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  • Question 1 - A 34-year-old male is admitted electively for a right inguinal hernia repair under...

    Incorrect

    • A 34-year-old male is admitted electively for a right inguinal hernia repair under local anaesthesia. He is otherwise asymptomatic and well. However, his family history shows that his grandfather died from a pulmonary embolism.

      What should be the most appropriate form of thromboprophylaxis in this patient?

      Your Answer: Administration of low-dose low-molecular-weight-heparin for two weeks

      Correct Answer: No prophylaxis

      Explanation:

      Repair of an inguinal hernia under local anaesthesia has a short operative time, and patients are usually ambulant immediately after. Furthermore, the family history of this patient is unlikely to be significant and therefore, he is at a very low risk of developing a pulmonary embolism (PE).

      Deep vein thrombosis (DVT) may develop insidiously in many surgical patients. If left untreated, it may progress to PE. The following surgical patients are at increased risk of developing DVT:

      1. Surgery greater than 90 minutes at any site or greater than 60 minutes if the procedure involves lower limbs or pelvis
      2. Acute admissions with inflammatory process involving the abdominal cavity
      3. Expected significant reduction in mobility
      4. Age over 60 years
      5. Known malignancy
      6. Thrombophilia
      7. Previous thrombosis
      8. BMI >30 kg/m2
      9. Taking hormone replacement therapy or contraceptive pills
      10. Varicose veins with phlebitis

      Thromboprophylaxis can be mechanical or therapeutic. The former includes:
      1. Early ambulation after surgery: cheap and effective
      2. Compression stockings (contraindicated in peripheral arterial disease)
      3. Intermittent pneumatic compression devices
      4. Foot impulse devices

      Therapeutic agents for thromboprophylaxis are:
      1. Low-molecular-weight heparin (LMWH)
      2. Unfractionated heparin
      3. Dabigatran

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      5
      Seconds

  • Question 2 - The surgical registrar is doing an exploratory laparotomy on a 35 year old...

    Incorrect

    • The surgical registrar is doing an exploratory laparotomy on a 35 year old lady of African descent with tuberculous of the abdomen and suspected perforation. The small bowel is matted due to adhesions and it is difficult to differentiate the ileum from the jejunum. Which of the following features is typical of the jejunum?

      Your Answer:

      Correct Answer: It has sparse aggregated lymph nodules

      Explanation:

      The jejunum has a wider diameter, is thicker and more vascularized, hence of a deeper colour compared to the ileum. The valvulae conniventes (circular folds) of its mucous membranes are large and thick and its villi are larger than those in the ileum. The jejunum also has sparse aggregates of lymph nodules and most of its part occupies the umbilical and left iliac regions whilst the ileum is mostly in the umbilical, hypogastric, right iliac and pelvic regions.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 3 - A middle aged woman presents with a 4 day history of sore throat,...

    Incorrect

    • A middle aged woman presents with a 4 day history of sore throat, malaise and fatigue and she is seen to have a large peritonsillar abscess on examination. Which of the following would most likely be the causative agent?

      Your Answer:

      Correct Answer: Streptococcus pyogenes

      Explanation:

      Answer: Streptococcus pyogenes

      Tonsillitis is inflammation of the pharyngeal tonsils. The inflammation usually extends to the adenoid and the lingual tonsils; therefore, the term pharyngitis may also be used. Most cases of bacterial tonsillitis are caused by group A beta-haemolytic Streptococcus pyogenes (GABHS).

      Signs and symptoms
      Tonsillitis

      Individuals with acute tonsillitis present with the following:
      Fever
      Sore throat
      Foul breath
      Dysphagia (difficulty swallowing)
      Odynophagia (painful swallowing)
      Tender cervical lymph nodes

      Airway obstruction may manifest as mouth breathing, snoring, sleep-disordered breathing, nocturnal breathing pauses, or sleep apnoea.

      Peritonsillar abscess

      Individuals with peritonsillar abscess (PTA) present with the following:
      Severe throat pain
      Fever
      Drooling
      Foul breath
      Trismus (difficulty opening the mouth)
      Altered voice quality (the hot-potato voice)

      Treatment of acute tonsillitis is largely supportive and focuses on maintaining adequate hydration and caloric intake and controlling pain and fever.

      Corticosteroids may shorten the duration of fever and pharyngitis in cases of infectious mononucleosis (MN). In severe cases of MN, corticosteroids or gamma globulin may be helpful. GABHS infection obligates antibiotic coverage.

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
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  • Question 4 - A 57-year-old male smoker noted a lump on his inner lip. Upon physical...

    Incorrect

    • A 57-year-old male smoker noted a lump on his inner lip. Upon physical examination the lump measured more than 2 cm but less than 4 cm in its greatest dimension. He is diagnosed with squamous cell carcinoma of the lip. What is the stage of the patient's cancer according to the TNM staging for head and neck cancers?

      Your Answer:

      Correct Answer: T2

      Explanation:

      Head and neck cancer is a group of cancers that starts within the mouth, nose, throat, larynx, sinuses, or salivary glands. The TNM staging system used for head and neck cancers is a clinical staging system that allows physicians to compare results across patients, assess prognosis, and design appropriate treatment regimens. The staging is as follows; Primary tumour (T): Tis: pre-invasive cancer (carcinoma in situ), T0: no evidence of primary tumour, T1: tumour 2 cm or less in its greatest dimension, T2: tumour more than 2 cm but not more than 4 cm, T3: tumour larger than 4 cm, T4: tumour with extension to bone, muscle, skin, antrum, neck, etc and TX: minimum requirements to assess primary tumour cannot be met. Regional lymph node involvement (N): N0: no evidence of regional lymph node involvement, N1: evidence of involvement of movable homolateral regional lymph nodes, N2: evidence of involvement of movable contralateral or bilateral regional lymph nodes, N3: evidence of involvement of fixed regional lymph nodes and NX: Minimum requirements to assess the regional nodes cannot be met. Distant metastases (M): M0: no evidence of distant metastases, M1: evidence of distant metastases and MX: minimum requirements to assess the presence of distant metastases cannot be met. Staging: Stage I: T1 N0 M0, Stage II: T2 N0 M0, Stage III: T2NOMO and T3N1MO, Stage IV: T4N1M0, any TN2M0, any TN3M0, any T and any NM1. The depth of infiltration is predictive of the prognosis. With increasing depth of invasion of the primary tumour, the risk of nodal metastasis increases and survival decreases. The patient in this scenario therefore has a T2 tumour.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 5 - Which of these illnesses is most likely to precede Guillain-Barré syndrome? ...

    Incorrect

    • Which of these illnesses is most likely to precede Guillain-Barré syndrome?

      Your Answer:

      Correct Answer: Viral pneumonia

      Explanation:

      Guillain–Barré syndrome (GBS) is characterized by a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. In about two-thirds of patients, the syndrome begins 5 days to 3 weeks after an infectious disease, surgery or vaccination. Infection is the trigger in over 50% of patients; common pathogens include Campylobacter jejuni, enteric viruses, herpesviruses (including cytomegalovirus and those causing infectious mononucleosis) and Mycoplasma species. The underlying mechanism involves an autoimmune disorder in which the body’s immune system mistakenly attacks the peripheral nerves and damages their myelin insulation, although the cause for this is still unknown.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 6 - Which of the following compensatory parameters is responsible for causing an increase in...

    Incorrect

    • Which of the following compensatory parameters is responsible for causing an increase in the blood pressure in a 30 year old patient with a BP of 40 mmHg?

      Your Answer:

      Correct Answer: Baroreceptor reflex

      Explanation:

      The baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for regulating blood pressure. It provides a negative feedback response in which an elevated blood pressure will causes blood pressure to decrease; similarly, decreased blood pressure depresses the baroreflex, causing blood pressure to rise. The system relies on specialised neurones (baroreceptors) in the aortic arch, carotid sinuses and elsewhere to monitor changes in blood pressure and relay them to the brainstem. Subsequent changes in blood pressure are mediated by the autonomic nervous system. Baroreceptors include those in the auricles of the heart and vena cava, but the most sensitive baroreceptors are in the carotid sinuses and aortic arch. The carotid sinus baroreceptors are innervated by the glossopharyngeal nerve (CN IX); the aortic arch baroreceptors are innervated by the vagus nerve (CN X).

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
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  • Question 7 - During work up for a 29 year-old lady who complained of chest pain,...

    Incorrect

    • During work up for a 29 year-old lady who complained of chest pain, a computed tomography showed a large mass in the posterior mediastinum. Which among the following structures could be involved?

      Your Answer:

      Correct Answer: Lymph glands

      Explanation:

      Boundaries of the posterior mediastinum include:
      Superior: a plane through the sternal angle and T4/5
      Inferior: the diaphragm
      Anterior: the middle mediastinal structures
      Posterior the spinal cord.
      Structures in the posterior mediastinum include the descending thoracic aorta, the azygos system, oesophagus, thoracic duct and lymph nodes. The great vessels and structures at the root of the lung are part of the middle mediastinum. In this case, the lymph nodes is the correct answer.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 8 - A 30-year-old male presents with a lump in his scalp. It is located...

    Incorrect

    • A 30-year-old male presents with a lump in his scalp. It is located approximately 4cm superior to the external occipital protuberance. It feels smooth and slightly fluctuant and has a centrally located small epithelial defect. What is the most likely underlying diagnosis?

      Your Answer:

      Correct Answer: Sebaceous cyst

      Explanation:

      Epidermoid cysts represent the most common cutaneous cysts. While they may occur anywhere on the body, they occur most frequently on the face, scalp, neck, and trunk.
      Because most lesions originate from the follicular infundibulum, the more general term epidermoid cyst is favoured. The term sebaceous cyst should be avoided because it implies that the cyst is of sebaceous origin.
      Epidermoid cysts are usually asymptomatic. Discharge of a foul-smelling “cheese like” material may be described. Less frequently, the cysts can become inflamed or infected, resulting in pain and tenderness. In the uncommon event of malignancy, rapid growth, friability, and bleeding may be reported.
      Epidermoid cysts appear as flesh–coloured-to-yellowish, firm, round nodules of variable size. A central pore or punctum may be present.
      Certain hereditary syndromes are associated with epidermoid cysts. Such syndromes include Gardner syndrome, basal cell nevus syndrome, and pachyonychia congenita. In addition, idiopathic scrotal calcinosis may actually represent an end-stage of dystrophic calcification of epidermoid cysts.
      Epidermoid cysts may be removed via simple excision or incision with removal of the cyst and cyst wall through the surgical defect. If the entire cyst wall is not removed, the lesion may recur. Excision with punch biopsy technique may be used if the size of the lesion permits. Minimal-incision surgery, with reduced scarring, has been reported. An intraoral approach has been used to minimize facial scarring.
      Incision and drainage may be performed if a cyst is inflamed. Injection of triamcinolone into the tissue surrounding the inflamed cyst results in a faster improvement in symptoms. This may facilitate the clearing of infection; however, it does not eradicate the cyst.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Skin Lesions
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  • Question 9 - A 63-year old lady presents with pain in multiple bones and renal failure....

    Incorrect

    • A 63-year old lady presents with pain in multiple bones and renal failure. On enquiry, there is history of recurrent pneumonia in the past. What will be the likely finding on her bone marrow biopsy?

      Your Answer:

      Correct Answer: Plasma cells

      Explanation:

      Multiple myeloma is a plasma cell malignancy that produce excessive monoclonal immunoglobulins. The disease presents with bone pains, renal dysfunction, increased calcium, anaemia and recurrent infections. Diagnosis is by demonstrating the presence of M-protein in urine or serum, lytic bone lesions, light chain proteinuria or excessive plasma cells on marrow biopsy.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 10 - A 51 year old female presents with a sensation of grittiness in her...

    Incorrect

    • A 51 year old female presents with a sensation of grittiness in her eyes which has been present for the past few months. She also complains of symptoms of a dry mouth. On examination, she is seen with a swelling of her parotid gland. However, she has no evidence of facial nerve palsy. Which of the following is the most likely underlying diagnosis?

      Your Answer:

      Correct Answer: Sjogren's syndrome

      Explanation:

      Sjogren syndrome (SS) is a long-term autoimmune disease that affects the body’s moisture-producing glands. Primary symptoms are a dry mouth and dry eyes. Other symptoms can include dry skin, vaginal dryness, a chronic cough, numbness in the arms and legs, feeling tired, muscle and joint pains, and thyroid problems. Those affected are at an increased risk (5%) of lymphoma. It primarily affects women in their peri and post-menopausal years of life.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Head And Neck Surgery
      0
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  • Question 11 - Which of the deep fasciae located in the anterolateral abdominal wall form the...

    Incorrect

    • Which of the deep fasciae located in the anterolateral abdominal wall form the inguinal ligament?

      Your Answer:

      Correct Answer: External abdominal oblique aponeurosis

      Explanation:

      The inguinal ligament is the inferior border of the aponeurosis of the external oblique abdominis and extends from the anterior superior iliac spine to the pubic tubercle from whence it is reflected backward and laterally to attach to the pectineal line and form the lacunar ligament.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 12 - A 10-year-old boy was sent for an x-ray of the leg because he...

    Incorrect

    • A 10-year-old boy was sent for an x-ray of the leg because he was complaining of pain and swelling. The x-ray showed the classic sign of Codman's triangle. What is the most likely diagnosis of this patient?

      Your Answer:

      Correct Answer: Osteosarcoma

      Explanation:

      Codman’s triangle is the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone. The main causes for this sign are osteosarcoma, Ewing’s sarcoma, eumycetoma, and a subperiosteal abscess.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 13 - A machine worker fractured the medial epicondyle of his right humerus resulting in...

    Incorrect

    • A machine worker fractured the medial epicondyle of his right humerus resulting in damage to an artery running with the ulnar nerve posterior to the medial epicondyle. The artery injured is the?

      Your Answer:

      Correct Answer: Superior ulnar collateral

      Explanation:

      The superior ulnar collateral artery runs posterior to the medial epicondyle of the humerus, accompanied by the ulnar nerve. This artery arises from the brachial artery near the middle of the arm and ends under the flexor carpi ulnaris muscle by anastomosing with two arteries: the posterior ulnar recurrent and inferior ulnar collateral.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 14 - A 47-year-old male smoker, who had been self-medicating with oral steroids for the...

    Incorrect

    • A 47-year-old male smoker, who had been self-medicating with oral steroids for the last two years due to persistent breathlessness presented to the doctor complaining of a productive cough, fever and chest pain. A chest X-ray revealed bilateral patchy opacities. He was diagnosed with bilateral bronchopneumonia. Which of these organisms is most probably causing these findings?

      Your Answer:

      Correct Answer: Nocardia asteroides

      Explanation:

      Nocardia is a Gram-positive aerobic actinomycete. Several species have been identified but the most common human pathogen is Nocardia asteroides. The predominant clinical finding in the majority of patients affected by nocardiosis is pulmonary disease. Predisposing factors for pulmonary nocardiosis include leukaemia, human immunodeficiency virus (HIV) infection, organ transplantation, diabetes and receiving prolonged corticosteroids.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 15 - Structures passing through the foramen magnum do NOT include the: ...

    Incorrect

    • Structures passing through the foramen magnum do NOT include the:

      Your Answer:

      Correct Answer: Vagus nerve

      Explanation:

      Structures passing through the foramen magnum include the medulla, meninges, tectorial membrane, anterior spinal artery, vertebral artery and spinal branches of the accessory nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 16 - Whilst snorkelling, a 30-year old gentleman has the respiratory rate of 10/min, tidal...

    Incorrect

    • Whilst snorkelling, a 30-year old gentleman has the respiratory rate of 10/min, tidal volume of 550 ml and an effective anatomical dead space of 250 ml. What is his alveolar ventilation?

      Your Answer:

      Correct Answer: 3000 ml/min

      Explanation:

      Alveolar ventilation is the amount of air reaching the alveoli per minute. Alveolar ventilation = respiratory rate × (tidal volume – anatomical dead space volume). Thus, alveolar ventilation = 10 × (550 − 250) = 3000 ml/min.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
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  • Question 17 - A 54-year-old male presents with central chest pain and vomiting. He has drunk...

    Incorrect

    • A 54-year-old male presents with central chest pain and vomiting. He has drunk a bottle of vodka. On examination, there is some mild crepitus in the epigastric region. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Oesophageal perforation

      Explanation:

      Boerhaave syndrome classically presents as the Mackler triad of chest pain, vomiting, and subcutaneous emphysema due to oesophageal rupture, although these symptoms are not always present.
      The classic clinical presentation of Boerhaave syndrome usually consists of repeated episodes of retching and vomiting, typically in a middle-aged man with recent excessive dietary and alcohol intake.
      These repeated episodes of retching and vomiting are followed by a sudden onset of severe chest pain in the lower thorax and the upper abdomen. The pain may radiate to the back or to the left shoulder. Swallowing often aggravates the pain.
      Typically, hematemesis is not seen after oesophageal rupture, which helps to distinguish it from the more common Mallory-Weiss tear.
      Swallowing may precipitate coughing because of the communication between the oesophagus and the pleural cavity.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
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  • Question 18 - Regarding the posterior compartment of the leg, which is correct? ...

    Incorrect

    • Regarding the posterior compartment of the leg, which is correct?

      Your Answer:

      Correct Answer: The muscles plantarflex the foot and are innervated by the tibial nerve

      Explanation:

      The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris. Deep muscles include tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus. The superficial ( calf muscles) which are responsible for plantarflexion of the foot are supplied by the tibial nerve as follows: the gastrocnemius and soleus muscles are supplied by the first and second sacral nerves and the plantaris by the fourth and fifth lumbar and first sacral nerve (the tibial nerve).

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 19 - Which of the following is the most likely cause of massive splenomegaly in...

    Incorrect

    • Which of the following is the most likely cause of massive splenomegaly in a 35-year old gentleman?

      Your Answer:

      Correct Answer: Myelofibrosis

      Explanation:

      Causes of massive splenomegaly include chronic myelogenous leukaemia, chronic lymphocytic leukaemia, lymphoma, hairy cell leukaemia, myelofibrosis, polycythaemia vera, sarcoidosis, Gaucher’s disease and malaria.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 20 - A 40-year old gentleman, who is a known with ulcerative colitis, complains of...

    Incorrect

    • A 40-year old gentleman, who is a known with ulcerative colitis, complains of recent-onset of itching and fatigue. On examination, his serum alkaline phosphatase level was found to be high. Barium radiography of the biliary tract showed a 'beaded' appearance. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Sclerosing cholangitis

      Explanation:

      Primary sclerosing cholangitis is characterised by patchy inflammation, fibrosis and strictures in intra- and extra-hepatic bile ducts. It is a chronic cholestatic condition with 80% patients having associated inflammatory bowel disease (likely to be ulcerative colitis). Symptoms include pruritus and fatigue. ERCP (endoscopic retrograde cholangiopancreatography) or MRCP (magnetic resonance cholangiopancreatography) are diagnostic. Disease can lead to complete obliteration of ducts, which can result in liver failure. Cholangiocarcinoma is also a recognised complication..

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 21 - A terrorist running away from the police was shot in the back. The...

    Incorrect

    • A terrorist running away from the police was shot in the back. The bullet hit his left lung halfway between its apex and the diaphragmatic surface. Which part of the lung was most likely to be injured?

      Your Answer:

      Correct Answer: Inferior lobe

      Explanation:

      The oblique fissure of the left lung is so sharp that the posterior surface of the left lung is mostly composed of the inferior lobe so that the point halfway between the apex and the diaphragmatic surface of the lung would result in injury to the inferior lobe.
      The hilum is the point on the medial surface of the lung where the structures that form the root of the lung enter and leave the lung.
      The lingual on the other hand is part of the superior lobe of the left lung and it is part of the anterior and superior sides of the lung.
      The middle lobe is only found on the right lung.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 22 - A 34 year old woman underwent a wide local excision for her breast...

    Incorrect

    • A 34 year old woman underwent a wide local excision for her breast carcinoma. Histology reveals an invasive lobular carcinoma present at three of the resection margins. Cavity shavings that were taken at the original operation are also involved. The sentinel lymph node biopsy was reported to be negative. Which of the following management plans would be the most appropriate for this patient?

      Your Answer:

      Correct Answer: Arrange for completion mastectomy alone

      Explanation:

      Mastectomy should ideally be done in this patient. This patient has extensive spread of disease and tumour margins are unclear which makes radiotherapy the less likely option. Mastectomy is the safest option in this scenario. Patients who have undergone mastectomy may be offered a reconstructive procedure either in conjunction with their primary resection or as a staged procedure at a later date.

    • This question is part of the following fields:

      • Breast And Endocrine Surgery
      • Generic Surgical Topics
      0
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  • Question 23 - 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 24 - A patient with this type of tumour is advised to follow up regularly...

    Incorrect

    • A patient with this type of tumour is advised to follow up regularly for monitoring of tumour size as there is a strong correlation with malignant potential and tumour size. Which of the following is the most likely tumour in this patient?

      Your Answer:

      Correct Answer: Renal adenocarcinoma

      Explanation:

      The distinction between a benign renal adenoma and renal adenocarcinoma is commonly made on the basis of size. Tumours less than 2 cm in size rarely become malignant as opposed to those greater than 3 cm.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 25 - A 78-year-old woman was brought to the emergency department with decreased consciousness, weakness...

    Incorrect

    • A 78-year-old woman was brought to the emergency department with decreased consciousness, weakness and dehydration. Which serum electrolyte would most likely be low in this patient?

      Your Answer:

      Correct Answer: Na+

      Explanation:

      Hyponatremia is a sodium level below 135 mEq/L. Signs and symptoms may include: nausea with vomiting, fatigue, headache or confusion, cramps or spasm, irritability and restlessness and severe cases may lead to seizures and comma.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 26 - A 50-year old gentleman who suffered a stroke was brought to the emergency...

    Incorrect

    • A 50-year old gentleman who suffered a stroke was brought to the emergency department by his relatives. The patient however denied the presence of paralysis of his left upper and lower limbs. What is the most likely site of the lesion in this patient?

      Your Answer:

      Correct Answer: Right posterior parietal cortex

      Explanation:

      A large injury to the non-dominant parietal cortex can make the patient neglect or refuse to acknowledge the presence of paralysis on the contralateral side. This can also involve the perception of the external world. Smaller injuries in this area which involve the precentral gyrus (primary motor cortex) or postcentral gyrus (primary sensory cortex) cause contralateral spastic paralysis or contralateral loss of tactile sensation respectively. A lesion in posterior inferior gyrus of the dominant frontal lobe results in motor aphasia. Involvement of the posterior superior gyrus of the dominant frontal lobe produces sensory aphasia.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 27 - A 30 year old welder presents to his family doctor with symptoms of...

    Incorrect

    • A 30 year old welder presents to his family doctor with symptoms of chronic ear discharge and a left-sided facial nerve palsy. On examination, he has foul smelling fluid draining from his left ear and a complete left-sided facial nerve palsy. What is the most likely cause?

      Your Answer:

      Correct Answer: Cholesteatoma

      Explanation:

      A cholesteatoma consists of squamous epithelium that is trapped within the skull base and that can erode and destroy important structures within the temporal bone. They often become infected and can result in chronically draining ears. Treatment almost always consists of surgical removal. The majority (98%) of people with cholesteatoma have ear discharge or conductive hearing loss or both in the affected ear.

      Other more common conditions (e.g. otitis externa) may also present with these symptoms, but cholesteatoma is much more serious and should not be overlooked. If a patient presents to a doctor with ear discharge and hearing loss, the doctor should consider cholesteatoma until the disease is definitely excluded.

      Other less common symptoms (all less than 15%) of cholesteatoma may include pain, balance disruption, tinnitus, earache, headaches and bleeding from the ear. There can also be facial nerve weakness. Balance symptoms in the presence of a cholesteatoma raise the possibility that the cholesteatoma is eroding the balance organs in the inner ear.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Head And Neck Surgery
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  • Question 28 - A 57 year old male is diagnosed with carcinoma of the caecum. A...

    Incorrect

    • A 57 year old male is diagnosed with carcinoma of the caecum. A CT scan is performed and it shows a tumour invading the muscularis propria with some regional lymphadenopathy. What is the best initial treatment?

      Your Answer:

      Correct Answer: Right hemicolectomy

      Explanation:

      Open right hemicolectomy (open right colectomy) is a procedure that involves removing the caecum, the ascending colon, the hepatic flexure (where the ascending colon joins the transverse colon), the first third of the transverse colon, and part of the terminal ileum, along with fat and lymph nodes. It is the standard surgical treatment for malignant neoplasms of the right colon; the effectiveness of other techniques are measured by the effectiveness of this technique.

      The caecum is a short, pouch-like region of the large intestine between the ascending colon and vermiform appendix. It is located in the lower right quadrant of the abdominal cavity, inferior and lateral to the ileum.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
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  • Question 29 - An infant, 5 weeks and 6 days old born with a large sub-aortic...

    Incorrect

    • An infant, 5 weeks and 6 days old born with a large sub-aortic ventricular septal defect, is prepared for pulmonary artery banding through a left thoracotomy (the child is not fit for a surgical closure). The surgeon initially passes his index finger immediately behind two great arteries in the pericardial sac to mobilise the great arteries in order to pass the tape around the pulmonary artery. Into which space is the surgeon's finger inserted?

      Your Answer:

      Correct Answer: Transverse pericardial sinus

      Explanation:

      Cardiac notch: is an indentation on the left lung of the heart.
      Coronary sinus: a venous sinus on the surface of the heart (the posterior aspect) that receives blood from the smaller veins that drain the heart.
      Coronary sulcus: a groove on the heart between the atria and ventricles.
      Transverse pericardial sinus: located behind the aorta and pulmonary trunk and anterior to the superior vena cava.
      Oblique pericardial sinus: located behind the left atrium. Accessed from the inferior side (or the apex) of the heart upwards.
      Horizontal pericardial sinus: this is a made-up term.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 30 - Which of the following tumours is very radiosensitive? ...

    Incorrect

    • Which of the following tumours is very radiosensitive?

      Your Answer:

      Correct Answer: Seminoma

      Explanation:

      Seminoma is the most radiosensitive tumour and responds well to radiation therapy after unilateral orchidectomy. The ipsilateral inguinal areas are routinely not treated however, depending on the stage, the mediastinum and the left supraclavicular regions may also be irradiated.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 31 - An 8 month old baby girl presents with a spiral fracture of her...

    Incorrect

    • An 8 month old baby girl presents with a spiral fracture of her left humerus. Her father states that he grabbed her arm because she was falling off the park slide. He noticed that something was wrong and he rushed to the hospital with her. Which of the following is the most likely issue?

      Your Answer:

      Correct Answer: Accidental fracture

      Explanation:

      In this case, there is no delay in treatment and the mechanism by which the fracture occurred fits accidental fracture.

      A statement from the parent or guardian and any witnesses regarding how the child sustained the injury will help determine whether the injury is accidental or abusive. A statement from the parent or guardian explaining why he or she delayed in seeking medical treatment is important to the investigation because caretakers often postpone medical treatment or fail to provide treatment for an injured child to hide physical abuse. The abusing parent or caregiver may also put a child in oversized clothing or keep the child inside a residence for extended periods of time in an attempt to conceal the child’s injuries.

      Parents who inflict fractures on their children tend to minimize the severity of the accident purported to cause the fracture, whereas many parents of children with accidental fractures will relate a history of high-energy events.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
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  • Question 32 - A middle aged man who is reported to have a penicillin allergy is...

    Incorrect

    • A middle aged man who is reported to have a penicillin allergy is given a dose of intravenous co-amoxiclav before undergoing an inguinal hernia repair. His vital signs a few minutes after are: pulse 131bpm and blood pressure 61/42mmHg. Which of the following is the first line treatment?

      Your Answer:

      Correct Answer: Adrenaline 1:1000 IM

      Explanation:

      Answer: Adrenaline 1:1000 IM

      Early treatment with intramuscular adrenaline is the treatment of choice for patients having an anaphylactic reaction. IM Injection:

      Adults: The usual dose is 500 micrograms (0.5ml of adrenaline 1/1000). If necessary, this dose may be repeated several times at 5-minute intervals according to blood pressure, pulse and respiratory function.

      Additional measures

      Beta2-agonists for bronchospasm: administer salbutamol or terbutaline by aerosol or nebuliser.

      Antihistamines: administer both H1and H2receptor blockers slowly intravenously:
      promethazine 0.5-1 mg/kg
      and
      ranitidine 1 mg/kg or famotidine 0.4 mg/kg or cimetidine 4 mg/kg
      Corticosteroids: administer intravenously: hydrocortisone 2-6 mg/kg or dexamethasone 0.1-0.4 mg/kg
      Nebulised adrenaline (5 mL of 1:1000) may be tried in laryngeal oedema and often will ease upper airways obstruction. However, do not delay intubation if upper airways obstruction is progressive.

      Anaphylaxis is an acute, potentially fatal, multiorgan system reaction caused by the release of chemical mediators from mast cells and basophils. The classic form involves prior sensitization to an allergen with later reexposure, producing symptoms via an immunologic mechanism.

      Anaphylaxis most commonly affects the cutaneous, respiratory, cardiovascular, and gastrointestinal systems. The skin or mucous membranes are involved in 80-90% of cases. A majority of adult patients have some combination of urticaria, erythema, pruritus, or angioedema. However, for poorly understood reasons, children may present more commonly with respiratory symptoms followed by cutaneous symptoms. It is also important to note that some of the most severe cases of anaphylaxis present in the absence of skin findings.

      Initially, patients often experience pruritus and flushing. Other symptoms can evolve rapidly, such as the following:

      Dermatologic/ocular: Flushing, urticaria, angioedema, cutaneous and/or conjunctival injection or pruritus, warmth, and swelling

      Respiratory: Nasal congestion, coryza, rhinorrhoea, sneezing, throat tightness, wheezing, shortness of breath, cough, hoarseness, dyspnoea

      Cardiovascular: Dizziness, weakness, syncope, chest pain, palpitations

      Gastrointestinal: Dysphagia, nausea, vomiting, diarrhoea, bloating, cramps

      Neurologic: Headache, dizziness, blurred vision, and seizure (very rare and often associated with hypotension)

      Other: Metallic taste, feeling of impending doom

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
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  • Question 33 - A 34-year-old woman with pelvic inflammatory disease is administered ceftriaxone. The subclass of...

    Incorrect

    • A 34-year-old woman with pelvic inflammatory disease is administered ceftriaxone. The subclass of antibiotics that ceftriaxone belongs to is:

      Your Answer:

      Correct Answer: Third-generation cephalosporins

      Explanation:

      Ceftriaxone is a third-generation cephalosporin antibiotic. It has a broad spectrum of activity against Gram-positive and Gram-negative bacteria. Its indications include middle ear infections, endocarditis, meningitis, pneumonia, bone and joint infections, intra-abdominal infections, skin infections, urinary tract infections, gonorrhoea, and pelvic inflammatory disease.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 34 - 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 35 - A 50 year old male point was diagnosed with tennis elbow that became...

    Incorrect

    • A 50 year old male point was diagnosed with tennis elbow that became worse after he started playing basket ball over the last three months. He was admitted to the orthopaedic ward to have elbow braces fitted. What type of synovial joint is the elbow joint?

      Your Answer:

      Correct Answer: Hinge

      Explanation:

      The elbow joint is one of the many synovial joints in the body. This joint is an example of the hinge joint as the humerus is received into the semilunar notch of the ulna and the capitulum of the humerus articulates with the fovea on the head of the radius, together acting as a hinge in one plane.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 36 - 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
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  • Question 37 - Which of the following muscles attaches to the pterygomandibular raphe? ...

    Incorrect

    • Which of the following muscles attaches to the pterygomandibular raphe?

      Your Answer:

      Correct Answer: Superior pharyngeal constrictor muscle

      Explanation:

      The pterygomandibular raphé (pterygomandibular ligament) provides attachment on its posterior border to the superior pharyngeal constrictor and on its anterior border to the buccinator muscle.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 38 - A 4-month-old boy is brought to the clinic by his mother who has...

    Incorrect

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

      Your Answer:

      Correct Answer: Rhabdomyosarcoma

      Explanation:

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

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

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
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  • Question 39 - A 45 year-old female presents with a drooping eyelid. During examination, the same...

    Incorrect

    • A 45 year-old female presents with a drooping eyelid. During examination, the same pupil of the patient is found to be dilated. Which nerve could be involve in this case?

      Your Answer:

      Correct Answer: Oculomotor nerve

      Explanation:

      The oculomotor nerve controls most of the eye muscles. It also controls the constriction of the pupils and thickening of the lens of the eye. This can be tested in two main ways. By moving a finger toward a person’s face to induce accommodation, their pupils should constrict or shining a light into one eye should result in equal constriction of the other eye. The neurons in the optic nerve decussate in the optic chiasm with some crossing to the contralateral optic nerve tract. This is the basis of the swinging-flashlight test. Loss of accommodation and continued pupillary dilation can indicate the presence of a lesion of the oculomotor nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 40 - 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 41 - During laparoscopic surgery to repair a direct inguinal hernia in a 68-year old...

    Incorrect

    • During laparoscopic surgery to repair a direct inguinal hernia in a 68-year old man, the surgeon asked the registrar to look at the medial inguinal fossa to identify the direct inguinal hernia. To do so, she would have to look at the area that is between the:

      Your Answer:

      Correct Answer: Medial umbilical ligament and inferior epigastric artery

      Explanation:

      The medial umbilical fold is made by the medial umbilical ligament-which is the obliterated portion of the umbilical artery, while the lateral umbilical fold is a fold of peritoneum over the inferior epigastric vessels. The median umbilical fold is a midline structure made by the median umbilical ligament i.e. the obliterated urachus. The medial inguinal fossa is the space on the inner abdominal wall between the medial umbilical fold and the lateral umbilical fold. It is place in the abdominal wall where there is an area of weak fascia i.e. the inguinal triangle through which direct inguinal hernias break through. The lateral inguinal fossa on the other hand is a space lateral to the lateral umbilical fold. Indirect inguinal hernias push through this space.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 42 - A 52 year old man undergoes a renal transplant from a living related...

    Incorrect

    • A 52 year old man undergoes a renal transplant from a living related donor. He is well for the first five months, but on review in the renal clinic, he is noted to have persistent hypertension and a slight deterioration in renal function. What is the best explanation for this?

      Your Answer:

      Correct Answer: Renal artery stenosis

      Explanation:

      Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplant. It occurs most frequently in the first 6 months after kidney transplant, and is one of the major causes of graft loss and premature death in transplant recipients. Transplant renal artery stenosis (TRAS) is the narrowing of the transplant renal artery, impeding blood flow to the allograft. It accounts for 1–5% cases of post-transplant hypertension. Patients with TRAS have activated RAAS and usually present with worsening or refractory hypertension, fluid retention and/or allograft dysfunction without evidence of rejection.
      Percutaneous transluminal angioplasty with stent placement is generally the first-line therapy to correct hemodynamically significant stenosis in TRAS, especially for lesions that are short, linear and distal to the anastomosis.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Organ Transplantation
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  • Question 43 - Regarding the coagulation cascade, Factor VII: ...

    Incorrect

    • Regarding the coagulation cascade, Factor VII:

      Your Answer:

      Correct Answer: Is mainly synthesised by the vascular endothelium

      Explanation:

      Factor VII is an important part of the coagulation cascade. Deficiency causes haemophilia A. It is synthesised predominantly by the vascular endothelium and is not affect by liver disease. In the circulation it is bound to von Willebrand factor and it forms a stable complex. It is activated by thrombin or factor Xa and acts as a co-factor to factor IXa to activate factor X.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 44 - Which one of the following is a derivative of the midgut? ...

    Incorrect

    • Which one of the following is a derivative of the midgut?

      Your Answer:

      Correct Answer: Caecum

      Explanation:

      The primary intestinal loop is formed from the midgut which gives rise to the distal half of the duodenum, the jejunum, ascending colon, proximal two thirds of the transverse colon and the ileum.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 45 - A 25 year-old female medical student presents with fever, lack of appetite, rashes,...

    Incorrect

    • A 25 year-old female medical student presents with fever, lack of appetite, rashes, sore throat and lymphadenopathy. Peripheral smear shows atypical lymphocytes. Which is the most likely organism responsible for this patient's condition?

      Your Answer:

      Correct Answer: Epstein–Barr virus

      Explanation:

      Epstein-Barr virus is in the herpes family of viruses and most people will become infected with EBV sometime during their lives. EBV commonly causes infectious mononucleosis, or mono, a contagious viral illness that initially attacks the lymph nodes in the neck and throat. When these tissues become less effective in fighting infection, sore throats, swelling of the nodes and fever may result.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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      Seconds

  • Question 46 - Hormones of the anterior pituitary include which of the following? ...

    Incorrect

    • Hormones of the anterior pituitary include which of the following?

      Your Answer:

      Correct Answer: Prolactin

      Explanation:

      The anterior pituitary gland (adenohypophysis or pars distalis) synthesizes and secretes:
      1. FSH (follicle-stimulating hormone)
      2. LH (luteinizing hormone)
      3. Growth hormone
      4. Prolactin
      5. ACTH (adrenocorticotropic hormone)
      6. TSH (thyroid-stimulating hormone).
      The posterior pituitary gland (neurohypophysis) stores and secretes 2 hormones produced by the hypothalamus:
      1. ADH (antidiuretic hormone or vasopressin)
      2. Oxytocin

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 47 - A 14 year old boy is taken to the emergency room after complaining...

    Incorrect

    • A 14 year old boy is taken to the emergency room after complaining of sudden onset of pain in the left hemiscrotum despite not having any other urinary symptoms. The superior pole of the testis is tender on examination and the cremasteric reflex is particularly marked. What would be the underlying diagnosis?

      Your Answer:

      Correct Answer: Torsion of a testicular hydatid

      Explanation:

      Answer: Torsion of a testicular hydatid

      The appendix testis (or hydatid of Morgagni) is a vestigial remnant of the Müllerian duct, present on the upper pole of the testis and attached to the tunica vaginalis. It is present about 90% of the time. The appendix of testis can, occasionally, undergo torsion (i.e. become twisted), causing acute one-sided testicular pain and may require surgical excision to achieve relief. One third of patients present with a palpable blue dot discoloration on the scrotum. This is nearly diagnostic of this condition. If clinical suspicion is high for the serious differential diagnosis of testicular torsion, a surgical exploration of the scrotum is warranted. Torsion of the appendix of testis occurs at ages 0-15 years, with a mean at 10 years, which is similar to that of testicular torsion.

      Occasionally a torsion of the hydatid of Morgagni can produce symptoms mimicking those created by a testicular torsion; a torsion of the hydatid, however, does not lead to any impairment of testicular function.
      Absence of the cremasteric reflex is a sign of testicular torsion. This therefore confirms that the diagnosis is Torsion of a testicular hydatid.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
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  • Question 48 - Cranial nerve XII, the hypoglossal nerve, innervates which one of the following muscles...

    Incorrect

    • Cranial nerve XII, the hypoglossal nerve, innervates which one of the following muscles in the list?

      Your Answer:

      Correct Answer: Hyoglossus

      Explanation:

      The cranial nerve XII, hypoglossal nerve, innervates all the intrinsic and extrinsic muscles of the tongue except the palatoglossus. The muscles of the tongue innervated by this nerve include the extrinsic muscles; hyoglossus, styloglossus, genioglossus and the intrinsic muscles; superior longitudinal, inferior longitudinal, vertical and transverse muscles. The salpingopharyngeus, palatoglossus and the palatopharyngeus muscles are innervated by the vagus nerve. The stylopharyngeus muscle is innervated by the glossopharyngeal nerve (CN IX). The mylohyoid muscle is innervated by the inferior alveolar nerve, a branch of the mandibular nerve. Finally, the geniohyoid muscle is innervated by the olfactory nerve (CN I) via the hypoglossal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 49 - A 50-year-old female has a metallic heart valve and requires a paraumbilical hernia...

    Incorrect

    • A 50-year-old female has a metallic heart valve and requires a paraumbilical hernia repair. Perioperatively, she is receiving intravenous unfractionated heparin. To perform the surgery safely a normal coagulation state is required. Which of the following strategies is a routine standard practice?

      Your Answer:

      Correct Answer: Stopping the heparin infusion 6 hours pre operatively

      Explanation:

      In performing noncardiac surgery on patients on anticoagulation, the major concern is when it is safe to perform surgery without increasing the risk of haemorrhage or increasing the risk of thromboembolism (e.g., venous, arterial) after discontinuing treatment.
      Any patient who is on long-term anticoagulation and is to undergo a major surgery needs proactive management.
      Heparin is discontinued 6-12 hours before surgery and restarted at 200-400 U/h at 4-6 hours after surgery. Coumadin is restarted as soon as tolerated by the patient. Stop oral anticoagulants at least 5 days preoperatively, and do not perform the procedure until the PT is in the reference range.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
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  • Question 50 - A 5 year-old-child with fever complains of sore throat . She was brought...

    Incorrect

    • A 5 year-old-child with fever complains of sore throat . She was brought to her paediatrician for consult because she has also developed a rash and has swollen lymph nodes. Upon physical examination she cried when her liver was palpated and the tip of her spleen is slightly palpable. Full blood count shows haemoglobin 13 g/dL, Haematocrit 40%, white blood cell count 13x109/L with a WBC differential count of 45 neutrophils, 4 bands, 26 lymphocytes, 15 atypical lymphocytesm, 10 monocytes and 1 eosinophil. Whick is the most likely infectious agent that is responsible for the patient's condition?

      Your Answer:

      Correct Answer: Epstein–Barr virus

      Explanation:

      Epstein-Barr virus (EBV), also known as human herpes virus 4,is a member of the herpes virus family. EBV spreads most commonly through bodily fluids, primarily saliva. EBV can cause infectious mononucleosis. Symptoms of EBV can include fatigue, fever, inflamed throat, swollen lymph nodes in the neck, enlarged spleen, swollen liver and rash.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

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