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  • Question 1 - A 39 year old female is admitted with biliary colic. Investigations show gallstones....

    Incorrect

    • A 39 year old female is admitted with biliary colic. Investigations show gallstones. A laparoscopic cholecystectomy is performed and a large stone is impacted in Hartman's pouch. After the operation, she fails to settle and becomes jaundiced. Bile continues to collect from the drain placed at the surgical site. What is the most appropriate course of action?

      Your Answer: Arrange an abdominal USS

      Correct Answer: Arrange an ERCP

      Explanation:

      Advances in endoscopy have suggested wider use of ERCP, which in the past was mostly restricted to the treatment of biliary fistulas and to patients with associated medical disease. Several series in literature demonstrate that ERCP with stenting for major bile duct injuries in the form of incomplete strictures has comparable efficacy with surgery and lower rates of morbidity and mortality, but few give long-term results.

      Bile duct injuries (BDI) can occur after many abdominal operations, e.g. liver surgery, gastrectomy, common bile duct (CBD) exploration. However, the majority of postoperative bile duct injuries (POBDI) occur during open or laparoscopic cholecystectomy. Despite increasing experience with laparoscopy, a review of 1.6 million cholecystectomies demonstrated an unchanging 0.5% incidence of bile duct injury, reported after many days post operation, of abdominal pain, bile leak, jaundice or cholangitis. Only 30% of injuries are recognized at the time of operation.
      Bile duct injuries, particularly strictures, have traditionally been managed by surgical reconstruction (Roux-en-Y hepaticojejunostomy). The reported occurrence of symptomatic anastomotic strictures after long-term follow-up of surgical reconstruction ranges from 9-25 %. Surgery is definitely associated with significant morbidity and mortality. Endoscopic treatment has demonstrated results comparable to those achieved with surgery, with lower morbidity and mortality.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
      1
      Seconds

  • Question 2 - Depression of the normal coagulation system and excessive bleeding after surgery can occur...

    Incorrect

    • Depression of the normal coagulation system and excessive bleeding after surgery can occur in which of the following medical conditions?

      Your Answer:

      Correct Answer: Liver disease

      Explanation:

      As most of the coagulation factors are synthesized in the liver, liver diseases like hepatitis or cirrhosis will depress the coagulation system. Vitamin K deficiency can also decrease the production of vitamin K dependent coagulation factors VII, XI, X and prothrombin.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      9
      Seconds

  • Question 3 - An anatomy instructor is giving a demonstration of the right lung. Which of...

    Incorrect

    • An anatomy instructor is giving a demonstration of the right lung. Which of the statements about the right lung made by the demonstrator is correct?

      Your Answer:

      Correct Answer: Its upper lobar bronchus lies behind and above the right pulmonary artery

      Explanation:

      The root of the lungs on both sides are similar in that the pulmonary veins are anterior and inferior while the bronchus is posterior. However, on the right side, the pulmonary arteries are anterior to the bronchus while on the left side the pulmonary arteries are superior to the bronchus. The lingual is only found on the left lung. The mediastinum is the space in the thorax between the two pleural sacs and does not contain any lung. The right lung, having three lobes, is slightly larger than the left lung. On both sides, the phrenic nerves passes in front of the root of the lung.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 4 - Congenital anomalies of genitourinary tract are more common than any other system. Which...

    Incorrect

    • Congenital anomalies of genitourinary tract are more common than any other system. Which of the following anomalies carries the greatest risk of morbidity?

      Your Answer:

      Correct Answer: Bladder exstrophy

      Explanation:

      Bladder exstrophy is the condition where the urinary bladder opens from the anterior aspect suprapubically. The mucosa of the bladder is continuous with the abdominal skin and there is separation of the pubic bones. The function of the upper urinary tract remains normal usually. Treatment consists of surgical reconstruction of the bladder and returning it to the pelvis. There can be a need for continent urinary diversion along with reconstruction of the genitals.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 5 - An 18-year-old male is admitted with a three-month history of intermittent pain in...

    Incorrect

    • An 18-year-old male is admitted with a three-month history of intermittent pain in the right iliac fossa. He suffers from episodic diarrhoea and has lost two kilograms of weight. On examination, he is febrile and has right iliac fossa tenderness.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Inflammatory bowel disease

      Explanation:

      A history of weight loss and intermittent diarrhoea makes inflammatory bowel disease (IBD) the most likely diagnosis. Conditions such as appendicitis and infections have a much shorter history. Although Meckel’s diverticulum can bleed and cause inflammation, it seldom causes marked weight loss. Irritable bowel syndrome (IBS) presents with alternating episodes of constipation and diarrhoea along with abdominal pain, bloating, and gas.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
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  • Question 6 - A 40-year old woman with portal hypertension has impaired venous drainage of the...

    Incorrect

    • A 40-year old woman with portal hypertension has impaired venous drainage of the anal canal above the pectinate line. Thus, there might be an increase in blood flow downward to the systemic venous system via anastomoses with the inferior rectal vein. This is a tributary of?

      Your Answer:

      Correct Answer: Internal pudendal vein

      Explanation:

      The inferior rectal vein drains into the internal pudendal vein. In addition the external iliac vein is one of the two branches of the common iliac vein however the internal iliac vein and it’s tributaries (including the pudendal vein) are much more important in draining the pelvic structures.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 7 - A patient under went repair of a lingual artery aneurysm in the floor...

    Incorrect

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

      Your Answer:

      Correct Answer: Hyoglossus

      Explanation:

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

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 8 - A 40-year old gentleman, known with past peptic ulcer disease, was brought to...

    Incorrect

    • A 40-year old gentleman, known with past peptic ulcer disease, was brought to the clinic in a dehydrated state with persistent vomiting. His blood investigations revealed sodium = 142 mmol/l, potassium = 2.6 mmol/l, chloride = 85 mmol/l, pH = 7.55, p(CO2) = 50 mmHg, p(O2) = 107 mmHg and standard bicarbonate = 40 mmol/l. This patient had:

      Your Answer:

      Correct Answer: Metabolic alkalosis

      Explanation:

      High pH with high standard bicarbonate indicates metabolic alkalosis. The pa(CO2) was appropriately low in compensation. This is hypokalaemia hypochloraemic metabolic acidosis due to prolonged vomiting. Treatment includes treating the cause and intravenous sodium chloride with potassium.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 9 - 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 10 - A 32-year-old man is brought to the emergency department following a crush injury...

    Incorrect

    • A 32-year-old man is brought to the emergency department following a crush injury to his right forearm. On examination, the arm is tender, red, and swollen. There is clinical evidence of an ulnar fracture, and the patient cannot move his fingers.

      What should be the most appropriate course of action?

      Your Answer:

      Correct Answer: Fasciotomy

      Explanation:

      The combination of a crush injury, limb swelling, and inability to move digits raises suspicion of compartment syndrome that would require a fasciotomy.

      Compartment syndrome is a particular complication that may occur following fractures, especially supracondylar fractures and tibial shaft injuries. It is characterised by raised pressure within a closed anatomical space which may, eventually, compromise tissue perfusion, resulting in necrosis.

      The clinical features of compartment syndrome include:
      1. Pain, especially on movement
      2. Paraesthesia
      3. Pallor
      4. Paralysis of the muscle group may also occur

      Diagnosis is made by measurement of intracompartmental pressure. Pressures >20mmHg are abnormal and >40mmHg are diagnostic.

      Compartment syndrome requires prompt and extensive fasciotomy. Myoglobinuria may occur following fasciotomy, resulting in renal failure. Therefore, aggressive IV fluids are required. If muscle groups are frankly necrotic at fasciotomy, they should be debrided, and amputation may have to be considered.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
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  • Question 11 - A 27-year-old ski instructor who falls off a ski lift and sustains a...

    Incorrect

    • A 27-year-old ski instructor who falls off a ski lift and sustains a spiral fracture of the midshaft of the tibia. Attempts to achieve a satisfactory position in plaster have failed. Overlying tissues are healthy. What is the most appropriate course of action?

      Your Answer:

      Correct Answer: Intramedullary nail

      Explanation:

      Initially, all tibial shaft fractures should be stabilized with a long posterior splint with the knee in 10-15° of flexion and the ankle flexed at 90°
      Closed fractures with minimal displacement or stable reduction may be treated nonoperatively with a long leg cast, but cast application should be delayed for 3-5 days to allow early swelling to diminish. The cast should extend from the midthigh to the metatarsal heads, with the ankle at 90° of flexion and the knee extended. The cast increases tibial stability and can decrease pain and swelling.
      Despite proper casting techniques and adequate follow-up, not all nonoperatively treated tibial shaft fractures heal successfully.
      Operative fixation is required when fractures are unstable. Surgical options include plating, external fixation, intramedullary nailing, and, in some cases, amputation.
      Intramedullary nailing with locking screws (see the image below) has become the treatment of choice for most tibial shaft fractures. The prevalence of non-union and malunion is greatly decreased in comparison with the other methods of fixation. Patients are also able to return to low-impact activities much sooner than they can with the other treatments.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
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  • Question 12 - Both the arytenoid muscles and the lateral cricoarytenoid muscles perform this action on...

    Incorrect

    • Both the arytenoid muscles and the lateral cricoarytenoid muscles perform this action on the glottis:

      Your Answer:

      Correct Answer: Adduction

      Explanation:

      Both the arytenoid and the cricoartenoid muscles close the glottis. The lateral cricoarytenoid muscles extend from the lateral cricoid cartilage to the muscular process of the arytenoid cartilage. By rotating the arytenoid cartilages medially, these muscles adduct the vocal cords and thereby close the rima glottidis. The arytenoid muscle adducts or approximates the arytenoid cartilages, and thus closes the aperture of the glottis.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 13 - An old woman complains of a lack of sensation halfway down the anterior...

    Incorrect

    • An old woman complains of a lack of sensation halfway down the anterior surface of the thigh. The cause of this:

      Your Answer:

      Correct Answer: Would result from damage to the nerve that innervates the pectineus muscle

      Explanation:

      The pectineus is supplied by the second, third and fourth lumbar nerves through the femoral nerve and by the third lumbar through the accessory obturator when it exists. The anterior surface of the thigh receives its innervation from the femoral nerve as well, thus this is the nerve most likely to be injured

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 14 - Where would you insert the needle when drawing blood from a patient's median...

    Incorrect

    • Where would you insert the needle when drawing blood from a patient's median cubital vein?

      Your Answer:

      Correct Answer: Anterior aspect of the elbow

      Explanation:

      The correct answer is to insert it into the anterior aspect of the elbow. If you look at the venous drainage of the upper limb, you will find that there are two main veins, the basilic and the cephalic vein; the connecting branch between these two veins is the median cubital vein. and this vein passes via the cubital fossa which is on the anterior aspect of the forearm.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 15 - A 27-year-old woman presents with abdominal pain. On investigation, her serum calcium is...

    Incorrect

    • A 27-year-old woman presents with abdominal pain. On investigation, her serum calcium is found to be 3.5 mmol/L.

      What should be the most appropriate initial management?

      Your Answer:

      Correct Answer: Intravenous 0.9% sodium chloride

      Explanation:

      The immediate treatment of hypercalcaemia involves intravenous fluid resuscitation. This may be complemented with the use of bisphosphonates and sometimes, diuretics. However, fluids are administered first. Normal saline is usually preferred for this over other solutions.

      Urgent management in hypercalcaemia is indicated if:
      1. Serum calcium level >3.5 mmol/L
      2. Reduced consciousness
      3. Severe abdominal pain
      4. Pre-renal failure

      Management options include:
      1. Intravenous fluid resuscitation with 3–6 litres of 0.9% normal saline in 24 hours
      2. Concurrent administration of calcitonin to help lower calcium levels
      3. Medical therapy (usually if corrected calcium >3.0mmol/L)

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
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  • Question 16 - A 45-year old gentleman presented to the emergency department at 5.00 AM with...

    Incorrect

    • A 45-year old gentleman presented to the emergency department at 5.00 AM with pain in his left flank. The pain began suddenly and presented in waves throughout the night. Urine examination was normal except for presence of blood and few white blood cells. The pH and specific gravity of the urine were also found to be within normal range. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Ureteric calculus

      Explanation:

      A calculus in the ureter, if less than 5mm in diameter is likely to pass spontaneously. However, a larger calculus irritates the ureter and may become lodged, leading to hydroureter and/or hydronephrosis. Likely sites where the calculus might get lodged, include pelviureteric junction, distal ureter at the level of iliac vessels and the vesicoureteric junction. An obstruction can result in reduced glomerular filtration. There can be deterioration in renal function due to hydronephrosis and a raised glomerular pressure, leading to poor renal blood flow. Permanent renal dysfunction usually takes about 4 weeks to occur. Secondary infection can also occur in chronic obstruction.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 17 - What best describes the muscles of the posterior compartment of the leg? ...

    Incorrect

    • What best describes the muscles of the posterior compartment of the leg?

      Your Answer:

      Correct Answer: One of the posterior compartment leg muscles laterally rotates the femur

      Explanation:

      The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris and are the chief extensors of the foot at the ankle joint. Deep muscles include the tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 18 - A 32-year-old female presents with painful bright red bleeding that occurs post defecation....

    Incorrect

    • A 32-year-old female presents with painful bright red bleeding that occurs post defecation. Digital rectal examination is too uncomfortable for the patient, perineal inspection shows a prominent posterior skin tag. What is the best course of action?

      Your Answer:

      Correct Answer: Prescribe topical diltiazem

      Explanation:

      An Anal fissure is a cut or a tear in the anal canal typically caused by passing a hard stool. Patients often complain of severe anal pain and bleeding with bowel movements. On physical examination, you may see the fissure or just the sentinel tag. If the examination appears normal, you can elicit point tenderness. We recommend against continuing the digital rectal examination or anoscopy if the patient is having pain during the examination.
      The primary goals of therapy are to properly bulk the stool with adequate fibre and relax the anal muscle. Specific steps include the following:
      Properly bulk the stool with adequate fibre to minimize constipation and diarrhoea; both frequent bowel movements and hard bowel movements can lead to an anal fissure.
      Temporary use of laxatives such as daily Miralax or senna. The dose of Miralax can be titrated up or down to achieve desired results. As the patient’s fibre supplementation increases, the need for Miralax will diminish.
      Chronic use of laxatives should be avoided because it can lead to worsening colonic function and constipation.
      Diltiazem 2% ointment is to be placed on the anal muscle 3 times daily—continue for a minimum of 8 weeks, even if symptoms improve earlier.
      If a patient cannot tolerate diltiazem or is breastfeeding or pregnant, 0.2% nitroglycerin-compounded ointment can be prescribed. However, the proper dose of nitroglycerin is important as too high of a dose can cause severe headaches.
      Do NOT prescribe haemorrhoid ointments or suppositories, especially steroid-based ones. Steroid ointments do not help. They do cause perianal skin thinning and dermatitis. At best, they act as a placebo, but they often are used chronically and cause unpleasant perianal skin changes.
      Use mental anal muscle relaxation: Actively thinking about relaxing sphincter tone.
      Consider sitz baths: Soaking the anal area in warm water induces relaxation. Warmer water induces more relaxation. No additives are needed.
      Surgical intervention (such as Botox injections or sphincterotomy) is considered for patients whose symptoms do not improve with the above management strategies. It is imperative that the patient increases fibre and water intake so bowel movements are very soft before the surgical intervention to maximize chances of postoperative healing.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
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  • Question 19 - The glossopharyngeal nerve provides the parasympathetic innervation of the: ...

    Incorrect

    • The glossopharyngeal nerve provides the parasympathetic innervation of the:

      Your Answer:

      Correct Answer: Parotid salivary gland

      Explanation:

      The glossopharyngeal nerve provides parasympathetic innervation for the parotid salivary gland via the auriculotemporal nerve. The facial nerve supplies the parasympathetic innervation of the lacrimal, nasal, sublingual and submandibular glands.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 20 - The fundus of the stomach receives blood supply from the same artery as...

    Incorrect

    • The fundus of the stomach receives blood supply from the same artery as the greater curvature of the stomach. Which of the following arteries when ligated will disrupt blood supply to the fundus of the stomach through this artery?

      Your Answer:

      Correct Answer: Splenic

      Explanation:

      The fundus of the stomach along with the greater curvature of the stomach receive blood supply from the short gastric artery. The short gastric artery arises from the end of the splenic artery. The ligation of the splenic artery therefore would cause a disruption of blood supply to the fundus of the stomach.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

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