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  • Question 1 - A 32-year-old motorist was involved in a road traffic accident in which he...

    Incorrect

    • A 32-year-old motorist was involved in a road traffic accident in which he collided head-on with another car at high speed. He was wearing a seatbelt and the airbags were deployed. When rescuers arrived, he was conscious and lucid but died immediately after.

      What could have explained his death?

      Your Answer: Splenic rupture

      Correct Answer: Aortic transection

      Explanation:

      Aortic transection was the underlying cause of death in this patient.

      Aortic transection, or traumatic aortic rupture, is typically the result of a blunt aortic injury in the context of rapid deceleration. This condition is commonly fatal as blood in the aorta is under great pressure and can quickly escape the vessel through a tear, resulting in rapid haemorrhagic shock and death. A temporary haematoma may prevent the immediate death. Injury to the aorta during a sudden deceleration commonly originates near the terminal section of the aortic arch, also known as the isthmus. This portion lies just distal to the take-off of the left subclavian artery at the intersection of the mobile and fixed portions of the aorta. As many as 80% of the patients with aortic transection die at the scene before reaching a trauma centre for treatment.

      A widened mediastinum may be seen on the X-ray of a person with aortic rupture.

      Other types of thoracic trauma include:
      1. Tension pneumothorax and pneumothorax
      2. Haemothorax
      3. Flail chest
      4. Cardiac tamponade
      5. Blunt cardiac injury
      6. Pulmonary contusion
      7. Diaphragm disruption
      8. Mediastinal traversing wounds

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
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      Seconds
  • Question 2 - Where is the foramen ovale located? ...

    Incorrect

    • Where is the foramen ovale located?

      Your Answer:

      Correct Answer: Sphenoid

      Explanation:

      The foramen ovale is an oval shaped opening in the middle cranial fossa located at the posterior base of the greater wing of the sphenoid bone, lateral to the lingula. It transmits the mandibular division of the trigeminal nerve (CN Vc), accessory meningeal artery, emissary veins between the cavernous sinuses and pterygoid plexus, otic ganglion, and occasionally the nervus spinosus and lesser petrosal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 3 - A 76 year old man who presented with lower back pain is diagnosed...

    Incorrect

    • A 76 year old man who presented with lower back pain is diagnosed with prostatic carcinoma that has metastasized to his lumber spine. Which of the following markers is characteristically elevated?

      Your Answer:

      Correct Answer: PSA

      Explanation:

      Spread of prostatic carcinoma is common to the lumbar spine and pelvis. This results in osteoblastic metastases that will present as lower back pain with increased alkaline phosphatase, prostatic acid phosphates and PSA. PSA is more specific and a PSA > 10 ng/ml for any age is worrisome.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 4 - A 25-year-old female had a painful abdomen and several episodes of vomiting. She...

    Incorrect

    • A 25-year-old female had a painful abdomen and several episodes of vomiting. She was severely dehydrated when she was brought to the hospital. Her ABG showed a pH 7.7, p(O2) 75 mmHg, p(CO2) 46 mmHg and bicarbonate 48 mmol/l. The most likely interpretation of this ABG report would be:

      Your Answer:

      Correct Answer: Metabolic alkalosis

      Explanation:

      Metabolic alkalosis is a primary increase in bicarbonate (HCO3−) with or without compensatory increase in carbon dioxide partial pressure (Pco2); pH may be high or nearly normal. Metabolic alkalosis occurs as a consequence of a loss of H+ from the body or a gain in HCO3 -. In its pure form, it manifests as alkalemia (pH >7.40). As a compensatory mechanism, metabolic alkalosis leads to alveolar hypoventilation with a rise in arterial carbon dioxide tension p(CO2), which diminishes the change in pH that would otherwise occur. Normally, arterial p(CO2) increases by 0.5–0.7 mmHg for every 1 mmol/l increase in plasma bicarbonate concentration, a compensatory response that occurs very rapidly. If the change in p(CO2) is not within this range, then a mixed acid–base disturbance occurs. Likewise, if the increase in p(CO2) is less than the expected change, then a primary respiratory alkalosis is also present. However an elevated serum bicarbonate concentration can also occur due to a compensatory response to primary respiratory acidosis. A bicarbonate concentration greater than 35 mmol/l is almost always caused by metabolic alkalosis (as is the case in this clinical scenario). Calculation of the serum anion gap can also help to differentiate between primary metabolic alkalosis and the metabolic compensation for respiratory acidosis. The anion gap is frequently elevated to a modest degree in metabolic alkalosis because of the increase in the negative charge of albumin and the enhanced production of lactate. However, the only definitive way to diagnose metabolic alkalosis is by performing a simultaneous blood gases analysis, which reveals elevation of both pH and arterial p(CO2) and increased calculated bicarbonate.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 5 - A 38 year old man is to undergo excision of the base of...

    Incorrect

    • A 38 year old man is to undergo excision of the base of the prostate for malignant growth, which of the following structures is directly related to the base of the prostate?

      Your Answer:

      Correct Answer: Urinary bladder

      Explanation:

      The prostate is situated in the pelvic cavity and is also located immediately below the internal urethral orifice at the commencement of the urethra. It is held in position by the puboprostatic ligaments, the superior fascia of the urogenital diaphragm and the anterior portions of the levatores ani. The base of the prostate is directed upward and is attached to the inferior surface of the urinary bladder while the apex is directed downward and is in contact with the superior fascia of the urogenital diaphragm.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 6 - Gastric acid secretion is stimulated by which of the following? ...

    Incorrect

    • Gastric acid secretion is stimulated by which of the following?

      Your Answer:

      Correct Answer: Gastrin

      Explanation:

      Gastric acid secretion is stimulated by three factors:
      – Acetylcholine, from parasympathetic neurones of the vagus nerve that innervate parietal cells directly
      – Gastrin, produced by pyloric G-cells
      – Histamine, produced by mast cells.
      Gastric acid is inhibited by three factors:
      – Somatostatin
      – Secretin
      – Cholecystokinin

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 7 - A lad involved in a road traffic accident is rushed to casualty where...

    Incorrect

    • A lad involved in a road traffic accident is rushed to casualty where physical examination reveals that he has limited extension of his right humerus. Which of the following nerves is most likely to have been injured?

      Your Answer:

      Correct Answer: Thoracodorsal nerve

      Explanation:

      Extension of the humerus is a function of the latissimus dorsi. This muscle is supplied by the thoracodorsal nerve which is a branch of the posterior cord of the plexus whose fibres are derived from cranial nerves V, VI and VII.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 8 - Which of the following is NOT true regarding malignant hyperpyrexia ...

    Incorrect

    • Which of the following is NOT true regarding malignant hyperpyrexia

      Your Answer:

      Correct Answer: It can be caused by nitrous oxide

      Explanation:

      Malignant hyerpyrexia occurs in 1 in 150,000. All inhalational anaesthetic agents and suxamethonium, except nitrous oxide can cause malignant hyperpyrexia.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 9 - A glycogen storage disorder is characterised by increased liver glycogen with a normal...

    Incorrect

    • A glycogen storage disorder is characterised by increased liver glycogen with a normal structure and no increase in serum glucose after oral intake of a protein-rich diet. Deficiency of which of the following enzymes is responsible for this disorder?

      Your Answer:

      Correct Answer: Glucose-6-phosphatase

      Explanation:

      The most common glycogen storage disorder is von Gierke’s disease or glycogen storage disease type I. It results from a deficiency of enzyme glucose-6-phosphatase which affects the ability of liver to produce free glucose from glycogen and gluconeogenesis; leading to severe hypoglycaemia. There is also increased glycogen storage in the liver and kidneys causing enlargement and various problems in their functioning. The disease also causes lactic acidosis and hyperlipidaemia. The main treatment includes frequent or continuous feedings of corn-starch or other carbohydrates.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 10 - Production of pain is most likely associated with: ...

    Incorrect

    • Production of pain is most likely associated with:

      Your Answer:

      Correct Answer: Substance P

      Explanation:

      Substance P is a short-chain polypeptide that functions as a neurotransmitter and as a neuromodulator, and is thus, a neuropeptide. It has been linked with pain regulation, mood disorders, stress, reinforcement, neurogenesis, respiratory rhythm, neurotoxicity, nausea and emesis. It is also a potent vasodilator as it brings about release of nitric oxide from the endothelium. Its release can also cause hypotension.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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