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  • Question 1 - Which ectopic tissue is usually contained in the Meckel's diverticulum? ...

    Correct

    • Which ectopic tissue is usually contained in the Meckel's diverticulum?

      Your Answer: Gastric

      Explanation:

      The Meckel’s diverticulum is a vestigial remnant of the omphalomesenteric duct. This structure is also referred to as the vitelline and contains two types of ectopic tissue, namely; gastric and pancreatic.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      6.4
      Seconds
  • Question 2 - A 23-year-old male presents with a persistent and unwanted erection that has been...

    Correct

    • A 23-year-old male presents with a persistent and unwanted erection that has been present for the previous 7 hours. On examination, the penis is rigid and tender. Aspiration of blood from the corpus cavernosa shows dark blood. Which of the following is the most appropriate initial management?

      Your Answer: Aspirate further blood from the corpus cavernosa in an attempt to decompress

      Explanation:

      Priapism is defined as a prolonged penile erection lasting for >4 h in the absence of sexual stimulation and remains despite orgasm.

      The classification of priapism is conventionally divided into three main groups. The commonest classification is into non‐ischaemic (high flow), ischaemic (low flow), and stuttering (recurrent) subtypes.

      The EAU guidelines refer to the subtypes as ischaemic (low flow, veno‐occlusive) and arterial (high flow, non‐ischaemic). Of these, ischaemic priapism is the commonest, with refractory cases at risk of smooth muscle necrosis in the corpus cavernosum leading to sequelae of corporal fibrosis and erectile dysfunction (ED).

      One of the key considerations in the management of priapism is the duration of the erection at presentation.
      The EAU guidelines do differentiate the periods such that the intervention varies accordingly, which is particularly important for prolonged episodes that are refractory to pharmacological interventions and allow a step‐wise intervention.

      Ischaemic priapism is a medical emergency as the progressive ischaemia within the cavernosal tissue is associated with time‐dependent changes in the corporal metabolic environment, which eventually leads to smooth muscle necrosis. As the duration of the penile erection becomes pathologically prolonged, as in the case of low‐flow priapism, the partial pressure of oxygen (pO2) progressively falls as the closed compartment prevents replenishment of stagnant blood with freshly oxygenated arterial blood.
      Investigations using corporal blood aspiration, that in itself can be a therapeutic intervention leading to partial or complete penile detumescence, helps to differentiate ischaemic from non‐ischaemic priapism subtypes based on the pO2, pCO2 and pH levels. The AUA guidelines state that typically the blood gas analysis would give a pO2 of <30 mmHg and pCO2 of >60 mmHg and a pH of <7.25 in ischaemic priapism, whereas non‐ischaemic blood gas analysis would show values similar to venous blood. Once the diagnosis of priapism has been made, the initial management involves corporal blood aspiration followed by instillation of α‐agonists directly into the corpus cavernosum.
      The EAU guidelines recommend several possible agents for intracavernosal injection, as well as oral terbutaline after intracavernosal injection.
      Phenylephrine – 200 μg every 3–5 min to a maximum of 1 mg within 1 h.
      Etilephrine – 2.5 mg diluted in 1–2 mL saline.
      Adrenaline – 2 mL of 1/100 000 solution given up to 5 times in a 20‐min period.
      Methylene blue – 50–100 mg intracavernosal injection followed by aspiration and compression.

      Shunt surgery allows diversion of blood from the corpus cavernosum into another area such as the corpus spongiosum (glans or urethra) or the venous system (saphenous vein). Both the EAU and AUA guidelines recommend surgical intervention using firstly distal shunts and then proximal shunts in cases where aspiration and instillation of pharmacological agents fails to achieve penile detumescence. The EAU guidelines recommend that distal shunts should be attempted before proximal shunts, although the specific technique is left to the individual surgeon’s preference. The EAU guidelines also define a time point (36 h) when shunt surgery is likely to be ineffective in maintaining long‐term erectile function and may serve to reduce pain only. This is an important consideration when contemplating early penile prosthesis placement.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
      30.6
      Seconds
  • Question 3 - A 45 year old women has a 4 cm non tender mass in...

    Correct

    • A 45 year old women has a 4 cm non tender mass in her right breast which is fixed to the chest wall. Another 2cm non-tender mass is palpable in the left axilla. Chest x ray reveals multiple nodules ranging from 0.5 - 0.2 cm in both the lungs. What is the stage of her disease?

      Your Answer: T4 N1 M1

      Explanation:

      This woman has an invasive primary tumour mass with axillary node and lung metastases, making this stage T4 N1 M1. Looking at the other stems, T1 N1 M0 signifies a small primary cancer with nodal metastases but no distant metastases; T1 N0 M1 signifies a small primary cancer with no lymph node metastases but with distant metastases; T2 N1 M0 signifies a larger primary cancer with nodal metastases but no distant metastases; and T3 N0 M0 indicates a larger primary cancer with no metastases to either lymph nodes or to distant sites.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      28.1
      Seconds
  • Question 4 - Destruction of the ventromedial nucleus of the hypothalamus will result in: ...

    Incorrect

    • Destruction of the ventromedial nucleus of the hypothalamus will result in:

      Your Answer: Loss of circadian rhythm

      Correct Answer: Loss of satiety

      Explanation:

      The ventromedial nucleus of the hypothalamus is divided into an anterior and a superior part. The anterior part controls the female sexual drive, whereas the superior part is responsible for satiety. Destruction of the superior part of the nucleus will result in overeating, as no signal tells the body that it is satisfied.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      11.6
      Seconds
  • Question 5 - Investigations in a 40-year old gentleman with splenomegaly reveal the following: haemoglobin 21.5...

    Correct

    • Investigations in a 40-year old gentleman with splenomegaly reveal the following: haemoglobin 21.5 g/dl, haematocrit 66%, mean corpuscular volume (MCV) 86 fl, mean cell haemoglobin concentration 34 g/dl, mean corpuscular haemoglobin 34.5 pg, platelet count 450 × 109/l, and white blood cell count 12 × 109/l, with 81% polymorphonuclear leukocytes, 4% bands, 3% monocytes, and 7% lymphocytes. What is the likely diagnosis?

      Your Answer: Polycythaemia vera

      Explanation:

      The markedly increased haematocrit, along with thrombocytosis and the leucocytosis suggest a myeloproliferative disorder.
      Polycythaemia vera is the commonest myeloproliferative disorders occurring more often in males (about 1.4 to 1). The mean age at diagnosis is 60 years (range 15–90 years) with 5% of patients below 40 years at onset. It involves increased production of all cell lines, including red blood cells (independent of erythropoietin), white blood cells and platelets. If confined only to red blood cells, it is known as ‘primary erythrocytosis’. There is an increase in blood volume and hyperviscosity occurs, predisposing to thrombosis. Increased bleeding occurs due to abnormal functioning of platelets. Patients become hypermetabolic, and increased cell turnover leads to hyperuricaemia.
      Usually asymptomatic, occasionally symptoms include weakness, pruritus, headache, light-headedness, visual disturbances, fatigue and dyspnoea. Face appears red with engorged retinal veins. Lower extremities appear red and painful, along with digital ischaemia (erythromelalgia). Hepatomegaly is common and massive splenomegaly is seen in 75% patients. Thrombosis can lead to stroke, deep venous thrombosis, myocardial infarction, retinal artery or vein occlusion, splenic infarction (often with a friction rub) or Budd–Chiari syndrome. Gastrointestinal bleeding is seen in 10-20% patients. Hypermetabolism can lead to low-grade fevers and weight loss. Late features include complications of hyperuricaemia (e.g. gout, renal calculi). 1.5% to 10% cases transform to acute leukaemia.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      7.9
      Seconds
  • Question 6 - A 60-year-old female has sudden onset of high-grade fever associated with cough with...

    Correct

    • A 60-year-old female has sudden onset of high-grade fever associated with cough with productive rusty-coloured sputum. Chest x-ray showed left-sided consolidation. What is the most accurate test for the diagnosis of this patient?

      Your Answer: Sputum culture

      Explanation:

      Sputum culture is used to detect and identify the organism that are infecting the lungs or breathing passages.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      31.7
      Seconds
  • Question 7 - What is the likely diagnosis in a 55-year old man presenting with jaundice,...

    Correct

    • What is the likely diagnosis in a 55-year old man presenting with jaundice, weight loss, pale coloured stools and elevated alkaline phosphatase?

      Your Answer: Pancreatic carcinoma

      Explanation:

      Increased alkaline phosphatase is indicative of cholestasis, with a 4x or greater increase seen 1-2 days after biliary obstruction. Its level can remain elevated several days after the obstruction is resolved due to the long half life (7 days). Increase up to three times the normal level can be seen in hepatitis, cirrhosis, space-occupying lesions and infiltrative disorders. Raised alkaline phosphatase with other liver function tests being normal can occur in focal hepatic lesions like abscesses or tumours, or in partial/intermittent biliary obstruction. However, alkaline phosphatase has several isoenzymes, which originate in different organs, particularly bone. An isolated rise can also be seen in malignancies (bronchogenic carcinoma, Hodgkin’s lymphoma), post-fatty meals (from the small intestine), in pregnancy (from the placenta), in growing children (from bone growth) and in chronic renal failure (from intestine and bone). One can differentiate between hepatic and non-hepatic cause by measurement of enzymes specific to the liver e.g. gamma-glutamyl transferase (GGT).
      In an elderly, asymptomatic patient, isolated rise of alkaline phosphatase usually points to bone disease (like Paget’s disease). Presence of other symptoms such as jaundice, pale stools, weight loss suggests obstructive jaundice, most probably due to pancreatic carcinoma.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      33.3
      Seconds
  • Question 8 - A 45-year-old man complains of shortness of breath, cough and chest pain. Chest...

    Incorrect

    • A 45-year-old man complains of shortness of breath, cough and chest pain. Chest X ray revealed a perihilar mass with bronchiectasis in the left mid-lung. Which of the following is most probably associated with these findings?

      Your Answer: Metastatic adenocarcinoma

      Correct Answer: Bronchial carcinoid

      Explanation:

      Bronchial carcinoids are neuroendocrine tumours that arise from Kulchitsky’s cells of the bronchial epithelium. Kulchitsky’s cells belong to the diffuse endocrine system. Patients affected by this tumour may be asymptomatic or may present with symptoms of airway obstruction, like dyspnoea, wheezing, and cough. Other common findings are recurrent pneumonia, haemoptysis, chest pain and paraneoplastic syndromes. Chest radiographs are abnormal in the majority of cases. Peripheral carcinoids usually present as a solitary pulmonary nodule. For central lesions common findings include hilar or perihilar masses with or without atelectasis, bronchiectasis, or consolidation. Bronchial carcinoids most commonly arise in the large bronchi causing obstruction.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      46.1
      Seconds
  • Question 9 - A 5-year-old child diagnosed with nephrotic syndrome developed generalised oedema. What is the...

    Correct

    • A 5-year-old child diagnosed with nephrotic syndrome developed generalised oedema. What is the mechanism for the development of oedema in patients with nephrotic syndrome?

      Your Answer: Decreased colloid osmotic pressure

      Explanation:

      The development of oedema in nephrotic syndrome has traditionally been viewed as an underfill mechanism. According to this view, urinary loss of protein results in hypoalbuminemia and decreased plasma oncotic pressure. As a result, plasma water translocates out of the intravascular space and results in a decrease in intravascular volume. In response to the underfilled circulation, effector mechanisms are then activated that signal the kidney to secondarily retain salt and water. While an underfill mechanism may be responsible for oedema formation in a minority of patients, recent clinical and experimental findings would suggest that oedema formation in most nephrotic patients is the result of primary salt retention. Direct measurements of blood and plasma volume or measurement of neurohumoral markers that indirectly reflect effective circulatory volume are mostly consistent with either euvolemia or a volume expanded state. The ability to maintain plasma volume in the setting of a decreased plasma oncotic pressure is achieved by alterations in transcapillary exchange mechanisms known to occur in the setting of hypoalbuminemia that limit excessive capillary fluid filtration.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      81.8
      Seconds
  • Question 10 - A 25 year old man is admitted with a splenic rupture despite not...

    Correct

    • A 25 year old man is admitted with a splenic rupture despite not being involved in any trauma. Which of the following infections can cause spontaneous splenic rupture?

      Your Answer: Epstein-Barr virus

      Explanation:

      Answer: Epstein-Barr virus

      The Epstein–Barr virus is one of eight known human herpesvirus types in the herpes family, and is one of the most common viruses in humans. Infection with Epstein-Barr virus (EBV) is common and usually occurs in childhood or early adulthood.
      EBV is the cause of infectious mononucleosis, an illness associated with symptoms and signs like:
      fever,
      fatigue,
      swollen tonsils,
      headache, and
      sweats,
      sore throat,
      swollen lymph nodes in the neck, and
      sometimes an enlarged spleen.

      Although EBV can cause mononucleosis, not everyone infected with the virus will get mononucleosis. White blood cells called B cells are the primary targets of EBV infection.
      Petechiae on the palate are characteristic of streptococcal pharyngitis but also can be seen in Epstein–Barr virus infection, Arcanobacterium haemolyticum pharyngitis, rubella, roseola, viral haemorrhagic fevers, thrombocytopenia, and palatal trauma.
      Despite the fact that infectious mononucleosis is a self-limiting disease, it may cause serious and lethal complications. The mechanism of splenic rupture secondary to infectious mononucleosis has been controversial. It is commonly believed that it is caused by an increase in intra-abdominal pressure or contraction of the diaphragm with vigorous cough, vomiting and defecation, leading to a compression of the spleen. However, Patel et al. argue that it is primarily the result of an expanding subcapsular haematoma which subsequently tears the capsule and leads to hemoperitoneum. Traditionally, rupture of spleen is treated by splenectomy. The rationale is to prevent the chance of sudden death as an early complication of splenic rupture and the risk from blood transfusion.

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
      25.2
      Seconds
  • Question 11 - An 8 month old baby girl presents with a spiral fracture of her...

    Incorrect

    • An 8 month old baby girl presents with a spiral fracture of her left humerus. Her father states that he grabbed her arm because she was falling off the park slide. He noticed that something was wrong and he rushed to the hospital with her. Which of the following is the most likely issue?

      Your Answer: Non accidental injury

      Correct Answer: Accidental fracture

      Explanation:

      In this case, there is no delay in treatment and the mechanism by which the fracture occurred fits accidental fracture.

      A statement from the parent or guardian and any witnesses regarding how the child sustained the injury will help determine whether the injury is accidental or abusive. A statement from the parent or guardian explaining why he or she delayed in seeking medical treatment is important to the investigation because caretakers often postpone medical treatment or fail to provide treatment for an injured child to hide physical abuse. The abusing parent or caregiver may also put a child in oversized clothing or keep the child inside a residence for extended periods of time in an attempt to conceal the child’s injuries.

      Parents who inflict fractures on their children tend to minimize the severity of the accident purported to cause the fracture, whereas many parents of children with accidental fractures will relate a history of high-energy events.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      43.9
      Seconds
  • Question 12 - The mandibular nerve, which is the largest of the 3 divisions of the...

    Correct

    • The mandibular nerve, which is the largest of the 3 divisions of the trigeminal nerve, exits the cranial cavity through which foramen?

      Your Answer: Foramen ovale

      Explanation:

      At the base of the skull the foramen ovale is one of the larger of the several holes that transmit nerves through the skull. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery, lesser petrosal nerve, a branch of the glossopharyngeal nerve, emissary vein connecting the cavernous sinus with the pterygoid plexus of veins and occasionally the anterior trunk of the middle meningeal vein.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      20.6
      Seconds
  • Question 13 - A patient with testicular seminoma has the following tumour markers: LDH 1.3 times...

    Correct

    • A patient with testicular seminoma has the following tumour markers: LDH 1.3 times the reference levels, β-hCG 4500 mIU/ml and AFP 875 ng/ml. What's the serum tumour marker stage in this case?

      Your Answer: S1

      Explanation:

      According to AJCC guidelines, the serum tumour marker staging is the following:
      S0: marker studies within normal limits
      S1: lactate dehydrogenase (LDH) less than 1.5 times the reference range, beta-human chorionic gonadotrophin (β-hCG) <5000 mIU/ml, and alpha-fetoprotein (AFP) <1000 ng/ml
      S2: LDH 1.5–10 times the reference range, β-hCG 5000–50,000 mIU/ml or AFP 1000–10,000 ng/ml
      S3: LDH greater than 10 times the reference range, β-hCG >50,000 mIU/ml or AFP >10,000 ng/ml.
      According to this, the patient’s tumour belongs to the S1 stage.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      543.1
      Seconds
  • Question 14 - A lesion involving the lateral portion of the dorsal columns at the level...

    Correct

    • A lesion involving the lateral portion of the dorsal columns at the level of the nape of the neck will most likely affect:

      Your Answer: Vibratory sensations from the ipsilateral arm

      Explanation:

      At the level mentioned in the question, the lateral portion of dorsal columns comprises of the fasciculus cuneatus. Axons carrying the sensations of touch, vibration and proprioception from the ipsilateral arm enter the spinal cord and ascend in the fasciculus cuneatus, synapsing in the nucleus cuneatus of the caudal medulla. Secondary neurons from this nucleus give rise to internal arcuate fibres, which decussate and ascend to the thalamus as the medial lemniscus. Tertiary neurons from there project to the ipsilateral somatosensory cortex. Thus, any damage to the fasciculus cuneatus will result in a deficit in tactile, proprioceptive and vibratory sensations in the ipsilateral arm, and not the contralateral arm.
      Fine motor control of the fingers is mainly carried by the ipsilateral lateral corticospinal tract in the lateral funiculus of the cord. Motor control of the contralateral foot is carried by the ipsilateral corticospinal tract in the lateral funiculus of the cord. Lack of sweating of the face could be produced by interruption of sympathetic innervation. Proprioception from the ipsilateral leg is carried by the fasciculus gracilis in the medial part of the dorsal columns.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      523.9
      Seconds
  • Question 15 - A 55 year old man presented with a 4 day history of cough...

    Correct

    • A 55 year old man presented with a 4 day history of cough and fever. His sputum culture showed the presence of Strep pneumoniae. Which of the following substances produced by the inflammatory cells will result in effective clearance of this organism from the lung parenchyma?

      Your Answer: Hydrogen peroxide

      Explanation:

      Hydrogen peroxide is produced by myeloperoxidase to form a potent oxidant that eliminates bacteria, but is not effective in chronic granulomatous diseases.
      Platelet activating factor will lead to the activation, adhesion and aggregation of platelets but will not directly kill bacteria.
      Prostaglandins cause vasodilation but do not activate neutrophils.
      Kallikrein promotes formation of bradykinin that leads to vasodilation.
      Leukreines increase vascular permeability.
      Cytokines are communicating molecules between immune cells but directly will not kill bacteria.
      Interleukins will regulate the immune response.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      296.9
      Seconds
  • Question 16 - An organ transplant patient may be at risk of developing which type of...

    Correct

    • An organ transplant patient may be at risk of developing which type of cancer?

      Your Answer: Skin cancer

      Explanation:

      The most common malignancies encountered in the post–solid organ transplant setting are non-melanoma skin cancers, post-transplant lymphoproliferative disorders and Kaposi’s sarcoma (KS). The pathogenesis of these tumours is likely related to the immunosuppressive drugs used post-transplantation and subsequent viral infection.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      105.2
      Seconds
  • Question 17 - A 34-year-old man is receiving chemotherapy for non-Hodgkin's lymphoma. Which of the following...

    Correct

    • A 34-year-old man is receiving chemotherapy for non-Hodgkin's lymphoma. Which of the following chemotherapy regimens would be used in this case?

      Your Answer: CHOP

      Explanation:

      CHOP is the acronym for a chemotherapy regimen used in the treatment of non-Hodgkin’s lymphoma, comprising cyclophosphamide, hydroxyrubicin (adriamycin), vincristine and prednisone. This regimen can also be combined with the monoclonal antibody rituximab if the lymphoma is of B cell origin; this combination is called R-CHOP.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      10.5
      Seconds
  • Question 18 - A 53-year-old woman is diagnosed with cellulitis surrounding her leg ulcer. A swab...

    Incorrect

    • A 53-year-old woman is diagnosed with cellulitis surrounding her leg ulcer. A swab is taken and oral flucloxacillin is started. The following result is obtained:

      Your Answer: No change

      Correct Answer: Add penicillin

      Explanation:

      Streptococci may be divided into alpha and beta haemolytic types

      Alpha haemolytic streptococci

      The most important alpha haemolytic streptococcus is Streptococcus pneumoniae (pneumococcus). Pneumococcus is a common cause of pneumonia, meningitis and otitis media. Another clinical example is Streptococcus viridans

      Beta haemolytic streptococci

      These can be subdivided into group A and B

      Group A

      most important organism is Streptococcus pyogenes
      responsible for erysipelas, impetigo, cellulitis, type 2 necrotizing fasciitis and pharyngitis/tonsillitis
      immunological reactions can cause rheumatic fever or post-streptococcal glomerulonephritis
      erythrogenic toxins cause scarlet fever

      Group B

      Streptococcus agalactiae may lead to neonatal meningitis and septicaemia

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
      38
      Seconds
  • Question 19 - A 9 year old boy is admitted with right iliac fossa pain and...

    Correct

    • A 9 year old boy is admitted with right iliac fossa pain and an appendicectomy is to be performed.Which of the following incision is the best for this procedure?

      Your Answer: Lanz

      Explanation:

      Answer: Lanz

      The Lanz and Gridiron incisions are two incisions that can be used to access the appendix, predominantly for appendectomy.

      Both incisions are made at McBurney’s point (two-thirds from the umbilicus to the anterior superior iliac spine). They involve passing through all of the abdominal muscles, transversalis fascia, and then the peritoneum, before entering the abdominal cavity.

      The Lanz incision is a transverse incision, whilst the Gridiron incision is oblique (superolateral to inferomedial). Due to its continuation with Langer’s lines, the Lanz incision produces much more aesthetically pleasing results with reduced scarring.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      9.1
      Seconds
  • Question 20 - The deep planter artery is a branch of the: ...

    Incorrect

    • The deep planter artery is a branch of the:

      Your Answer: Posterior tibial artery

      Correct Answer: Dorsalis pedis artery

      Explanation:

      The deep plantar artery is a branch of the dorsalis pedis artery.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      9.4
      Seconds
  • Question 21 - The otic ganglion receives its preganglionic sympathetic fibres from which of the following...

    Correct

    • The otic ganglion receives its preganglionic sympathetic fibres from which of the following nerves?

      Your Answer: Glossopharyngeal nerve

      Explanation:

      The otic ganglion is a small (2–3 mm), oval shaped, flattened parasympathetic ganglion of a reddish-grey colour, located immediately below the foramen ovale in the infratemporal fossa and on the medial surface of the mandibular nerve. The preganglionic parasympathetic fibres originate in the inferior salivatory nucleus of the glossopharyngeal nerve. They leave the glossopharyngeal nerve by its tympanic branch and then pass via the tympanic plexus and the lesser petrosal nerve to the otic ganglion. Here, the fibres synapse, and the postganglionic fibres pass by communicating branches to the auriculotemporal nerve, which conveys them to the parotid gland. They produce vasodilator and secretomotor effects.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      5.2
      Seconds
  • Question 22 - A 55 year old man undergoes a live donor related renal transplant for...

    Correct

    • A 55 year old man undergoes a live donor related renal transplant for end stage renal failure. He had good urine output following surgery but it was noticed while he was on the ward that his urinary catheter is not draining despite the urostomy continuing to drain urine. Which intervention would be appropriate in this case?

      Your Answer: Bladder wash out

      Explanation:

      In this patient, a blocked catheter is the case because the urine is flowing into the urostomy bag but it is not able to pass through the catheter.
      It is recommended that in cases without hypotension, a bladder washout should be done if there is clot retention. The catheter may also be changed.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Organ Transplantation
      34.7
      Seconds
  • Question 23 - Which of these conditions is mithramycin used for? ...

    Incorrect

    • Which of these conditions is mithramycin used for?

      Your Answer: Organ transplantation

      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
      17
      Seconds
  • Question 24 - 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: Undertake a laparotomy

      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
      112.3
      Seconds
  • Question 25 - Out of the given options, which of the following is the most likely...

    Incorrect

    • Out of the given options, which of the following is the most likely diagnosis in a 25-year old gentleman presenting with a testicular germ cell tumour?

      Your Answer: Leydig cell tumour

      Correct Answer: Embryonal carcinoma

      Explanation:

      Embryonal carcinoma is a non-seminomatous germ cell tumour of the testis, accounting for 25% testicular tumours. Other germ cell tumours include seminoma, teratoma and choriocarcinoma. Embryonal carcinomas are known to occur in men aged 25-35 years, and occasionally in teens. They are rarely seen in ovaries of females. It can spread to the vas deferens and also to the aortic lymph nodes. Embryonal carcinomas are known to have elements of fetal origin such as cartilage. Usually, the main tumour is about 2.5cm long, with an extension of 8-9cm along the testicular cord. Contiguous spread to the testicle is seen in less than 1% cases.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      73.3
      Seconds
  • Question 26 - Which of the following conditions is characterized by generalised oedema due to effusion...

    Correct

    • Which of the following conditions is characterized by generalised oedema due to effusion of fluid into the extracellular space?

      Your Answer: Anasarca

      Explanation:

      Anasarca (or ‘generalised oedema’) is a condition characterised by widespread swelling of the skin due to effusion of fluid into the extracellular space. It is usually caused by liver failure (cirrhosis of the liver), renal failure/disease, right-sided heart failure, as well as severe malnutrition/protein deficiency.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      18
      Seconds
  • Question 27 - A medical intern wanting to perform her first thoracentesis (remove fluid from the...

    Correct

    • A medical intern wanting to perform her first thoracentesis (remove fluid from the pleural cavity) wishes to be reminded where to insert the needle to aspirate in order to avoid injuring the lung or neurovascular elements. Where is this place?

      Your Answer: The bottom of interspace 9 in the midaxillary line

      Explanation:

      Thoracentesis is performed in the costodiaphragmatic recess. The needle needs to be inserted below the level of the lungs to avoid injury to the lungs. At the paravertebral line, is between ribs 10 and 12, at the midaxillary line between ribs 8 and 10 and at the midclavicular line between interspaces 6 and 8. The needle should be inserted at the top of the rib (or the bottom of the interspace) to avoid damage to the neurovascular structures found below the rib running in the costal groove.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      23.7
      Seconds
  • Question 28 - Paracentesis of ascetic fluid in a 45-year old woman revealed the following :...

    Correct

    • 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: 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
      40.9
      Seconds
  • Question 29 - Which of the following diseases can cause paraesthesia along the distribution of the...

    Correct

    • Which of the following diseases can cause paraesthesia along the distribution of the median nerve of the hand, especially after activities which require flexion and extension of the wrist?

      Your Answer: Carpal tunnel syndrome

      Explanation:

      Carpal tunnel syndrome tends to occur in women between the ages of 30-50. There are many risk factors, including diabetes, hypothyroidism, obesity, pregnancy, and repetitive wrist work. Symptoms include pain in the hand and wrist, tingling, and numbness distributed along the median nerve (the palmar side of the thumb, the index and middle fingers, and the radial half of the ring finger), which worsens at night.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      8.1
      Seconds
  • Question 30 - A 27-year-old male complains of passing painless bright red blood rectally. It has...

    Incorrect

    • A 27-year-old male complains of passing painless bright red blood rectally. It has been occurring over the past week and tends to occur post defecation. He also suffers from pruritus ani. The underlying cause is likely to be manageable by treatment from which of the following modalities?

      Your Answer: Lateral internal sphincterotomy

      Correct Answer: Rubber band ligation

      Explanation:

      The patient has Haemorrhoid Disease
      A total of 40% of individuals with haemorrhoids are asymptomatic.
      For internal haemorrhoids, bleeding is the most commonly reported symptom. The occurrence of bleeding is usually associated with defecation and almost always painless. The blood is bright red and coats the stool at the end of defection.
      Another frequent symptom is the sensation of tissue prolapse. Prolapsed internal haemorrhoids may accompany mild faecal incontinence, mucus discharge, a sensation of perianal fullness, and irritation of perianal skin. Pain is significantly less common with internal haemorrhoids than with external haemorrhoids but can occur in the setting of prolapsed, strangulated internal haemorrhoids that develop gangrenous changes due to the associated ischemia.
      In contrast, external haemorrhoids are more likely to be associated with pain, due to activation of perianal innervations associated with thrombosis. Patients typically describe a painful perianal mass that is tender to palpation. This painful mass may be initially increasing in size and severity over time. Bleeding can also occur if ulceration develops from necrosis of the thrombosed haemorrhoid, and this blood tends to be darker and more clotted than the bleeding from the internal disease. Painless external skin tags often result from previous oedematous or thrombosed external haemorrhoids.

      Lifestyle and dietary modification are the mainstays of conservative medical treatment of haemorrhoid disease. Specifically, lifestyle modifications should include increasing oral fluid intake, reducing fat consumptions, avoiding straining, and regular exercise. Diet recommendations should include increasing fibre intake, which decreases the shearing action of passing a hard stool.
      Most patients with grade I and II and select patients with grade III internal hemorrhoidal disease who fail medical treatment can be effectively treated with office-based procedures.
      For internal haemorrhoids, rubber band ligation, sclerotherapy, and infrared coagulation are the most common procedures but there is no consensus on optimal treatment. Overall, the goals of each procedure are to decrease vascularity, reduce redundant tissue, and increase hemorrhoidal rectal wall fixation to minimize prolapse.
      Rubber band ligation is the most commonly performed procedure in the office and is indicated for grade II and III internal haemorrhoids.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
      116.5
      Seconds
  • Question 31 - Evaluation of a 60-year old gentleman, who has been a coal miner all...

    Incorrect

    • Evaluation of a 60-year old gentleman, who has been a coal miner all his life and is suspected to have pulmonary fibrosis reveals the following: FEV1 of 75% (normal > 65%), arterial oxygen saturation 92%, alveolar ventilation 6000 ml/min at a tidal volume of 600 ml and a breathing rate of 12 breaths/min. There are also pathological changes in lung compliance and residual volume. Calculate his anatomical dead space.

      Your Answer: 150 ml

      Correct Answer: 100 ml

      Explanation:

      Dead space refers to inhaled air that does not take part in gas exchange. Because of this dead space, taking deep breaths slowly is more effective for gas exchange than taking quick, shallow breaths where a large proportion is dead space. Use of a snorkel by a diver increases the dead space marginally. Anatomical dead space refers to the gas in conducting areas such as mouth and trachea, and is roughly 150 ml (2.2 ml/kg body weight). This corresponds to a third of the tidal volume (400-500 ml). It can be measured by Fowler’s method, a nitrogen wash-out technique. It is posture-dependent and increases with increase in tidal volume. Physiological dead space is equal to the anatomical dead space plus the alveolar dead space, where alveolar dead space is the area in the alveoli where no effective exchange takes place due to poor blood flow in capillaries. This physiological dead space is very small normally (< 5 ml) but can increase in lung diseases. Physiological dead space can be measured by Bohr’s method. Total ventilation per minute (minute ventilation) is given by the product of tidal volume and the breathing rate. Here, the total ventilation is 600 ml times 12 breaths/min = 7200 ml/min. The problem mentions alveolar ventilation to be 6000 ml/min. Thus, the difference between the alveolar ventilation and total ventilation is 7200 – 6000 ml/min = 1200 ml/min, or 100 ml per breath at 12 breaths per min. This 100 ml is the dead space volume.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      120.4
      Seconds
  • Question 32 - A 13 month old baby was taken to the hospital after his father...

    Incorrect

    • A 13 month old baby was taken to the hospital after his father saw that he had periorbital oedema for two days. He is seen by the doctor and noted to have facial oedema and a tender distended abdomen. His temperature is 39.1 and his blood pressure is 91/46 mmHg. There is also clinical evidence of poor peripheral perfusion. What is the diagnosis?

      Your Answer: Henoch Schönlein purpura

      Correct Answer: Spontaneous bacterial peritonitis

      Explanation:

      Answer: Spontaneous bacterial peritonitis

      The presence of periorbital and facial oedema with normal blood pressure in this toddler indicates that he has nephrotic syndrome. Nephrotic syndrome can be associated with a series of complications that can affect an individual’s health and quality of life:
      Spontaneous bacterial peritonitis can develop where there is ascites present. This is a frequent development in children but very rarely found in adults.

      Spontaneous bacterial peritonitis (SBP) is the development of a bacterial infection in the peritoneum, despite the absence of an obvious source for the infection. It is specifically an infection of the ascitic fluid – an increased volume of peritoneal fluid. Ascites is most commonly a complication of cirrhosis of the liver. It can also occur in patients with nephrotic syndrome. SBP has a high mortality rate.

      The diagnosis of SBP requires paracentesis, a sampling of the peritoneal fluid taken from the peritoneal cavity. If the fluid contains large numbers of white blood cells known as neutrophils (>250 cells/µL), infection is confirmed and antibiotics will be given, without waiting for culture results. In addition to antibiotics, infusions of albumin are usually administered.

      Signs and symptoms of spontaneous bacterial peritonitis (SBP) include fevers, chills, nausea, vomiting, abdominal pain and tenderness, general malaise, altered mental status, and worsening ascites. Thirteen percent of patients have no signs or symptoms. In cases of acute or chronic liver failure SBP is one of the main triggers for hepatic encephalopathy, and where there is no other clear causal indication for this, SBP may be suspected.

      These symptoms can also be the same for a spontaneous fungal peritonitis (SFP) and therefore make a differentiation difficult. Delay of diagnosis can delay antifungal treatment and lead to a higher mortality rate.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      144.7
      Seconds
  • Question 33 - Which of the following diseases is caused by intra-articular and/or extra-articular deposition of...

    Correct

    • Which of the following diseases is caused by intra-articular and/or extra-articular deposition of calcium pyrophosphate dihydrate (CPPD) crystals, due to unknown causes?

      Your Answer: Pseudogout

      Explanation:

      Pseudogout or chondrocalcinosis is a rheumatological disease caused by the accumulation of crystals of calcium pyrophosphate dihydrate (CPPD) in the connective tissues. It is frequently associated with other conditions, such as trauma, amyloidosis, gout, hyperparathyroidism and old age, which suggests that it is secondary to degenerative or metabolic changes in the tissues. The knee is the most commonly affected joint. It causes symptoms similar to those of rheumatoid arthritis or osteoarthritis.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      27.2
      Seconds
  • Question 34 - A 40 year old man sustained a fracture to the surgical neck of...

    Incorrect

    • A 40 year old man sustained a fracture to the surgical neck of his left humerus. Which of the following arteries is suspected to be injured in this case?

      Your Answer: Subscapular

      Correct Answer: Posterior humeral circumflex

      Explanation:

      The posterior humeral circumflex artery arises from the axillary artery and runs with the axillary nerve through the quadrangular space which is bounded laterally by the surgical neck of the humerus. After winding around the surgical neck of the humerus, it is distributed to the deltoid muscle and the shoulder joint. Thus fractures in the surgical neck of the humerus could result in an injury to this artery.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      107.2
      Seconds
  • Question 35 - A 42 year old man presents with end stage renal failure and is...

    Incorrect

    • A 42 year old man presents with end stage renal failure and is prepared to receive a kidney from his best friend. HLA testing showed that they are not a 100% match and he is given immunosuppressant therapy for this. Three months later when his renal function is assessed, he showed signs of deteriorating renal function, with decreased renal output, proteinuria of +++ and RBCs in the urine. He was given antilymphocyte globulins and his condition reversed. During the crisis period the patient is likely to be suffering from?

      Your Answer: Hyperacute rejection

      Correct Answer: Acute rejection

      Explanation:

      This patients is most likely experiencing an acute rejection. It is a cell mediated attack against the organ that has been transplanted. Antigens are either presented by blood borne cells with in the graft or antigen presenting cells in the body may be presenting class I and class II molecules that have been shed by the graft. Class I will activate CD8 and class II, CD4 cells, both of which will attack the graft.
      Chronic rejection is a slow process which occurs months to years after the transplant. The exact mechanism is not very well understood but it probably involves a combination of Type III and Type IV hypersensitivity directed against the foreign MHC molecules which look like self-MHC presenting a foreign antigen.
      Hyperacute Transplant Rejection occurs almost immediately and is often evident while you are still in surgery. It is caused by accidental ABO Blood type mismatching of the donor and recipient which almost never happens anymore. This means the host has preformed antibodies against the donated tissue.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      17.6
      Seconds
  • Question 36 - A patient with Paget's disease of the bone is predisposed to developing which...

    Incorrect

    • A patient with Paget's disease of the bone is predisposed to developing which type of cancer?

      Your Answer: Ewing’s sarcoma

      Correct Answer: Osteosarcoma

      Explanation:

      Paget’s disease of bone (PDB) is a focal disorder of bone. It is presumed benign in nature and mediated by abnormal osteoclast function. However osteosarcomas may occur in <1% of patients with Paget's disease of the bone. Osteosarcomas are osteogenic in origin, and consistently arise in sites of pagetic bone. This is not to be confused with Paget's disease of the breast.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      29.9
      Seconds
  • Question 37 - Which of the following structure forms the floor of the posterior triangle of...

    Incorrect

    • Which of the following structure forms the floor of the posterior triangle of the neck:

      Your Answer: Investing fascia

      Correct Answer: Prevertebral fascia

      Explanation:

      The posterior triangle (or lateral cervical region) is a region of the neck which has the following boundaries:
      Apex: Union of the sternocleidomastoid and the trapezius muscles at the superior nuchal line of the occipital bone
      Anterior: Posterior border of the sternocleidomastoid muscle
      Posterior: Anterior border of the trapezius
      Base: Middle one third of the clavicle
      Roof: Investing layer of the deep cervical fascia
      Floor: The anterolateral portion of prevertebral fascia

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      90.8
      Seconds
  • Question 38 - A 29-year-old woman presents to the doctor complaining of cough, shortness of breath,...

    Incorrect

    • A 29-year-old woman presents to the doctor complaining of cough, shortness of breath, fever and weight loss. Chest X-ray revealed bilateral hilar and mediastinal lymph node enlargement and bilateral pulmonary opacities. Non-caseating granulomas were found on histological examination. The most likely diagnosis is:

      Your Answer: Silicosis

      Correct Answer: Sarcoidosis

      Explanation:

      Sarcoidosis is an inflammatory disease of unknown aetiology that affects multiple organs but predominantly the lungs and intrathoracic lymph nodes. Systemic and pulmonary symptoms may both be present. Pulmonary involvement is confirmed by a chest X-ray and other imaging studies. The main histological finding is the presence of non-caseating granulomas.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      8.7
      Seconds
  • Question 39 - Which of the following is the cause of flattened (notched) T waves on...

    Correct

    • Which of the following is the cause of flattened (notched) T waves on electrocardiogram (ECG)?

      Your Answer: Hypokalaemia

      Explanation:

      The T-wave is formed due to ventricular repolarisation. Normally, it is seen as a positive wave. It can be normally inverted (negative) in V1 (occasionally in V2-3 in African-Americans/Afro-Caribbeans). Hyperacute T-waves are the earliest ECG change of acute myocardial infarction. ECG findings of hyperkalaemia include high, tent-shaped T-waves, a small P-wave and a wide QRS complex. Hypokalaemia results in flattened (notched) T-waves, U-waves, ST-segment depression and prolonged QT interval.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      23.8
      Seconds
  • Question 40 - A 26-year-old female sought consultation due to excessive vaginal discharge. Vaginal smear showed...

    Incorrect

    • A 26-year-old female sought consultation due to excessive vaginal discharge. Vaginal smear showed numerous bacilli under the microscope. The organism was non-pathogenic. What is the most likely organism:

      Your Answer: Proteus species

      Correct Answer: Lactobacillus species

      Explanation:

      Lactobacillus is a Gram-positive facultative bacteria. It is commonly present in the vagina and the gastrointestinal tract. Colonization of Lactobacillus is usually benign and it makes up a small portion of the gastrointestinal flora.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      22.9
      Seconds
  • Question 41 - Coagulation in the body (in vivo) is a process in which several proteins...

    Incorrect

    • Coagulation in the body (in vivo) is a process in which several proteins known as coagulation factors are activated in a cascade effect to stop bleeding. Which of the following initiates this cascade effect?

      Your Answer: Factor VIII

      Correct Answer: Tissue factor

      Explanation:

      Tissue factor (TF), also known as ‘factor III’ or ‘thromboplastin’, is an anti-coagulation protein that initiates the extrinsic coagulation. TF acts as a transmembrane receptor for Factor VII/VIIa . It is expressed by endothelial cells but also certain tissues, such as the heart and brain.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      598.8
      Seconds
  • Question 42 - Calculate the stroke volume in an adult male with the following parameters: Heart...

    Incorrect

    • Calculate the stroke volume in an adult male with the following parameters: Heart rate 70 beats/min, Arterial [O2] 0.24 ml O2/min, Venous [O2] 0.16 ml O2/min, Whole body O2 consumption 500 ml/min, Pulmonary diastolic pressure 15 mmHg, Pulmonary systolic pressure 25 mmHg, Wedge pressure 5 mmHg.

      Your Answer: 75 ml

      Correct Answer: 90 ml

      Explanation:

      Fick’s principle states that, VO2 = (CO × CAO2) – (CO × CVO2) where VO2 = oxygen consumption, CO = cardiac output, CAO2 = oxygen concentration of arterial blood and CVO2 = oxygen concentration of venous blood. Thus, CO = VO2/CAO2– CVO2, CO = 500/0.24–0.16, CO = 500/0.8, CO = 6.25 l/min. Cardiac output is also given by product of stroke volume and heart rate. Thus, stroke volume = cardiac output / heart rate = 6.25/70 × 1000 stroke volume = 90 ml approximately.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      43.4
      Seconds
  • Question 43 - A 70-year old man presents to the surgical out patient clinic with a...

    Incorrect

    • A 70-year old man presents to the surgical out patient clinic with a direct inguinal hernia on the right side. He had undergone and appendicectomy 6 months prior. The examining doctor correlated the development of the hernia to iatrogenic nerve injury that happened during the operation. Which nerve had been injured?

      Your Answer: Genital branch of the genitofemoral

      Correct Answer: Ilioinguinal

      Explanation:

      Direct inguinal hernias occur because of weakness in the abdominal muscles. The ilioinguinal nerve is important for innervating the muscles of the lower abdominal wall and damage during appendicectomy therefore prevents the man from being able to contract abdominal muscles to pull the falx inguinalis over the weak fascia.
      The genitofemoral nerve innervates the cremaster muscle and injury to it would cause inability to elevate the testes.
      The subcostal nerve and the ventral primary ramus of T10 innervate the muscles, skin and fascia of the upper abdominal wall.
      The iliohypogastric nerve supplies the skin over the upper part of the buttock behind the area supplied by the subcostal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      31.2
      Seconds
  • Question 44 - Which of the following is the most likely cause of prolonged thrombin clotting...

    Incorrect

    • Which of the following is the most likely cause of prolonged thrombin clotting time?

      Your Answer: Warfarin therapy

      Correct Answer: Hypofibrinogenemia

      Explanation:

      Thrombin clotting time, also called thrombin time (TT), is test used for the investigation of possible bleeding or clotting disorders. TT reflects the conversion of fibrinogen to fibrin and it’s also very sensitive to the presence of the anticoagulant heparin. A prolonged thrombin time may indicate the presence of hypofibrinogenemia (decreased fibrinogen level ), dysfibrinogenaemia, disseminated intravascular coagulation (DIC), end stage liver disease or malnutrition.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      150.1
      Seconds
  • Question 45 - Pain in the epigastric region occurring typically 2-3 hours after meals and causing...

    Incorrect

    • Pain in the epigastric region occurring typically 2-3 hours after meals and causing the patient to wake up at night is characteristic of which of the following conditions?

      Your Answer: Zollinger–Ellison syndrome

      Correct Answer: Duodenal ulcer

      Explanation:

      The description is typical for duodenal ulcers. There is no pain upon waking in the morning however it appears around mid-morning and is relieved by ingestion of food. The pain also often causes the patient to wake up at night.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      44.2
      Seconds
  • Question 46 - A 30 year old male has a painless and transilluminant swelling at the...

    Incorrect

    • A 30 year old male has a painless and transilluminant swelling at the upper pole of his left testi. There is a negative cough test. Which of the following is the likely diagnosis?

      Your Answer: Inguinal hernia

      Correct Answer: Spermatocoele

      Explanation:

      Spermatocele, also known as a spermatic cyst is a cystic mass usually occurring at the upper pole of the testis. Differential diagnosis included hydrocele as both are cystic, painless and transilluminant. Ultrasound is a useful modality. If symptomatic or large, surgical excision can be done.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      26.7
      Seconds
  • Question 47 - Which of these illnesses is most likely to precede Guillain-Barré syndrome? ...

    Incorrect

    • Which of these illnesses is most likely to precede Guillain-Barré syndrome?

      Your Answer: Meningitis

      Correct Answer: Viral pneumonia

      Explanation:

      Guillain–Barré syndrome (GBS) is characterized by a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. In about two-thirds of patients, the syndrome begins 5 days to 3 weeks after an infectious disease, surgery or vaccination. Infection is the trigger in over 50% of patients; common pathogens include Campylobacter jejuni, enteric viruses, herpesviruses (including cytomegalovirus and those causing infectious mononucleosis) and Mycoplasma species. The underlying mechanism involves an autoimmune disorder in which the body’s immune system mistakenly attacks the peripheral nerves and damages their myelin insulation, although the cause for this is still unknown.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      70.4
      Seconds
  • Question 48 - A 22-year-old male presents with a 10-day history of right-sided abdominal pain. Prior...

    Incorrect

    • A 22-year-old male presents with a 10-day history of right-sided abdominal pain. Prior to this, he was well. On examination, he has a low-grade fever and a palpable mass in the right iliac fossa. The rest of his abdomen is soft. An abdominal USS demonstrates matted bowel loops surrounding a thickened appendix. What is the best course of action?

      Your Answer: Perform an open appendicectomy

      Correct Answer: Manage conservatively with antibiotics

      Explanation:

      The patient mostly has an appendicular mass.
      At present, the treatment of choice for uncomplicated acute appendicitis in adults continues to be surgical. The inflammation in acute appendicitis may sometimes be enclosed by the patient’s own defence mechanisms, by the formation of an inflammatory phlegmon or a circumscribed abscess. The management of these patients is controversial. An immediate appendectomy may be technically demanding. The exploration often ends up in an ileocecal resection or a right-sided hemicolectomy. Recently, the conditions for conservative management of these patients have changed due to the development of computed tomography and ultrasound, which has improved the diagnosis of enclosed inflammation and made drainage of intra-abdominal abscesses easier. New efficient antibiotics have also given new opportunities for nonsurgical treatment of complicated appendicitis. The traditional management of these patients is nonsurgical treatment followed by interval appendectomy to prevent a recurrence. The need for interval appendectomy after successful nonsurgical treatment has recently been questioned because the risk of recurrence is relatively small.
      In patients with suspicion of contained appendiceal inflammation, based on a palpable mass or long duration of symptoms, the diagnosis should be confirmed by imaging techniques, especially CT scan. The patient should receive primary nonsurgical treatment with antibiotics and abscess drainage as needed. After successful nonsurgical treatment, no interval appendectomy is indicated in some cases, but the patient should be informed about the risk of recurrence especially in the presence of appendicolith. The risk of missing another underlying condition (cancer or CD) is low, but motivates a follow-up with a colon examination and/or a CT scan or US, especially in patients above the age of 40 years.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      38.5
      Seconds
  • Question 49 - A 55-year-old man underwent CT scan of the whole abdomen. The result showed...

    Incorrect

    • A 55-year-old man underwent CT scan of the whole abdomen. The result showed renal cell carcinoma with a tumour size of 7cm and extension into the regional lymph. What is the clinical stage of his renal cell cancer?

      Your Answer: Stage 0

      Correct Answer: Stage III

      Explanation:

      Renal cell carcinoma is a kidney cancer that originates in the lining of the proximal convoluted tubule. It is the most common type of kidney cancer in adults, responsible for approximately 90–95% of cases. Renal cell carcinomas can be staged by using the American Joint Committee on Cancer (AJCC) TNM (tumour-node-metastasis) classification, as follows: Stage I: tumours that are 7 cm or smaller and confined to the kidney, Stage II: tumours that are larger than 7 cm but still confined to the kidney, Stage III: tumours extending into the renal vein or vena cava, involving the ipsilateral adrenal gland and/or perinephric fat, or which have spread to one local lymph node and Stage IV: tumours extending beyond Gerota’s fascia, to more than one local node, or with distant metastases Recent literature has questioned whether the cut-off in size between stage I and stage II tumours should be 5 cm instead of 7 cm. The patient’s cancer in this case is stage III.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      52
      Seconds
  • Question 50 - 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: Flexor hallucis longus, flexor digitorum longus, posterior tibial

      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
      22
      Seconds
  • Question 51 - Chronic obstructive pulmonary disease (COPD) is likely to result in: ...

    Incorrect

    • Chronic obstructive pulmonary disease (COPD) is likely to result in:

      Your Answer: Metabolic acidosis

      Correct Answer: Respiratory acidosis

      Explanation:

      COPD leads to respiratory acidosis (chronic). This occurs due to hypoventilation which involves multiple causes, such as poor responsiveness to hypoxia and hypercapnia, increased ventilation/perfusion mismatch leading to increased dead space ventilation and decreased diaphragm function.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      18.5
      Seconds
  • Question 52 - Which of the following is a true statement regarding the pupil? ...

    Incorrect

    • Which of the following is a true statement regarding the pupil?

      Your Answer: Pupil diameter is determined by the balance between parasympathetic tone to the radial fibres of the iris and sympathetic tone to the pupillary sphincter muscle.

      Correct Answer: Phentolamine causes pupil constriction

      Explanation:

      A balance between the sympathetic tone to the radial fibres of the iris and parasympathetic tone to the pupillary sphincter muscle determines the pupil size. Phentolamine (α-adrenergic receptor blocker) causes pupillary constriction. Dilatation of the pupil occurs with increased sympathetic activity, decreased parasympathetic activity during darkness or block of muscarinic receptors by atropine.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      18.4
      Seconds
  • Question 53 - Acute respiratory distress syndrome (ARDS) is a medical condition that occurs in critically...

    Incorrect

    • Acute respiratory distress syndrome (ARDS) is a medical condition that occurs in critically ill patients, and can be triggered by events such as trauma and sepsis. Which of the following variables is most likely to be lower than normal in a patient with ARDS?

      Your Answer: Alveolar–arterial pressure difference

      Correct Answer: Lung compliance

      Explanation:

      Acute (or Adult) respiratory distress syndrome (ARDS) is a medical condition occurring in critically ill patients characterized by widespread inflammation in the lungs. The development of acute respiratory distress syndrome (ARDS) starts with damage to the alveolar epithelium and vascular endothelium, resulting in increased permeability to plasma and inflammatory cells. These cells pass into the interstitium and alveolar space, resulting in pulmonary oedema. Damage to the surfactant-producing type II cells and the presence of protein-rich fluid in the alveolar space disrupt the production and function of pulmonary surfactant, leading to micro atelectasis and impaired gas exchange. The pathophysiological consequences of lung oedema in ARDS include a decrease in lung volumes, compliance and large intrapulmonary shunts. ARDS may be seen in the setting of pneumonia, sepsis, following trauma, multiple blood transfusions, severe burns, severe pancreatitis, near-drowning, drug reactions, or inhalation injuries.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      57.3
      Seconds
  • Question 54 - A man came to the hospital complaining of a sensation of pins and...

    Incorrect

    • A man came to the hospital complaining of a sensation of pins and needles in the dorsum of the thumb and digits 1 and 2. On further examination they found that he had weakness in wrist dorsiflexion and finger extension. Which nerve do you think is injured in this case?

      Your Answer: Axillary

      Correct Answer: Radial

      Explanation:

      The radial nerve can be injured in multiple sites along its course in the upper limb, and each site has its own presentation. The major complaint is wrist drop which if high above the elbow, can cause numbness of the forearm and hand. It can last for several days or weeks. The most common site of compression for the radial nerve is at the proximal forearm in the area of the supinator muscles.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      65.2
      Seconds
  • Question 55 - Which statement is true about the inferior sagittal sinus? ...

    Correct

    • Which statement is true about the inferior sagittal sinus?

      Your Answer: Is formed between two layers of meningeal dura

      Explanation:

      The inferior sagittal sinus is also known as the inferior longitudinal sinus. It courses along the inferior border of the falx cerebri, superior to the corpus callosum. It is cylindrical in shape and increases in size as it passes backward ending in the straight sinus. It receives blood from the deep and medial aspects of the cerebral hemispheres and drains into the straight sinus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      53.6
      Seconds
  • Question 56 - A 25-year-old football player suffers severe head trauma during a game. Physical examination...

    Correct

    • A 25-year-old football player suffers severe head trauma during a game. Physical examination reveals a decerebrate posture and bilateral papilledema. A CT scan reveals marked diffuse cerebral oedema. This condition will be most severe in which component of the brain?

      Your Answer: White matter

      Explanation:

      The greatest amount of salt and water increase with cerebral oedema occurs within the white matter. Any swelling from oedema, haemorrhage or haematoma increases the intracranial pressure (ICP). As the ICP increases, the cerebral perfusion decreases and brain tissue can become ischaemic, even leading to brain death.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      87
      Seconds
  • Question 57 - A 44-year old man, who was euthyroid underwent thyroidectomy following neoplastic cells found...

    Correct

    • A 44-year old man, who was euthyroid underwent thyroidectomy following neoplastic cells found on fine-needle aspiration. Frozen section of multiple thyroid masses showed malignant neoplasm of polygonal cells in nests. The neoplasm also showed presence of amyloid which was positive with Congo-red staining. Immunoperoxidase staining for calcitonin was also positive. Chest X-ray revealed no abnormality. However, his blood pressure was found to be raised, and his serum ionised calcium was high. What is the likely diagnosis?

      Your Answer: Multiple endocrine neoplasia type IIA

      Explanation:

      MEN (Multiple Endocrine Neoplasia) syndromes are a group of three separate familial disease which consists of adenomatous hyperplasia and neoplasia in several endocrine glands. All three conditions are inherited as an autosomal dominant trait, with a single gene producing multiple effects. MEN IIA is characterized by medullary carcinoma of the thyroid, pheochromocytoma and hyperparathyroidism. It should be suspected in patients with bilateral pheochromocytoma, a familial history of MEN, or at least two characteristic endocrine manifestations. Genetic testing is used to confirm the diagnosis. Early diagnosis is crucial to aid in complete excision of the localized tumour. Pheochromocytomas can be detected by plasma free metanephrines and fractionated urinary catecholamines, particularly adrenaline (epinephrine). Imaging studies such as computed tomography or magnetic resonance imaging might also prove useful. Hyperparathyroidism is diagnosed by the standard finding of hypercalcaemia, hypophosphatemia and an increased parathyroid hormone level. Once MEN IIA syndrome is identified in any patient, it is recommended that his or her first-degree relatives and any other symptomatic also undergo genetic testing. Relatives should be subjected to annual screening for hyperparathyroidism and pheochromocytoma beginning in early childhood and continue indefinitely. Serum calcium levels help in screening for hyperparathyroidism. Similarly, screening for pheochromocytoma is by history, measurement of the blood pressure and laboratory testing.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      97.3
      Seconds
  • Question 58 - Calculate the cardiac stroke volume of a patient whose oxygen consumption (measured by...

    Incorrect

    • Calculate the cardiac stroke volume of a patient whose oxygen consumption (measured by analysis of mixed expired gas) is 300 ml/min, arterial O2 content is 20 ml/100 ml blood, pulmonary arterial O2 content is 15 ml/100 ml blood and heart rate is 60/min.

      Your Answer: 10 ml

      Correct Answer: 100 ml

      Explanation:

      By Fick’s principle, VO2 = Q × (CA (O2) − CV (O2)) where VO2 = O2 consumption, Q = cardiac output and CA(O2) and CV(O2) are arterial and mixed venous O2 content respectively. Thus, in the given problem, 300 ml O2/min = Q × (20−15) ml O2/100 ml. Thus, Q = 6000 ml blood/min. Then, we can calculate stroke volume by dividing the cardiac output with heart rate. Thus, stroke volume = 6000 ml/min divided by 60/min stroke volume = 100 ml.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      50.3
      Seconds
  • Question 59 - A 12 year old boy presents with a sharp pain on the left...

    Correct

    • A 12 year old boy presents with a sharp pain on the left side of his lower back. His parents both have a similar history of the condition. His urine tests positive for blood. A radio dense stone is seen in the region of the mid ureter when a KUB style x-ray is done. Which of the following is most likely the composition of the stone?

      Your Answer: Cystine stone

      Explanation:

      Answer: Cystine stone

      Cystinuria is a genetic cause of kidney stones with an average prevalence of 1 in 7000 births. Cystine stones are found in 1 to 2 percent of stone formers, although they represent a higher percentage of stones in children (approximately 5 percent). Cystinuria is an inherited disorder. Inherited means it is passed down from parents to children through a defect in a specific gene. In order to have cystinuria, a person must inherit the gene from both parents.
      Cystine is a homodimer of the amino acid cysteine. Patients with cystinuria have impairment of renal cystine transport, with decreased proximal tubular reabsorption of filtered cystine resulting in increased urinary cystine excretion and cystine nephrolithiasis. The cystine transporter also promotes the reabsorption of dibasic amino acids, including ornithine, arginine, and lysine, but these compounds are soluble so that an increase in their urinary excretion does not lead to stones. Intestinal cystine transport is also diminished, but the result is of uncertain clinical significance.

      Cystinuria only causes symptoms if you have a stone. Kidney stones can be as small as a grain of sand. Others can become as large as a pebble or even a golf ball. Symptoms may include:

      Pain while urinating
      Blood in the urine
      Sharp pain in the side or the back (almost always on one side)
      Pain near the groin, pelvis, or abdomen
      Nausea and vomiting

      Struvite stones are a type of hard mineral deposit that can form in your kidneys. Stones form when minerals like calcium and phosphate crystallize inside your kidneys and stick together. Struvite is a mineral that’s produced by bacteria in your urinary tract. Bacteria in your urinary tract produce struvite when they break down the waste product urea into ammonia. For struvite to be produced, your urine needs to be alkaline. Having a urinary tract infection can make your urine alkaline. Struvite stones often form in women who have a urinary tract infection.

      Calcium oxalate stones are the most common type of kidney stone. Kidney stones are solid masses that form in the kidney when there are high levels of calcium, oxalate, cystine, or phosphate and too little liquid. There are different types of kidney stones. Your healthcare provider can test your stones to find what type you have. Calcium oxalate stones are caused by too much oxalate in the urine.

      What is oxalate and how does it form stones?
      Oxalate is a natural substance found in many foods. Your body uses food for energy. After your body uses what it needs, waste products travel through the bloodstream to the kidneys and are removed through urine. Urine has various wastes in it. If there is too much waste in too little liquid, crystals can begin to form. These crystals may stick together and form a solid mass (a kidney stone). Oxalate is one type of substance that can form crystals in the urine. This can happen if there is too much oxalate, too little liquid, and the oxalate “sticks” to calcium while urine is being made by the kidneys.

      Uric acid stones are the most common cause of radiolucent kidney stones in children. Several products of purine metabolism are relatively insoluble and can precipitate when urinary pH is low. These include 2- or 8-dihydroxyadenine, adenine, xanthine, and uric acid. The crystals of uric acid may initiate calcium oxalate precipitation in metastable urine concentrates.
      Uric acid stones form when the levels of uric acid in the urine is too high, and/or the urine is too acidic (pH level below 5.5) on a regular basis. High acidity in urine is linked to the following causes:
      Uric acid can result from a diet high in purines, which are found especially in animal proteins such as beef, poultry, pork, eggs, and fish. The highest levels of purines are found in organ meats, such as liver and fish. Eating large amounts of animal proteins can cause uric acid to build up in the urine. The uric acid can settle and form a stone by itself or in combination with calcium. It is important to note that a person’s diet alone is not the cause of uric acid stones. Other people might eat the same diet and not have any problems because they are not prone to developing uric acid stones.
      There is an increased risk of uric acid stones in those who are obese or diabetic.
      Patients on chemotherapy are prone to developing uric acid stones.

      Only cystine stone is inherited.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
      63
      Seconds
  • Question 60 - The thoracic duct : ...

    Incorrect

    • The thoracic duct :

      Your Answer: Have no valves to ensure free flow of chyle

      Correct Answer: varies in length from 38 to 45 cm

      Explanation:

      The thoracic duct is the main drainage of lymph in the body. It varies in length from 38 to 45 cm and extends from the second lumbar vertebra to the root of the neck.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      21.9
      Seconds
  • Question 61 - Which of the following cytokines produced by the T cell induce MHC-II proteins?...

    Incorrect

    • Which of the following cytokines produced by the T cell induce MHC-II proteins?

      Your Answer: Tumour necrosis factor

      Correct Answer: γ-Interferon

      Explanation:

      Interferons elicit a non-specific antiviral activity by inducing specific RNA synthesis and expression of proteins in neighbouring cells. Common interferon inducers are viruses, double-stranded RNA and micro-organisms. INF-γ is produced mainly by CD4+, CD8+ T cells and less commonly by B cells and natural killer cells. INF-γ has antiviral and antiparasitic activity but its main biological activity appears to be immunomodulatory. Among its many functions are activation of macrophages and enhanced expression of MHC-II proteins or macrophages.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      27
      Seconds
  • Question 62 - An ECG of a 30 year old woman revealed low voltage QRS complexes....

    Correct

    • An ECG of a 30 year old woman revealed low voltage QRS complexes. This patient is most probably suffering from?

      Your Answer: Pericardial effusion

      Explanation:

      The QRS complex is associated with current that results in the contraction of both the ventricles. As ventricles have more muscle mass than the atria, they result in a greater deflection on the ECG. The normal duration of a QRS complex is 10s. A wide and deep Q wave depicts myocardial infarction. Abnormalities in the QRS complex maybe indicative of a bundle block, ventricular tachycardia or hypertrophy of the ventricles. Low voltage QRS complexes are characteristic of pericarditis or a pericardial effusion.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      57.5
      Seconds
  • Question 63 - The inferior palpebral nerve ascends behind the orbicularis oculi. What is the terminal...

    Incorrect

    • The inferior palpebral nerve ascends behind the orbicularis oculi. What is the terminal branch of the inferior palpebral nerve?

      Your Answer: Lacrimal nerve

      Correct Answer: Infraorbital nerve

      Explanation:

      The inferior palpebral nerve is a branch of the maxillary nerve. It supplies the skin and conjunctiva of the lower eyelid.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      34.8
      Seconds
  • Question 64 - A 4-year-old boy develops a persistent fever following an open appendicectomy for gangrenous...

    Incorrect

    • A 4-year-old boy develops a persistent fever following an open appendicectomy for gangrenous appendicitis. On examination, he has erythema of the wound and some abdominal distension. What is the most appropriate course of action?

      Your Answer: Open the wound

      Correct Answer: Arrange an abdominal ultrasound scan

      Explanation:

      Post-operative fever is very common.
      It is known to occur after all types of surgical procedures, irrespective of the type of anaesthesia.
      Postoperative fever can occur after minor surgical procedures but is rare and depends on the type of procedure. Overall, both abdominal and chest procedures result in the highest incidence of postoperative fever.

      In this case:
      Acute Fever
      Fever occurs in the first week (1 to 7 POD)
      POD 7 (5 to 10): Wound infection: Risk increases if the patient is immunocompromised (e.g., diabetic), abdominal wound, duration of surgery greater than 2 hours or contamination during surgery. Signs include erythema, warmth, tenderness, discharge.
      Rule out abscess or collections by physical exam plus ultrasound if needed. If an abscess is present, drainage and antibiotics are needed. Prevention is by careful surgical technique and prophylactic antibiotics (e.g., intravenous cefazolin at the time of induction of anaesthesia as well as postoperatively if needed)

      Other causes of Postoperative fever:
      An Immediate Fever
      Fever occurs immediately after surgery or within hours on postoperative days (POD) 0 or 1.
      – Malignant hyperthermia: high-grade fever (greater than 40 C), occurs shortly after inhalational anaesthetics or muscle relaxant (e.g., halothane or succinylcholine), may have a family history of death after anaesthesia. Laboratory studies will reveal with metabolic acidosis and hypercalcemia. If not readily recognized, it can cause cardiac arrest. The treatment is intravenous dantrolene, 100% oxygen, correction of acidosis, cooling blankets, and watching for myoglobinuria.
      – Bacteraemia: High-grade fever (greater than 40 C) occurring 30 to 40 minutes after the beginning of the procedure (e.g., Urinary tract instrumentation in the presence of infected urine). Management includes blood cultures three times and starting empiric antibiotics.
      – Gas gangrene of the wound: High-grade fever (greater than 40 C) occurring after gastrointestinal (GI) surgery due to contamination with Clostridium perfringens; severe wound pain; treat with surgical debridement and antibiotics.
      – Febrile non-haemolytic transfusion reaction: Fevers, chills, and malaise 1 to 6 hours after surgery (without haemolysis). Management: Stop transfusion (rule out haemolytic transfusion reaction) and give antipyretics (avoid aspirin in the thrombocytopenic patient).

      B. Acute Fever
      – Fever occurs in the first week (1 to 7 POD).
      POD 1 to 3: atelectasis: After prolonged intubation, the presence of upper abdominal incision, inadequate postoperative pain control, lying supine. Should be prevented by incentive spirometry, semi-recumbent position, adequate pain control, early ambulation. Clinically may be asymptomatic or with increased work of breathing, respiratory alkalosis, chest x-ray with volume loss. Treatment includes spirometry, chest physiotherapy, semi-recumbent position (improves expansion of alveoli by preventing pressure from intra-abdominal organs on the diaphragm and hence improving functional residual capacity)
      – POD 3: Unresolved atelectasis resulting in pneumonia (respiratory symptoms, Chest x-ray with infiltrate or consolidation, sputum culture, empiric antibiotics and modify according to culture result and sensitivity), or development of urinary tract infection (urine analysis and culture, treat with empiric antibiotics and modify according to culture result and sensitivity)
      – POD 5: Thrombophlebitis (may be asymptomatic or symptomatic, diagnose with Doppler ultrasound of deep leg and pelvic veins and treat with heparin)
      – POD 7: Pulmonary embolism (tachycardia, tachypnoea, pleuritic chest pain, ECG with right heart strain pattern (a low central venous pressure goes against diagnosis), arterial blood gas with hypoxemia and hypocapnia, confirm diagnosis with CT angiogram, and treat with heparin, if recurrent pulmonary embolism while anticoagulated with therapeutic INR, Inferior vena cava filter placement is the next step

      C. Subacute Fever
      Fever occurs between postoperative weeks 1 and 4.
      – POD 10: Deep infection (pelvic or abdominal abscess and if abdominal abscess could be sub-hepatic or sub-phrenic). A digital rectal exam to rule out the pelvic abscess and CT scan to localize intra-abdominal abscess. Treatment includes re-exploration vs. radiological guided percutaneous drainage
      Drugs: Diagnosis of exclusion includes rash and peripheral eosinophilia

      D. Delayed Fever
      Fever after more than 4 weeks.
      Skin and soft tissue infections (SSTI)
      Viral infections

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Surgical Technique And Technology
      47.7
      Seconds
  • Question 65 - A 40 year old man suffered severe trauma following a MVA. His BP...

    Incorrect

    • A 40 year old man suffered severe trauma following a MVA. His BP is 72/30 mmhg, heart rate of 142 beats/mins and very feeble pulse. He was transfused 3 units of blood and his BP returned to 100/70 and his heart rate slowed to 90 beats/min. What decreased after transfusion?

      Your Answer: Cardiac output

      Correct Answer: Total peripheral resistance

      Explanation:

      The patient is in hypovolemic shock, he is transfused with blood, this fluid resuscitation will result in a decreased sympathetic discharge and adequate ventricular filling which will result in the decreases TPR with an increased CO and cardiac filling pressures

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      71.5
      Seconds
  • Question 66 - A 31 year old detective has been having symptoms of post-defecation bleeding over...

    Incorrect

    • A 31 year old detective has been having symptoms of post-defecation bleeding over the past 6 years. She visits her doctor and on examination, large prolapsed haemorrhoids were seen. A colonoscopy was done and it showed no other disease. Which of the following options is the best course of action?

      Your Answer: Rubber band ligation

      Correct Answer: Excisional haemorrhoidectomy

      Explanation:

      The American Society of Colon and Rectal Surgeons (ASCRS) states that clinicians should typically offer haemorrhoidectomy to patients with symptomatic disease from external haemorrhoids or combined internal/external haemorrhoids with prolapse. For those who undergo surgical haemorrhoidectomy, a multimodality pain regimen is recommended to reduce use of narcotics and promote a faster recovery.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
      8
      Seconds
  • Question 67 - Where is the mental foramen located? ...

    Incorrect

    • Where is the mental foramen located?

      Your Answer: Immediately inferior to the orbit

      Correct Answer: In the mandible

      Explanation:

      The mental foramen is found bilaterally on the anterior surface of the mandible adjacent to the second premolar tooth. The mental nerve and terminal branches of the inferior alveolar nerve and mental artery leave the mandibular canal through it.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      26.6
      Seconds
  • Question 68 - A 23-year-old female with a history of bilateral vitreous haemorrhage is referred with...

    Incorrect

    • A 23-year-old female with a history of bilateral vitreous haemorrhage is referred with bilateral lesions in the cerebellar region. What is the likely diagnosis?

      Your Answer: Neurofibromatosis type II

      Correct Answer: Von Hippel-Lindau syndrome

      Explanation:

      von Hippel-Lindau (VHL) disease, or von Hippel-Lindau syndrome, is a rare genetic disorder characterized by visceral cysts and benign tumours in multiple organ systems that have a subsequent potential for malignant change.
      Clinical hallmarks of VHL disease include the development of retinal and central nervous system (CNS) hemangioblastomas (blood vessel tumours), pheochromocytomas, multiple cysts in the pancreas and kidneys, and an increased risk for malignant transformation of renal cysts into renal cell carcinoma. The wide age range and the pleiotropic manner in which VHL disease presents complicates diagnosis and treatment in affected individuals, as well as their at-risk relatives.

      Because VHL disease is a multiple-organ disease that widely varies in clinical presentation, various manifestations may lead to the diagnosis. Criteria are the following:
      More than one hemangioblastoma in the CNS (brain, spinal cord) or eye
      A single hemangioblastoma in the CNS or retina, plus a visceral manifestation (multiple renal, pancreatic, or hepatic cysts; pheochromocytoma; renal cancer)
      Positive family history plus any one of the above clinical manifestations
      Elucidation of a deleterious mutation in the VHL gene

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Surgical Disorders Of The Brain
      27.2
      Seconds
  • Question 69 - Which of the following physiological changes will you see in a young man...

    Incorrect

    • Which of the following physiological changes will you see in a young man who has been trekking in the Himalayas for 3 years?

      Your Answer: Pulmonary vasodilatation

      Correct Answer: Increased renal excretion of HCO3 –

      Explanation:

      The atmospheric pressure is lower at high altitudes as compared with sea level. This leads to a decrease in the partial pressure of oxygen. Once 2100 m (7000 feet) of altitude is reached, there is a drop in saturation of oxyhaemoglobin. The oxygen saturation of haemoglobin determines the oxygen content in the blood. The body physiological tries to adapt to high altitude by acclimatization. Immediate effects include hyperventilation, fluid loss (due to a decreased thirst drive), increase in heart rate and slightly lowered stroke volume. Long term effects include lower lactate production, compensatory alkali loss in urine, decrease in plasma volume, increased erythropoietin release and red cell mass, increased haematocrit, higher concentration of capillaries in striated muscle tissue, increase in myoglobin, increase in mitochondria, increase in aerobic enzyme concentration such as 2,3-DPG and pulmonary vasoconstriction.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      245
      Seconds
  • Question 70 - A 50-year old gentleman was recently diagnosed with hypertension, with no other abnormality...

    Incorrect

    • A 50-year old gentleman was recently diagnosed with hypertension, with no other abnormality on physical examination. Further investigations revealed the following : Na+ 144 mmol/l, K+ 3.0 mmol/l, Cl- 107 mmol/l, Bicarbonate 25 mmol/l. Blood glucose 5.8 mmol/l. What is the likely diagnosis?

      Your Answer: Congenital adrenal hyperplasia

      Correct Answer: Conn syndrome

      Explanation:

      Overproduction of aldosterone (a mineralocorticoid) by the adrenal glands is known as Conn’s syndrome. It can be either due to an aldosterone-secreting adrenal adenoma (50-60% cases) or adrenal gland hyperplasia (40-50% cases). Excess aldosterone leads to sodium and water retention, along with potassium excretion. This leads to arterial (non-essential) hypertension. Conn’s syndrome is the commonest cause of primary hyperaldosteronism. Other symptoms include muscle cramps, headache (due to hypokalaemia) and metabolic alkalosis, which occurs due to increased secretion of H+ ions by the kidney. The raised pH of the blood traps calcium leading to symptoms of hypocalcaemia, which can be mimicked by liquorice ingestion and Liddle syndrome. To diagnose Conn’s syndrome, the ratio of renin and aldosterone is measured. Due to suppression of renin secretion, there is low renin to aldosterone ratio (<0.05). However, anti-hypertensives may affect the test results and should be withdrawn for 6 weeks. Computed tomography can also be done to detect the presence of adrenal adenoma.
      Cushing’s syndrome does not cause hypokalaemia with normal serum glucose levels. Nelson’s syndrome refers to increased ACTH secretion due to pituitary adenoma. Pheochromocytoma will not lead to hypokalaemia even though hypertension can be seen.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      31.5
      Seconds
  • Question 71 - Staphylococcus aureus can be identified in the laboratory based on the clotting of...

    Incorrect

    • Staphylococcus aureus can be identified in the laboratory based on the clotting of plasma. Which microbial product is responsible for this activity?

      Your Answer: Plasminogen

      Correct Answer: Coagulase

      Explanation:

      Staphylococcus aureus is the most pathogenic species and is implicated in a variety of infections.  S. aureus can be identified due to its production of coagulase. The staphylococcal enzyme coagulase will cause inoculated citrated rabbit plasma to gel or coagulate. The coagulase converts soluble fibrinogen in the plasma into insoluble fibrin.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      57.5
      Seconds
  • Question 72 - A 32-year old gentleman came to the emergency department, complaining of progressively increasing...

    Incorrect

    • A 32-year old gentleman came to the emergency department, complaining of progressively increasing weakness in his arms and legs over 5 days. On examination, there is symmetrical weakness on both sides of his face, along with weakness of the proximal and distal muscles of all four limbs. No loss of sensation noted. Deep tendon reflexes could not be elicited and plantar responses were downward. On enquiry, it was revealed that he had an upper respiratory tract infection 10 days ago. The likely diagnosis is:

      Your Answer: Myasthenia gravis

      Correct Answer: Guillain–Barré syndrome

      Explanation:

      Guillain–Barré syndrome (GBS) is an acute, autoimmune polyradiculoneuropathy which affects the peripheral nervous system and is usually triggered by an acute infectious process. 75% patients have a history of acute infection within the past 1–4 weeks, usually respiratory or gastrointestinal. immunisations have also been implicated. The most common form is acute inflammatory demyelinating polyneuropathy. It results in an ascending paralysis with complete loss of deep tendon reflexes. Treatment includes immunoglobulins and supportive care. However, the disease may be fatal due to severe pulmonary complications and dysautonomia.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      45.7
      Seconds
  • Question 73 - A 47-year-old male is recovering in hospital following a total hip replacement. He...

    Incorrect

    • A 47-year-old male is recovering in hospital following a total hip replacement. He develops profuse and watery diarrhoea. Several other patients have been suffering from similar symptoms. Infection with which of the following is the most likely underlying cause?

      Your Answer: Clostridium perfringens

      Correct Answer: Clostridium difficile

      Explanation:

      Clostridioides difficile (formerly Clostridium difficile) colitis results from a disturbance of the normal bacterial flora of the colon, colonization by C difficile, and the release of toxins that cause mucosal inflammation and damage. Antibiotic therapy is the key factor that alters the colonic flora. C difficile infection (CDI) occurs primarily in hospitalized patients.
      The diagnosis of C difficile colitis should be suspected in any patient with diarrhoea who has received antibiotics within the previous 3 months, has been recently hospitalized, and/or has an occurrence of diarrhoea within 48 hours or more after hospitalization. In addition, C difficile can be a cause of diarrhoea in community dwellers without previous hospitalization or antibiotic exposure

      The following recommendations on Clostridium difficile infection (CDI) were released on February 2018 by the Infectious Diseases Society of America (ISDA) and Society for Healthcare Epidemiology of America (SHEA).
      Diagnosis (adults)
      Patients with unexplained and new-onset ≥3 unformed stools in 24 hours are the preferred target population for testing for CDI.
      Use a stool toxin test as part of a multistep algorithm (i.e., glutamate dehydrogenase [GDH] plus toxin; GDH plus toxin, arbitrated by nucleic acid amplification test [NAAT]; or NAAT plus toxin) rather than NAAT alone for all specimens when there are no pre-agreed institutional criteria for patient stool submission.
      Use NAAT alone or a multistep algorithm for testing (i.e., GDH plus toxin; GDH plus toxin, arbitrated by NAAT; or NAAT plus toxin) rather than a toxin test alone when there are pre-agreed institutional criteria for patient stool submission.
      Do not perform repeat testing (within 7 days) during the same episode of diarrhoea and do not test stool from asymptomatic patients, except for epidemiologic studies

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
      18
      Seconds
  • Question 74 - During a clinical rotation in the ENT clinic, you observe a flexible bronchoscopy....

    Incorrect

    • During a clinical rotation in the ENT clinic, you observe a flexible bronchoscopy. As the scope is passed down the trachea, you see a cartilaginous structure that resembles a ship's keel and separates the right and the left main stem bronchi. This structure is the:

      Your Answer: Costal cartilage

      Correct Answer: Carina

      Explanation:

      The carina (a keel-like cartilage) is found at the bifurcation of the trachea separating the right from the left main stem bronchi. It is a little more to the left than to the right.
      The cricoid cartilage is the inferior and posterior cartilage of the larynx.
      The costal cartilage on the other hand elongates the ribs anteriorly and contribute to the elasticity of the thoracic cage.
      The pulmonary ligament is a fold of pleura located below the root of the lung.
      Tracheal rings are rings of cartilage that support the trachea.
      Peritracheal fascia is a layer of connective tissue that invests the trachea from the outside and is not visible on bronchoscopy.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      29.7
      Seconds
  • Question 75 - Some substances, such as Chromium-51 and Technetium-99, are freely filtered but not secreted...

    Incorrect

    • Some substances, such as Chromium-51 and Technetium-99, are freely filtered but not secreted or absorbed by the kidney. In these cases, their clearance rate is equal to:

      Your Answer: Renal plasma flow

      Correct Answer: Glomerular filtration rate

      Explanation:

      If a substance passes through the glomerular membrane with perfect ease, the glomerular filtrate contains virtually the same concentration of the substance as does the plasma and if the substance is neither secreted nor reabsorbed by the tubules, all of the filtered substance continues on into the urine. Glomerular filtration rate (GFR) describes the flow rate of filtered fluid through the kidney.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      6.6
      Seconds
  • Question 76 - Point of entry of the vagal trunk into the abdomen: ...

    Incorrect

    • Point of entry of the vagal trunk into the abdomen:

      Your Answer: Aortic hiatus

      Correct Answer: Oesophageal hiatus

      Explanation:

      The oesophageal hiatus is located in the muscular part of the diaphragm a T10 and is above, in front and a little to the left of the aortic hiatus. It transmits the oesophagus, the vagus nerves and some small oesophageal arteries.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      39.7
      Seconds
  • Question 77 - A chef, whilst preparing food, cut her thumb with a knife. She transected...

    Incorrect

    • A chef, whilst preparing food, cut her thumb with a knife. She transected the arteria princeps pollicis. This artery is a branch of the?

      Your Answer: Ulnar artery

      Correct Answer: Radial artery

      Explanation:

      The radial artery branches into the arteria princeps pollicis as it turns medially into the deep part of the hand. The arteria princeps pollicis is distributed to the skin and subcutaneous tissue of the thumb.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      44.7
      Seconds
  • Question 78 - A 6 week old preterm infant is scheduled for an inguinal hernia repair....

    Correct

    • A 6 week old preterm infant is scheduled for an inguinal hernia repair. Which of the following fluids should be ideally administered to him while he is on NPO?

      Your Answer: 10% dextrose

      Explanation:

      There is a substantial risk of hypoglycaemia in neonates following surgery, therefore 10% dextrose should be administered to them to avoid the complications associated with hypoglycaemia.

    • This question is part of the following fields:

      • Post-operative Management And Critical Care
      • Principles Of Surgery-in-General
      43.4
      Seconds
  • Question 79 - During a radical mastectomy for advanced breast cancer, the surgeon injured the long...

    Incorrect

    • During a radical mastectomy for advanced breast cancer, the surgeon injured the long thoracic nerve. Which among the following muscles is likely to be affected?

      Your Answer: Subscapularis

      Correct Answer: Serratus anterior

      Explanation:

      The long thoracic nerve innervates the serratus anterior muscle which holds the scapula forward and balances the rhomboids and the trapezius muscles which retract the scapula. Injury to this nerve results in a ‘winged scapula’ with a posterior protrusion.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      21.1
      Seconds
  • Question 80 - The normal location of the major duodenal papilla: ...

    Correct

    • The normal location of the major duodenal papilla:

      Your Answer: Descending part of the duodenum

      Explanation:

      The major duodenal papilla is on the descending portion of the duodenum on the medial side, about 7-10cm from the pylorus. The pancreatic ducts and the common bile ducts unite and open by a common orifice on the summit of the duodenal papilla.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      51.2
      Seconds
  • Question 81 - Renal function is an indication of the state of the kidney, measured by glomerular...

    Incorrect

    • Renal function is an indication of the state of the kidney, measured by glomerular filtration rate (GFR). In a healthy person, GFR would be greatly increased by: 

      Your Answer: Vasoconstriction of vasa recta

      Correct Answer: Substantial increases in renal blood flow

      Explanation:

      An increase in the rate of renal blood flow (RBF) greatly increases the glomerular filtration rate (GFR). The more plasma available (from increased RBF), the more filtrate is formed. Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. Central to the physiologic maintenance of GFR is the differential basal tone of the afferent and efferent arterioles.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      39
      Seconds
  • Question 82 - The oesophagus is an important part of the alimentary canal. It receives blood...

    Incorrect

    • The oesophagus is an important part of the alimentary canal. It receives blood from various arteries in the body. Which one of the following is an artery that will lead to some level of ischaemia to the oesophagus when ligated?

      Your Answer: Right suprarenal

      Correct Answer: Left inferior phrenic

      Explanation:

      The oesophagus receives its blood supply from the following arteries: the inferior thyroid branch of the thyrocervical trunk, the descending thoracic aorta, the left gastric branch of the coeliac artery and the from the left inferior phrenic artery of the abdominal aorta. Hence ligation of the left inferior phrenic will lead to ischemia to some portions of the oesophagus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      18.7
      Seconds
  • Question 83 - A 27 year old lady presents with bright red rectal bleeding that occurs...

    Incorrect

    • A 27 year old lady presents with bright red rectal bleeding that occurs after defecation and is seen in the toilet bowl and on the tissue. She is constipated but her bowel habit is otherwise normal. A digital rectal examination is done which is also normal. What is the most likely diagnosis?

      Your Answer: Rectal cancer

      Correct Answer: Haemorrhoidal disease

      Explanation:

      Answer: Haemorrhoidal disease

      Haemorrhoids are a normal part of the anatomy of the anorectum. They are vascular cushions that serve to protect the anal sphincter, aid closure of the anal canal during increased abdominal pressure, and provide sensory information that helps differentiate among stool, liquid and gas. Because of their high vascularity and sensitive location, they are also a frequent cause of pathology. Contributing factors include pregnancy, chronic constipation, diarrhoea or prolonged straining, weight lifting, and weakening of supporting tissue as a result of aging or genetics.
      Haemorrhoids are classified according to their position relative to the dentate line. External haemorrhoids lie below the dentate line, are covered by squamous epithelium and innervated by cutaneous nerves. If symptomatic, the only definitive therapy is surgical excision.
      Internal haemorrhoids arise above the dentate line, are covered by columnar cells and have a visceral nerve supply. They are further categorized — and treated — according to their degree of prolapse:
      -Grade I haemorrhoids bleed but do not prolapse; on colonoscopy, they are seen as small bulges into the lumen.
      -Grade II haemorrhoids prolapse outside the anal canal but reduce spontaneously.
      -Grade III haemorrhoids protrude outside the anal canal and usually require manual reduction.
      -Grade IV haemorrhoids are irreducible and constantly prolapsed. Acutely thrombosed haemorrhoids and those involving rectal mucosal prolapse are also grade IV.

      Most gastrointestinal and surgical societies advocate anoscopy and/or flexible sigmoidoscopy to evaluate any bright-red rectal bleeding. Colonoscopy should be considered in the evaluation of any rectal bleeding that is not typical of haemorrhoids such as in the presence of strong risk factors for colonic malignancy or in the setting of rectal bleeding with a negative anorectal examination.

      Anal fissures are tears of the sensitive mucosal lining of the anus. Anal fissures often cause pain during and after a bowel movement, sometimes followed by throbbing pain for several hours. They are also often associated with itching and blood on toilet tissue, in the bowl, or on the surface of the stool. Anal fissures are caused by
      trauma to the anal canal usually during bowel movements. Anal fissures are also sometimes caused by inflammatory bowel disease or infection.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
      75.9
      Seconds
  • Question 84 - Which of the following is true about myasthenia gravis? ...

    Incorrect

    • Which of the following is true about myasthenia gravis?

      Your Answer: Response of skeletal muscles to direct electrical stimulation is weakened

      Correct Answer: Response of skeletal muscle to nerve stimulation is weakened

      Explanation:

      An autoimmune disorder, myasthenia gravis leads to progressive muscle weakness. It occurs due to formation of antibodies against the nicotinic acetylcholine (ACh) receptor of the motor endplate, which leads to impaired neuromuscular transmission. Thus, nerve stimulation will lead to a weakened muscle response, but direct electrical stimulation will bring about a normal response. Diagnostic test includes improvement of muscle weakness by small doses of acetylcholinesterase inhibitors (physostigmine or edrophonium). However, a large dose of physostigmine worsens the weakness due to desensitisation of the endplate to persistent Ach. One of the investigative tools includes radiolabelled snake venom α-bungarotoxin. It is an in vitro study performed on muscle biopsy specimens and used to quantify the number of ACh receptors at the motor endplate.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      87.9
      Seconds
  • Question 85 - A 3 year old girl is taken to the clinic with a 3...

    Correct

    • A 3 year old girl is taken to the clinic with a 3 day history of feeling unwell and having a sore throat. When examined by the doctor, marked cervical lymphadenopathy is observed and the oropharynx is covered with a thick grey membrane which bleeds following attempted removal. Which of the following is the most likely diagnosis?

      Your Answer: Diphtheria

      Explanation:

      Diphtheria is an infection caused by the bacterium Corynebacterium diphtheriae. Signs and symptoms may vary from mild to severe. They usually start two to five days after exposure. Symptoms often come on fairly gradually, beginning with a sore throat and fever. In severe cases, a grey or white patch develops in the throat. This can block the airway and create a barking cough as in croup. The neck may swell in part due to enlarged lymph nodes.

      The disease may remain manageable, but in more severe cases, lymph nodes in the neck may swell, and breathing and swallowing are more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy. Abnormal cardiac rhythms can occur early in the course of the illness or weeks later, and can lead to heart failure. Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases are put in a hospital intensive care unit and given a diphtheria antitoxin (consisting of antibodies isolated from the serum of horses that have been challenged with diphtheria toxin). Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration increases risk of death. Therefore, the decision to administer diphtheria antitoxin is based on clinical diagnosis, and should not await laboratory confirmation.
      Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others. The Centres for Disease Control and Prevention recommends either:
      Metronidazole
      Erythromycin is given (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or
      Procaine penicillin G is given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg); patients with allergies to penicillin G or erythromycin can use Rifampicin or clindamycin.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Head And Neck Surgery
      14.1
      Seconds
  • Question 86 - A 14-year old girl presented with a 2cm, mobile, cystic mass in the...

    Incorrect

    • A 14-year old girl presented with a 2cm, mobile, cystic mass in the midline of her neck. Fine needle aspiration of the mass revealed clear fluid. This is most likely a case of:

      Your Answer: Lymph node metastasis of follicular carcinoma

      Correct Answer: Thyroglossal duct cyst

      Explanation:

      Thyroglossal cyst is the most common congenital thyroid anomaly which is clinically significant and affects women more than men. It is a vestigial remnant of developing thyroid. Although the thyroglossal cyst can develop anywhere along the thyroglossal duct, the most common site is in the midline between the isthmus of thyroid and hyoid bone, or just above the hyoid. Thyroglossal cysts are also associated with ectopic thyroid tissue. Clinically, the cyst moves upward with protrusion of the tongue. Rarely, the persistent duct can become malignant (thyroglossal duct carcinoma) where the cancerous cells arise in the ectopic thyroid tissue that are deposited along the duct. Exposure to radiation is a predisposing factor.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      76.8
      Seconds
  • Question 87 - A group of surgeons in the colorectal unit wish to identify if there...

    Incorrect

    • A group of surgeons in the colorectal unit wish to identify if there is a significant difference in their individual leak rates for anterior resection of the rectum. Which investigation would be appropriate?

      Your Answer: Unpaired T test

      Correct Answer: Kruskall Wallis test

      Explanation:

      Answer: Kruskall Wallis test

      Kruskall Wallis test is a non-parametric method for testing whether samples originate from the same distribution. It is used for comparing two or more independent samples of equal or different sample sizes. It extends the Mann–Whitney U test, which is used for comparing only two groups. The parametric equivalent of the Kruskal–Wallis test is the one-way analysis of variance (ANOVA).
      T-tests are useful for comparing the means of two samples. There are two types: paired and unpaired.

      Paired means that both samples consist of the same test subjects. A paired t-test is equivalent to a one-sample t-test.

      Unpaired means that both samples consist of distinct test subjects. An unpaired t-test is equivalent to a two-sample t-test.
      A chi-squared test, also written as χ2 test, is any statistical hypothesis test where the sampling distribution of the test statistic is a chi-squared distribution when the null hypothesis is true. The chi-squared test is used to determine whether there is a significant difference between the expected frequencies and the observed frequencies in one or more categories.

      Fisher’s exact test is a statistical test used to determine if there are non-random associations between two categorical variables.

    • This question is part of the following fields:

      • Management And Legal Issues In Surgery
      • Principles Of Surgery-in-General
      76.6
      Seconds
  • Question 88 - Which of the following structures is not easily palpable? ...

    Incorrect

    • Which of the following structures is not easily palpable?

      Your Answer: Sternocleidomastoid muscle

      Correct Answer: Styloid process of the temporal bone

      Explanation:

      The styloid process is a thin, pointed process that projects antero-inferiorly from the base of the petrous temporal bone. It can vary in length from a short, stubby process to a slender, four to five centimetre rod. It forms from the cranial elements of the second pharyngeal arch. The tympanic plate of the temporal bone ensheathes the base of this process. The pointed, projecting portion of the process provides attachment to the stylohyoid and stylomandibular ligaments, and to three muscles – the styloglossus, stylohyoid, and stylopharyngeus. As the styloid process is covered by the various muscles, it is not easily palpable in live subjects.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      25.3
      Seconds
  • Question 89 - A 35 year old woman presents to her family physician complaining of perianal...

    Incorrect

    • A 35 year old woman presents to her family physician complaining of perianal discomfort. She is diagnosed with pruritis ani. Which of the following would not be associated with this condition?

      Your Answer: Syphilis

      Correct Answer: Tuberculosis

      Explanation:

      Tuberculosis is least likely to be associated with this condition. Anal pruritus affects up to 5% of the population. It is often persistent and the constant urge to scratch the area can cause great distress. Although usually caused by a combination of irritants, particularly faecal soiling and dietary factors, it can be a symptom of serious dermatosis, skin or generalised malignancy or systemic illness.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
      46.7
      Seconds
  • Question 90 - A 53 year old male presents with generalised right upper quadrant pain which...

    Incorrect

    • A 53 year old male presents with generalised right upper quadrant pain which started from the previous day. On admission, he is septic and jaundiced and there is tenderness in the right upper quadrant. What is the most likely diagnosis?

      Your Answer: Gallbladder abscess

      Correct Answer: Cholangitis

      Explanation:

      Acute cholangitis is a bacterial infection superimposed on an obstruction of the biliary tree most commonly from a gallstone, but it may be associated with neoplasm or stricture. The classic triad of findings is right upper quadrant (RUQ) pain, fever, and jaundice. A pentad may also be seen, in which mental status changes and sepsis are added to the triad.

      A spectrum of cholangitis exists, ranging from mild symptoms to fulminant overwhelming sepsis. Thus, therapeutic options for patient management include broad-spectrum antibiotics and, potentially, emergency decompression of the biliary tree.
      The main factors in the pathogenesis of acute cholangitis are biliary tract obstruction, elevated intraluminal pressure, and infection of bile. A biliary system that is colonized by bacteria but is unobstructed, typically does not result in cholangitis. It is believed that biliary obstruction diminishes host antibacterial defences, causes immune dysfunction, and subsequently increases small bowel bacterial colonization. Although the exact mechanism is unclear, it is believed that bacteria gain access to the biliary tree by retrograde ascent from the duodenum or from portal venous blood. As a result, infection ascends into the hepatic ducts, causing serious infection. Increased biliary pressure pushes the infection into the biliary canaliculi, hepatic veins, and perihepatic lymphatics, leading to bacteraemia (25-40%). The infection can be suppurative in the biliary tract.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
      94.1
      Seconds
  • Question 91 - A 30-year-old male is playing tennis when he suddenly collapses and has a...

    Incorrect

    • A 30-year-old male is playing tennis when he suddenly collapses and has a GCS of 4 when examined. What is the most likely cause?

      Your Answer: Chronic subdural haematoma

      Correct Answer: Subarachnoid haemorrhage

      Explanation:

      The term subarachnoid haemorrhage (SAH) refers to extravasation of blood into the subarachnoid space between the pial and arachnoid membranes. SAH constitutes half of all spontaneous atraumatic intracranial haemorrhages; the other half consists of bleeding that occurs within the brain parenchyma.
      Intracranial saccular aneurysms (“berry aneurysms”) represent the most common aetiology of nontraumatic SAH; about 80% of cases of SAH result from ruptured aneurysms.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Surgical Disorders Of The Brain
      55.9
      Seconds
  • Question 92 - A 59-year-old man was brought to the emergency department by his family after...

    Correct

    • A 59-year-old man was brought to the emergency department by his family after complaining of sudden, severe upper back pain and a ripping sensation, that radiated to his neck. On arrival, his pulse was weak in one arm compared with the other however his ECG result was normal. Which of the following is most probably the cause of these findings and symptoms?

      Your Answer: Acute aortic dissection

      Explanation:

      Acute aortic dissection is a serious condition in which the inner layer of the aorta tears and the blood flows in between the inner and middle layers of the aorta causing their separation (dissection). Aortic dissection can lead to rupture or decreased blood flow to organs. Clinical manifestations most often include the sudden onset of severe, tearing or ripping chest pain that can radiate to the shoulder, back or neck; syncope; altered mental status; dyspnoea; pale skin; stroke symptoms etc. The diagnosis of acute aortic dissection is based on clinical findings, imaging studies, electrocardiography and laboratory analysis.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      60.5
      Seconds
  • Question 93 - A patient presented with continuous bleeding several hours after dental extraction. Which of...

    Incorrect

    • A patient presented with continuous bleeding several hours after dental extraction. Which of the following findings is most often associated with clinical bleeding?

      Your Answer: High-molecular-weight kininogen deficiency

      Correct Answer: Factor IX deficiency

      Explanation:

      Factor IX deficiency, also called Haemophilia B or Christmas disease, is a disorder caused by missing or defective clotting factor IX. Deficiency of the factor IX causes irregular bleeding that can happen spontaneously or after mild trauma, surgery and dental extractions.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      37.8
      Seconds
  • Question 94 - A 15-day old baby was brought to the emergency department with constipation for...

    Incorrect

    • A 15-day old baby was brought to the emergency department with constipation for 4 days. On examination, the abdomen of the baby was found to be distended and tender all over. No bowel sounds were heard. A sigmoid colon biopsy was carried out, which showed absent ganglion cells. What is the diagnosis?

      Your Answer: Cystic fibrosis

      Correct Answer: Hirschsprung’s disease

      Explanation:

      Hirschsprung’s disease is characterized by congenital absence of the autonomic plexus (Meissner’s and Auerbach’s plexus) in the intestinal wall. Usually limited to the distal colon, it can occasionally involve the entire colon or even the small bowel. There is abnormal or absent peristalsis in the affected segment, resulting in continuous spasm of smooth muscle and partial/complete obstruction. This causes accumulation of intestinal contents and dilatation of proximal segment. Skip lesions are highly uncommon. This disease is seen early in life with 15% patients presenting in first month, 60% by 1 year of age and 85% by the age of 4 years. Symptoms include severe and complete constipation, abdominal distension and vomiting. Patients with involvement of ultra-short segments might have mild constipation with intervening diarrhoea. In older children, symptoms include failure to thrive, anorexia, and lack of an urge to defecate. On examination, an empty rectum is revealed with stool palpable high up in the colon. If not diagnosed in time, it can lead to Hirschsprung’s enterocolitis (toxic megacolon), which can be fulminant and lead to death. Diagnosis involves a barium enema or a rectal suction biopsy. Barium enema shows a transition in diameter between the dilated, normal colon proximal to the narrowed, affected distal segment. It is to be noted that barium enema should be done without prior preparation, which can dilate the abnormal segment, leading to a false-negative result. A 24-hour post-evacuation film can be obtained in the neonatal period – if the colon is still filled with barium, there is a high likelihood of Hirschsprung’s disease. Full-thickness rectal biopsy is diagnostic by showing the absence of ganglion cells. Acetylcholinesterase staining can be done to highlight the enlarged nerve trunks. Abnormal innervation can also be demonstrated by rectal manometry.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      51.3
      Seconds
  • Question 95 - A 35 year old man presented to the surgical OPD with a lump...

    Incorrect

    • A 35 year old man presented to the surgical OPD with a lump on his right forearm which appeared 3 weeks ago and was tender on examination. He gave a history was being in a car accident with pieces of glass from the windshield piercing his forearm removed manually and on further elective surgery. Which of these cells are characteristically found during inflammation in this situation?

      Your Answer: Plasma cell

      Correct Answer: Giant cell

      Explanation:

      A foreign body reaction Is characteristic of giant cells. Glass being the foreign object initiates an inflammatory response in this condition.
      Mast cells are involved in allergic reactions.
      Eosinophils are characteristic of a parasitic infection and allergic inflammatory process but are not due to foreign bodies.
      Plasma cells are typical of chronic inflammation.
      Lymphocytes are involved in viral infections.
      Macrophages combine together to form giant cells.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      90.5
      Seconds
  • Question 96 - 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: Trapezius

      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
      57.3
      Seconds
  • Question 97 - A patient in the intensive care unit developed hyperphosphatemia. The phosphate level is...

    Incorrect

    • A patient in the intensive care unit developed hyperphosphatemia. The phosphate level is 160 mmol/L. Which of the following is most likely responsible for this abnormality?

      Your Answer: Acute alcoholism

      Correct Answer: Renal insufficiency

      Explanation:

      Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood. It is caused by conditions that impair renal phosphate excretion (ex: renal insufficiency, hypoparathyroidism, parathyroid suppression) and conditions with massive extracellular fluid phosphate loads (ex: rapid administration of exogenous phosphate, extensive cellular injury or necrosis, transcellular phosphate shifts).

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      11.4
      Seconds
  • Question 98 - Which of the following proteins prevents red blood cells (RBCs) from bursting when...

    Incorrect

    • Which of the following proteins prevents red blood cells (RBCs) from bursting when they pass through capillaries?

      Your Answer: Myosin

      Correct Answer: Spectrin

      Explanation:

      Spectrin is a structural protein found in the cytoskeleton that lines the intercellular side of the membrane of cells which include RBCs. They maintain the integrity and structure of the cell. It is arranged into a hexagonal arrangement formed from tetramers of spectrin and associated with short actin filaments that form junctions allowing the RBC to distort its shape.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      1940.6
      Seconds
  • Question 99 - After a total colectomy and ileotomy, a 50-year old diabetic man who was...

    Incorrect

    • After a total colectomy and ileotomy, a 50-year old diabetic man who was a known case of diabetic nephropathy had persistent metabolic acidosis. The patient appeared well perfused, with normal vital signs and normal fluid balance. Investigations revealed:Sodium = 132 mmol/l, Potassium = 6.6 mmol/l, Creatinine = 185 μmol/l (2.16 mg/dl), Chloride = 109 μmol/l, 8am cortisol = 500 nmol/l (18 μg/dl), pH = 7.29, p(CO2) = 27 mmHg, p(O2) = 107 mmHg, standard bicarbonate = 12 mmol/l. What is the likely causes of his acidosis?

      Your Answer: Ischaemic bowel

      Correct Answer: Renal tubular acidosis

      Explanation:

      Acidosis here is due to low bicarbonate. The low p(CO2) is seen in compensation. The anion gap is normal, ruling out intra-abdominal ischaemia (which leads to metabolic acidosis). If it was a gastrointestinal aetiology, low potassium would be seen. The history of diabetic nephropathy predisposes to renal tubular acidosis. Type 4 (hyporeninaemic hypoaldosteronism) is associated with high potassium and is found in diabetic and hypertensive renal disease.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      60.6
      Seconds
  • Question 100 - A 35 year old woman with cholecystitis is admitted for laparoscopic cholecystectomy. She...

    Incorrect

    • A 35 year old woman with cholecystitis is admitted for laparoscopic cholecystectomy. She has reported feeling unwell for the last 10 days. During the procedure, while attempting to dissect the distended gallbladder, only the fundus is visualized and dense adhesions make it difficult to access Calot's triangle. Which of the following would be the next best course of action?

      Your Answer:

      Correct Answer: Perform an operative cholecystostomy

      Explanation:

      Chronic cholecystitis can be a surgical challenge due to an inflammatory process that creates multiple adhesions, complicates dissection, and can hamper recognition of normal anatomical structures. In such cases cholecystostomy can be performed in order to alleviate the acute symptoms. Tube cholecystostomy allows for resolution of sepsis and delay of definitive surgery. Interval laparoscopic cholecystectomy can be safely performed once sepsis and acute infection has resolved.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (17/21) 81%
Basic Sciences (55/76) 72%
Generic Surgical Topics (12/17) 71%
Urology (2/2) 100%
Pathology (25/35) 71%
Physiology (13/20) 65%
Clinical Microbiology (2/3) 67%
Principles Of Surgery-in-General (3/6) 50%
Orthopaedics (0/1) 0%
The Abdomen (2/3) 67%
Organ Transplantation (1/1) 100%
Hepatobiliary And Pancreatic Surgery (2/3) 67%
Colorectal Surgery (2/4) 50%
Surgical Technique And Technology (0/1) 0%
Surgical Disorders Of The Brain (2/2) 100%
Post-operative Management And Critical Care (1/1) 100%
Head And Neck Surgery (1/1) 100%
Management And Legal Issues In Surgery (0/1) 0%
Passmed