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  • Question 1 - When a young boy falls on his outstretched hand, he fractures one of...

    Correct

    • When a young boy falls on his outstretched hand, he fractures one of the bones at his wrist joint. The doctors told his parents that the fractured bone has special importance as it is that bone that articulates with the distal end of the radius. Which one of the following is it?

      Your Answer: Scaphoid

      Explanation:

      It is the scaphoid bone that articulates with the radius at this level. It is located at the radial side of the wrist and is considered the largest bone in the proximal row of carpal bones. It articulates with the radius via its superior surface. This bone also articulates with trapezium and trapezoid bones via the inferior surface, capitate and lunate medially.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      25
      Seconds
  • Question 2 - A 41-year-old man presents with a severe left-sided loin pain radiating to the...

    Correct

    • A 41-year-old man presents with a severe left-sided loin pain radiating to the groin. Imaging demonstrates a 2 mm left-sided calculus in the distal ureter. Renal function is normal. What should be the most appropriate course of action?

      Your Answer: Arrange to review the patient in two weeks with a KUB X-ray

      Explanation:

      As the stone is smaller in size, there is a strong likelihood (75%) of it to be passed spontaneously. Furthermore, distally sited stones are more likely to pass spontaneously than proximally sited ones. Hence, it should be arranged to review the patient in two weeks with a KUB X-ray.

      Urolithiasis affects up to 15% of the population worldwide. The development of sudden-onset, colicky loin to groin pain is a classical feature in the history. It is nearly always associated with haematuria that is either micro- or macroscopic. The most sensitive and specific diagnostic test is helical, non-contrast CT scanning.

      Management options for urolithiasis are:
      1. Most renal stones measuring <5mm in maximum diameter typically pass within four weeks of onset of symptoms. More intensive and urgent treatment is indicated in the presence of ureteric obstruction, renal developmental abnormality such as horseshoe kidney, and previous renal transplant.
      2. Ureteric obstruction due to stones together with infection is a surgical emergency and the system must be decompressed. Options include nephrostomy tube placement, insertion of ureteric catheters, and ureteric stent placement.
      3. In the non-emergency setting, the preferred options for treatment include extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, ureteroscopy, and open surgery (selected cases). Minimally invasive options are the most popular first-line treatment.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
      19.2
      Seconds
  • Question 3 - A male teenager is taken to the A&E department with lower abdominal discomfort....

    Correct

    • A male teenager is taken to the A&E department with lower abdominal discomfort. For the last several months, he has been having intermittent right iliac fossa pain. A negative colonoscopy and gastroscopy for iron deficiency anaemia are seen in his past medical history notes. He states that the pain is worse after eating. Tests show that his inflammatory markers are normal. What is the likely diagnosis?

      Your Answer: Meckel's diverticulum

      Explanation:

      Answer: Meckel’s diverticulum

      Meckel’s diverticulum is the most common congenital malformation of the gastrointestinal tract (present in 2%-4% of population) due to persistence of the congenital vitello-intestinal duct. Bleeding from Meckel’s diverticulum due to ectopic gastric mucosa is the most common clinical presentation, especially in younger patients, but it is rare in the adult population. This is due to the persistence of the proximal part of the congenital vitello-intestinal duct. It is a true diverticulum, typically located on anti-mesenteric border, and contains all three coats of intestinal wall with its separate blood supply from the vitelline artery. Meckel’s diverticulum is lined mainly by the typical ileal mucosa as in the adjacent small bowel. However, ectopic gastric, duodenal, colonic, pancreatic, Brunner’s glands, hepatobiliary tissue and endometrial mucosa may be found, usually near the tip. The main mechanism of bleeding is the acid secretion from ectopic mucosa, leading to ulceration of adjacent ileal mucosa. It is possible that the recurrent intussusception may cause trauma, inflammation, mucosal erosion and bleeding. The pathogenic role of Helicobacter pylori in the development of gastritis and bleeding in the ectopic gastric mucosa is still debatable. NSAIDs’ effect on the ectopic gastric mucosa is yet to be proved. Bleeding from Meckel’s diverticulum can cause the iron deficiency anaemia, but it may also cause megaloblastic anaemia due to the bacterial overgrowth and vitamin B12 deficiency as a result of the dilatation and stasis in adjacent obstructed ileal loop. The presence of bleeding with hypoalbuminemia and low ferritin due to ongoing slow unrecognized bleeding may lead to the diagnosis of inflammatory bowel disease.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      52.4
      Seconds
  • Question 4 - An enlarged lymph node excised from a patient and submitted for histopathological evaluation...

    Correct

    • An enlarged lymph node excised from a patient and submitted for histopathological evaluation showed well-defined, prominent paracortical follicles with germinal centres? Which of the following patients are we likely talking about?

      Your Answer: A 5-year-old boy with a sore throat and runny nose

      Explanation:

      Lymphadenopathy is common in children and is usually reactive in nature. The description fits that of a benign, reactive lymph node.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      24.9
      Seconds
  • Question 5 - During work up for a 29 year-old lady who complained of chest pain,...

    Correct

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

      Your Answer: Lymph glands

      Explanation:

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

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      20.5
      Seconds
  • Question 6 - A 30-year old lady was admitted to the general surgical ward after a...

    Correct

    • A 30-year old lady was admitted to the general surgical ward after a diagnosis of perforation of the first part of the duodenum that resulted from a long standing ulcer. If this perforation led to the expulsion of the gastric content that resulted to the erosion of an artery found in this part of the duodenum (the posterior of the first part of the duodenum). Which of the following arteries is this most likely to be?

      Your Answer: Gastroduodenal

      Explanation:

      The proximal part of the duodenum is supplied by the gastroduodenal artery. This artery is found descending behind the first part of the duodenum after branching from the hepatic artery. If gastric content was to be expelled in the posterior portion of the first part of the duodenum, then this artery would be most likely to be damaged. The common hepatic artery and the left gastric artery are branches of the coeliac trunk that are found superior to the duodenum. The proper hepatic artery is a branch of the common hepatic artery also found superior to the duodenum. The superior mesenteric artery is found behind the pancreas as a branch of the aorta that is at the bottom of the L1 level. The right gastric artery arises above the pylorus from the proper hepatic artery and supplies the lesser curvature of the stomach. The intestinal arteries supply the ileum and the jejunum.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      37.6
      Seconds
  • Question 7 - A surgical registrar performing an adrenalectomy procedure on the left suprarenal gland of...

    Incorrect

    • A surgical registrar performing an adrenalectomy procedure on the left suprarenal gland of a 25 - year old male patient, accidentally jabbed and injured a vital structure that lies anterior to the left suprarenal organ. Which of the following was the structure most likely injured?

      Your Answer: Liver

      Correct Answer: Pancreas

      Explanation:

      The adrenal (suprarenal) glands are organs of the endocrine system located on top of each of the kidneys. The left suprarenal gland, in question, is crescent in shape and slightly larger than the right suprarenal gland. It is posteriorly located to the lateral aspect of the head of the pancreas which is thus the most likely to be injured. The other organs like the duodenum, liver and the inferior vena cava are related to the right suprarenal gland. The spleen and the colon are not in close proximity with the left suprarenal gland and are not likely to be the organs injured.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      1634.1
      Seconds
  • Question 8 - The extent of cancer growth can be described through staging. What is taken...

    Incorrect

    • The extent of cancer growth can be described through staging. What is taken into consideration when staging a cancer?

      Your Answer: Cell differentiation

      Correct Answer: Local invasion

      Explanation:

      Cancer stage is based on four characteristics: the size of cancer, whether the cancer is invasive or non-invasive, whether the cancer has spread to the lymph nodes, and whether the cancer has spread to other parts of the body, in this case beyond the breast. Staging is important as it is often a good predictor of outcomes and treatment is adjusted accordingly.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      15.3
      Seconds
  • Question 9 - In a cardiac cycle, what event does the closing of atrioventricular (AV) valves...

    Incorrect

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

      Your Answer: Beginning of diastole

      Correct Answer: Second heart sound

      Explanation:

      The beginning of ventricular systole corresponds to the beginning of the QRS complex in the ECG. The beginning of the ventricular systole also corresponds to the closure of the atrioventricular valves, causing the first heart sound (S1). S2, the second heart sound is due to closure of the aortic and pulmonary valves at the end of ventricular systole.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      17
      Seconds
  • Question 10 - A 55-year old gentleman presented to the doctor with worsening dysphagia for both...

    Correct

    • A 55-year old gentleman presented to the doctor with worsening dysphagia for both solids and liquids over 6 months. This was associated with regurgitation of undigested food and occasional chest pain. Barium swallow revealed distal oesophageal dilatation with lack of peristalsis in the distal two-third oesophagus. The likely diagnosis is:

      Your Answer: Achalasia

      Explanation:

      Achalasia is an oesophageal motility disorder where inappropriate contractions in the oesophagus lead to reduced peristalsis and failure of the lower oesophageal sphincter to relax properly in response to swallowing. Classical triad of symptoms include dysphagia to fluids followed by solids, chest pain and regurgitation of undigested food. Other symptoms include belching, hiccups, weight loss and cough. Diagnosis is by:
      – X-ray with a barium swallow or oesophagography : narrowing at the gastroesophageal junction (‘bird/parrot beak’ or ‘rat tail’ appearance) and various degrees of mega-oesophagus (oesophageal dilatation) as the oesophagus is gradually stretched by retained food. Effectiveness of treatment can be measured with a 5-minute timed barium swallow.
      – Manometry – probe measures the pressure waves in different parts of oesophagus and stomach while swallowing.
      – Endoscopy
      – CT scan to exclude other causes like malignancy
      – Pathological examination showing defect in the nerves which control oesophageal motility (myenteric plexus).
      In Chagas disease, there is destruction of ganglion cells by Trypanosoma cruzi.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      26.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (3/4) 75%
Basic Sciences (4/7) 57%
Generic Surgical Topics (2/2) 100%
Urology (1/1) 100%
The Abdomen (1/1) 100%
Pathology (1/2) 50%
Physiology (0/1) 0%
Passmed