-
Question 1
Correct
-
A 4 year old girl falls off the monkey bars in the park and lands on her left forearm. She is rushed to the hospital and on examination, she has bony tenderness and bruising. X-ray shows unilateral cortical disruption and development of periosteal haematoma. What is the most likely diagnosis?
Your Answer: Greenstick fracture
Explanation:A greenstick fracture is a fracture in a young, soft bone in which the bone bends and breaks. Greenstick fractures occur most often during infancy and childhood when bones are soft.
Some clinical features of a greenstick fracture are similar to those of a standard long bone fracture – greenstick fractures normally cause pain at the injured area. As these fractures are specifically a paediatric problem, an older child will be protective of the fractured part and babies may cry inconsolably. As per a standard fracture, the area may be swollen and either red or bruised. Greenstick fractures are stable fractures as a part of the bone remains intact and unbroken so this type of fracture normally causes a bend to the injured part, rather than a distinct deformity, which is problematic.
Radiographic features
-usually mid-diaphyseal
-occur in tandem with angulation
-incomplete fracture, with cortical breach of only one side of the bone -
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
-
-
Question 2
Incorrect
-
A 66 year old retired judge has recently undergone a wide local excision and sentinel lymph node biopsy for breast cancer. Which of the factors listed below will provide the most important prognostic information?
Your Answer: Oestrogen receptor status
Correct Answer: Nodal status
Explanation:Even in the era of gene-expression profiling, the nodal status still remains the primary prognostic discriminant in breast cancer patients. The exclusion of node involvement using non-invasive methods could reduce the rate of axillary surgery, thereby preventing from suffering complications.
Lymph node status is highly related to prognosis (chances for survival).
-
This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
-
-
Question 3
Incorrect
-
A 43 year old man presents with a perianal abscess which is managed by incision and drainage. The wound measures 2.5cm x 2.5cm. What is the best step in management?
Your Answer: Insert a seton through the cavity into the rectum to allow a mature fistula track to develop
Correct Answer: Allow the wound to heal by secondary intention
Explanation:Answer: Allow the wound to heal by secondary intention
A perianal abscess is a type of anorectal abscess that is confined to the perianal space. Other causes can include inflammatory bowel diseases such as Crohn’s disease, as well as trauma, or cancerous origins. Patients with recurrent or complex abscesses should be evaluated for Crohn’s disease. Perianal abscesses are the most common type of anorectal abscesses. These abscesses can cause significant discomfort for patients. They are located at the anal verge and if left untreated can extend into the ischioanal space or intersphincteric space since these areas are continuous with the perianal space. They can also cause systemic infection if left untreated. Patients will complain of anal pain which may be dull, sharp, aching, or throbbing. This may be accompanied by fever, chills, constipation, or diarrhoea. Patients with perianal abscess typically present with pain around the anus, which may or may not be associated with bowel movements, but is usually constant. Purulent discharge may be reported if the abscess is spontaneously draining, and blood per rectum may be reported in a spontaneously draining abscess.
A physical exam can typically rule out other causes of anal pain, such as haemorrhoids, and will yield an area of fluctuance or an area of erythema and induration in the skin around the perianal area. Cellulitis should be noted and marked if extending beyond the fluctuant area.
Perianal abscesses are an indication for timely incision and drainage. Antibiotic administration alone is inadequate and inappropriate. Once incision and drainage are performed, there is no need for antibiotic administration unless certain medical issues necessitate the use. Such conditions include valvular heart disease, immunocompromised patients, diabetic patients, or in the setting of sepsis. Antibiotics are also considered in these patients or cases with signs of systemic infection or significant surrounding cellulitis.
Incision and drainage are typically performed in an office setting, or immediately in the emergency department. Local anaesthesia with 1% lidocaine may be administered to the surrounding tissues. A cruciate incision is made as close to the anal verge as possible to shorten any potential fistula formation. Blunt palpation is used to ensure no other septation or abscess pocket is missed. It is useful before completion of procedure to excise a skin flap of the cruciate incision or the tips of the four skin flaps to ensure adequate drainage and prevent premature healing of the skin over the abscess pocket. Packing may be placed initially for haemostasis. Continual packing may be further utilized for healing by secondary intention. Patients are encouraged to keep the incision and drainage site clean. Sitz baths may assist in pain relief.
More extensive abscesses may require the operating room for the adequate exam under anaesthesia to ensure adequate drainage, as well as inspect for other diseases such as fistula in ano.
-
This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
-
-
Question 4
Incorrect
-
A 56 year old man presenting with acute appendicitis undergoes an appendicectomy through a lower midline laparotomy incision. Which of the following would be the best option for providing post operative analgesia?
Your Answer: Oral tramadol alone
Correct Answer: Patient controlled analgesic infusion
Explanation:Patient-controlled analgesia (PCA) is a delivery system with which patients self-administer predetermined doses of analgesic medication to relieve their pain. The use of PCA in hospitals has been increasing because of its proven advantages over conventional intramuscular injections. These include improved pain relief, greater patient satisfaction, less sedation and fewer postoperative complications.
-
This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
-
-
Question 5
Correct
-
A 32 year old woman with a history of Crohn's disease, presents with a recurrent discharging anal fistula. Examination reveals a low anal fistula with involvement of a small area of the external anal sphincter muscle. Which of the following is the most appropriate management plan?
Your Answer: Insertion of a loose seton
Explanation:Fistulotomy could achieve good results in terms of wound healing and incontinence in strictly selected patients with Crohn’s disease suffering from low-lying trans-sphincteric fistulae. For more high-lying or complicated fistulae, seton placement is more appropriate. For high transsphincteric fistulae, the only option is placement of loose seton.
Fistulae are classified into four main groups according to anatomical location and the degree of sphincter involvement. Simple uncomplicated fistulae are low and do not involve more than 30% of the external sphincter. Complex fistulae involve the sphincter, have multiple branches or are non cryptoglandular in origin -
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
-
-
Question 6
Incorrect
-
A teacher had varicosities in the region of the small saphenous vein. Which of the following is true about that vein?
Your Answer: Is in close relation with the sural nerve in the upper two-thirds of the leg
Correct Answer: Has nine to twelve valves
Explanation:It is known that the small saphenous vein has nine to twelve valves along its course. This vein begins as a direct continuation of the lateral marginal vein posterior to the lateral malleolus. It is superficially situated but closer to its termination, perforates the deep fascia in the lower part of the popliteal fossa to end in the popliteal vein.
-
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 7
Incorrect
-
Which of the following statements is true of Colles’ fracture?
Your Answer: Is typically associated with compression of the ulnar nerve
Correct Answer: Is a cause of carpal tunnel syndrome
Explanation:Colles’ fracture is a distal fracture of the radius that is a known cause of carpal tunnel syndrome (compression of the median nerve in the carpal tunnel). It rarely results in ulnar nerve compression. A Colles’ fracture is extra-articular and does not extend into the wrist joint, otherwise this would make it an intra-articular fracture (Barton’s fracture). The distal fragment in a Colles’ fracture is displaced dorsally, unlike in a Smith’s fracture where the distal fragment is displaced volarly (ventrally). Associated fracture of the ulnar styloid process may occur and is a common associated injury.
-
This question is part of the following fields:
- Basic Sciences
- Pathology
-
-
Question 8
Correct
-
C5a (a complement component) is a potent?
Your Answer: Anaphylotoxin
Explanation:C5a is a strong chemoattractant as well as an anaphylotoxin and is involved in the recruitment of inflammatory cells such as neutrophils, eosinophils, monocytes, and T lymphocytes. It is also involved in activation of phagocytic cells, release of granule-based enzymes and generation of oxidants. All of which contribute to innate immune functions.
-
This question is part of the following fields:
- Basic Sciences
- Physiology
-
-
Question 9
Correct
-
What is expected from complete transection of the inferior gluteal nerve when it emerges from the greater sciatic foramen?
Your Answer: Extension of the thigh would be the action most affected
Explanation:As the inferior gluteal nerve emerges from the greater sciatic foramen below the piriformis muscle, it divides into branches and enters the gluteus maximus muscle which extends the femur and bends the thigh in line with the body.
-
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 10
Correct
-
A 34 year old woman underwent a wide local excision for her breast carcinoma. Histology reveals an invasive lobular carcinoma present at three of the resection margins. Cavity shavings that were taken at the original operation are also involved. The sentinel lymph node biopsy was reported to be negative. Which of the following management plans would be the most appropriate for this patient?
Your Answer: Arrange for completion mastectomy alone
Explanation:Mastectomy should ideally be done in this patient. This patient has extensive spread of disease and tumour margins are unclear which makes radiotherapy the less likely option. Mastectomy is the safest option in this scenario. Patients who have undergone mastectomy may be offered a reconstructive procedure either in conjunction with their primary resection or as a staged procedure at a later date.
-
This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
-
SESSION STATS - PERFORMANCE PER SPECIALTY
