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  • Question 1 - What is the reason for a deranged thrombin clotting time? ...

    Incorrect

    • What is the reason for a deranged thrombin clotting time?

      Your Answer: Thrombocytopaenia

      Correct Answer: Heparin therapy

      Explanation:

      Thrombic clotting time is also known as thrombin time. It is clinically performed to determine the therapeutic levels of heparin. After plasma is isolated from the blood, bovine thrombin is added to it and the time it takes from the addition to clot is recorded. The reference interval is usually <21s. deranged results are indicative of heparin therapy, hypofibrinogenemia, hyperfibrinogenaemia or lupus anticoagulant.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      5
      Seconds

  • Question 2 - A 41 year old paediatrician presents with right upper quadrant pain and a...

    Incorrect

    • A 41 year old paediatrician presents with right upper quadrant pain and a sensation of abdominal fullness. A 6.7 cm hyperechoic lesion in the right lobe of the liver is detected when an ultrasound scan is done. Tests show that the serum AFP is normal. What is the most likely underlying lesion?

      Your Answer:

      Correct Answer: Haemangioma

      Explanation:

      A cavernous liver haemangioma or hepatic haemangioma is a benign tumour of the liver composed of hepatic endothelial cells. It is the most common liver tumour, and is usually asymptomatic and diagnosed incidentally on radiological imaging. Liver haemangiomas are thought to be congenital in origin. Several subtypes exist, including the giant hepatic haemangioma, which can cause significant complications. This large, atypical haemangioma of the liver may present with abdominal pain or fullness due to haemorrhage, thrombosis or mass effect. It may also lead to left ventricular volume overload and heart failure due to the increase in cardiac output which it causes. Further complications are Kasabach-Merritt syndrome, a form of consumptive coagulopathy due to thrombocytopaenia, and rupture.

      As one of the benign neoplasms, the AFP level of hepatic cavernous haemangioma patients is not usually outside the normal range.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
      0
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  • Question 3 - After finding elevated PSA levels, a 69-year-old man undergoes a needle biopsy and...

    Incorrect

    • After finding elevated PSA levels, a 69-year-old man undergoes a needle biopsy and is diagnosed with prostatic cancer. What is the stage of this primary tumour?

      Your Answer:

      Correct Answer: T1c

      Explanation:

      The AJCC uses a TNM system to stage prostatic cancer, with categories for the primary tumour, regional lymph nodes and distant metastases:
      TX: cannot evaluate the primary tumour T0: no evidence of tumour
      T1: tumour present, but not detectable clinically or with imaging T1a: tumour was incidentally found in less than 5% of prostate tissue resected (for other reasons)
      T1b: tumour was incidentally found in more than 5% of prostate tissue resected
      T1c: tumour was found in a needle biopsy performed due to an elevated serum prostate-specific antigen
      T2: the tumour can be felt (palpated) on examination, but has not spread outside the prostate
      T2a: the tumour is in half or less than half of one of the prostate gland’s two lobes
      T2b: the tumour is in more than half of one lobe, but not both
      T2c: the tumour is in both lobes
      T3: the tumour has spread through the prostatic capsule (if it is only part-way through, it is still T2)
      T3a: the tumour has spread through the capsule on one or both sides
      T3b: the tumour has invaded one or both seminal vesicles
      T4: the tumour has invaded other nearby structures.
      In this case, the tumour has a T1c stage.

    • This question is part of the following fields:

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

    Incorrect

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

      Your Answer:

      Correct Answer: Transverse cervical

      Explanation:

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

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 5 - What is the name of the cutaneous branch of the posterior primary ramus...

    Incorrect

    • What is the name of the cutaneous branch of the posterior primary ramus of C2?

      Your Answer:

      Correct Answer: Greater occipital nerve

      Explanation:

      The dorsal primary ramus of the spinal nerve C2 is the greater occipital nerve which provides cutaneous innervation to the skin of the back of the head. The ventral primary ramus gives off the great auricular nerve, the lesser occipital nerve and the ansa cervicalis.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 6 - A patient is diagnosed with Brucellosis. What is the mode of transmission of...

    Incorrect

    • A patient is diagnosed with Brucellosis. What is the mode of transmission of this disease?

      Your Answer:

      Correct Answer: Unpasteurised milk

      Explanation:

      Brucellosis is a highly contagious zoonosis caused by ingestion of unpasteurized milk or undercooked meat from infected animals, or close contact with their secretions.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
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  • Question 7 - Which of the following is a large artery that runs immediately posterior to...

    Incorrect

    • Which of the following is a large artery that runs immediately posterior to the stomach?

      Your Answer:

      Correct Answer: Splenic

      Explanation:

      The splenic artery is the large artery that would be found running off the posterior wall of the stomach. It is a branch of the coeliac trunk and sends off branches to the pancreas before reaching the spleen. The gastroduodenal artery on the other hand is found inferior to the stomach, posterior to the first portion of the duodenum. The left gastroepiploic artery runs from the left to the right of the greater curvature of the stomach. The common hepatic artery runs on the superior aspect of the lesser curvature of the stomach, and is a branch of the coeliac trunk. The superior mesenteric artery arises from the abdominal aorta just below the junction of the coeliac trunk.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 8 - Cyclophosphamide is used as a chemotherapy and immunosuppressant agent and is indicated in...

    Incorrect

    • Cyclophosphamide is used as a chemotherapy and immunosuppressant agent and is indicated in various diseases. One of the most severe complications of its use is cancer of the:

      Your Answer:

      Correct Answer: Urinary bladder

      Explanation:

      Cyclophosphamide is used to treat various types of cancer and autoimmune disorders. The main use of cyclophosphamide is in combination with other chemotherapy agents in the treatment of lymphomas, some forms of leukaemia and some solid tumours. Side-effects include nausea and vomiting, bone marrow suppression, stomach ache, diarrhoea, darkening of the skin
      ails, alopecia, lethargy, and haemorrhagic cystitis. Cyclophosphamide is itself carcinogenic, potentially causing transitional cell carcinoma of the bladder as a long-term complication.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 9 - Calculate the resistance of the artery if the pressure at one end is...

    Incorrect

    • Calculate the resistance of the artery if the pressure at one end is 60 mmHg, pressure at the other end is 20 mm Hg and the flow rate in the artery is 200 ml/min.

      Your Answer:

      Correct Answer: 0.2

      Explanation:

      Flow in any vessel = Effective perfusion pressure divided by resistance, where effective perfusion pressure is the mean intraluminal pressure at the arterial end minus the mean pressure at the venous end. Thus, in the given problem, resistance = (60 − 20)/200 = 0.2 mmHg/ml per min.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 10 - A 27-year-old woman who is 32 weeks pregnant is struck by a car....

    Incorrect

    • A 27-year-old woman who is 32 weeks pregnant is struck by a car. On arrival in the emergency department, she has a systolic blood pressure of 105 mmHg and a pulse rate of 126 bpm. Abdominal examination demonstrates diffuse tender abdomen and some bruising of the left flank. The FAST scan is normal.

      What should be the most appropriate course of action?

      Your Answer:

      Correct Answer: Arrange an urgent abdominal CT scan

      Explanation:

      The patient’s history and examination point towards a significant visceral injury. FAST scan is associated with a false-negative result in pregnancy which makes the normal result, in this scenario, less reassuring. CT scan of the abdomen remains the gold standard for diagnosis.

      Sonography and FAST scanning are established in pregnancy and provide the advantage of avoiding ionising radiations. However, the sensitivity of the FAST scan is reduced in pregnancy especially with advanced gestational age. CT scan remains the first-line investigation in major trauma where significant visceral injury is suspected. The maximum permitted safe dose of radiation in pregnancy is 5 mSv.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
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  • Question 11 - Which of the following coagulation factors is responsible for the formation of a...

    Incorrect

    • Which of the following coagulation factors is responsible for the formation of a complex with tissue factor to activate factors IX and X?

      Your Answer:

      Correct Answer: Factor VII

      Explanation:

      Factor VII, also known as proconvertin or stable factor, is a vitamin K–dependent protein that plays a central role in haemostasis and coagulation. Tissue factor is a protein that is normally not exposed on the surface of intact blood vessels. Damage to the vascular lumen leads to tissue factor exposure. The exposed tissue factor binds to factor VII. This facilitates the activation of factor VII to factor VIIa.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 12 - 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 13 - A urologist makes a transverse suprapubic incision to retrieve a stone from the...

    Incorrect

    • A urologist makes a transverse suprapubic incision to retrieve a stone from the urinary bladder. Which of the following abdominal wall layers will the surgeon NOT traverse?

      Your Answer:

      Correct Answer: Posterior rectus sheath

      Explanation:

      Pfannenstiel incision (a transverse suprapubic incision) is made below the arcuate line. Thus, there is no posterior layer of the rectus sheath here, only the transversalis fascia lines the inner layer of the rectus abdominis. The layers traversed include: skin, superficial fascia (fatty and membranous), deep fascia, anterior rectus sheath, rectus abdominis muscle, transversalis fascia, extraperitoneal connective tissue and peritoneum.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 14 - Which of the following is a likely consequence of severe diarrhoea? ...

    Incorrect

    • Which of the following is a likely consequence of severe diarrhoea?

      Your Answer:

      Correct Answer: A decrease in the sodium content of the body

      Explanation:

      Diarrhoea can occur due to any of the numerous aetiologies, which include infectious, drug-induced, food related, surgical, inflammatory, transit-related or malabsorption. Four mechanisms have been implicated in diarrhoea: increased osmotic load, increased secretion, inflammation and decreased absorption time. Diarrhoea can result in fluid loss with consequent dehydration, electrolyte loss (Na+, K+, Mg2+, Cl–) and even vascular collapse. Loss of bicarbonate ions can lead to a metabolic acidosis.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
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  • Question 15 - A 52-year-old female presents with pain in her proximal femur. Imaging demonstrates a...

    Incorrect

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

      Your Answer:

      Correct Answer: Renal

      Explanation:

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

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

    • This question is part of the following fields:

      • Oncology
      • Principles Of Surgery-in-General
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  • Question 16 - Intracellular shifting of hydrogen ions can generate a metabolic alkalosis. In which of...

    Incorrect

    • Intracellular shifting of hydrogen ions can generate a metabolic alkalosis. In which of the following conditions is metabolic alkalosis caused by this mechanism ?

      Your Answer:

      Correct Answer: Hypokalaemia

      Explanation:

      Metabolic alkalosis is characterized by a primary increase in the concentration of serum bicarbonate ions. This may occur as a consequence of a loss of hydrogen ions or a gain in bicarbonate. Hydrogen ions may be lost through the kidneys or the GI tract, as for example during vomiting, nasogastric suction or use of diuretics. Intracellular shifting of hydrogen ions develops mainly during hypokalaemia to maintain neutrality. Gain in bicarbonate ions may develop during administration of sodium bicarbonate in high amounts or in amounts that exceed the capacity of excretion of the kidneys, as seen in renal failure. Fluid losses may be another cause of metabolic alkalosis, causing the reduction of extracellular fluid volume.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
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  • Question 17 - Which of the following is an anion? ...

    Incorrect

    • Which of the following is an anion?

      Your Answer:

      Correct Answer: Phosphate

      Explanation:

      Cations: sodium, magnesium, calcium and potassium
      Anions: chloride, phosphate, bicarbonate, lactate, sulphate and albumin

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 18 - During an OSCE exam a medical student is asked to locate the sternal...

    Incorrect

    • During an OSCE exam a medical student is asked to locate the sternal angle. The sternal angle is a land mark for locating the level of the:

      Your Answer:

      Correct Answer: Second costal cartilage

      Explanation:

      The sternal angle, a key landmark used in the clinic for auscultating for heart sounds, is the point of attachment of the costal cartilage of rib 2 to the sternum. It thus corresponds to the location of the second rib. A horizontal plane through the sternal angle traverses the T4/T5 intervertebral disc and marks the inferior boundary of the superior mediastinum.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 19 - A 68 year old woman who underwent a mastectomy with axillary node clearance...

    Incorrect

    • A 68 year old woman who underwent a mastectomy with axillary node clearance for breast cancer is going to have a drain inserted to prevent seroma development. Which of the following devices should ideally be used?

      Your Answer:

      Correct Answer: A closed suction drainage system made of polypropylene

      Explanation:

      A surgical drain is a tube used to remove pus, blood or other fluids from a wound. They are commonly placed by surgeons or interventional radiologists. Suction is applied through the drain to generate a vacuum and draw fluids into a bottle. Following breast surgery, it is standard practice to use a Redivac type system that is made of polypropylene.

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Surgical Technique And Technology
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  • Question 20 - A 75-year old patient is in atrial fibrallation but has never been on...

    Incorrect

    • A 75-year old patient is in atrial fibrallation but has never been on anticoagulation therapy. To reduce the risk of future emboli, she would benefit from starting on long-term warfarin. Arterial emboli leading to acute limb ischaemia most commonly lodge at which one of the following sites?

      Your Answer:

      Correct Answer: Common femoral artery

      Explanation:

      The common femoral artery is the commonest site of arterial emboli causing acute limb ischemia. The treatment of choice is urgent femoral embolectomy.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 21 - A 69 year old woman presents with chest pain. She has undergone esophagogastrectomy...

    Incorrect

    • A 69 year old woman presents with chest pain. She has undergone esophagogastrectomy for carcinoma of the distal oesophagus. The next day, a brisk bubbling is noticed in the chest drain when the suction is applied. Which of the following would be the most likely cause of this finding?

      Your Answer:

      Correct Answer: Air leak from lung

      Explanation:

      The possible causes of post-operative pneumothorax after thoracotomy and esophagectomy include lung parenchymal leak/injury, bronchopleural fistula, ruptured bullae and malpositioned chest drains. When suction is applied to the chest drainage system, active and persistent bubbling may be seen. Although an anastomotic leak may produce a small pneumothorax, a large volume air leak is more indicative of lung injury.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
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  • Question 22 - Which of these conditions is mithramycin used for? ...

    Incorrect

    • Which of these conditions is mithramycin used for?

      Your Answer:

      Correct Answer: Hypercalcaemia of malignancy

      Explanation:

      Mithramycin or Plicamycin is a tricyclic pentaglycosidic antibiotic derived from Streptomyces strains. It inhibits RNA and protein synthesis by adhering to DNA. It is used as a fluorescent dye and as an antineoplastic agent. It is also used to reduce hypercalcaemia, especially caused by malignancy. Plicamycin is currently used in multiple areas of research, including cancer cell apoptosis and as a metastasis inhibitor.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 23 - At which cervical level does the common carotid artery bifurcate into the internal...

    Incorrect

    • At which cervical level does the common carotid artery bifurcate into the internal and external carotid arteries?

      Your Answer:

      Correct Answer: C4

      Explanation:

      The common carotid arteries are present on the left and right sides of the body. These arteries originate from different sources, but follow symmetrical courses. The right common carotid originates in the neck from the brachiocephalic trunk; the left from the aortic arch in the thorax. These split into the external and internal carotid arteries at the upper border of the thyroid cartilage, at around the level of the fourth cervical vertebra.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 24 - From which branchial (pharyngeal) pouch does the inferior parathyroid gland arise? ...

    Incorrect

    • From which branchial (pharyngeal) pouch does the inferior parathyroid gland arise?

      Your Answer:

      Correct Answer: 3rd

      Explanation:

      The following structures arise from each branchial pouch:
      1st pouch – eustachian tube, middle ear, mastoid, and inner layer of the tympanic membrane
      2nd pouch – middle ear, palatine tonsils
      3rd pouch – inferior parathyroid glands, thymus
      4th pouch – superior parathyroid glands, ultimobranchial body which forms the parafollicular C-cells of the thyroid gland, musculature and cartilage of larynx (along with the sixth pharyngeal pouch)
      5th pouch – rudimentary structure
      6th pouch – along with the fourth pouch, contributes to the formation of the musculature and cartilage of the larynx.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 25 - A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for...

    Incorrect

    • A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for the last 5 days. A CT scan reveals an oedematous mass with ring enhancement in the left temporal region. It is biopsied, revealing glial cells, necrosis, neutrophils and lymphocytes. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Cerebral abscess

      Explanation:

      A cerebral abscess can result from direct extension of cranial infections, penetrating head trauma, haematogenous spread, or for unknown causes. An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts. Oedema around the abscess can increase the intracranial pressure. Symptoms result from increased intracranial pressure and mass effects. It is most frequent in the third decade of life, and when it occurs in children, it is usually associated with congenital heart disease.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 26 - Which of the following structures lying posterior to the ovary are at risk...

    Incorrect

    • Which of the following structures lying posterior to the ovary are at risk of injury in excision of a malignant tumour in the right ovary?

      Your Answer:

      Correct Answer: Ureter

      Explanation:

      The ovaries are two nodular structures situated one on either side of the uterus in relation to the lateral wall of the pelvis and attached to the back of the broad ligament of the uterus, lying posteroinferiorly to the fallopian tubes. Each ovary has a lateral and medial surface. The ureter is at greater risk of iatrogenic injury at this location.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 27 - A 26-year-old right-handed tennis player presents to the A&E department with a painful,...

    Incorrect

    • A 26-year-old right-handed tennis player presents to the A&E department with a painful, swollen right arm. On examination, his upper limb pulses are present, but he has dusky fingers. A diagnosis of axillary vein thrombosis is made and confirmed. He is immediately started on low-molecular-weight heparin (LMWH).

      What should be the next best step of management to achieve venous patency?

      Your Answer:

      Correct Answer: Catheter-directed tPA

      Explanation:

      Catheter-directed thrombolysis (CDT) is recommended as the next step of management for patients with proximal upper-extremity deep vein thrombosis (UEDVT) of recent onset or severe symptoms.

      Primary UEDVT is less common than secondary forms. The most common primary form is effort-related thrombosis, also called Paget-Schroetter syndrome. It usually occurs in otherwise healthy young men who report, before the onset of thrombosis, vigorous arm exercise such as lifting weights, playing badminton, pitching a baseball, or performing repetitive overhead activities, such as painting or car repair. Most patients with effort-related UEDVT have an underlying venous thoracic outlet syndrome (VTOS). Secondary causes of UEDVT include central line insertion, malignancy, or pacemakers.

      Patients with UEDVT typically present with heaviness, discomfort, pain, paraesthesia, and swelling of the affected arm. Physical examination may reveal pitting oedema, redness, or cyanosis of the involved extremity; visible collateral veins at the shoulder or upper arm; and fever.

      Diagnosis is made by:
      1. FBC: platelet function
      2. Coagulation profile
      3. Liver function tests
      4. Duplex scan: investigation of choice
      5. D-dimer testing
      6. CT scan: for VTOS

      Treatment options for primary UEDVT are as follows:
      1. Anticoagulation therapy should be undertaken with a once-daily regimen of LMWH or fondaparinux for at least five days, followed by vitamin K antagonists for at least three months. Unfractionated heparin instead of LMWH is recommended for patients with renal failure or for those treated with CDT.

      2. Early thrombus removal and restoration of venous patency should be done immediately after starting the patient on heparin. Catheter-based therapy is recommended for patients with proximal UEDVT of recent onset and severe symptoms, low risk for bleeding complications, and good functional status.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Vascular
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  • Question 28 - Which nodes are most likely to be enlarged in a patient complaining of...

    Incorrect

    • Which nodes are most likely to be enlarged in a patient complaining of a boil located on the labia majora?

      Your Answer:

      Correct Answer: Superficial inguinal

      Explanation:

      The perineum, external genitalia, the labia majora and scrotum drain to the superficial inguinal lymph nodes. In a man, the testes do not drain to the superficial inguinal lymph nodes but rather travel in the spermatic cord and drain into the lumbar nodes. The lumbar nodes drain the internal pelvic organs. The sacral nodes drain the prostrate gland, uterus, vagina, rectum and posterior pelvic wall and the external iliac nodes in turn drain the lower limb. The internal iliac nodes drain the pelvis and gluteal region.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 29 - 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
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  • Question 30 - A 56 year old man, on his 8th day following a left hemicolectomy,...

    Incorrect

    • A 56 year old man, on his 8th day following a left hemicolectomy, complains of swinging pyrexia over the past 48 hours. Clinical examination is significant for an ileus. Which of the following investigations would be the most appropriate?

      Your Answer:

      Correct Answer: Abdominal CT scan with IV contrast

      Explanation:

      Abdominal CT with IV contrast would be carried out in this case and this presentation has most likely resulted due to an anastomotic leak with abscess formation which is a common complication following surgery. This can occur in any of the branches and anticipating the likely complication and appropriate avoidance will minimize their occurrence. Detailed imaging is required to allow accurate diagnosis and further planning.

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Surgical Technique And Technology
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  • Question 31 - Which of the following morphological features is most characteristic of hyaline degeneration? ...

    Incorrect

    • Which of the following morphological features is most characteristic of hyaline degeneration?

      Your Answer:

      Correct Answer: Homogeneous, ground-glass, pink-staining appearance of cells

      Explanation:

      The characteristic morphological features of hyaline degeneration is ground-glass, pinking staining cytoplasm with an intact cell membrane. The accumulation of lipids, calcium salts, lipofuscin and an amorphous cytoplasm with an intact cell membrane are all characteristically found in different situations.
      Pyknotic nucleus and orphan Annie eye nucleus are not seen in hyaline degeneration.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 32 - In a cardiac cycle, what event does the opening of the atrioventricular (AV)...

    Incorrect

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

      Your Answer:

      Correct Answer: Beginning of diastole

      Explanation:

      Cardiac diastole refers to the time period when the heart is relaxed after contraction and is preparing to refill with blood. Both ventricular and atrial diastole are together known as complete cardiac diastole. At its beginning, the ventricles relax, causing a drop in the ventricular pressure. As soon as the left ventricular pressure drops below that in left atrium, the mitral valve opens and there is ventricular filling of blood. Similarly, the tricuspid valve opens filling the right atrium.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 33 - A 25-year-old woman is undergoing an appendicectomy for perforated appendicitis. What is the...

    Incorrect

    • A 25-year-old woman is undergoing an appendicectomy for perforated appendicitis. What is the single most important modality for reducing the risks of postoperative wound infection?

      Your Answer:

      Correct Answer: Perioperative administration of antibiotics

      Explanation:

      Perioperative administration of antibiotics is very important for reducing the risks of postoperative wound infection. Clips make infections easier to manage but do not reduce the risks. Drains have no effect on the skin wounds in these cases.

      Surgical site infections (SSI) comprise up to 20% of all healthcare-associated infections and at least 5% of patients undergoing surgery will develop an SSI as a result. SSIs may occur following a breach in tissue surfaces and allow normal commensals and other pathogens to initiate infection. The organisms are mostly derived from the patient’s own body.

      SSIs are a major cause of morbidity and mortality.
      Some preoperative measures that may increase the risk of SSI include:
      1. Shaving the wound using a razor (disposable clipper preferred)
      2. Tissue hypoxia
      3. Delayed administration of prophylactic antibiotics in tourniquet surgery

      SSIs can be prevented by taking certain precautionary steps pre-, intra-, and postoperatively.

      1. Preoperatively:
      a. Do not remove body hair routinely
      b. If hair needs removal, use electrical clippers (razors increase the risk of infection)
      c. Antibiotic prophylaxis if:
      – placement of prosthesis or valve
      – clean-contaminated surgery
      – contaminated surgery

      2. Intraoperatively:
      a. Prepare the skin with alcoholic chlorhexidine (Lowest incidence of SSI)
      b. Cover surgical site with dressing

      3. Postoperatively:
      a. Prevention of incisional infection by appropriate cleansing, skin care, and moisture management
      b.Tissue viability advice for management of surgical wound healing by secondary intention

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Surgical Technique And Technology
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  • Question 34 - Injury to this nerve will affect the function of the palatoglossus and levator...

    Incorrect

    • Injury to this nerve will affect the function of the palatoglossus and levator veli palatini muscles:

      Your Answer:

      Correct Answer: Cranial nerve X

      Explanation:

      The vagus nerve (cranial nerve X) innervates both the palatoglossus and levator veli palatini muscles.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 35 - A 46 year old policeman was admitted with peritonitis secondary to a perforated...

    Incorrect

    • A 46 year old policeman was admitted with peritonitis secondary to a perforated appendix. A laparoscopic appendicectomy was done but he had a stormy post operative course. He has now started to develop increasing abdominal pain and has been vomiting. A laparotomy is performed and at operation a large amount of small bowel shows evidence of patchy areas of infarction. Which of the following is the most likely cause?

      Your Answer:

      Correct Answer: Mesenteric venous thrombosis

      Explanation:

      Mesenteric venous thrombosis (MVT) is a blood clot in one or more of the major veins that drain blood from the intestine. The superior mesenteric vein is most commonly involved. The exact cause of MVT is unknown. However, there are many diseases that can lead to MVT. Many of the diseases cause swelling (inflammation) of the tissues surrounding the veins, and include:
      Appendicitis
      Cancer of the abdomen
      Diverticulitis
      Liver disease with cirrhosis
      High blood pressure in the blood vessels of the liver
      Abdominal surgery or trauma
      Pancreatitis
      Inflammatory bowel disorders
      Heart failure
      Protein C or S deficiencies
      Polycythaemia vera
      Essential thrombocythemia
      People who have disorders that make the blood more likely to stick together (clot) have a higher risk for MVT. Birth control pills and oestrogen medicines also increase risk.

      MVT is more common in men than women. It mainly affects middle aged or older adults. Symptoms may include any of the following:
      Abdominal pain, which may get worse after eating and over time; Bloating; Constipation; Bloody diarrhoea; Fever; Septic shock; Lower gastrointestinal bleeding; Vomiting and nausea.
      Blood thinners (most commonly heparin or related medicines) are used to treat MVT when there is no associated bleeding. In some cases, medicine can be delivered directly into the clot to dissolve it. This procedure is called thrombolysis. Less often, the clot is removed by thrombectomy.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Vascular
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  • Question 36 - An 11 year old girl undergoes a delayed open reduction and fixation of...

    Incorrect

    • An 11 year old girl undergoes a delayed open reduction and fixation of a significantly displaced supracondylar fracture. She complains of paraesthesia of the hand and significant forearm pain. The radial pulse is normal. What is the best course of action?

      Your Answer:

      Correct Answer: Fasciotomy

      Explanation:

      Answer: Fasciotomy

      Fasciotomy is a surgical procedure where the fascia is cut to relieve tension or pressure commonly to treat the resulting loss of circulation to an area of tissue or muscle. Fasciotomy is a limb-saving procedure when used to treat acute compartment syndrome. A delay in performing the procedure can lead to neurovascular complications or lead to the need for amputation of a limb. Complications can also involve the formation of scar tissue after the operation. A thickening of the surgical scars can result in the loss of mobility of the joint involved. This can be addressed through occupational or physical therapy.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
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  • Question 37 - A 63 year old woman reports colicky abdominal pain and foul smelling diarrhoea...

    Incorrect

    • A 63 year old woman reports colicky abdominal pain and foul smelling diarrhoea on the 4th day following a cholecystectomy for acute cholecystitis. Her surgery was complicated as the gallbladder spilled stones intraoperatively. She has been on ciprofloxacin therapy ever since her surgery. Which of the following organisms is most likely responsible for her symptoms?

      Your Answer:

      Correct Answer: Clostridium difficile

      Explanation:

      Clostridioides difficile (C. difficile; formerly known as Clostridium difficile) is a gram-positive rod-shaped bacillus that is commonly involved in antibiotic-associated diarrhoea. As the bacterial spores are difficult to eradicate and easily transmitted (via faecal-oral transmission), the C. difficile infection rate is particularly high among hospitalized patients and residents in long-term care facilities.
      Colonization with C. difficile occurs following antibiotic treatment of other diseases, as the bacteria is particularly resistant to antibiotics. The resulting damage to the intestinal flora promotes infection, which may be accompanied by high fever, abdominal pain, and characteristically foul-smelling diarrhoea. The most severe form of C. difficile infection is pseudomembranous colitis, which may lead to ileus, sepsis, and toxic megacolon. In most cases, however, colonization results in asymptomatic carriage rather than symptomatic infection.
      Diagnosis is usually made via detection of the C. difficile toxin and/or corresponding genes in stool samples. C. difficile infections are treated with oral vancomycin or oral fidaxomicin. Following diagnosis, strict adherence to hygiene measures and patient isolation is essential, especially in hospitals and other healthcare settings.

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
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  • Question 38 - A 35 year old man presents to his family doctor with swelling of...

    Incorrect

    • A 35 year old man presents to his family doctor with swelling of his face.
      On examination, the swelling was noted to be to the below and to the left of his nose. When the area is palpated, it feels like the underlying bone is cracking.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Ameloblastoma

      Explanation:

      Ameloblastoma is a rare, benign or cancerous tumour of odontogenic epithelium (ameloblasts, or outside portion, of the teeth during development) much more commonly appearing in the lower jaw than the upper jaw.
      Ameloblastomas can be found both in the maxilla and mandible. Although, 80% are situated in the mandible with the posterior ramus area being the most frequent site. The neoplasms are often associated with the presence of unerupted teeth, displacement of adjacent teeth and resorption of roots.

      Symptoms include a slow-growing, painless swelling leading to facial deformity. As the swelling gets progressively larger it can impinge on other structures resulting in loose teeth and malocclusion. Bone can also be perforated leading to soft tissue involvement.

      The lesion has a tendency to expand the bony cortices because of the slow growth rate of the lesion allows time for the periosteum to develop a thin shell of bone ahead of the expanding lesion. This shell of bone cracks when palpated. This phenomenon is referred to as Egg Shell Cracking or crepitus, an important diagnostic feature.

      Maxillary ameloblastomas can be dangerous and even lethal. Due to thin bone and weak barriers, the neoplasm can extend into the sinonasal passages, pterygomaxillary fossa and eventually into the cranium and brain. Rare orbital invasion of the neoplasm has also been reported.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Head And Neck Surgery
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  • Question 39 - A 31-year-old woman who is 30 weeks pregnant presents with sudden onset of...

    Incorrect

    • A 31-year-old woman who is 30 weeks pregnant presents with sudden onset of chest pain associated with loss of consciousness. On examination, she is afebrile and her heart rate is 120 bpm, blood pressure is 170/90 mmHg, and saturation is 93% on 15L oxygen. Furthermore, an early diastolic murmur and occasional bibasilar crepitations are auscultated and mild pedal oedema is observed. Her ECG shows ST-segment elevation in leads II, III, and aVF.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Aortic dissection

      Explanation:

      The most likely diagnosis is aortic dissection.

      Aortic dissection occurs following a tear in the aortic intima with subsequent separation of the tissue within the weakened media by the propagation of blood. There are four different classifications of aortic dissection and the commonest one used is the Stanford classification dividing them into type A and type B. A type A dissection involves the ascending aorta and/or the arch whilst type B dissection involves only the descending aorta and occurs distal to the origin of the left subclavian artery.

      Aortic dissection in pregnancy occurs most commonly in the third trimester due to the hyperdynamic state and hormonal effect on vasculature. Other common predisposing factors for aortic dissection include Marfans syndrome, Ehlers-Danlos syndrome, and bicuspid aortic valve. Aortic dissection often presents with sudden severe, tearing chest pain, vomiting, and syncope, most often from acute pericardial tamponade. The patient may be hypertensive, clinically. The right coronary artery may become involved in the dissection, causing myocardial infarct in up to 2% of the cases (hence ST-segment elevation in the inferior leads). An aortic regurgitant murmur may be auscultated.

      The management options during pregnancy include:
      1. <28 weeks of gestation: aortic repair with the foetus kept in utero
      2. 28–32 weeks of gestation: dependent on foetal condition
      3. >32 weeks of gestation: caesarean section followed by aortic repair in the same operation

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
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  • Question 40 - Which muscle is responsible for directing the gaze downward when the eye is...

    Incorrect

    • Which muscle is responsible for directing the gaze downward when the eye is abducted?

      Your Answer:

      Correct Answer: Inferior rectus muscle

      Explanation:

      The inferior rectus muscle is a muscle in the orbit. As with most of the muscles of the orbit, it is innervated by the inferior division of oculomotor nerve (Cranial Nerve III). It depresses, adducts, and helps laterally rotate the eye.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 41 - The following organs would be expected to lie within the right lower quadrant...

    Incorrect

    • The following organs would be expected to lie within the right lower quadrant of the abdomen, assuming that the gastrointestinal tract is rotated normally:

      Your Answer:

      Correct Answer: Distal jejunum, caecum, vermiform appendix

      Explanation:

      The abdomen is divided by theoretical anatomic lines into four quadrants. The median plane follows the linea alba and extends from the xiphoid process to the pubic symphysis and splits the abdomen in half. The transumbilical plane is a horizontal line that runs at the level of the umbilicus. This forms the upper right and left quadrants and the lower right and left quadrants. Structures in the right lower quadrant include: caecum, appendix, part of the small intestine, ascending colon, the right half of the female reproductive system, right ureter. Pain in this region is most commonly associated with appendicitis.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 42 - A 47-year-old male develops acute respiratory distress syndrome during an attack of severe...

    Incorrect

    • A 47-year-old male develops acute respiratory distress syndrome during an attack of severe acute pancreatitis. Which of the following is not a feature of adult respiratory distress syndrome?

      Your Answer:

      Correct Answer: A Swann Ganz Catheter would typically have a reading in excess of 18mmHg.

      Explanation:

      Acute respiratory distress syndrome (ARDS) is an inflammatory process in the lungs that induces non-hydrostatic protein-rich pulmonary oedema. The immediate consequences are profound hypoxemia, decreased lung compliance, and increased intrapulmonary shunt and dead space. The clinicopathological aspects include severe inflammatory injury to the alveolar-capillary barrier, surfactant depletion, and loss of aerated lung tissue.

      The most recent definition of ARDS, the Berlin definition, was proposed by a working group under the aegis of the European Society of Intensive Care Medicine. It defines ARDS by the presence within 7 days of a known clinical insult or new or worsening respiratory symptoms of a combination of acute hypoxemia (PaO2/FiO2 ≤ 300 mmHg), in a ventilated patient with a positive end-expiratory pressure (PEEP) of at least 5 cmH2O, and bilateral opacities not fully explained by heart failure or volume overload i.e. the heart pressure is norma. The Berlin definition uses the PaO2/FiO2 ratio to distinguish mild ARDS (200 < PaO2/FiO2 ≤ 300 mmHg), moderate ARDS (100 < PaO2/FiO2 ≤ 200 mmHg), and severe ARDS (PaO2/FiO2 ≤ 100 mmHg).
      Most cases of ARDS in adults are associated with pulmonary sepsis (46 percent) or nonpulmonary sepsis (33 percent). Risk factors include those causing direct lung injury (e.g., pneumonia, inhalation injury, pulmonary contusion) and those causing indirect lung injury (e.g., nonpulmonary sepsis, burns, transfusion-related acute lung injury)

      Most patients with ARDS need sedation, intubation, and ventilation while the underlying injury is treated. Any ventilator mode may be used, according to the Surviving Sepsis Clinical Practice Guideline and the National Heart, Lung, and Blood Institute’s ARDS Network (ARDSNet). Respiratory rate, expiratory time, positive end-expiratory pressure, and FiO2 are set following ARDSNet protocols. Settings are adjusted to maintain an oxygen saturation of 88 to 95 percent and a plateau pressure of 30 cm H2O or less to avoid barotrauma. Clinical practice guidelines recommend maintaining an arterial pH of 7.30 to 7.45, although patients in some research trials have tolerated permissive hypercapnia and a pH as low as 7.15

    • This question is part of the following fields:

      • Post-operative Management And Critical Care
      • Principles Of Surgery-in-General
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  • Question 43 - A 76-year-old man with a urinary tract obstruction due to prostatic hyperplasia develops...

    Incorrect

    • A 76-year-old man with a urinary tract obstruction due to prostatic hyperplasia develops acute renal failure. Which of the following physiological abnormalities of acute renal failure will be most life threatening for this patient?

      Your Answer:

      Correct Answer: Acidosis

      Explanation:

      Acute renal failure (ARF) is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. This accumulation may be accompanied by metabolic disturbances, such as metabolic acidosis and hyperkalaemia, changes in body fluid balance and effects on many other organ systems. Metabolic acidosis and hyperkalaemia are the two most serious biochemical manifestations of acute renal failure and may require medical treatment with sodium bicarbonate administration and antihyperkalaemic measures. If not appropriately treated these can be life-threatening. ARF is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient amounts of urine.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 44 - An 11 year old boy is referred to the clinic with pain in...

    Incorrect

    • An 11 year old boy is referred to the clinic with pain in the left knee. He has been experiencing the pain for the past four months and it usually lasts for a few hours. He is seen to be walking with an antalgic gait and has apparent left leg shortening. The left knee is normal but the left hip reveals pain on internal and external rotation. Flattening of the femoral head is shown on imaging. Which of the following is the most likely underlying diagnosis?

      Your Answer:

      Correct Answer: Perthes disease

      Explanation:

      Answer: Perthes disease

      Perthes’ disease is a condition affecting the hip joint in children. It is rare (1 in 9,000 children are affected) and we do not clearly understand why it occurs.

      Part or all of the femoral head (top of the thigh bone: the ball part of the ball-and-socket hip joint) loses its blood supply and may become misshapen. This may lead to arthritis of the hip in later years.

      The earliest sign of Legg-Calvé-Perthes disease (LCPD) is an intermittent limp (abductor lurch), especially after exertion, with mild or intermittent pain in the anterior part of the thigh. LCPD is the most common cause of a limp in the 4- to 10-year-old age group, and the classic presentation has been described as a painless limp.
      The patient may present with limited range of motion of the affected extremity. The most common symptom is persistent pain.

      Hip pain may develop and is a result of necrosis of the involved bone. This pain may be referred to the medial aspect of the ipsilateral knee or to the lateral thigh. The quadriceps muscles and adjacent thigh soft tissues may atrophy, and the hip may develop adduction flexion contracture. The patient may have an antalgic gait with limited hip motion.
      Early radiographic changes may reveal only a nonspecific effusion of the joint associated with slight widening of the joint space, metaphyseal demineralization (decreased bone density around the joint), and periarticular swelling (bulging capsule). This is the acute phase, and it may last 1-2 weeks. Decreasing bone density in and around the joint is noted after a few weeks. Eventually, the disease may progress to collapse of the femoral head, increase in the width of the neck, and demineralization of the femoral head. The final shape of this area depends on the extent of necrosis and the degree of collapse.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
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  • Question 45 - An 26-year-old man sought admission due to persistent non-bloody diarrhoea. The patient is...

    Incorrect

    • An 26-year-old man sought admission due to persistent non-bloody diarrhoea. The patient is HIV-positive. Examination of stool sample showed numerous acid-fast cysts. Which of the following organism is the most likely cause of diarrhoea?

      Your Answer:

      Correct Answer: Cryptosporidium parvum

      Explanation:

      Cryptosporidium parvum is one of several species that causes cryptosporidiosis, a parasitic disease of the mammalian intestinal tract. Primary symptoms of C. parvum infection are acute, watery, and non-bloody diarrhoea. C. parvum infection is of particular concern in immunocompromised patients, where diarrhoea can reach 10–15 l per day.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 46 - An intern is attempting to put in an arterial line in an ICU...

    Incorrect

    • An intern is attempting to put in an arterial line in an ICU patients left foot. Which is the best site to feel for the pulsation of the dorsalis pedis artery in the foot?

      Your Answer:

      Correct Answer: Just lateral to the tendon of extensor hallucis longus

      Explanation:

      The dorsalis pedis artery is the continuation of the anterior tibial artery. The pulse of the posterior tibial artery, which comes from the posterior compartment of the leg, may be felt behind the medial malleolus just lateral to the tendon of the extensor hallucis longus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 47 - The lateral thoracic artery: ...

    Incorrect

    • The lateral thoracic artery:

      Your Answer:

      Correct Answer: Accompanies the long thoracic nerve to the serratus anterior muscle

      Explanation:

      The thoracic nerve, along with the lateral thoracic artery, follow the pectoralis minor to the side of the chest which supplies the serratus anterior and the pectoralis. It then sends branches across the axilla to the axillary glands and subscapularis. The pectoral branch of the thoraco-acromial anastomoses with the internal mammary, subscapular and intercostal arteries, which in women, supply an external mammary branch.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 48 - The blood investigations of a 30-year old man with jaundice revealed the following...

    Incorrect

    • The blood investigations of a 30-year old man with jaundice revealed the following : total bilirubin 6.5 mg/dl, direct bilirubin 1.1 mg/dl, indirect bilirubin 5.4 mg/dl and haemoglobin 7.3 mg/dl. What is the most likely diagnosis out of the following?

      Your Answer:

      Correct Answer: Haemolysis

      Explanation:

      Hyperbilirubinemia can be caused due to increased bilirubin production, decreased liver uptake or conjugation, or decreased biliary excretion. Normal bilirubin level is less than 1.2 mg/dl (<20 μmol/l), with most of it unconjugated. Elevated unconjugated bilirubin (indirect bilirubin fraction >85%) can occur due to haemolysis (increased bilirubin production) or defective liver uptake/conjugation (Gilbert syndrome). Such increases are less than five-fold usually (<6 mg/dl or <100 μmol/l) unless there is coexistent liver disease.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 49 - A 45-year old gentleman presents with diarrhoea for two weeks. He has no...

    Incorrect

    • A 45-year old gentleman presents with diarrhoea for two weeks. He has no history of fever and the diarrhoea stops on fasting. Which is the most likely type of diarrhoea that he is suffering from?

      Your Answer:

      Correct Answer: Osmotic

      Explanation:

      The different types of diarrhoea are:
      1. Secretory diarrhoea – Due to increased secretion or decreased absorption. There is minimal to no structural damage in this type. The most common cause is cholera toxin which stimulates secretion of anions (especially chloride), with sodium and water.
      2. Osmotic diarrhoea – Due to increased osmotic load, there is water loss. This occurs in cases of maldigestion syndromes, such as coeliac or pancreatic disease.
      3. Motility-related diarrhoea – Occurs in cases of abnormal gastrointestinal motility. Due to increased motility, there is poor absorption and this leads to diarrhoea. This is seen post-vagotomy or in diabetic neuropathy.
      4. Inflammatory diarrhoea – Due to damage to the mucosa or brush border, there is a loss of protein-rich fluids and poor absorption. Features of all the above three types can be seen in this type. Aetiology includes bacterial, viral, parasitic infections or autoimmune problems including inflammatory bowel disease.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 50 - 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
      0
      Seconds

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