuclear phagocyte system originate? ...

    Incorrect

    • Where do the cells belonging to the mononuclear phagocyte system originate?

      Your Answer:

      Correct Answer: Bone marrow

      Explanation:

      The macrophage originates from a committed bone marrow stem cell. It is called the pluripotent hematopoietic stem cell. This differentiates into a monoblast and then into a promonocyte and finally matures into a monocyte. When called upon they leave the bone marrow and enter into the circulation. Upon entering the tissue they transform into macrophages. Tissue macrophages include: Kupffer cells (liver), alveolar macrophages (lung), osteoclasts (bone), Langerhans cells (skin), microglial cells (central nervous system), and possibly the dendritic immunocytes of the dermis, spleen and lymph nodes.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 15 - 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
      0
      Seconds

  • Question 16 - Regarding innervation to the peroneus brevis muscle: ...

    Incorrect

    • Regarding innervation to the peroneus brevis muscle:

      Your Answer:

      Correct Answer: Could be damaged by a fracture of the neck of the fibula

      Explanation:

      The peroneus brevis is supplied by the fourth and fifth lumbar and first sacral nerves through the superficial peroneal nerve which is one of the two terminal branches of the common peroneal nerve. The common peroneal nerve winds around the neck of the fibula and can be injured in cases of fractured neck of fibula.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 17 - What is the correct order of structures a needle must pass before it...

    Incorrect

    • What is the correct order of structures a needle must pass before it enters the pleural cavity?

      Your Answer:

      Correct Answer: External intercostals – internal intercostals – innermost intercostals – parietal pleura

      Explanation:

      The correct order of structures from superficial to deep are: the skin and subcutaneous tissue, the external intercostals followed by internal intercostals, innermost intercostals and finally parietal pleura.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 18 - A 29-year-old woman presents to the doctor complaining of cough, shortness of breath,...

    Incorrect

    • A 29-year-old woman presents to the doctor complaining of cough, shortness of breath, fever and weight loss. Chest X-ray revealed bilateral hilar and mediastinal lymph node enlargement and bilateral pulmonary opacities. Non-caseating granulomas were found on histological examination. The most likely diagnosis is:

      Your Answer:

      Correct Answer: Sarcoidosis

      Explanation:

      Sarcoidosis is an inflammatory disease of unknown aetiology that affects multiple organs but predominantly the lungs and intrathoracic lymph nodes. Systemic and pulmonary symptoms may both be present. Pulmonary involvement is confirmed by a chest X-ray and other imaging studies. The main histological finding is the presence of non-caseating granulomas.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 19 - A 34 year old athlete presents to the clinic after receiving a hard...

    Incorrect

    • A 34 year old athlete presents to the clinic after receiving a hard blow to his palm that has resulted into a painful swelling over the volar aspect of his hand. On examination, pain is felt on wrist movement and longitudinal compression of the thumb. Which of the following is the most likely injury?

      Your Answer:

      Correct Answer: Scaphoid fracture

      Explanation:

      The scaphoid bone is the most commonly fractured carpal bone. Fractures are most often localized in the middle third of the scaphoid bone.
      Generally, scaphoid bone fractures result from indirect trauma when an individual falls onto the outstretched hand with a hyperextended and radially deviated wrist. Pain when applying pressure to the anatomical snuffbox is highly suggestive of a scaphoid bone fracture.
      X-ray is the initial test of choice for diagnosis. Computer tomography and magnetic resonance imaging may be indicated, if x-ray findings are negative but clinical suspicion is high.
      Treatment can be conservative (e.g., wrist immobilization) or in certain cases surgical (e.g., proximal pole fracture). Complications include non-union and avascular necrosis.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      0
      Seconds

  • Question 20 - A 50 year old female patient with an history of chronic headache was...

    Incorrect

    • A 50 year old female patient with an history of chronic headache was scheduled for CT scan. If the CT scan revealed a tumour at the horn of the lateral ventricle, which of the following structures is most likely to be compressed by this tumour?

      Your Answer:

      Correct Answer: Fibres of the corpus callosum

      Explanation:

      The ventricular system of the brain is made up of four ventricles namely; two lateral and a third and forth ventricle. The ventricles are the site of the development of the cerebrospinal fluid. The left and right lateral ventricles are located in each of the brain’s hemispheres. The roof of the lateral ventricles are made up of the fibres of the corpus callosum. This is the structure that would be compressed by the a tumour on the roof of the lateral ventricles.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 21 - A 35-year-old female notices bloody discharge from her left nipple. She is, otherwise,...

    Incorrect

    • A 35-year-old female notices bloody discharge from her left nipple. She is, otherwise, asymptomatic. On examination, there are no discrete lesions to feel, and mammography shows dense breast tissue but no mass lesion.What is the most likely cause?

      Your Answer:

      Correct Answer: Intraductal papilloma

      Explanation:

      Intraductal papilloma is the most common cause of blood-stained nipple discharge in young females.

      An intraductal papilloma is a benign breast condition that develops in one or more of the milk ducts in the
      breast. It is usually close to the nipple, but can
      sometimes be found elsewhere in the breast. It most commonly occurs in women between ages 35–55 and generally does not increase the risk of developing breast cancer. There are no known risk factors for intraductal papilloma.

      Signs and symptoms include:
      1. Small lump or a discharge of
      clear or blood-stained fluid from the nipple
      2. Discomfort or pain around the area (usually not painful)

      Diagnosis can be made by:
      1. Breast examination
      2. Mammogram
      3. Ultrasound scan
      4. Core biopsy
      5. Fine needle aspiration

      Women under the age of 40 are more likely to have an
      ultrasound scan than a mammogram. The breast tissue in such patients can be dense which can
      make the X-ray image in a mammogram less clear.
      However, some women under 40 may still have
      a mammogram.

      Intraductal papillomas are often removed using
      surgery. The surgical options include:
      1. Excision biopsy
      2. Vacuum assisted excision biopsy

      If nipple discharge continues, then further surgical options are explored:
      1. Microdochectomy (removal of the affected duct or ducts)
      2. Total duct excision (removal of all the major ducts)

    • This question is part of the following fields:

      • Breast And Endocrine Surgery
      • Generic Surgical Topics
      0
      Seconds

  • Question 22 - A 45-year-old female will undergo a diagnostic laparoscopy. Which of the agents listed...

    Incorrect

    • A 45-year-old female will undergo a diagnostic laparoscopy. Which of the agents listed below should be used for inducing pneumoperitoneum?

      Your Answer:

      Correct Answer: Carbon dioxide

      Explanation:

      Laparoscopic surgery involves insufflation of a gas (usually carbon dioxide) into the peritoneal cavity producing a pneumoperitoneum. This causes an increase in intra-abdominal pressure (IAP). Carbon dioxide is insufflated into the peritoneal cavity at a rate of 4–6 litre min−1 to a pressure of 10–20 mm Hg. The pneumoperitoneum is maintained by a constant gas flow of 200–400 ml min−1.

      Carbon dioxide is the most frequently used gas for insufflation of the abdomen as it is colourless, non-toxic, non-flammable and has the greatest margin of safety in the event of a venous embolus (highly soluble). It is absorbed readily from the peritoneum, causing an increase in PaCO2. This has direct, as well as indirect (by raising catecholamine levels), effects on the cardiovascular system. Thus, tachycardia, increased cardiac contractility and reduction in the diastolic filling can result in decreased myocardial oxygen supply to demand ratio and greater risk of myocardial ischaemia.

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Surgical Technique And Technology
      0
      Seconds

  • Question 23 - A 56-year-old woman trips over a step, injuring her right ankle. Examination reveals...

    Incorrect

    • A 56-year-old woman trips over a step, injuring her right ankle. Examination reveals tenderness over the lateral malleolus and X-ray demonstrates an undisplaced fracture distal to the syndesmosis. What should be the best course of action?

      Your Answer:

      Correct Answer: Application of ankle boot

      Explanation:

      The patient has a Weber type A fracture, based on the Danis-Weber classification system for lateral malleolar fractures. It is a stable ankle injury and can, therefore, be managed conservatively. Whilst this patient could also be treated in a below-knee plaster, most clinicians, nowadays, treat this injury in an ankle boot. Patients are also advised to mobilise with the ankle boot as pain allows and can wean themselves off as the symptoms improve.

      The Danis-Weber classification system is based on the level of the fibula fracture in relation to the syndesmosis (the connection between the distal ends of the tibia and fibula). The more proximal, the greater the risk of syndesmotic injury and, therefore, fracture instability.

      1. Weber type A: fracture below the level of the syndesmosis
      2. Weber type B: fracture at the level of the syndesmosis/level of the tibial plafond
      3. Weber type C: fracture above the level of the syndesmosis. This includes Maisonneuve fracture (proximal fibula fracture) which can be associated with ankle instability.

      Ankle fractures are common. They affect men and women in equal numbers, but men have a higher rate as young adults (sports and contact injuries), and women have a higher rate post-menopausal (fragility-type fractures). Patients present, following a traumatic event, with a painful, swollen ankle, and reluctance/inability to bear weight.

      Radiographs of clearly deformed or dislocated joints are not necessary, and removing the pressure on the surrounding soft tissues from the underlying bony deformity is the priority. If the fracture pattern is not clinically obvious, then plain radiographs are appropriate. Antero-posterior, lateral, and mortise views are essential to evaluate fracture displacement and syndesmotic injury. Decreased tibiofibular overlap, medial joint clear space, and lateral talar shift all indicate a syndesmotic injury.

      When deciding upon treatment for an ankle fracture, one must consider both the fracture and the patient. Diabetic patients and smokers are at greater risk of post-operative complication, especially wound problems and infection. Likewise, the long term outcome of post-traumatic arthritis from a malunited ankle fracture is extremely important for a young patient, but not as relevant in the elderly. Unimalleolar Weber type A fractures, by definition, are stable and therefore, can be mobilised fully in an ankle boot.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      0
      Seconds

  • Question 24 - A 52 year old man complains of significant abdominal pain and presents to...

    Incorrect

    • A 52 year old man complains of significant abdominal pain and presents to his family doctor. Past medical history shows that he is recovering following a live donor related renal transplant. Which analgesic drug would be avoided in this patient?

      Your Answer:

      Correct Answer: Diclofenac

      Explanation:

      As a class, NSAIDs are known to have direct nephrotoxic effects including afferent vasoconstriction leading to reduced glomerular filtration; allergic reactions leading to tubulointerstitial nephritis; nephrotic syndromes, which commonly include minimal change disease and membranous glomerulonephropathy; fluid and sodium retention; worsening of pre-existing hypertension; papillary necrosis and various electrolyte disturbances, including hyponatremia, hyperkalaemia and type 4 renal tubular acidosis.
      The use of NSAIDs should be minimized among patients with Stage 3 CKD and avoided in those with Stage 4 or Stage 5 CKD with residual kidney function or recipients of kidney transplant regardless of CKD stage. It is conceivable that compromised intraglomerular hemodynamic may be potentiated with concurrent use of NSAIDs and calcineurin inhibitors in the transplant setting.
      Diclofenac which is an NSAID should therefore be avoided in this patient.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Organ Transplantation
      0
      Seconds

  • Question 25 - 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
      0
      Seconds

  • Question 26 - A 65 year old man with a history of carcinoma of the distal...

    Incorrect

    • A 65 year old man with a history of carcinoma of the distal oesophagus undergoes an Ivor-Lewis oesophagogastrectomy. The next day a pale opalescent liquid is noticed in the right chest drain. Which of the following is the most likely explanation of this finding?

      Your Answer:

      Correct Answer: Chyle leak

      Explanation:

      Chyle leakage is one of the most challenging complications following an esophagectomy and can lead to hypovolemia, metabolic and nutritional depletion, infection, and even death. The leakage occurs in 1.1 to 3.7% of esophagectomy patients; mortality occurs in excess of 50% of patients. Surgeons administer a lipid rich material prior to surgery to facilitate its identification if it occurs.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      0
      Seconds

  • Question 27 - Causes of metabolic acidosis with a normal anion gap include: ...

    Incorrect

    • Causes of metabolic acidosis with a normal anion gap include:

      Your Answer:

      Correct Answer: Diarrhoea

      Explanation:

      Excess acid intake and excess bicarbonate loss as in diarrhoea, are causes of metabolic acidosis with a normal anion gap. The other conditions all result in an increased anion gap.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 28 - A Jewish man was diagnosed with haemophilia C. Which of the following factors...

    Incorrect

    • A Jewish man was diagnosed with haemophilia C. Which of the following factors is deficient in this form of haemophilia?

      Your Answer:

      Correct Answer: Factor XI

      Explanation:

      Haemophilia C, also known as plasma thromboplastin antecedent (PTA) deficiency or Rosenthal syndrome, is a condition caused by the deficiency of the coagulation factor XI. The condition is rare and it is usually found in Ashkenazi Jews.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 29 - A 55 year old lady underwent an uneventful appendicectomy. Two hours later, her...

    Incorrect

    • A 55 year old lady underwent an uneventful appendicectomy. Two hours later, her arterial blood gas analysis on room revealed pH: 7.30, p(CO2): 53 mmHg and p(O2): 79 mmHg. What is the most likely cause of these findings?

      Your Answer:

      Correct Answer: Alveolar hypoventilation

      Explanation:

      In the given problem, there is respiratory acidosis due to hypercapnia from a low respiratory rate and/or volume (hypoventilation). Causes of hypoventilation include conditions impairing the central nervous system (CNS) respiratory drive, impaired neuromuscular transmission and other causes of muscular weakness (drugs and sedatives), along with obstructive, restrictive and parenchymal pulmonary disorders. Hypoventilation leads to hypoxia and hypercapnia reduces the arterial pH. Severe acidosis leads to pulmonary arteriolar vasoconstriction, systemic vascular dilatation, reduced myocardial contractility, hyperkalaemia, hypotension and cardiac irritability resulting in arrhythmias. Raised carbon dioxide concentration also causes cerebral vasodilatation and raised intracranial pressure. Over time, buffering and renal compensation occurs. However, this might not be seen in acute scenarios where the rise in p(CO2) occurs rapidly.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 30 - A 25 year old woman is trapped for several hours after falling down...

    Incorrect

    • A 25 year old woman is trapped for several hours after falling down a slope while hiking in the winter. She is airlifted to the nearest hospital where she was found to be hypothermic with a core temperature of 29oC. What is the most effective method of raising core temperature?

      Your Answer:

      Correct Answer: Instillation of warmed intra peritoneal fluid

      Explanation:

      Answer: Instillation of warmed intra peritoneal fluid

      Hypothermia describes a state in which the body’s mechanism for temperature regulation is overwhelmed in the face of a cold stressor. Hypothermia is classified as accidental or intentional, primary or secondary, and by the degree of hypothermia.
      Active central rewarming is the fastest and most invasive method of rewarming. It involves use of warm IV fluids, gastric lavage and peritoneal dialysis by warm fluids. Peritoneal dialysis can be safely done with crystalloid dialysate at 40 to 42°C and it raises the body temperature by 4 to 6°C/hour.

    • This question is part of the following fields:

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