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  • Question 1 - A 70-year-old man suffers an ischaemic stroke and develops a left homonymous hemianopia....

    Incorrect

    • A 70-year-old man suffers an ischaemic stroke and develops a left homonymous hemianopia. Where is the likely infarct?

      Your Answer: Right frontal lobe

      Correct Answer: Right occipital lobe

      Explanation:

      The man has a left homonymous hemianopia which means he is unable to view objects in the left visual field. This information is processed by the right primary visual cortex which lies in the right occipital lobe.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      5
      Seconds

  • Question 2 - A 30-year-old woman undergoes a laparotomy for a perforated duodenal ulcer and broad-spectrum...

    Incorrect

    • A 30-year-old woman undergoes a laparotomy for a perforated duodenal ulcer and broad-spectrum antibiotics are administered. However, she develops hearing impairment postoperatively.

      Which of the following agents is responsible for this adverse effect?

      Your Answer:

      Correct Answer: Gentamicin

      Explanation:

      Ototoxicity is a recognised adverse reaction with the aminoglycoside antibiotics.

      Gentamicin belongs to a class of drugs known as aminoglycoside antibiotics. It is a broad-spectrum antibiotic that is most affective against aerobic gram-negative rods. Gentamicin acts by inhibiting bacterial protein synthesis. This creates a pool of inactive bacterial ribosomes that can no longer re-initiate and translate new proteins.

      The hearing loss produced by gentamicin is known as gentamycin-induced ototoxicity. The antibiotic itself is not dangerous. It becomes toxic when it binds to iron in the blood and produces destructive chemical agents known as free radicals.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      0
      Seconds

  • Question 3 - A 32 year old woman complains of a sudden, severe headache, the worst...

    Incorrect

    • A 32 year old woman complains of a sudden, severe headache, the worst one she has ever experienced and collapses. CT scan shows a subarachnoid haemorrhage. However, she currently has no signs of an elevated ICP. Which of the following drugs should be administered?

      Your Answer:

      Correct Answer: Nimodipine

      Explanation:

      Nimodipine, a calcium-channel antagonist with a relatively selective vasodilatory effect on cerebral blood vessels, has been approved for improvement of neurologic deficits due to spasm following subarachnoid haemorrhage. Oral nimodipine is the most studied calcium channel blocker for prevention of vasospasm after Subarachnoid haemorrhage.
      An American Heart Association/American Stroke Association guideline recommends its use for this purpose (class I, level of evidence A). Calcium channel blockers have been shown to reduce the incidence of ischemic neurologic deficits, and nimodipine has been shown to improve overall outcome within 3 months of aneurysmal SAH. Calcium channel blockers and other antihypertensives should be used cautiously to avoid the deleterious effects of hypotension.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Surgical Disorders Of The Brain
      0
      Seconds

  • Question 4 - What is the innervation of the tensor tympani muscle? ...

    Incorrect

    • What is the innervation of the tensor tympani muscle?

      Your Answer:

      Correct Answer: Trigeminal nerve

      Explanation:

      The tensor veli palatini is innervated by the medial pterygoid nerve, a branch of mandibular nerve, the third branch of the trigeminal nerve (CN V3) – the only muscle of the palate not innervated by the pharyngeal plexus, which is formed by the vagal and glossopharyngeal nerves.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 5 - A gymnast was admitted to hospital for investigation of a weakness in the...

    Incorrect

    • A gymnast was admitted to hospital for investigation of a weakness in the extension and adduction of his arm. He had a previous penetrating wound in the area of the posterior axillary fold. Which of these muscles is the likely cause?

      Your Answer:

      Correct Answer: Latissimus dorsi

      Explanation:

      All the criteria of this case points towards the latissimus dorsi. This muscle is greatly involved in extension, adduction and medial rotation of the arm and forms the posterior axillary fold which in this case was injured.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 6 - A 21-year-old woman is admitted with loin pain and fever. She has given...

    Incorrect

    • A 21-year-old woman is admitted with loin pain and fever. She has given a history of haematuria for the past one week with associated dysuria, for which she was started on trimethoprim as an empirical outpatient treatment.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Pyelonephritis

      Explanation:

      This is most likely a case of pyelonephritis.

      Acute pyelonephritis is a common bacterial infection of the renal pelvis and kidneys most often seen in young adult women. History and physical examination are the most important tools for diagnosis. Most patients have fever, although it may be absent early in the illness. E. coli is the most common pathogen in acute pyelonephritis.

      For diagnosing the disease:
      1. A positive urinalysis confirms the diagnosis in patients with a compatible history and physical examination.
      2. Urine culture should be obtained in all patients to guide antibiotic therapy if the patient does not respond to initial empirical antibiotic regimens.
      3. Imaging, usually with contrast-enhanced CT scan, is not necessary unless there is no improvement in the patient’s symptoms or if there is recurrence of symptoms after initial improvement.

      Outpatient treatment is appropriate for most patients. Inpatient therapy is recommended for patients who have severe illness or in whom a complication is suspected. Oral beta-lactam antibiotics and trimethoprim/sulfamethoxazole are generally inappropriate for outpatient therapy because of high resistance rates. Several antibiotic regimens can be used for inpatient treatment, including fluoroquinolones, aminoglycosides, and cephalosporins.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
      0
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  • Question 7 - A patient presents with loss of fine touch and sense of proprioception in...

    Incorrect

    • A patient presents with loss of fine touch and sense of proprioception in the lower part of the body (below T6). He is likely to have a lesion involving:

      Your Answer:

      Correct Answer: Gracile nucleus

      Explanation:

      The gracile nucleus is located in the medulla oblongata and is one of the dorsal column nuclei involved in the sensation of fine touch and proprioception. It contains second-order neurons of the dorsal column–medial lemniscus system, that receive inputs from sensory neurones of the dorsal root ganglia and send axons that synapse in the thalamus.
      The gracile nucleus and fasciculus carry epicritic, kinaesthetic and conscious proprioceptive information from the lower part of the body (below the level of T6 in the spinal cord). Similar information from the upper part of body (above T6, except for face and ear) is carried by the cuneate nucleus and fasciculus. The information from face and ear is carried by the primary sensory trigeminal nucleus.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
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  • Question 8 - An old man was diagnosed with squamous cell carcinoma with axillary lymph node...

    Incorrect

    • An old man was diagnosed with squamous cell carcinoma with axillary lymph node metastasis. The doctor said he will excise the tumour and remove all axillary lymph nodes medial to the edge of the pectoralis minor muscle. One of the following axillary lymph nodes won't be removed by this procedure. Which is it?

      Your Answer:

      Correct Answer: Apical

      Explanation:

      The apical lymph node group won’t be removed which include 20 to 30 lymph nodes. They are grouped according to location. The lateral group, the anterior to pectoral group, the posterior or subscapular group, the central group, and the medial or apical group. The lateral, pectoral, and subscapular groups are found lateral to the pectoralis minor muscle. The central group is situated directly under that muscle. Thus, if all lymph nodes lateral to the medial edge of the pectoralis minor muscle are removed, all the above four groups will be removed. The apical group won’t be removed which is situated medial to the medial edge of the pectoralis minor muscle.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 9 - A 20 year old lady is involved in a motor vehicle accident in...

    Incorrect

    • A 20 year old lady is involved in a motor vehicle accident in which her car crashes head on into a truck. She complains of severe chest pain and a chest x-ray performed as part of a trauma series shows widening of the mediastinum. Which of the following is the most likely injury that she has sustained?

      Your Answer:

      Correct Answer: Rupture of the aorta distal to the left subclavian artery

      Explanation:

      Answer: Rupture of the aorta distal to the left subclavian artery

      Aortic rupture is typically the result of a blunt aortic injury in the context of rapid deceleration. After traumatic brain injury, blunt aortic rupture is the second leading cause of death following blunt trauma. Thus, this condition is commonly fatal as blood in the aorta is under great pressure and can quickly escape the vessel through a tear, resulting in rapid haemorrhagic shock, exsanguination, and death.
      Traumatic aortic transection or rupture is associated with a sudden and rapid deceleration of the heart and the aorta within the thoracic cavity. Anatomically, the heart and great vessels (superior vena cava, inferior vena cava, pulmonary arteries, pulmonary veins, and aorta) are mobile within the thoracic cavity and not fixed to the chest wall, unlike the descending abdominal aorta. Injury to the aorta during a sudden deceleration commonly originates near the terminal section of the aortic arch, also known as the isthmus. This portion lies just distal to the take-off of the left subclavian artery at the intersection of the mobile and fixed portions of the aorta.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
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  • Question 10 - A 78-year-old man who has been bedridden for a month is prescribed griseofulvin....

    Incorrect

    • A 78-year-old man who has been bedridden for a month is prescribed griseofulvin. What class of drugs does griseofulvin belong to?

      Your Answer:

      Correct Answer: Antifungal

      Explanation:

      Griseofulvin is an antifungal drug. It is administered orally, and it is used to treat ringworm infections of the skin and nails. It binds to keratin in keratin precursor cells and makes them resistant to fungal infections. Griseofulvin works by interfering with fungal mitosis.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 11 - Paracentesis of ascetic fluid in a 45-year old woman revealed the following :...

    Incorrect

    • Paracentesis of ascetic fluid in a 45-year old woman revealed the following : clear, yellow fluid with protein 2.0 g/dl and a few mesothelial and mononuclear cells seen. No malignant cells seen. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Micronodular cirrhosis

      Explanation:

      Cirrhosis is disease of the liver that is characterized by fibrosis leading to disorganization of the hepatic architecture. It shows the development of regenerative nodules surrounded by dense fibrotic tissue. Cirrhosis shows non-specific symptoms initially, which include fatigue, anorexia and weight loss. It can later progress to portal hypertension, ascites and liver failure.
      Micronodular cirrhosis is named so, due to the uniformly small nodules (<3 mm in diameter) and thick regular bands of connective tissue. These nodules lack lobular organization with distortion of central hepatic venules and portal triads. Over a period of time, macronodular cirrhosis develops, with bigger nodules (3 mm to 5 cm in diameter) surrounded by broad fibrous bands, and some amount of lobular organization. Mixed cirrhosis combines features of both micronodular and macronodular cirrhosis.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
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  • Question 12 - What is the nerve supply of the muscle that is inserted onto the...

    Incorrect

    • What is the nerve supply of the muscle that is inserted onto the crest of the lesser tubercle of the humerus?

      Your Answer:

      Correct Answer: Lower subscapular

      Explanation:

      The muscle is the subscapularis muscle which is supplied by the lower subscapular nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 13 - A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect: ...

    Incorrect

    • A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect:

      Your Answer:

      Correct Answer: Regulation of circadian rhythm

      Explanation:

      The suprachiasmatic nucleus (SCN) in the hypothalamus is responsible for controlling endogenous circadian rhythms and destruction of the SCN leads to a loss of circadian rhythm.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
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  • Question 14 - Where is the foramen ovale located? ...

    Incorrect

    • Where is the foramen ovale located?

      Your Answer:

      Correct Answer: Sphenoid

      Explanation:

      The foramen ovale is an oval shaped opening in the middle cranial fossa located at the posterior base of the greater wing of the sphenoid bone, lateral to the lingula. It transmits the mandibular division of the trigeminal nerve (CN Vc), accessory meningeal artery, emissary veins between the cavernous sinuses and pterygoid plexus, otic ganglion, and occasionally the nervus spinosus and lesser petrosal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 15 - A 50 year old man develops a colocutaneous fistula after having reversal of...

    Incorrect

    • A 50 year old man develops a colocutaneous fistula after having reversal of a loop colostomy fashioned for the defunctioning of an anterior resection. Pre-operative Gastrografin enema showed no distal obstruction or anastomotic stricture. Which of the following is the most appropriate course of action?

      Your Answer:

      Correct Answer: Provide local wound care and await spontaneous resolution

      Explanation:

      Containment of fistula output and skin protection should be instituted as soon as the diagnosis is made as it will decrease local skin excoriation and inflammation, pain and infection. While low output fistulas may be controlled with a simple absorbent dressing, complex fistulas often require advanced techniques including barrier creams, powders, and sealants to protect the skin from auto-digestion as well as bridging for fistula isolation, topographical enhancements, and complex pouching systems with or without sump drainage
      Fistulas arising from the oesophagus, duodenal stump after gastric resection, pancreaticobiliary tract, and jejunum are more likely to close without operative intervention. Additionally, those with long tracts and small enteric wall defects are associated with higher spontaneous closure rates. Fistulas in the colon show favourable rates of spontaneous resolution.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
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  • Question 16 - A 54 year old man undergoes Milligan Morgan haemorrhoidectomy. He had no associated...

    Incorrect

    • A 54 year old man undergoes Milligan Morgan haemorrhoidectomy. He had no associated co-morbidities. Which of the following would be the best option for immediate post operative analgesia?

      Your Answer:

      Correct Answer: Caudal block

      Explanation:

      Open haemorrhoidectomy is traditionally viewed as a painful procedure. Most operations are performed under general or regional anaesthesia. Following excisional haemorrhoidectomy, severe pain is not unusual, a well placed caudal anaesthetic will counter this. A pudendal nerve block is an alternative but is less effective than a caudal.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
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  • Question 17 - A 27 year old women works in a dry-cleaning shop. She was exposed...

    Incorrect

    • A 27 year old women works in a dry-cleaning shop. She was exposed to massive amounts of carbon tetrachloride on her skin as well as inhaled. Which of the following organs is most susceptible to damage?

      Your Answer:

      Correct Answer: Liver

      Explanation:

      Carbon tetrachloride (CCl4) is a common agent used in the dry cleaning industry and is thought to cause the formation of free radicals. It causes rapid breakdown of the endoplasmic reticulum due to decomposition of lipids and severe liver cell injury. Within less than 30 mins, hepatic protein synthesis declines, lipid export is reduced due to lack of apoprotein and there is an influx of calcium and cell death.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
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  • Question 18 - A 46-year old female patient experienced a stroke that affected her glossopharyngeal nerve....

    Incorrect

    • A 46-year old female patient experienced a stroke that affected her glossopharyngeal nerve. Damage to the glossopharyngeal nerve would most likely:

      Your Answer:

      Correct Answer: Result in general sensory deficit to the pharynx

      Explanation:

      The glossopharyngeal nerve (CN IX) has many functions which include:
      – Contributes to the pharyngeal plexus
      – Receiving general somatic sensory fibres from the tonsils, pharynx, the middle ear and the posterior third of the tongue.
      – supplies motor fibres to only one muscle; the stylopharyngeus muscle.
      – provides parasympathetic fibres to the parotid gland via the otic ganglion.
      – Receives visceral sensory fibres from the carotid bodies & carotid sinus.
      – Receives special visceral sensory fibres from the posterior third of the tongue.
      The above functions will directly be affected by the damage of the glossopharyngeal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 19 - 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
      0
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  • Question 20 - A victim of assault in a domestic violence is stabbed in the left...

    Incorrect

    • A victim of assault in a domestic violence is stabbed in the left chest. The tip of the pen knife entered the pleural space just above the cardiac notch. Luckily the lung was spared as it would only occupy this space during deep inspiration. Which of these structures was pierced by the knife?

      Your Answer:

      Correct Answer: Costomediastinal recess

      Explanation:

      The costomediastinal recess is located immediately next to the cardiac notch. The medial aspect of the superior lobe of the left lung, when fully inflated expands to this place. The lung wouldn’t enter the anterior or the posterior mediastinum which are found between the two pleural cavities.
      The costodiaphragmatic recess is the lowest extent of the pleural cavity where the inferior lobes of the lungs would expand into in deep inhalation.
      The cupola, is the part of the pleural cavity that extends above the first rib into the root of the neck. The superior most part of the superior lobe of the lung might extend into this part.
      Pulmonary ligament: pleural fold that is located below the root of the lung where the visceral pleura and the mediastinal pleura are in continuity.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 21 - Which nerve lies immediately medial to the psoas major muscle? ...

    Incorrect

    • Which nerve lies immediately medial to the psoas major muscle?

      Your Answer:

      Correct Answer: Obturator

      Explanation:

      The obturator nerve is formed from the ventral divisions of the 2nd, 3rd and 4th lumbar nerves. It courses through the fibres of the psoas major and emerges from the medial border near the pelvic brim.
      The iliohypogastric nerve comes from the first lumbar nerve and emerges from the upper part of the lateral border of psoas major.
      The ilioinguinal nerve arises with the iliohypogastric nerve from the first lumbar nerve and also emerges from the lateral border of the psoas major muscle.
      The lateral femoral cutaneous nerve comes from the posterior division of the 2nd and 3rd lumbar nerves to emerge from the lateral border of the psoas major muscle near its middle.
      The femoral nerve also arises from the dorsal divisions, but of the 2nd, 3rd and 4th lumbar nerves and courses through the muscle fibres to emerge at the lower part of the lateral border.
      The coccygeal nerve doesn’t arise from the lumbar plexus but from the sacral plexus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 22 - Which is the correct order of tendons passing from medial to lateral-posterior to...

    Incorrect

    • Which is the correct order of tendons passing from medial to lateral-posterior to the medial malleolus?

      Your Answer:

      Correct Answer: Posterior tibial, flexor digitorum longus, flexor hallucis longus

      Explanation:

      The correct order of structures is the tendon of tibialis posterior, tendon of flexor digitorum longus, posterior tibial artery (and vein), tibial nerve and tendon of flexor hallucis longus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 23 - During a procedure to treat an ulcer in the first part of the...

    Incorrect

    • During a procedure to treat an ulcer in the first part of the duodenum, the most appropriate site to make the incision on the anterior abdominal wall to approach this ulcer would be the:

      Your Answer:

      Correct Answer: Epigastric region

      Explanation:

      The abdomen is divided into nine regions for descriptive purposes. The epigastric region contains the first part of the duodenum, part of the stomach, part of the liver and pancreas. This would be the region that the surgeon would need to enter to access the ulcer.
      The left inguinal region contains the sigmoid colon.
      The left lumbar region contains the descending colon and kidney.
      The right lumbar region contains the right kidney and descending colon.
      The right hypochondrial region contains part of the liver and gall bladder.
      The hypogastric region contains the urinary bladder and the rectum.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 24 - A 38-year-old woman with end-stage renal disease, is undergoing haemodialysis. She has normocytic...

    Incorrect

    • A 38-year-old woman with end-stage renal disease, is undergoing haemodialysis. She has normocytic normochromic anaemia. What is the best treatment for her?

      Your Answer:

      Correct Answer: Erythropoietin

      Explanation:

      E erythropoietin (EPO) is a hormone that is released by the kidney. It is responsible for the regulation of red blood cell production in the body. It can be made using recombinant technology and is used in the treatment of anaemia of chronic renal failure and in patients under going chemotherapy

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
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  • Question 25 - Which of the following is a likely cause of jaundice? ...

    Incorrect

    • Which of the following is a likely cause of jaundice?

      Your Answer:

      Correct Answer: Hepatic disease if plasma albumin is low and serum aminotransferase elevations > 500 units

      Explanation:

      Jaundice can occur due to any of the possible causes and treatment depends upon diagnosing the correct condition. Mild hyperbilirubinemia with normal levels of aminotransferase and alkaline phosphatase is often unconjugated (e.g., due to haemolysis or Gilbert’s syndrome rather than hepatobiliary disease). Moderate or severe hyperbilirubinemia along with increased urinary bilirubin (bilirubinuria), high alkaline phosphatase or aminotransferase levels suggest hepatobiliary disease. Hyperbilirubinemia produced by any hepatobiliary disease is largely conjugated. In this case, other blood tests include hepatitis serology for suspected hepatitis, prothrombin time (PT) or international normalised ratio (INR), albumin and globulin levels, and antimitochondrial antibody levels (suspected primary biliary cirrhosis). Low albumin and high globulin levels suggest chronic rather than acute liver disease. In cases where there is only a an elevation of alkaline phosphatase, γ-glutamyl transpeptidase (GGT) levels should be checked – the levels of which will be found high in hepatobiliary disease, but not in bone disorder which can also lead to elevated alkaline phosphatase levels. In diseases of hepatobiliary origin, aminotransferase elevations > 500 units suggest a hepatocellular cause, whereas disproportionate increases of alkaline phosphatase (e.g., alkaline phosphatase > 3 times normal and aminotransferase < 200 units) suggest cholestasis. Because hepatobiliary disease alone rarely causes bilirubin levels > 30 mg/dl, higher levels are suggestive of a combination of severe hepatobiliary disease and haemolysis or renal dysfunction. Imaging is best for diagnosing infiltrative and cholestatic causes of jaundice. Liver biopsy is rarely needed, but can be of use in intrahepatic cholestasis and in some types of hepatitis.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 26 - A CT-scan report of a patient with gastric carcinoma shows that the lymph...

    Incorrect

    • A CT-scan report of a patient with gastric carcinoma shows that the lymph nodes around the coeliac trunk are enlarged. The coeliac trunk:

      Your Answer:

      Correct Answer: Gives rise to the splenic, left gastric and common hepatic arteries

      Explanation:

      The coeliac trunk is a branch of the aorta arising just below the aortic hiatus of the diaphragm to pass nearly horizontally forward to divide into 3 large branches i.e. the left gastric, the hepatic and the splenic arteries. Occasionally it may give off one of the inferior phrenic arteries. It is covered by the lesser omentum and on the right side bordered by the right coeliac ganglion and the cardiac end of the stomach. Inferiorly it is bordered by the upper border of the pancreas and splenic vein. The embryonic midgut is supplied by the superior mesenteric artery.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 27 - A 34-year-old female teacher is admitted with severe epigastric pain. Her blood reports...

    Incorrect

    • A 34-year-old female teacher is admitted with severe epigastric pain. Her blood reports show normal levels of serum amylase.

      In order to exclude a perforated viscus and determine whether pancreatitis is present, what should be the best course of action?

      Your Answer:

      Correct Answer: Request a CT scan of the abdomen and pelvis with intravenous contrast

      Explanation:

      A CT scan with IV contrast is needed because a scan without contrast will exclude a perforated viscus but will not be able to determine the presence of pancreatitis.

      Acute pancreatitis may be mild or life-threatening but it usually subsides. Gallstones and alcohol abuse are the main causes of acute pancreatitis. Severe abdominal pain is the predominant symptom.

      For diagnosis of acute pancreatitis, serum lipase is both more sensitive and specific than serum amylase.
      Serum amylase levels do not correlate with disease severity and may give both false positive and negative results. Three scoring systems are used to assess the severity of the disease, which are Glasgow pancreatitis score, Ranson criteria, and APACHE II scoring system.

      Management options are as follows:
      1. There is very little evidence to support the administration of antibiotics to patients with acute pancreatitis. These may contribute to antibiotic resistance and increase the risks of antibiotic-associated diarrhoea.
      2. Patients with acute pancreatitis due to gallstones should undergo early cholecystectomy.
      3. Patients with obstructed biliary system due to stones should undergo early ERCP.
      4. Patients with infected necrosis should undergo either radiological drainage or surgical necrosectomy.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
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  • Question 28 - 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 29 - A tumour on the floor of the fourth ventricle is most likely to...

    Incorrect

    • A tumour on the floor of the fourth ventricle is most likely to compress which of the following cranial nerve nuclei?

      Your Answer:

      Correct Answer: Abducent

      Explanation:

      The fourth ventricle, is a cavity of the brains ventricular system in which the cerebrospinal fluid is formed. This cavity is located behind the pons and upper half of the medulla oblongata. It extends from the cerebral aqueduct, to its connection to the third ventricle, and to the obex- which is the caudal tip of the fourth ventricle. The floor of the fourth ventricle consists of three parts – superior, intermediate and inferior. This inferior aspect of the floor of the fourth ventricle has the nucleus of the abducens nerve, CN VI which is looped over by the facial nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 30 - A 35-year old lady presents to her GP with vague abdominal symptoms. Examination...

    Incorrect

    • A 35-year old lady presents to her GP with vague abdominal symptoms. Examination reveals a normal size spleen. Which of the following is the likely diagnosis?

      Your Answer:

      Correct Answer: Idiopathic thrombocytopenic purpura

      Explanation:

      Idiopathic thrombocytopenic purpura (ITP) is a disease caused due to development of an antibody against a platelet antigen (autoantibody). In childhood disease, the autoantibody gets triggered by binding of viral antigen to the megakaryocytes. Presentation includes unexplained thrombocytopenia, petechiae and bleeding from mucosal surfaces. The spleen usually does not enlarge in size. However, splenomegaly can occur due to coexisting viral infection. Marrow examination reveals normal or increased number of megakaryocytes. Diagnosis is by exclusion of other thrombocytopenic disorders.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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