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

    Incorrect

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

      Your Answer: White blood cell presence

      Correct 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
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  • Question 2 - A patient under went repair of a lingual artery aneurysm in the floor...

    Incorrect

    • A patient under went repair of a lingual artery aneurysm in the floor of the mouth. During surgical dissection from the inside of the mouth which muscle would you have to pass through to reach the main portion of the lingual artery?

      Your Answer:

      Correct Answer: Hyoglossus

      Explanation:

      The lingual artery first runs obliquely upward and medialward to the greater horns of the hyoid bone. It then curves downward and forward, forming a loop which is crossed by the hypoglossal nerve, and passing beneath the digastric muscle and stylohyoid muscle it runs horizontally forward, beneath the hyoglossus, and finally, ascending almost perpendicularly to the tongue, turns forward on its lower surface as far as the tip, to become the deep lingual artery.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 3 - A 30 year old lawyer presented with a history of pleural effusions, pericarditis,...

    Incorrect

    • A 30 year old lawyer presented with a history of pleural effusions, pericarditis, arthralgia without joint deformity and episodes of myalgia for the past 12 months. Blood tests reveal a normocytic anaemia. Which of the following tests should be performed to investigate this condition further?

      Your Answer:

      Correct Answer: Antinuclear antibody test

      Explanation:

      These non specific findings are suggestive of autoimmune disease. Antinuclear antibody (ANA) is the first test that should be performed when autoimmune diseases are suspected and later on more specific tests should be performed. This tests aids in the diagnosis of SLE, scleroderma, Sjogren’s syndrome, Raynaud’s disease, juvenile chronic arthritis, rheumatoid arthritis and antiphospholipid antibody syndrome etc. To confirm the disease a history, physical examination along with specific tests are required.
      CPK is more specific for acute conditions.
      ESR is a non specific test for inflammation.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 4 - Where does the ejaculatory duct open into? ...

    Incorrect

    • Where does the ejaculatory duct open into?

      Your Answer:

      Correct Answer: Prostatic urethra

      Explanation:

      There are two ejaculatory ducts, one on either side of the midline. Each ejaculatory duct is formed by the union of the duct from the seminal vesicles with the ductus deferens. They start at the base of the prostate and run forward and downward between the middle and lateral lobes and along the side of the prostatic utricle to end in the prostatic urethra.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 5 - Which of the following substances is most likely to cause pulmonary vasodilatation? ...

    Incorrect

    • Which of the following substances is most likely to cause pulmonary vasodilatation?

      Your Answer:

      Correct Answer: Nitric oxide

      Explanation:

      In the body, nitric oxide is synthesised from arginine and oxygen by various nitric oxide synthase (NOS) enzymes and by sequential reduction of inorganic nitrate. The endothelium of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, so dilating the artery and increasing blood flow. Nitric oxide/oxygen blends are used in critical care to promote capillary and pulmonary dilation to treat primary pulmonary hypertension in neonatal patients post-meconium aspiration and related to birth defects.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 6 - Which of the following arteries, if ligated, will most likely affect blood supply...

    Incorrect

    • Which of the following arteries, if ligated, will most likely affect blood supply to the pancreas?

      Your Answer:

      Correct Answer: Superior mesenteric

      Explanation:

      The pancreas is a glandular organ in the body that produces important hormones such as insulin and glucagon. Its blood supply is from branches of the coeliac artery, superior mesenteric artery and the splenic artery. These are the arteries that if ligated, would affect blood supply to the pancreas.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 7 - 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:

      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 8 - What will the destruction of endoplasmic reticulum stop? ...

    Incorrect

    • What will the destruction of endoplasmic reticulum stop?

      Your Answer:

      Correct Answer: Synthesis of proteins

      Explanation:

      The rough endoplasmic reticulum is the factory for the manufacturing of proteins. It contains ribosomes attached to it and transports proteins that are destined for membranes and secretions. The rough ER is connected to the nuclear envelope and to the cisternae of the Golgi apparatus by vesicles that shuttle between the two compartments.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 9 - A 45 years old women was diagnosed with breast cancer. After a radical...

    Incorrect

    • A 45 years old women was diagnosed with breast cancer. After a radical mastectomy to remove all axillary lymph nodes from her right breast, it was noticed that she had a winged scapula. Which nerve injury would explain this?

      Your Answer:

      Correct Answer: Long thoracic nerve

      Explanation:

      The long thoracic nerve supplies the serratus anterior muscle. When this nerve is injured the muscle undergoes paralysis, which is seen clinically as winging of the scapula most apparent when the arm is lifted forward. The long thoracic nerve is greatly susceptible to injury during breast surgery because of its long and superficial course along the thorax from its origin, the brachial plexus, to the lower border of the serratus anterior muscle.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 10 - A 37 year old woman has recently undergone a mastectomy along with axillary...

    Incorrect

    • A 37 year old woman has recently undergone a mastectomy along with axillary node clearance for an invasive ductal carcinoma. Histological analysis show a completely excised grade III lesion measuring 3.5cm. Two of the axillary nodes are significant for metastatic spread. The tumour is found to be oestrogen receptor negative. Which of the following would be the next best step in the management of this patient?

      Your Answer:

      Correct Answer: Administration of cytotoxic chemotherapy

      Explanation:

      Chemotherapy is offered to patients to help downstage advanced lesions to facilitate breast conserving surgery i.e. in grade 3 tumours with axillary node metastasis.

    • This question is part of the following fields:

      • Breast And Endocrine Surgery
      • Generic Surgical Topics
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  • Question 11 - A 46-year-old male is involved in a polytrauma and requires a massive transfusion...

    Incorrect

    • A 46-year-old male is involved in a polytrauma and requires a massive transfusion of packed red cells and fresh frozen plasma. Three hours later he develops marked hypoxia and his CVP is noted to be 10mm Hg. A chest x-ray shows bilateral diffuse pulmonary infiltrates. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Transfusion associated lung injury

      Explanation:

      A massive blood transfusion is defined as the replacement of a patient’s total blood volume in <24 h
      The abnormalities which result include effects upon coagulation status, serum biochemistry, acid-base balance and temperature homeostasis.
      One of the complications is Transfusion-related acute lung injury
      (TRALI) which is the most common cause of major morbidity and death after transfusion. It presents as an acute respiratory distress syndrome (ARDS) either during or within 6 h of transfusion.

      Clinical features
      Hypoxaemia, dyspnoea, cyanosis, fever, tachycardia and hypotension result from non-cardiogenic pulmonary oedema. The radiographic appearance is of bilateral pulmonary infiltration, characteristic of pulmonary oedema. It is important to differentiate TRALI from other causes of ARDS such as circulatory overload or myocardial or valvular heart disease. Invasive monitoring in TRALI demonstrates normal intracardiac pressures

      Pathogenesis
      Two different mechanisms for the pathogenesis of TRALI have been identified: immune (antibody-mediated) and non-immune. Immune TRALI results from the presence of leucocyte antibodies in the plasma of donor blood directed against human leucocyte antigens (HLA) and human neutrophil alloantigens (HNA) in the recipient. Antibodies present in the recipient only rarely cause TRALI. In up to 40% of patients, leucocyte antibodies cannot be detected in either donor or recipient. In these cases, it is possible that reactive lipid products released from the membranes of the donor blood cells act as the trigger. This is known as non-immune TRALI.
      The target cell in both forms of TRALI is the neutrophil granulocyte. On activation of their acute phase cycle, these cells migrate to the lungs where they become trapped within the pulmonary microvasculature. Oxygen-free radicals and other proteolytic enzymes are then released which destroy the endothelial cells of the lung capillaries. A pulmonary capillary leak syndrome develops with the exudation of fluid and protein into the alveoli resulting in pulmonary oedema. The majority of reactions are severe, and often life-threatening; 70% require mechanical ventilation and 6–9% are fatal. A definitive diagnosis requires antibody detection. The mortality in non-immune TRALI is lower, and the syndrome is encountered predominantly in critically ill patients.
      Other Complications of blood transfusion
      Early:
      – Haemolytic reactions
      Immediate
      Delayed
      – Non-haemolytic febrile reactions
      – Allergic reactions to proteins, IgA
      – Reactions secondary to bacterial contamination
      – Circulatory overload
      – Air embolism
      – Thrombophlebitis
      – Hyperkalaemia
      – Citrate toxicity
      – Hypothermia
      – Clotting abnormalities (after massive transfusion)
      Late:
      – Transmission of infection
      – Viral (hepatitis A, B, C, HIV, CMV)
      – Bacterial (Treponeum pallidum, Salmonella)
      – Parasites (malaria, toxoplasma)
      – Graft-vs-host disease
      – Iron overload (after chronic transfusions)
      – Immune sensitization (Rhesus D antigen)

    • This question is part of the following fields:

      • Post-operative Management And Critical Care
      • Principles Of Surgery-in-General
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  • Question 12 - During a radical mastectomy for advanced breast cancer, the surgeon injured the long...

    Incorrect

    • During a radical mastectomy for advanced breast cancer, the surgeon injured the long thoracic nerve. Which among the following muscles is likely to be affected?

      Your Answer:

      Correct Answer: Serratus anterior

      Explanation:

      The long thoracic nerve innervates the serratus anterior muscle which holds the scapula forward and balances the rhomboids and the trapezius muscles which retract the scapula. Injury to this nerve results in a ‘winged scapula’ with a posterior protrusion.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 13 - What is expected from complete transection of the inferior gluteal nerve when it...

    Incorrect

    • What is expected from complete transection of the inferior gluteal nerve when it emerges from the greater sciatic foramen?

      Your Answer:

      Correct Answer: Extension of the thigh would be the action most affected

      Explanation:

      As the inferior gluteal nerve emerges from the greater sciatic foramen below the piriformis muscle, it divides into branches and enters the gluteus maximus muscle which extends the femur and bends the thigh in line with the body.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 14 - A 28 year gang member was shot in the chest. The bullet hit...

    Incorrect

    • A 28 year gang member was shot in the chest. The bullet hit a vessel that courses horizontally across the mediastinum. Which of the following vessels is it likely to be?

      Your Answer:

      Correct Answer: Left brachiocephalic vein

      Explanation:

      The superior vena cava that empties blood into the right atrium is formed by the right and the left brachiocephalic veins. Hence, the left brachiocephalic has to course across the mediastinum horizontally to join with its right ‘counterpart’. The left subclavian artery and vein being lateral to the mediastinum do not cross the mediastinum while the left jugular and the common carotid artery course vertically.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 15 - A 40 year old woman, who is under anaesthesia for an elective procedure,...

    Incorrect

    • A 40 year old woman, who is under anaesthesia for an elective procedure, received an antibiotic injection. She immediately developed a rash and her airway constricted raising the airway pressure. Which mechanism is responsible for this reaction?

      Your Answer:

      Correct Answer: Type I hypersensitivity

      Explanation:

      Type I hypersensitivity reaction is an immediate reaction that occurs due to binding of the antigen with antibodies attached to mast cells in a previously sensitized person. It has an immediate phase, which is characterised by vasodilation, leakage of plasma, smooth muscle spasm, or glandular secretions. This manifests in about 5-30 min and usually resolves within 60 mins. The delayed phase follows after 24 hours and can persist up to several days. It is due to infiltration of eosinophils, neutrophils, basophils and CD4+ cells and leads to tissue destruction. The nature of the reaction varies according to the site. It can take the form of skin allergy, hives, allergic rhinitis, conjunctivitis, bronchial asthma or food allergy.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 16 - A patient who has used NSAIDS for many years presents to the A&E...

    Incorrect

    • A patient who has used NSAIDS for many years presents to the A&E with symptoms of acute haemorrhagic shock. An emergency endoscopy is done that shows that a duodenal ulcer has perforated the posterior wall of the first part of the duodenum. Which artery is most likely to be the cause of the haemorrhage?

      Your Answer:

      Correct Answer: Gastroduodenal

      Explanation:

      The gastroduodenal artery is a branch of the hepatic artery and descends near the pylorus between the first part of the duodenum and the neck of the pancreas to divide at the lower border of the duodenum into the right gastroepiploic and pancreaticoduodenal arteries. Before it divides, it gives off a few branches to the pyloric end of the stomach and to the pancreas. The artery that is most likely involved in this situation is the gastroduodenal artery since it is posterior to the first part of the duodenum.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 17 - 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 18 - 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 19 - A 18-year old girl presents to her doctor with an excessively enlarged left...

    Incorrect

    • A 18-year old girl presents to her doctor with an excessively enlarged left breast as compared to the right breast since puberty. The most likely cause for this is:

      Your Answer:

      Correct Answer: Virginal breast hypertrophy

      Explanation:

      Virginal breast hypertrophy’ is the term assigned to excessive growth of breasts during puberty and is a common phenomenon. It is also known as ‘juvenile macromastia’ or ‘ juvenile gigantomastia’. The breast hypertrophy often starts with menarche and occasionally occurs in growth spurts. These spurts can cause physical discomfort, red and itchy skin or pain in the breasts. The breasts can also grow continuously over several years and lead to overdevelopment of a normal breast. Nipples also undergo enlargement along with the breasts.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 20 - A 20-year old boy presented with low grade fever, night sweats and weakness...

    Incorrect

    • A 20-year old boy presented with low grade fever, night sweats and weakness over two months. On examination, he had multiple, non-tender, cervical, supraclavicular and axillary adenopathy. Microscopy of lymph node biopsy showed the presence of Reed-Sternberg cells. He is likely suffering from:

      Your Answer:

      Correct Answer: Hodgkin’s lymphoma

      Explanation:

      Hodgkin’s lymphoma is a disease characterized by malignant proliferation of cells of the lymphoreticular system. It can be localized or disseminated, and can involve the nodes, spleen, liver and marrow. Symptoms of the disease include non-tender lymphadenopathy, fever, night sweats, weight loss, itching and hepatosplenomegaly. Histologically, the involved nodes show the presence of Reed-Sternberg cells, which are large, binucleated cells, in a heterogenous cellular infiltrate of histiocytes, lymphocytes, monocytes, plasma cells and eosinophils.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 21 - A 29-year-old man who plays social rugby presents with recurrent anterior dislocation of...

    Incorrect

    • A 29-year-old man who plays social rugby presents with recurrent anterior dislocation of the right shoulder. Which of the following abnormalities is most likely to be present?

      Your Answer:

      Correct Answer: Bankart lesion

      Explanation:

      This patient has a Bankart lesion which is the most common underlying abnormality in recurrent anterior dislocation of the shoulder.

      Bankart lesion is an injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. It is usually visualised by CT and MRI scanning and is often repaired arthroscopically.

      Shoulder fractures and dislocations usually result from low-energy falls in predominantly elderly females or from high-energy trauma in young males. They can be associated with nerve injury (commonly axillary), and fracture-dislocation of the humeral head. Anterior shoulder dislocation (glenohumeral dislocation) is the most common type of shoulder dislocation (>90%) and is usually traumatic in nature.

      Early assessment of shoulder dislocation:
      Careful history, examination, and documentation of neurovascular status of the upper limb, in particular the axillary nerve, is important. This should be re-assessed after manipulation. Early radiographs should also be done to confirm the direction of the dislocation.

      Initial management of anterior dislocation:
      It consists of emergent closed reduction (to prevent lasting chondral damage) under Entonox and analgesia, but often requires conscious sedation. The affected arm should then be immobilised in a polysling. Initial management requires emergent reduction to prevent lasting chondral damage.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
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  • Question 22 - A 21-year-old woman presents with intermittent diarrhoea for the past eight months and...

    Incorrect

    • A 21-year-old woman presents with intermittent diarrhoea for the past eight months and loss in weight of about two kilograms. Colonoscopy is carried out in which appearances of melanosis coli are identified. This is confirmed on biopsy.

      What could be the most likely cause of melanosis coli in this patient?

      Your Answer:

      Correct Answer: Laxative abuse

      Explanation:

      Melanosis coli may have occurred as a result of laxative abuse in this patient.

      Melanosis coli, also pseudomelanosis coli, is a disorder of pigmentation of the wall of the colon, often identified at the time of colonoscopy. It is benign, and may have no significant correlation with the disease. The brown pigment seen is lipofuscin in macrophages, not melanin.

      According to the World Health Organisation (WHO), chronic diarrhoea is defined as lasting for more than 14 days. It is very common in irritable bowel syndrome (IBS). Patients may be divided into those with diarrhoea-predominant IBS and those with constipation-predominant IBS. Along with diarrhoea/constipation, clinical features such as abdominal pain, bloating, weight loss, change in bowel habit, lethargy, nausea, backache, and bladder symptoms are also seen. Bloody diarrhoea is more common in ulcerative colitis than in Crohn’s disease.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
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  • Question 23 - Which of the following enzymes is secreted by the small intestinal mucosa? ...

    Incorrect

    • Which of the following enzymes is secreted by the small intestinal mucosa?

      Your Answer:

      Correct Answer: Lactase

      Explanation:

      Lactase, an enzyme belonging to β-galactosidase family of enzymes, brings about the hydrolysis of the disaccharide lactose into galactose and glucose. In humans, it is present along the brush border membrane of the cells lining the small intestinal villi. Deficiency of lactase causes lactose intolerance.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 24 - A 39-year-old man, after radiological evaluation and thoracentesis, was found to have chylothorax....

    Incorrect

    • A 39-year-old man, after radiological evaluation and thoracentesis, was found to have chylothorax. What is the most probable cause of this diagnose?

      Your Answer:

      Correct Answer: Mediastinal malignant lymphoma

      Explanation:

      Chylothorax is a potentially lethal condition characterized by fluid (chyle) accumulation in the pleural cavity, resulting from disruption of lymphatic drainage in the thoracic duct. Chyle is a fluid rich in triglycerides and chylomicrons and can originate from the thorax, the abdomen or both. Malignant tumours, especially lymphoma, are the most common causes of nontraumatic chylothorax. Bronchogenic carcinoma and trauma are the most common causes after lymphomas. Other rare causes of chylothorax are; granulomatous diseases, tuberculosis, congenital malformations, nephrotic syndrome, hypothyroidism, cirrhosis, decompensated heart failure and idiopathic chylothorax.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 25 - Which statement is correct regarding secretions from the adrenal glands? ...

    Incorrect

    • Which statement is correct regarding secretions from the adrenal glands?

      Your Answer:

      Correct Answer: Aldosterone is producd by the zona glomerulosa

      Explanation:

      The secretions of the adrenal glands by zone are:
      Zona glomerulosa – aldosterone
      Zona fasciculata – cortisol and testosterone
      Zona reticularis – oestradiol and progesterone
      Adrenal medulia – adrenaline, noradrenaline and dopamine.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 26 - A surgeon trainee is assisting in an operation to ligate the ductus arteriosus....

    Incorrect

    • A surgeon trainee is assisting in an operation to ligate the ductus arteriosus. The consultant supervising explains that caution is required when placing a clamp on the ductus to avoid injury to an important structure immediately dorsal to it. To which structure is the consultant referring?

      Your Answer:

      Correct Answer: Left recurrent laryngeal nerve

      Explanation:

      The left recurrent laryngeal nerve branches off the vagus and wraps around the aorta, posterior to the ductus arteriosus/ligamentum arteriosum from whence it courses superiorly to innervate the laryngeal muscles.
      Accessory Hemiazygous vein is on the left side of the body draining the posterolateral chest wall and emptying blood into the azygos vein.
      The left internal thoracic artery is branch of the left subclavian artery supplying blood to the anterior wall of the thorax.
      Left phrenic nerve is lateral to the vagus nerve.
      Thoracic duct: is behind the oesophagus, coursing between the aorta and the azygos vein in the posterior chest.
      Right recurrent laryngeal nerve: loops around the right subclavian artery and is not in danger in this procedure.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 27 - A 6 year old girl falls during dance class and fractures the growth...

    Incorrect

    • A 6 year old girl falls during dance class and fractures the growth plate of her left wrist. Which system can be used to classify the injury?

      Your Answer:

      Correct Answer: Salter - Harris system

      Explanation:

      A Salter–Harris fracture is a fracture that involves the epiphyseal plate or growth plate of a bone, specifically the zone of provisional calcification. It is a common injury found in children, occurring in 15% of childhood long bone fractures.
      There are nine types of Salter–Harris fractures; types I to V as described by Robert B Salter and W Robert Harris in 1963, and the rarer types VI to IX which have been added subsequently:
      Type I – transverse fracture through the growth plate (also referred to as the physis): 6% incidence
      Type II – A fracture through the growth plate and the metaphysis, sparing the epiphysis: 75% incidence, takes approximately 12-90 weeks or more in the spine to heal.
      Type III – A fracture through growth plate and epiphysis, sparing the metaphysis: 8% incidence
      Type IV – A fracture through all three elements of the bone, the growth plate, metaphysis, and epiphysis: 10% incidence
      Type V – A compression fracture of the growth plate (resulting in a decrease in the perceived space between the epiphysis and metaphysis on x-ray): 1% incidence
      Type VI – Injury to the peripheral portion of the physis and a resultant bony bridge formation which may produce an angular deformity (added in 1969 by Mercer Rang)
      Type VII – Isolated injury of the epiphyseal plate (VII–IX added in 1982 by JA Ogden)
      Type VIII – Isolated injury of the metaphysis with possible impairment of endochondral ossification
      Type IX – Injury of the periosteum which may impair intramembranous ossification

      The mnemonic SALTER can be used to help remember the first five types.
      N.B.: This mnemonic requires the reader to imagine the bones as long bones, with the epiphyses at the base.

      I – S = Slip (separated or straight across). Fracture of the cartilage of the physis (growth plate)
      II – A = Above. The fracture lies above the physis, or Away from the joint.
      III – L = Lower. The fracture is below the physis in the epiphysis.
      IV – TE = Through Everything. The fracture is through the metaphysis, physis, and epiphysis.
      V – R = Rammed (crushed). The physis has been crushed.
      Alternatively, SALTER can be used for the first 6 types, as above but adding Type V — ‘E’ for ‘Everything’ or ‘Epiphysis’ and Type VI — ‘R’ for ‘Ring’.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
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  • Question 28 - A 13 month old baby was taken to the hospital after his father...

    Incorrect

    • A 13 month old baby was taken to the hospital after his father saw that he had periorbital oedema for two days. He is seen by the doctor and noted to have facial oedema and a tender distended abdomen. His temperature is 39.1 and his blood pressure is 91/46 mmHg. There is also clinical evidence of poor peripheral perfusion. What is the diagnosis?

      Your Answer:

      Correct Answer: Spontaneous bacterial peritonitis

      Explanation:

      Answer: Spontaneous bacterial peritonitis

      The presence of periorbital and facial oedema with normal blood pressure in this toddler indicates that he has nephrotic syndrome. Nephrotic syndrome can be associated with a series of complications that can affect an individual’s health and quality of life:
      Spontaneous bacterial peritonitis can develop where there is ascites present. This is a frequent development in children but very rarely found in adults.

      Spontaneous bacterial peritonitis (SBP) is the development of a bacterial infection in the peritoneum, despite the absence of an obvious source for the infection. It is specifically an infection of the ascitic fluid – an increased volume of peritoneal fluid. Ascites is most commonly a complication of cirrhosis of the liver. It can also occur in patients with nephrotic syndrome. SBP has a high mortality rate.

      The diagnosis of SBP requires paracentesis, a sampling of the peritoneal fluid taken from the peritoneal cavity. If the fluid contains large numbers of white blood cells known as neutrophils (>250 cells/µL), infection is confirmed and antibiotics will be given, without waiting for culture results. In addition to antibiotics, infusions of albumin are usually administered.

      Signs and symptoms of spontaneous bacterial peritonitis (SBP) include fevers, chills, nausea, vomiting, abdominal pain and tenderness, general malaise, altered mental status, and worsening ascites. Thirteen percent of patients have no signs or symptoms. In cases of acute or chronic liver failure SBP is one of the main triggers for hepatic encephalopathy, and where there is no other clear causal indication for this, SBP may be suspected.

      These symptoms can also be the same for a spontaneous fungal peritonitis (SFP) and therefore make a differentiation difficult. Delay of diagnosis can delay antifungal treatment and lead to a higher mortality rate.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
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  • Question 29 - A 70-year-old man who was previously healthy develops a rapidly progressing neurological deficit....

    Incorrect

    • A 70-year-old man who was previously healthy develops a rapidly progressing neurological deficit. A MRI reveals a large, poorly defined mass with central necrosis in his left temporal lobe. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Glioblastoma multiforme

      Explanation:

      Glioblastoma multiforme, or grade 4 astrocytoma, is the most common and aggressive primary brain tumour. They are formed by small areas of necrotising tissue surrounded by highly anaplastic cells. Most of them arise from the deep white matter of the brain and quickly infiltrate it, becoming very large before they are symptomatic. The most common symptom is progressive memory, personality or neurological deficit due to temporal and frontal lobe involvement. It is most common in men, and risk factors include: neurofibromatosis, tuberous sclerosis, Von Hippel-Lindau disease, Li-Fraumeni syndrome, and Turcot syndrome.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 30 - In a cardiac cycle, what event does the closing of atrioventricular (AV) valves...

    Incorrect

    • In a cardiac cycle, what event does the closing of atrioventricular (AV) valves coincide with?

      Your Answer:

      Correct Answer: Second heart sound

      Explanation:

      The beginning of ventricular systole corresponds to the beginning of the QRS complex in the ECG. The beginning of the ventricular systole also corresponds to the closure of the atrioventricular valves, causing the first heart sound (S1). S2, the second heart sound is due to closure of the aortic and pulmonary valves at the end of ventricular systole.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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