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Question 1
Incorrect
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A 11 month old baby develops periumbilical abdominal discomfort and diarrhoea after having a sore throat and fever for a few days. He presents to the A&E department and an ultrasound is done which shows a 'target sign' on the right side of the abdomen. What is the best initial course of action?
Your Answer: Undertake a colonoscopy
Correct Answer: Obtain intravenous access, administer fluids and antibiotics
Explanation:Answer: Obtain intravenous access, administer fluids and antibiotics.
Intussusception is a condition in which one segment of intestine telescopes inside of another, causing an intestinal obstruction (blockage). Although intussusception can occur anywhere in the gastrointestinal tract, it usually occurs at the junction of the small and large intestines. The obstruction can cause swelling and inflammation that can lead to intestinal injury. The patient with intussusception is usually an infant, often one who has had an upper respiratory infection, who presents with the following symptoms:
Vomiting: Initially, vomiting is nonbilious and reflexive, but when the intestinal obstruction occurs, vomiting becomes bilious
Abdominal pain: Pain in intussusception is colicky, severe, and intermittent
Passage of blood and mucus: Parents report the passage of stools, by affected children, that look like currant jelly; this is a mixture of mucus, sloughed mucosa, and shed blood; diarrhoea can also be an early sign of intussusception
Lethargy: This can be the sole presenting symptom of intussusception, which makes the condition’s diagnosis challenging
Palpable abdominal mass
Diagnosis:
Ultrasonography: Hallmarks of ultrasonography include the target and pseudo kidney signs.For all children, start intravenous fluid resuscitation and nasogastric decompression as soon as possible.
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This question is part of the following fields:
- Generic Surgical Topics
- Paediatric Surgery
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Question 2
Incorrect
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A man had noticed weakness in his left arm causing flexion of the elbow and supination of the forearm. Which nerve in this case was injured?
Your Answer:
Correct Answer: Musculocutaneous
Explanation:The musculocutaneous nerve supplies the biceps brachii and the brachialis muscles. The first one flexes the elbow and the shoulder. It is also involved in supination. The brachialis muscle flexes the forearm. The injury to the musculocutaneous nerve results in paralysis of these muscles.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 3
Incorrect
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Choose the most correct answer regarding the common peroneal nerve.
Your Answer:
Correct Answer: It gives rise to the nerve that supplies the anterior compartment leg muscles
Explanation:The common peroneal nerve divides beneath the peroneus longus muscle and gives off articular and lateral sural cutaneous nerves which supply muscular branches to the muscles of the anterior compartment of the leg which are the tibialis anterior, extensor digitorum, peroneus tertius and extensor hallucis longus.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 4
Incorrect
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The dural venous sinuses are venous channels that drain blood from the brain. This sinuses are located between which structures?
Your Answer:
Correct Answer: Meningeal and periosteal layers of the dura mater
Explanation:The dural venous sinuses lies between the periosteal and meningeal layer of the dura mater. Dural venous sinuses is unique because it does not run parallel with arteries and allows bidirectional flow of blood intracranially as it is valve-less.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 5
Incorrect
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During a case presentation, a 26 year old is said to have fractured his pelvis and shattered his coccyx following a motorbike accident. It is mentioned that he is likely to have lacerated his middle sacral artery from this kind of injury. Where does the middle sacral artery branch from?
Your Answer:
Correct Answer: Abdominal aorta
Explanation:The middle sacral artery arises from behind the aorta a little above the point of its bifurcation to descend down in front of L4,5, the sacrum and coccyx.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 6
Incorrect
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A 20-year old involved in a brawl was stabbed in the anterior chest in a structure that is in close proximity to where the first rib articulates with the sternum. What is the structure that was most likely injured?
Your Answer:
Correct Answer: Sternoclavicular joint
Explanation:The first rib articulates with the sternum right below the sternoclavicular joint.
The sternal angle articulates with the costal cartilage of the second rib.
The nipple is found between the fourth and the fifth ribs, in the fourth intercostal space.
The xiphoid process is located right below the point of articulation of the costal cartilage of rib 7 with the sternum.
The root of the lung is the part of the lung where neurovascular structures enter and leave the lung.
Acromioclavicular joint is the point of articulation between the acromion process and the clavicle, near the shoulder. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 7
Incorrect
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A suspected recreational drug user was brought to the Emergency department in an unconscious state, and was found to be hypoventilating. Which of the following set of arterial blood gas analysis report is most consistent with hypoventilation as the primary cause? pH, pa(CO2) (mmHg), pa(O2) (mmHg).
Your Answer:
Correct Answer: 7.28, 55, 81
Explanation:Hypoventilation (or respiratory depression) causes an increase in carbon dioxide (hypercapnia) and respiratory acidosis. It can result due to drugs such as alcohol, benzodiazepines, barbiturates, opiates, mechanical conditions or holding ones breath. Strong opioids such as heroin and fentanyl are commonly implicated and can lead to respiratory arrest. In recreational drug overdose, acute respiratory acidosis occurs with an increase in p(CO2) over 45 mm Hg and acidaemia (pH < 7.35)
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 8
Incorrect
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If a 68-year-old man is diagnosed with a testicular seminoma that reaches the tunica albuginea and involves the tunica vaginalis, with retroperitoneal lymph nodes greater than 5cm, LDH 1.4 times the reference levels, β-hCG 4250 mIU/ml and AFP 780 ng/ml, what's the clinical stage in this case?
Your Answer:
Correct Answer: Stage IIC
Explanation:According to the AJCC, the clinical staging for testicular seminoma is:
Stage IA: T1 N0 M0 S0
Stage IB: T2/3/4 N0 M0 S0
Stage IC: any T N0 M0 S1/2/3
Stage IIA: any T N1 M0 S0/1
Stage IIB: any T N2 M0 S0/1
Stage IIC: any T N3 M0 S0/1
Stage IIIA: any T any N M1a S0/1
Stage IIIB: any T any N M0/1a S2
Stage IIIC: any T any N M1a/1b S3.
The patient in this case has IIC stage -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 9
Incorrect
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From which of the following cells is heparin produced?
Your Answer:
Correct Answer: Mast cells
Explanation:Heparin is a natural highly-sulphated glycosaminoglycan that has anticoagulant functions. It is produced by the body basophils and mast cells.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 10
Incorrect
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In the adult heart, the sinus venosus gives rise to the:
Your Answer:
Correct Answer: Coronary sinus
Explanation:The sinus venosus is a large quadrangular cavity which precedes the atrium on the venous side of the chordate heart. It exists distinctly only in the embryonic heart (where it is found between the two venae cavae); however, the sinus venosus persists in the adult. In the adult, it is incorporated into the wall of the right atrium to form a smooth part called the sinus venarum, which is separated from the rest of the atrium by a ridge of fibres called the crista terminalis. The sinus venosus also forms the SA node and the coronary sinus.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 11
Incorrect
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A young girl injured her arm following a fall down the steps On examination, it was found that her left proximal radioulnar joint had dislocated and the annular ligament was stretched. This will make which movement extremely painful?
Your Answer:
Correct Answer: Supination
Explanation:Supination is the rotation of the forearm so that the palm of the hand faces anteriorly. This is performed by the biceps brachii and supinator of the extensor muscles of the thumb. The opposite action of moving the palm from an anterior-facing position to a posterior-facing position is called pronation. Pronation is performed by the pronator teres and pronator quadratus.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 12
Incorrect
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A 45 -year-old female is recently diagnosed with breast cancer. She has a 8-cm-diameter mass in her left breast, with enlarged left axillary node. What is the most likely stage of her disease?
Your Answer:
Correct Answer: IIIA
Explanation:Stage IIIA breast cancer is T0–2 N2 M0 or T3 N1-2 M0 disease. It describes invasive breast cancer in which either: the tumour is smaller than 5 cm in diameter and has spread to 4 to 9 axillary lymph nodes; or it is found through imaging studies or clinical exam to have spread to internal mammary nodes (near the breastbone found during imaging tests or a physical exam); or the tumour is larger than 5 cm and has spread to 1 to 9 axillary nodes, or to internal mammary nodes. In this stage, the cancer has not metastasized (spread to distant sites).
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 13
Incorrect
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A 26-year-old female presents with a long history of obstructed defecation and chronic constipation. She often strains to open her bowels for long periods and occasionally notices that she has passed a small amount of blood. On examination, she has an indurated area located anteriorly approximately 3cm proximal to the anal verge. What is the most likely diagnosis?
Your Answer:
Correct Answer: Solitary rectal ulcer syndrome
Explanation:Solitary rectal ulcer syndrome is a rare disorder that involves straining during defecation, a sense of incomplete evacuation, and sometimes passage of blood and mucus by rectum.
The syndrome is poorly named because associated lesions may be solitary or multiple and ulcerated or nonulcerated; they range from mucosal erythema to ulcers to small mass lesions.
Lesions are typically located in the anterior rectal wall within 10 cm of the anal verge.
It is probably caused by localized ischemic injury or prolapse of the distal rectal mucosa. Diagnosis is clinical with confirmation by flexible sigmoidoscopy and biopsy. Treatment is a bowel regimen for mild cases, but surgery is sometimes needed if rectal prolapse is the cause.The cardinal symptom of Fissure in ano is pain.
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This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 14
Incorrect
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If a 55-year old gentleman who has suffered a stroke, develops a tremor in his fingers that worsens on reaching for an object, what part of his brain is likely to be involved?
Your Answer:
Correct Answer: Cerebellum
Explanation:The cerebellum plays an important role in the integration of sensory perception and motor output. Multiple neural pathways link the cerebellum with the motor cortex and the spinocerebellar tract. The cerebellum uses the constant feedback on body position to fine-tune the movements and integrates these pathways. The patient described here has a characteristic cerebellar tremor that is a slow, broad tremor of the extremities and occurs at the end of a purposeful movement.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 15
Incorrect
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Multiple, non-tender lymphadenopathy with biopsy showing several crowded follicles of small, monomorphic lymphocytes and the absence of Reed-Sternberg cells is seen in which of the following?
Your Answer:
Correct Answer: Poorly differentiated lymphocytic lymphoma
Explanation:Malignant lymphoma usually causes non-tender lymphadenopathy, unlike the tender lymphadenopathy caused by infections (including infectious mononucleosis caused by Epstein-Barr virus). Also, the lymphoid hyperplasia seen in infectious mononucleosis is benign and polyclonal.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 16
Incorrect
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During a surgical operation, whilst dissecting the mediastinal lymph nodes for a bronchogenic carcinoma of the right upper lobe bronchus, a patient's right sympathetic trunk is accidentally severed above the level of spinal nerve T1. Which function would be left intact in the affected region?
Your Answer:
Correct Answer: Voluntary muscle activity
Explanation:The sympathetic nervous system regulates vascular tone, dilation of pupils, arrector pili muscles, sweat production and visceral reflexes. Neurones that supply the voluntary muscles originate from the ventral horn of the spinal cord. If these nerves were thus damaged, these functions would be impaired. The sympathetic nervous system is not responsible for voluntary muscle activity.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 17
Incorrect
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A 30-year-old male presents with pain in the testis and scrotum. It began 10 hours previously and has worsened during that time. On examination, he has pyrexia, the testis is swollen and tender and there is an associated hydrocele. What is the most likely diagnosis?
Your Answer:
Correct Answer: Acute epididymo-orchitis
Explanation:The following history findings are associated with acute epididymitis and orchitis:
– Gradual onset of scrotal pain and swelling, usually unilateral, often developing over several days (as opposed to hours for testicular torsion)
– Dysuria, frequency, or urgency
– Fever and chills (in only 25% of adults with acute epididymitis but in up to 71% of children with the condition)
Usually, no nausea or vomiting (in contrast to testicular torsion)
– Urethral discharge preceding the onset of acute epididymitis (in some cases)Physical examination findings may fail to distinguish acute epididymitis from testicular torsion. Physical findings associated with acute epididymitis may include the following:
– Tenderness and induration occurring first in the epididymal tail and then spreading
– Elevation of the affected hemiscrotum
– Normal cremasteric reflex
– Erythema and mild scrotal cellulitis
– Reactive hydrocele (in patients with advanced epididymo-orchitis)
– Bacterial prostatitis or seminal vesiculitis (in post pubertal individuals)
– With tuberculosis, focal epididymitis, a draining sinus, or beading of the vas deferens
– In children, an underlying congenital anomaly of the urogenital tract
Findings associated with orchitis may include the following:
– Testicular enlargement, induration, and a reactive hydrocele (common)
– Non-tender epididymis
In 20-40% of cases, association with acute epididymitis -
This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 18
Incorrect
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A 60-year-old woman complains of left sided headaches which have been recurring for several years. She recently suffered from a focal seizure for the first time a few days ago. A CT scan shows a mass in the left hemisphere of the brain. The most likely diagnosis is:
Your Answer:
Correct Answer: Meningioma
Explanation:Meningiomas are a common benign intracranial tumour, and their incidence is higher in women between the ages of 40-60 years old. Many of these tumours are asymptomatic and are diagnosed incidentally, although some of them may have malignant presentations (less than 2% of cases). These benign tumours can develop wherever there is dura, over the convexities near the venous sinuses, along the base of the skull, in the posterior fossa and, within the ventricles.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 19
Incorrect
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A 55- year old male patient with cancer of the head of the pancreas was to undergo whipple's operation to have the tumour removed. During the surgery, the surgeon had to ligate the inferior pancreaticoduodenal artery to stop blood supply to the head of the pancreas. Which of the following arteries does the inferior pancreaticoduodenal artery branch from?
Your Answer:
Correct Answer: Superior mesenteric artery
Explanation:The inferior pancreaticoduodenal artery is a branch of the superior mesenteric artery or from the first intestinal branch of the superior mesenteric artery. Once given off, it runs to the right between the pancreatic head and the duodenum and then ascends to form an anastomosis with the superior pancreaticoduodenal artery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 20
Incorrect
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Which of the following arteries branches from the deep femoral artery and courses between the pectineus and iliopsoas muscles?
Your Answer:
Correct Answer: Medical femoral circumflex
Explanation:The medial femoral circumflex artery is an artery in the upper thigh that supplies blood to the head and neck of the femur. It arises from the deep femoral artery and winds around the medial side of the femur. It passes first between pectineus and psoas major, and then between obturator externus and adductor brevis.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 21
Incorrect
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Which of the following muscles may be affected by a fracture to the tuberosity on the medial surface of the right navicular bone?
Your Answer:
Correct Answer: Tibialis posterior
Explanation:The navicular bone is situated at the medial side of the tarsus, between the talus and the cuneiform bones. Its medial surface presents a rounded tuberosity, the lower part of which gives attachment to part of the tendon of the tibialis posterior.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 22
Incorrect
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What is the likely course of a pulmonary embolism arising from the leg veins and ending in the apical segmental pulmonary artery that supplies the superior lobe of left lung?.
Your Answer:
Correct Answer: Inferior vena cava – right atrium – tricuspid valve – right ventricle – pulmonary trunk – left pulmonary artery – left superior lobar artery – left apical segmental artery
Explanation:A clot originating in the leg vein will go to the inferior vena cava, into the right atrium, through the tricuspid valve, into the right ventricle, through the pulmonary trunk, into the left pulmonary artery, into the left superior lobar artery and then finally reach the left apical segmental artery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 23
Incorrect
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A 68 year old man who is scheduled for an amputation suddenly presents to the physician with episodes of vertigo and dysarthria. After a while he collapses and his GCS is recorded to be 3. Which of the following is the most likely diagnosis of this presentation?
Your Answer:
Correct Answer: Basilar artery occlusion
Explanation:The clinical presentation of basilar artery occlusion (BAO) ranges from mild transient symptoms to devastating strokes with high fatality and morbidity. Often, non-specific prodromal symptoms such as vertigo or headaches are indicative of BAO, and are followed by the hallmarks of BAO, including decreased consciousness, quadriparesis, pupillary and oculomotor abnormalities, dysarthria, and dysphagia. When clinical findings suggest an acute brainstem disorder, BAO has to be confirmed or ruled out as a matter of urgency. If BAO is recognised early and confirmed with multimodal CT or MRI, intravenous thrombolysis or endovascular treatment can be undertaken. The goal of thrombolysis is to restore blood flow in the occluded artery and salvage brain tissue; however, the best treatment approach to improve clinical outcome still needs to be ascertained.
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This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 24
Incorrect
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An 80 year old woman is undergoing excision of a basal cell carcinoma from her periorbital region under local anaesthesia. Medical history reveals multiple medical comorbities. Which medication should be stopped prior to surgery?
Your Answer:
Correct Answer: Aspirin
Explanation:Answer: Aspirin
Aspirin increases bleeding time when taken orally. Aspirin causes several different effects in the body, mainly the reduction of inflammation, analgesia (relief of pain), the prevention of clotting, and the reduction of fever. Much of this is believed to be due to decreased production of prostaglandins and TXA2. Aspirin’s ability to suppress the production of prostaglandins and thromboxanes is due to its irreversible inactivation of the cyclooxygenase (COX) enzyme. Cyclooxygenase is required for prostaglandin and thromboxane synthesis. Prostaglandins are local chemical messengers that exert multiple effects including but not limited to the transmission of pain information to the brain, modulation of the hypothalamic thermostat, and inflammation. They are produced in response to the stimulation of phospholipids within the plasma membrane of cells resulting in the release of arachidonic acid (prostaglandin precursor). Thromboxanes are responsible for the aggregation of platelets that form blood clots.
Low-dose, long-term aspirin use irreversibly blocks the formation of thromboxane A2 in platelets, producing an inhibitory effect on platelet aggregation.Antihypertensive and antidiabetic medications do not need to be stopped when a patient is undergoing local anaesthesia. Steroid (Prednisolone) use cannot be stopped abruptly; tapering the drug gives the adrenal glands time to return to their normal patterns of secretion. Withdrawal symptoms and signs (weakness, fatigue, decreased appetite, weight loss, nausea, vomiting, diarrhoea, abdominal pain) can mimic many other medical problems. Some may be life-threatening.
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This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
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Question 25
Incorrect
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A histopathological analysis of a specimen showed loss of individual cell structure with karyorrhexis and fragmentation. The overall integrity of the tissue structure is preserved. This is typical of which of the following pathologies?
Your Answer:
Correct Answer: Viral hepatitis
Explanation:Viral infections will cause necrosis of the hepatocytes with characteristic changes of karyorrhexis and cell fragmentation.
Brown atrophy of the heart is due to accumulation of lipofuscin in the myocardium.
Tissue destruction associated with transplant rejection leads to widespread loss of structural integrity.
Single cell necrosis is not characteristically seen in chronic alcoholic liver.
Barbiturate overdose will result in hypertrophy of the smooth endoplasmic reticulum.
Carcinoma insitu will cause dysplastic cells without the overall structural integrity being disrupted.
Atrophy is due to apoptosis with ordered cellular fragmentation and phagocytosis and will not induce an inflammatory process unlike necrosis. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 26
Incorrect
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A 12 month old baby boy is taken to the office with a history of failure to thrive. He is observed to have a large head and to be small for his age. A cupped appearance of the epiphysis of the wrist is seen on the x-ray. Which condition is this linked to?
Your Answer:
Correct Answer: Rickets
Explanation:Answer: Rickets
Rickets is a disease of growing bone that is unique to children and adolescents. It is caused by a failure of osteoid to calcify in a growing person.
The signs and symptoms of rickets can include:pain – the bones affected by rickets can be sore and painful, so the child may be reluctant to walk or may tire easily; the child’s walk may look different (waddling)
skeletal deformities – thickening of the ankles, wrists and knees, bowed legs, soft skull bones and, rarely, bending of the spine
dental problems – including weak tooth enamel, delay in teeth coming through and increased risk of cavities
poor growth and development – if the skeleton doesn’t grow and develop properly, the child will be shorter than average
fragile bones – in severe cases, the bones become weaker and more prone to fractures.Marfan syndrome (MFS) is a genetic disorder of the connective tissue. The degree to which people are affected varies. People with Marfan tend to be tall and thin, with long arms, legs, fingers and toes. They also typically have flexible joints and scoliosis. The most serious complications involve the heart and aorta, with an increased risk of mitral valve prolapse and aortic aneurysm. Other commonly affected areas include the lungs, eyes, bones and the covering of the spinal cord.
Ehlers-Danlos syndrome is a group of inherited disorders that affect your connective tissues — primarily your skin, joints and blood vessel walls. People who have Ehlers-Danlos syndrome usually have overly flexible joints and stretchy, fragile skin. This can become a problem if you have a wound that requires stitches, because the skin often isn’t strong enough to hold them.
A more severe form of the disorder, called Ehlers-Danlos syndrome, vascular type, can cause the walls of your blood vessels, intestines or uterus to rupture.Osteoporosis is a disease in which bone weakening increases the risk of a broken bone. It is the most common reason for a broken bone among the elderly. Bones that commonly break include the vertebrae in the spine, the bones of the forearm, and the hip. Until a broken bone occurs there are typically no symptoms. Bones may weaken to such a degree that a break may occur with minor stress or spontaneously. Chronic pain and a decreased ability to carry out normal activities may occur following a broken bone.
Osteoporosis may be due to lower-than-normal maximum bone mass and greater-than-normal bone loss. Bone loss increases after menopause due to lower levels of oestrogen. Osteoporosis may also occur due to a number of diseases or treatments, including alcoholism, anorexia, hyperthyroidism, kidney disease, and surgical removal of the ovaries.
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This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 27
Incorrect
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A 45-year-old man complains of shortness of breath, cough and chest pain. Chest X ray revealed a perihilar mass with bronchiectasis in the left mid-lung. Which of the following is most probably associated with these findings?
Your Answer:
Correct Answer: Bronchial carcinoid
Explanation:Bronchial carcinoids are neuroendocrine tumours that arise from Kulchitsky’s cells of the bronchial epithelium. Kulchitsky’s cells belong to the diffuse endocrine system. Patients affected by this tumour may be asymptomatic or may present with symptoms of airway obstruction, like dyspnoea, wheezing, and cough. Other common findings are recurrent pneumonia, haemoptysis, chest pain and paraneoplastic syndromes. Chest radiographs are abnormal in the majority of cases. Peripheral carcinoids usually present as a solitary pulmonary nodule. For central lesions common findings include hilar or perihilar masses with or without atelectasis, bronchiectasis, or consolidation. Bronchial carcinoids most commonly arise in the large bronchi causing obstruction.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 28
Incorrect
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A 51 year old man undergoes a live donor renal transplant. The donor's right kidney is anastomosed to the recipient. On removal of the arterial clamps there is good urinary flow and the wounds are closed. While he is in the ward, it is observed that the he suddenly becomes anuric. Irrigation of the bladder does not improve the situation. What is the most likely cause?
Your Answer:
Correct Answer: Renal artery thrombosis
Explanation:Renal vein thrombosis (RVT) is the formation of a clot in the vein that drains blood from the kidneys, ultimately leading to a reduction in the drainage of one or both kidneys and the possible migration of the clot to other parts of the body.
Venous thrombosis is a rare occurrence, occurring in 0.5% of kidney transplants. With aggressive treatment,
i.e. thrombectomy, the chances of success are very poor, but treatment is successful in rare cases. More often, patients are treated with transplantectomy.The left side is preferred for live donor transplants due to longer renal vein while right side has been associated with renal vein thrombosis and shorter vessels.
With the iliac artery anatomically located lateral to iliac vein, one would need a longer vein in the graft to enable the graft placement in the iliac fossa, its final location. Most renal transplant surgeons would intuitively prefer to implant a graft harvested from the left side. The right kidney has a simpler anatomy for retrieval, with no adrenal or lumbar veins to tackle. However, a long artery and short vein make this kidney’s anatomy skewed for grafting. Studies on cadavers have shown significantly shorter right renal vein length (average 13.7%) on the right side. With its weak posterior wall, there is an added risk of tear of the right renal vein if there is tension during anastomosis. Overzealous manoeuvres and stretching of a short vein during retrieval, or handling during allografting may also risk intimal damage, a possible aetiology for some early reports of right grafts lost to renal vein thrombosis following laparoscopic harvest.
Recommendations:
• On the right, lengthen the renal vein with the infra renal vena cava in order to avoid an anastomosis
under tension.
• Carry out a large venous anastomosis; at declamping, if the renal vein is tight, re-do the venous anastomosis. -
This question is part of the following fields:
- Generic Surgical Topics
- Organ Transplantation
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Question 29
Incorrect
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A 43 year old female with thyrotoxicosis is referred to the endocrinology clinic because she was poorly controlled on carbimazole and has received orbital radiotherapy for severe proptosis. She had improved clinically but she relapsed on stopping her carbimazole. What is the best course of action?
Your Answer:
Correct Answer: Total thyroidectomy
Explanation:Due to this patient having a relapse after using carbimazole following orbital radiotherapy for severe proptosis., total thyroidectomy is the treatment of choice.
Thyroidectomy is the definitive surgical management for Graves thyrotoxicosis and usually requires a short course of pre-treatment with thionamides or inorganic iodine to achieve euthyroid state; this reduces operative complications and thyroid vascularity. Although subtotal thyroidectomy was once practiced, most surgeons now recommend complete thyroidectomy to minimize chances of relapse.Radioactive iodine (I-131) is widely used to treat the thyrotoxicosis of Graves’ disease, but, despite its demonstrable efficacy and safety, there have long been concerns about its possible adverse effect on thyroid eye disease. A study showed that after radioiodine treatment 15% of patients developed new or worsened ophthalmopathy, whereas this occurred in only 3% of patients treated with methimazole and in none treated with radioiodine plus prednisone. In the radioiodine group 24% of those with pre-existing ophthalmopathy suffered an exacerbation, whereas only 8% of patients without eye disease at baseline developed it.
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This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 30
Incorrect
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Which of the following is a true statement regarding secretion of gastric acid?
Your Answer:
Correct Answer: Acetylcholine increases gastric acid secretion
Explanation:Gastric acid secretion is increased by acetylcholine, histamine and gastrin, with the help of cAMP as a secondary messenger. They increase H+ and Cl- secretion by increasing the number of H+/K+ ATPase molecules and Cl- channels. In contrast, gastric acid secretion is decreased by somatostatin, epidermal growth factor and prostaglandins.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
