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  • Question 1 - A 4-month-old boy is brought to the clinic by his mother who has...

    Correct

    • A 4-month-old boy is brought to the clinic by his mother who has noticed a swelling in the right hemiscrotum. On examination, there is a firm mass affecting the right spermatic cord distally, the testis is felt separately from it. What is the most likely diagnosis?

      Your Answer: Rhabdomyosarcoma

      Explanation:

      Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children.
      Rhabdomyosarcoma usually manifests as an expanding mass. Tumours in superficial locations may be palpable and detected relatively early, but those in deep locations (e.g., retroperitoneum) may grow large before causing symptoms.
      Symptoms depend on the location of the tumour, and pain may be present. Typical presentations of nonmetastatic disease, by location, are as follows:
      Orbit: Proptosis or dysconjugate gaze
      Paratesticular: Painless scrotal mass, testes are felt separately
      Prostate: Bladder or bowel difficulties
      Uterus, cervix, bladder: Menorrhagia or metrorrhagia
      Vagina: Protruding polypoid mass (botryoid, meaning a grapelike cluster)
      Extremity: Painless mass
      Parameningeal (ear, mastoid, nasal cavity, paranasal sinuses, infratemporal fossa, pterygopalatine fossa): Upper respiratory symptoms or pain

      In the international classification of rhabdomyosarcoma, there are 5 recognized variants: embryonal, alveolar, botryoid embryonal, spindle cell embryonal and anaplastic. The most common variant is embryonal, most associated with tumours of the genitourinary tract and the head and neck. Histologically, the embryonal subtype resembles that of a 6- to an 8-week old embryo.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
      20
      Seconds
  • Question 2 - A 45-year-old pregnant woman develops high blood pressure at 20 weeks. She complains...

    Correct

    • A 45-year-old pregnant woman develops high blood pressure at 20 weeks. She complains of headaches and swollen feet, and a test reveals proteinuria (350 mg/day). Which of the following is the most likely diagnosis?

      Your Answer: Pre-eclampsia

      Explanation:

      Pre-eclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure (two separate readings taken at least 6 h apart of 140/90 or more) and often a significant amount of protein in the urine (>300 mg of protein in a 24-h urine sample). While blood pressure elevation is the most visible sign of the disease, it involves generalised damage to the maternal endothelium of the kidneys and liver, with the release of vasopressive factors only secondary to the original damage. Pre-eclampsia may develop at varying times within pregnancy and its progress differs among patients; most cases present pre-term. It has no known cure apart from ending the pregnancy (induction of labour or abortion). It may also present up to 6 weeks post partum. Risk factors for pre-eclampsia include obesity, prior hypertension, older age, and diabetes mellitus.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      8.4
      Seconds
  • Question 3 - A young man undergoes a total thyroidectomy and develops respiratory stridor and a...

    Correct

    • A young man undergoes a total thyroidectomy and develops respiratory stridor and a small haematoma in the neck, 5 hours after surgery. Which of the following is the most appropriate course of action?

      Your Answer: Re-open the neck wound

      Explanation:

      Answer: Re-open the neck wound

      Thyroidectomy: complications
      Airway obstruction (compressing hematoma, tracheomalacia)

      Incidence of hematoma is 1-2%, tracheomalacia incidence is <1%. Acute airway obstruction from hematoma may occur immediately postoperatively and is the most frequent cause of airway obstruction in the first 24 hours. Definitive therapy is opening the surgical incision to evacuate the hematoma. Re-intubation may be lifesaving for persistent airway obstruction. Consider awake fibreoptic intubation.

    • This question is part of the following fields:

      • Post-operative Management And Critical Care
      • Principles Of Surgery-in-General
      13.4
      Seconds
  • Question 4 - Which of the following is involved in vitamin B12 absorption? ...

    Correct

    • Which of the following is involved in vitamin B12 absorption?

      Your Answer: Intrinsic factor

      Explanation:

      Absorption of vitamin B12 is by an active transport process and occurs in the ileum. Most cobalamins are bound to proteins and are released in the stomach due to low pH and pepsin. The cobalamins then bind to R proteins, i.e. haptocorrin (HC) secreted from salivary glands and gastric juice. Another cobalamin binding protein is Intrinsic factor (IF) secreted from the gastric parietal cells. The cobalamin-HC complex is digested by pancreatic proteases in the intestinal lumen, and the free cobalamin then binds to IF. The complex then reaches a transmembrane receptor in the ileum and undergoes endocytosis. Cobalamin is then released intracellularly and binds to transcobalamin II (TC II). The newly formed complex then exits the ileal cell and enters the blood circulation.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      16.6
      Seconds
  • Question 5 - Which of the following morphological features is most characteristic of hyaline degeneration? ...

    Incorrect

    • Which of the following morphological features is most characteristic of hyaline degeneration?

      Your Answer: Orphan Annie eye nucleus

      Correct Answer: Homogeneous, ground-glass, pink-staining appearance of cells

      Explanation:

      The characteristic morphological features of hyaline degeneration is ground-glass, pinking staining cytoplasm with an intact cell membrane. The accumulation of lipids, calcium salts, lipofuscin and an amorphous cytoplasm with an intact cell membrane are all characteristically found in different situations.
      Pyknotic nucleus and orphan Annie eye nucleus are not seen in hyaline degeneration.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      27.1
      Seconds
  • Question 6 - What's the nodal stage of a testicular seminoma if several lymph nodes between...

    Correct

    • What's the nodal stage of a testicular seminoma if several lymph nodes between 2cm and 5cm are found?

      Your Answer: N2

      Explanation:

      According to the American Joint Committee on Cancer (AJCC) 2002 guidelines, the nodal staging of testicular seminoma is the following:
      N0: no regional lymph node metastases
      N1: metastasis with lymph nodes 2 cm or less in their greatest dimension or multiple lymph nodes, none more than 2 cm
      N2: metastasis with lymph nodes greater than 2 cm but not greater than 5 cm in their greatest dimension, or multiple lymph nodes, any one mass greater than 2 cm, but not more than 5 cm
      N3: metastasis with lymph nodes greater than 5 cm in their greatest dimension.
      The patient in this case has N2 testicular seminoma. This TNM staging is extremely important because treatment options are decided depending on this classification.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      150.1
      Seconds
  • Question 7 - A 34 year old woman underwent a wide local excision for her breast...

    Incorrect

    • A 34 year old woman underwent a wide local excision for her breast carcinoma. Histology reveals an invasive lobular carcinoma present at three of the resection margins. Cavity shavings that were taken at the original operation are also involved. The sentinel lymph node biopsy was reported to be negative. Which of the following management plans would be the most appropriate for this patient?

      Your Answer: Arrange for re-excision of margins

      Correct Answer: Arrange for completion mastectomy alone

      Explanation:

      Mastectomy should ideally be done in this patient. This patient has extensive spread of disease and tumour margins are unclear which makes radiotherapy the less likely option. Mastectomy is the safest option in this scenario. Patients who have undergone mastectomy may be offered a reconstructive procedure either in conjunction with their primary resection or as a staged procedure at a later date.

    • This question is part of the following fields:

      • Breast And Endocrine Surgery
      • Generic Surgical Topics
      78
      Seconds
  • Question 8 - A patient had sudden complete loss of vision of the right eye. Fundoscopy...

    Correct

    • A patient had sudden complete loss of vision of the right eye. Fundoscopy showed the distinct cherry red spot on the retina. Which of the following arteries was occluded?

      Your Answer: Central artery of the retina

      Explanation:

      The central retinal artery supplies all the nerve fibres that form the optic nerve, which carries the visual information to the lateral geniculate nucleus of the thalamus. Thus if the central retinal artery gets occluded, there is complete loss of vision in that eye and the entire retina (with the exception of the fovea) becomes pale, swollen and opaque while the central fovea still appears reddish (this is because the choroid colour shows through). This is the basis of the famous Cherry red spot seen on examination of the retina on fundoscopy of a central retinal artery occlusion (CRAO).

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      50.7
      Seconds
  • Question 9 - Which of the following is the most likely cause of prolonged thrombin clotting...

    Correct

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

      Your 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
      48
      Seconds
  • Question 10 - A 55-year old lady underwent a major surgery for repair of an aortic...

    Correct

    • A 55-year old lady underwent a major surgery for repair of an aortic aneurysm. Her blood pressure was low throughout the intra-operative and the post-operative period, along with increasing serum creatinine and urea. Microscopic examination of her urine showed multiple granular and hyaline casts. What is the likely condition the patient is suffering from?

      Your Answer: Acute tubular necrosis

      Explanation:

      The most common predisposing factor leading to acute tubular necrosis is ischemia, typically seen in hospitalized patients with low blood pressure.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      25.5
      Seconds
  • Question 11 - 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 VII

      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
      11.8
      Seconds
  • Question 12 - A 30-year-old woman feels thirsty. This thirst is probably due to: ...

    Correct

    • A 30-year-old woman feels thirsty. This thirst is probably due to:

      Your Answer: Increased level of angiotensin II

      Explanation:

      Thirst is the basic need or instinct to drink. It arises from a lack of fluids and/or an increase in the concentration of certain osmolites such as salt. If the water volume of the body falls below a certain threshold or the osmolite concentration becomes too high, the brain signals thirst. Excessive thirst, known as polydipsia, along with excessive urination, known as polyuria, may be an indication of diabetes. Angiotensin II is a hormone that is a powerful dipsogen (i.e. it stimulates thirst) that acts via the subfornical organ. It increases secretion of ADH in the posterior pituitary and secretion of ACTH in the anterior pituitary.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      9.8
      Seconds
  • Question 13 - A 24-year old, lactating mother presents to the clinic with a tender, 1.5cm...

    Correct

    • A 24-year old, lactating mother presents to the clinic with a tender, 1.5cm mass just below the right nipple, which shows multiple fissures. What finding is likely associated with her condition?

      Your Answer: Staphylococcus aureus infection

      Explanation:

      Breast abscess occur commonly in lactating mothers in the postpartum period due to cracking of the nipple. It is commonly caused due to Staphylococcus aureus infection. Fat necrosis usually results from trauma wherein an ill-defined mass is formed. Ductal carcinomas are malignant masses which are not tender usually, and rare in the young age group. Plasma cell mastitis affect women in an older age group. Sclerosing adenosis is a type of fibrocystic disease which can lead to a tender, cystic mass but no fissuring or cracks are seen in the nipple. Fibroadenoma and lipomas are non-tender, well-defined masses.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      24.5
      Seconds
  • Question 14 - A 12 hour old baby is seen to be cyanotic whilst feeding and...

    Correct

    • A 12 hour old baby is seen to be cyanotic whilst feeding and crying. A diagnosis of congenital heart disease is suspected by the team of doctors. Which of the following is the most likely cause?

      Your Answer: Transposition of the great arteries

      Explanation:

      Answer: Transposition of the great arteries

      Transposition of the great arteries (TGA) is the most common cyanotic congenital heart lesion that presents in neonates. The hallmark of transposition of the great arteries is ventriculoarterial discordance, in which the aorta arises from the morphologic right ventricle and the pulmonary artery arises from the morphologic left ventricle.

      Infants with transposition of the great arteries (TGA) are usually born at term, with cyanosis apparent within hours of birth.

      The clinical course and manifestations depend on the extent of intercirculatory mixing and the presence of associated anatomic lesions. Note the following:

      Transposition of the great arteries with intact ventricular septum: Prominent and progressive cyanosis within the first 24 hours of life is the usual finding in infants if no significant mixing at the atrial level is evident.

      Transposition of the great arteries with large ventricular septal defect: Infants may not initially manifest symptoms of heart disease, although mild cyanosis (particularly when crying) is often noted. Signs of congestive heart failure (tachypnoea, tachycardia, diaphoresis, and failure to gain weight) may become evident over the first 3-6 weeks as pulmonary blood flow increases.

      Transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction: Infants often present with extreme cyanosis at birth, proportional to the degree of left ventricular (pulmonary) outflow tract obstruction. The clinical history may be similar to that of an infant with tetralogy of Fallot.

      Transposition of the great arteries with ventricular septal defect and pulmonary vascular obstructive disease: Progressively advancing pulmonary vascular obstructive disease can prevent this rare subgroup of patients from developing symptoms of congestive heart failure, despite a large ventricular septal defect. Most often, patients present with progressive cyanosis, despite an early successful palliative procedure.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Paediatric Surgery
      107.5
      Seconds
  • Question 15 - A 41 year old librarian undergoes a gastric bypass surgery and she returns...

    Correct

    • A 41 year old librarian undergoes a gastric bypass surgery and she returns to the clinic complaining that she develops vertigo and crampy abdominal pain after eating. Which of the following is the underlying cause?

      Your Answer: Dumping syndrome

      Explanation:

      Dumping syndrome is the effect of altered gastric reservoir function, abnormal postoperative gastric motor function, and/or pyloric emptying mechanism. Clinically significant dumping syndrome occurs in approximately 10% of patients after any type of gastric surgery and in up to 50% of patients after laparoscopic Roux-en-Y gastric bypass. Dumping syndrome has characteristic alimentary and systemic manifestations. It is a frequent complication observed after a variety of gastric surgical procedures, such as vagotomy, pyloroplasty, gastrojejunostomy, and laparoscopic Nissan fundoplication. Dumping syndrome can be separated into early and late forms, depending on the occurrence of symptoms in relation to the time elapsed after a meal.
      Postprandially, the function of the body of the stomach is to store food and to allow the initial chemical digestion by acid and proteases before transferring food to the gastric antrum. In the antrum, high-amplitude contractions triturate the solids, reducing the particle size to 1-2 mm. Once solids have been reduced to this desired size, they are able to pass through the pylorus. An intact pylorus prevents the passage of larger particles into the duodenum. Gastric emptying is controlled by the fundic tone, antropyloric mechanisms, and duodenal feedback. Gastric surgery alters each of these mechanisms in several ways.

      The late dumping syndrome is suspected in the person who has symptoms of hypoglycaemia in the setting of previous gastric surgery, and this late dumping can be proven with an oral glucose tolerance test (hyperinsulinemic hypoglycaemia), as well as gastric emptying scintigraphy, which shows the abnormal pattern of initially delayed and then accelerated gastric emptying.

      The clinical presentation of dumping syndrome can be divided into GI symptoms and vasomotor symptoms. GI symptoms include early satiety, crampy abdominal pain, nausea, vomiting, and explosive diarrhoea. Vasomotor symptoms include diaphoresis, flushing, dizziness, palpitations, and an intense desire to lie down.

      The expression of these symptoms varies in different individuals. Most patients with early dumping have both GI and vasomotor symptoms, while patients with late dumping have mostly vasomotor symptoms. Patients with severe dumping often limit their food intake to avoid symptoms. This leads to weight loss and, over time, malnutrition.

      Early dumping syndrome generally occurs within 15 minutes of ingesting a meal and is attributable to the rapid transit of food into the small intestine, whereas late dumping syndrome occurs later and may be attributed to hypoglycaemia with tremors, cold sweats, difficulty in concentrating, and loss of consciousness.

      Early dumping systemic symptoms are as follows:
      Desire to lie down
      Palpitations
      Fatigue
      Faintness
      Syncope
      Diaphoresis
      Headache
      Flushing

      Early dumping abdominal symptoms are as follows:
      Epigastric fullness
      Diarrhoea
      Nausea
      Abdominal cramps
      Borborygmi

      Late dumping symptoms are as follows:
      Perspiration
      Shakiness
      Difficulty to concentrate
      Decreased consciousness
      Hunger

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Upper Gastrointestinal Surgery
      53.9
      Seconds
  • Question 16 - A 50-year-old man is diagnosed with emphysema and cirrhosis of the liver. Which...

    Incorrect

    • A 50-year-old man is diagnosed with emphysema and cirrhosis of the liver. Which of the following condition may be the cause of both cirrhosis and emphysema in this patient?

      Your Answer: Wilson’s disease

      Correct Answer: Alpha1-antitrypsin deficiency

      Explanation:

      Alpha-1 antitrypsin (A1AT) deficiency is a condition characterised by the lack of a protein that protects the lungs and liver from damage, called alpha1-antytripsin. The main complications of this condition are liver diseases such as cirrhosis and chronic hepatitis, due to accumulation of abnormal alpha 1-antytripsin and emphysema due to loss of the proteolytic protection of the lungs.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      34.4
      Seconds
  • Question 17 - Regarding innervation to the peroneus brevis muscle: ...

    Correct

    • Regarding innervation to the peroneus brevis muscle:

      Your Answer: Could be damaged by a fracture of the neck of the fibula

      Explanation:

      The peroneus brevis is supplied by the fourth and fifth lumbar and first sacral nerves through the superficial peroneal nerve which is one of the two terminal branches of the common peroneal nerve. The common peroneal nerve winds around the neck of the fibula and can be injured in cases of fractured neck of fibula.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      106.2
      Seconds
  • Question 18 - A 24 year old female is rushed to the emergency room after complaining...

    Correct

    • A 24 year old female is rushed to the emergency room after complaining of pain in the lower abdomen. She is diffusely tender on examination and a laparoscopy is performed. Multiple fine adhesions are seen between the liver and abdominal wall during the operation. However, her appendix is normal. Which of the following is her diagnosis?

      Your Answer: Fitz Hugh Curtis Syndrome

      Explanation:

      Answer: Fitz Hugh Curtis syndrome

      Fitz-Hugh-Curtis syndrome is a rare disorder that occurs almost exclusively in women. It is characterized by inflammation of the membrane lining the stomach (peritoneum) and the tissues surrounding the liver (perihepatitis). The muscle that separates the stomach and the chest (diaphragm), which plays an essential role in breathing, may also be affected. Common symptoms include severe pain in the upper right area (quadrant) of the abdomen, fever, chills, headaches, and a general feeling of poor health (malaise). Fitz-Hugh-Curtis syndrome is a complication of pelvic inflammatory disease (PID), a general term for infection of the upper genital tract in women. Infection is most often caused by Neisseria gonorrhoeae and Chlamydia trachomatis.

      Fitz-Hugh-Curtis syndrome is characterized by the onset of sudden, severe pain in the upper right area of the abdomen. Pain may spread to additional areas including the right shoulder and the inside of the right arm. Movement often increases pain. The upper right area may be extremely tender.

      Additional symptoms may occur in some cases including fever, chills, night sweats, vomiting and nausea. Some affected individuals may develop headaches, hiccupping, and a general feeling of poor health (malaise).

      Some affected individuals may have symptoms associated with pelvic inflammatory disease including fever, vaginal discharge, and lower abdominal pain. Lower abdominal pain may precede, follow, or occur simultaneously with upper abdominal pain.

      Most cases of Fitz-Hugh-Curtis syndrome are caused by infection with the bacterium Chlamydia trachomatis, which causes Chlamydia or the organism Neisseria gonorrhoeae, which causes gonorrhoea. Chlamydia and gonorrhoea are common sexually transmitted diseases (STDs). Researchers believe that more cases of Fitz-Hugh-Curtis syndrome are caused by infection with Chlamydia trachomatis than with Neisseria gonorrhoeae.

      The exact process by which such infections cause Fitz-Hugh-Curtis syndrome (pathogenesis) is not completely understood. Some researchers believe that it occurs because of infection of the liver and surrounding tissue, which may result from bacteria traveling from the pelvis directly to the liver or via the bloodstream or lymphatic system. Fitz-Hugh-Curtis syndrome is characterized by the developed of string-like, fibrous scar tissue (adhesions) between the liver and the abdominal wall or the diaphragm.

      Laparoscopy is the gold standard for diagnosing FHCS and PID. In the setting of PID, laparoscopy can show oedema with exudates on tubal surfaces, ectopic pregnancy, or tubo-ovarian abscess. FHCS can be diagnosed directly via visualization of adhesions between the diaphragm and liver or liver and the anterior abdominal wall.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      101.2
      Seconds
  • Question 19 - Regarding the posterior compartment of the leg, which is correct? ...

    Incorrect

    • Regarding the posterior compartment of the leg, which is correct?

      Your Answer: The muscles dorsiflex the foot and are innervated by the deep fibular nerve

      Correct Answer: The muscles plantarflex the foot and are innervated by the tibial nerve

      Explanation:

      The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris. Deep muscles include tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus. The superficial ( calf muscles) which are responsible for plantarflexion of the foot are supplied by the tibial nerve as follows: the gastrocnemius and soleus muscles are supplied by the first and second sacral nerves and the plantaris by the fourth and fifth lumbar and first sacral nerve (the tibial nerve).

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      19.2
      Seconds
  • Question 20 - A 70-year-old man suffers an ischaemic stroke and develops a left homonymous hemianopia....

    Incorrect

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

      Your Answer: Left temporal lobe

      Correct Answer: Right occipital lobe

      Explanation:

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

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      37
      Seconds
  • Question 21 - A 31-year-old woman who is 30 weeks pregnant presents with sudden onset of...

    Incorrect

    • A 31-year-old woman who is 30 weeks pregnant presents with sudden onset of chest pain associated with loss of consciousness. On examination, she is afebrile and her heart rate is 120 bpm, blood pressure is 170/90 mmHg, and saturation is 93% on 15L oxygen. Furthermore, an early diastolic murmur and occasional bibasilar crepitations are auscultated and mild pedal oedema is observed. Her ECG shows ST-segment elevation in leads II, III, and aVF.What is the most likely diagnosis?

      Your Answer: Pulmonary embolism

      Correct Answer: Aortic dissection

      Explanation:

      The most likely diagnosis is aortic dissection.

      Aortic dissection occurs following a tear in the aortic intima with subsequent separation of the tissue within the weakened media by the propagation of blood. There are four different classifications of aortic dissection and the commonest one used is the Stanford classification dividing them into type A and type B. A type A dissection involves the ascending aorta and/or the arch whilst type B dissection involves only the descending aorta and occurs distal to the origin of the left subclavian artery.

      Aortic dissection in pregnancy occurs most commonly in the third trimester due to the hyperdynamic state and hormonal effect on vasculature. Other common predisposing factors for aortic dissection include Marfans syndrome, Ehlers-Danlos syndrome, and bicuspid aortic valve. Aortic dissection often presents with sudden severe, tearing chest pain, vomiting, and syncope, most often from acute pericardial tamponade. The patient may be hypertensive, clinically. The right coronary artery may become involved in the dissection, causing myocardial infarct in up to 2% of the cases (hence ST-segment elevation in the inferior leads). An aortic regurgitant murmur may be auscultated.

      The management options during pregnancy include:
      1. <28 weeks of gestation: aortic repair with the foetus kept in utero
      2. 28–32 weeks of gestation: dependent on foetal condition
      3. >32 weeks of gestation: caesarean section followed by aortic repair in the same operation

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      106.9
      Seconds
  • Question 22 - A 42 year old man with an abdominal aortic aneurysm (AAA) underwent an...

    Incorrect

    • A 42 year old man with an abdominal aortic aneurysm (AAA) underwent an abdominal aortic angiography which revealed that his inferior mesenteric artery was occluded. If this patient showed no symptoms, the most likely reason is that the area the inferior mesenteric artery supplies, must be supplied by collateral blood flow from which arteries?

      Your Answer: Right and middle colic

      Correct Answer: Left and middle colic

      Explanation:

      The arterial branches that form an anastomosis between the superior mesenteric artery and the inferior mesenteric artery are the left colic artery and the middle colic artery. The middle colic artery is the most distal branch of the superior mesenteric artery while the left colic forms the most proximal branch of the inferior mesenteric artery. These two arteries will give collateral blood flow in the case that the inferior mesenteric artery gets occluded. The superior mesenteric artery gives off the following branches; ileocolic, appendicular, ileal artery, right colic and middle colic arteries. The left colic, sigmoid and superior rectal arteries are branches of the inferior mesenteric artery. The marginal artery branches off directly from the abdominal aorta.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      28.3
      Seconds
  • Question 23 - A 21 year old lady notices a non-tender, mobile breast lump while doing...

    Correct

    • A 21 year old lady notices a non-tender, mobile breast lump while doing her breast self-examination. The lump is smooth and not tethered to her skin. What is the diagnosis?

      Your Answer: Fibroadenoma

      Explanation:

      Answer: Fibroadenoma

      A fibroadenoma is a painless, unilateral, benign (non-cancerous) breast tumour that is a solid, not fluid-filled, lump. It occurs most commonly in women between the age of 14 to 35 years but can be found at any age. Fibroadenomas shrink after menopause, and therefore, are less common in post-menopausal women. Fibroadenomas are often referred to as a breast mouse due to their high mobility. Fibroadenomas are a marble-like mass comprising both epithelial and stromal tissues located under the skin of the breast. These firm, rubbery masses with regular borders are often variable in size.

      Fibroadenoma tends to occur in early age. It is most commonly found in adolescents and less commonly found in postmenopausal women. The incidence of fibroadenoma decreases with increasing age and generally found before 30 years of age in females in the general population. It is estimated that 10% of the world’s female population suffers from fibroadenoma once in a lifetime.

    • This question is part of the following fields:

      • Breast And Endocrine Surgery
      • Generic Surgical Topics
      8.9
      Seconds
  • Question 24 - A 19 year old female presents with a firm mobile mass in the...

    Correct

    • A 19 year old female presents with a firm mobile mass in the upper outer quadrant of her left breast. Which of the following could be the underlying disease process?

      Your Answer: Fibroadenoma

      Explanation:

      A fibroadenoma is a painless, unilateral, benign (non-cancerous) breast tumour that is a solid, not fluid-filled, lump. It occurs most commonly in women between the age of 14 to 35 years but can be found at any age. Fibroadenomas shrink after menopause, and therefore, are less common in post-menopausal women. Fibroadenomas are often referred to as a breast mouse due to their high mobility. Fibroadenomas are a marble-like mass comprising both epithelial and stromal tissues located under the skin of the breast. These firm, rubbery masses with regular borders are often variable in size.

      Duct ectasia, also known as mammary duct ectasia, is a benign (non-cancerous) breast condition that occurs when a milk duct in the breast widens and its walls thicken. This can cause the duct to become blocked and lead to fluid build-up. It’s more common in women who are getting close to menopause. But it can happen after menopause, too.

      Fat necrosis is a benign condition and does not increase the risk of developing breast cancer. It can occur anywhere in the breast and can affect women of any age. Men can also get fat necrosis, but this is very rare.

      Breast cysts are a benign condition. They’re one of the most common causes of a breast lump, and can develop in either one or both breasts. It’s thought they develop naturally as the breast changes with age due to normal changes in hormone levels. It’s common to have more than one cyst. Breast cysts can feel soft or hard and can be any size, ranging from a few millimetres to several centimetres. They’re usually oval or round in shape and can develop quickly.

      Atypical hyperplasia is a precancerous condition that affects cells in the breast. Atypical hyperplasia describes an accumulation of abnormal cells in the breast.

    • This question is part of the following fields:

      • Breast And Endocrine Surgery
      • Generic Surgical Topics
      18
      Seconds
  • Question 25 - A recognised side-effect of prefrontal leukotomy is: ...

    Correct

    • A recognised side-effect of prefrontal leukotomy is:

      Your Answer: Confusion

      Explanation:

      Used previously as a treatment for psychiatric disorders, prefrontal leucotomy severs the connection between the prefrontal cortical association area and the thalamus. This leads to functional isolation of the prefrontal and orbitofrontal association cortex. Thus, along with the desired reduction in anger and frustration, undesirable side effects included changes in mood and affect, as well as confusion.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      10.9
      Seconds
  • Question 26 - A man in his sixties underwent surgery to remove a lump from his...

    Correct

    • A man in his sixties underwent surgery to remove a lump from his axilla. During removal, a nerve originating from the lateral cord of the brachial plexus was damaged. Which nerve is this referring to?

      Your Answer: Lateral pectoral

      Explanation:

      The only branch of the lateral cord of brachial plexus in the options given, is the lateral pectoral nerve. It supplies the pectoralis major muscle and sends a branch to join the medial pectoral nerve forming a loop in front of the first part of the axillary artery.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      15.7
      Seconds
  • Question 27 - A 45-year old male, who was a chronic smoker presented to the clinic...

    Correct

    • A 45-year old male, who was a chronic smoker presented to the clinic with backache and dry, incessant cough. On examination, he was found to have raised blood pressure, purplish striae on his abdomen, truncal obesity and tenderness over the lower thoracic spine. These findings are suggestive of which condition?

      Your Answer: Small-cell anaplastic (oat cell) carcinoma

      Explanation:

      The symptoms suggest Cushing syndrome due to increased glucocorticoid levels. One cause of Cushing syndrome is ectopic production of adrenocorticotrophic hormone from oat cell carcinoma. As oat cell carcinoma is known to be highly metastatic, the tenderness in lower back could represent metastatic involvement.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      166.2
      Seconds
  • Question 28 - Basal Metabolic Rate (BMR) will most likely be reduced by which of the...

    Correct

    • Basal Metabolic Rate (BMR) will most likely be reduced by which of the following?

      Your Answer: Decrease in body temperature

      Explanation:

      The basal metabolic rate (BMR) is defined as the rate of calorie consumption after an overnight fast, in the absence of any muscular activity, with the patient in a restful state. Various factors affect the BMR including weight, body surface area and age. The BMR is 30 kcal/m2 per hour at birth; at age 2, the rate is 57 kcal/m2 per hour; and at age 20, 41 kcal/m2 per hour. After this, the BMR decreases by 10% between 20-60 years of age. Women are known to have a 10% lower BMR than men (due to higher fat content). A one-degree change in body temperature leads to a 10% change in BMR in the same direction. However, shivering and increasing ambient temperature brings about a rise in BMR, and so does stress, physical activity, caffeine, theophylline and hyperthyroidism. Also, thermogenesis induced by diet results in increased metabolic rate and hence, BMR should be ideally measured after overnight fasting.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      7.7
      Seconds
  • Question 29 - Which of the following muscles aid in inspiration? ...

    Correct

    • Which of the following muscles aid in inspiration?

      Your Answer: Diaphragm and external intercostals

      Explanation:

      The diaphragm and external intercostals are muscles of inspiration as they increase the volume of thoracic cavity and reduce the intrathoracic pressure. Muscles of expiration include abdominal muscles and internal intercostals.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      11.4
      Seconds
  • Question 30 - When the pitch of a sound increases, what is the physiological response seen...

    Incorrect

    • When the pitch of a sound increases, what is the physiological response seen in the listener?

      Your Answer: A greater number of hair cells become activated

      Correct Answer: The location of maximal basilar membrane displacement moves toward the base of the cochlea

      Explanation:

      An increase in the frequency of sound waves results in a change in the position of maximal displacement of the basilar membrane in the cochlea. Low pitch sound produces maximal displacement towards the cochlear apex and greatest activation of hair cells there. With an increasing pitch, the site of greatest displacement moves towards the cochlear base. However, increased amplitude of displacement, increase in the number of activated hair cells, increased frequency of discharge of units in the auditory nerve and increase in the range of frequencies to which such units respond, are all seen in increases in the intensity or a sound stimulus.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      91.9
      Seconds
  • Question 31 - A 14 year old boy is taken to the emergency room after complaining...

    Correct

    • A 14 year old boy is taken to the emergency room after complaining of sudden onset of pain in the left hemiscrotum despite not having any other urinary symptoms. The superior pole of the testis is tender on examination and the cremasteric reflex is particularly marked. What would be the underlying diagnosis?

      Your Answer: Torsion of a testicular hydatid

      Explanation:

      Answer: Torsion of a testicular hydatid

      The appendix testis (or hydatid of Morgagni) is a vestigial remnant of the Müllerian duct, present on the upper pole of the testis and attached to the tunica vaginalis. It is present about 90% of the time. The appendix of testis can, occasionally, undergo torsion (i.e. become twisted), causing acute one-sided testicular pain and may require surgical excision to achieve relief. One third of patients present with a palpable blue dot discoloration on the scrotum. This is nearly diagnostic of this condition. If clinical suspicion is high for the serious differential diagnosis of testicular torsion, a surgical exploration of the scrotum is warranted. Torsion of the appendix of testis occurs at ages 0-15 years, with a mean at 10 years, which is similar to that of testicular torsion.

      Occasionally a torsion of the hydatid of Morgagni can produce symptoms mimicking those created by a testicular torsion; a torsion of the hydatid, however, does not lead to any impairment of testicular function.
      Absence of the cremasteric reflex is a sign of testicular torsion. This therefore confirms that the diagnosis is Torsion of a testicular hydatid.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
      57.3
      Seconds
  • Question 32 - A 33 year old woman presents with a complaint of dysphagia. She has...

    Correct

    • A 33 year old woman presents with a complaint of dysphagia. She has a ten year history of treatment refractory anaemia secondary to menorrhagia. Which of the following is the most likely underlying cause?

      Your Answer: Plummer Vinson syndrome

      Explanation:

      Iron deficiency anaemia (IDA) is the most common form of anaemia worldwide and can be due to inadequate intake, decreased absorption (e.g., atrophic gastritis, inflammatory bowel disease), increased demand (e.g., during pregnancy), or increased loss (e.g., gastrointestinal bleeding, menorrhagia) of iron. Prolonged deficiency depletes the iron stores in the body, resulting in decreased erythropoiesis and anaemia.
      Symptoms are nonspecific and include fatigue, pallor, lethargy, hair loss, brittle nails, and pica. Diagnostic lab values include low haemoglobin, microcytic, hypochromic red blood cells on peripheral smear, and low ferritin and iron levels. Once diagnosed, the underlying cause should be determined. Patients at risk for underlying gastrointestinal malignancy should also undergo a colonoscopy.
      Iron deficiency anaemia is treated with oral (most common) or parenteral iron supplementation. Severe anaemia or those with concomitant cardiac conditions may also require blood transfusions. The underlying cause of IDA should also be corrected. IDA may manifest as Plummer-Vinson syndrome (PVS): triad of postcricoid dysphagia, upper oesophageal webs, and iron deficiency anaemia

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Upper Gastrointestinal Surgery
      19
      Seconds
  • Question 33 - A 22-year-old male is diagnosed with an intersphincteric fistula-in-ano during an examination under...

    Correct

    • A 22-year-old male is diagnosed with an intersphincteric fistula-in-ano during an examination under anaesthetic. Which is the most appropriate treatment?

      Your Answer: Insertion of a ‘loose’ seton

      Explanation:

      An anal fistula is an abnormal tract between the anal canal and the skin around the anus.
      Anal fistulas can be classified according to their relationship with the external sphincter. A fistula may be complex, with several openings onto the perianal skin. Intersphincteric fistulas are the most common type and cross only the internal anal sphincter. Trans-sphincteric fistulas pass through both the internal and external sphincters.

      The aim is to drain the infected material and encourage healing.
      For simple intersphincteric and low trans-sphincteric anal fistulas, the most common treatment is a fistulotomy or laying open of the fistula tract.
      For high and complex (deeper) fistulas that involve more muscle, with a high risk of faecal incontinence or recurrence, surgery aims to treat the fistula and preserve sphincter-muscle function. Techniques include a 1‑stage or 2‑stage seton (suture material or rubber sling) either alone or in combination with fistulotomy, ligation of an intersphincteric fistula tract, creating a mucosal advancement flap, injecting glue or paste, or inserting a fistula plug .

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
      18.1
      Seconds
  • Question 34 - In an anatomy demonstration, the instructor asked one of the medical students to...

    Correct

    • In an anatomy demonstration, the instructor asked one of the medical students to pass his index finger inferior to the root of the left lung. The student notices that his finger is blocked by a structure. Which structure do you think is responsible for this?

      Your Answer: Pulmonary ligament

      Explanation:

      The pulmonary ligament is dual layer of pleura stretching from the inferior part of the hilar reflection toward the diaphragm.
      The costodiaphragmatic recess is the cavity at the inferior border of the lung where the costal pleura becomes the diaphragmatic pleura.
      The cupola: is part of the pleura that extends superiorly above the first rib and has no association with the root of the lung.
      Inferior vena cava is located in the mediastinum, not near the root of the lung.
      Left pulmonary veins being part of the root of the lung, would not block access to behind the lung. Costomediastinal recess is the part of the pleura where the costal pleura become the mediastinal pleura.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      14.4
      Seconds
  • Question 35 - A 17 year old girl is taken to the hospital with a 10...

    Correct

    • A 17 year old girl is taken to the hospital with a 10 hour history of pelvic pain. Her last normal menstrual cycle was 14 days ago and she is otherwise well. Her abdomen was soft with mild suprapubic pain on examination. What is the underlying cause?

      Your Answer: Mittelschmerz

      Explanation:

      Answer: Mittelschmerz

      Mittelschmerz is midcycle abdominal pain due to leakage of prostaglandin-containing follicular fluid at the time of ovulation. It is self-limited, and a theoretical concern is treatment of pain with prostaglandin synthetase inhibitors, which could prevent ovulation. The pain of mittelschmerz usually occurs in the lower abdomen and pelvis, either in the middle or to one side. The pain can range from a mild twinge to severe discomfort and usually lasts from minutes to hours. In some cases, a small amount of vaginal bleeding or discharge might occur. Some women have nausea, especially if the pain is very strong.
      Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, ovarian torsion) must be considered.
      Many women never have pain at ovulation. Some women, however, have mid-cycle pain every month, and can tell by the pain that they are ovulating.
      As an egg develops in the ovary, it is surrounded by follicular fluid. During ovulation, the egg and the fluid, as well as some blood, are released from the ovary. While the exact cause of mittelschmerz is not known, it is believed to be caused by the normal enlargement of the egg in the ovary just before ovulation. Also, the pain could be caused by the normal bleeding that comes with ovulation.
      Pelvic inflammatory disease can be ruled out if the patient is not sexually active.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      42.3
      Seconds
  • Question 36 - A 35-year-old male presents with recurrent episodes of knife-like pain within his rectum....

    Correct

    • A 35-year-old male presents with recurrent episodes of knife-like pain within his rectum. On examination, there is no abnormality to find on either proctoscopy or palpation. What is the most likely diagnosis?

      Your Answer: Proctalgia fugax

      Explanation:

      Proctalgia fugax or functional recurrent anorectal pain is part of a spectrum of functional gastrointestinal disorders defined by the Rome III diagnostic criteria as episodes of sharp fleeting pain that recur over weeks, are localized to the anus or lower rectum, and last from seconds to several minutes with no pain between episodes. There is no diurnal variation. There are numerous precipitants including sexual activity, stress, constipation, defecation and menstruation, although the condition can occur without a trigger. It should be differentiated from chronic proctalgia, a functional anorectal pain disorder with a vague, dull ache or pressure sensation high in the rectum, often worse when sitting than when standing or lying down, and lasts at least 20 minutes.
      Most treatments for proctalgia fugax (e.g., oral diltiazem, topical glyceryl nitrate, nerve blocks) act by relaxing the anal sphincter spasm, but the effectiveness of these treatments are supported only by case reports or case series, with the exception of a single randomized controlled trial of salbutamol, making the value of most treatment options, including salbutamol, difficult to judge.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
      11.3
      Seconds
  • Question 37 - Which nuclei of the posterior grey column of the spinal cord are likely...

    Incorrect

    • Which nuclei of the posterior grey column of the spinal cord are likely affected in a patient who has lost the sensation of pain and temperature?

      Your Answer: Intermediolateral nucleus

      Correct Answer: Substantia gelatinosa

      Explanation:

      Substantia gelatinosa is one of the nuclei in the posterior grey column along side other posterior grey column nuclei like the nucleus dorsalis, nucleus proprius, and posteromarginal nucleus. These nuclei are a collection of cells in the posterior grey area found in throughout the spinal cord. The substantia gelatinosa receives direct input from the dorsal nerve roots (sensory), especially from thermoreceptors and nociceptors (receptors for temperature and pain).

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      31.5
      Seconds
  • Question 38 - Different substances have different renal clearance rates. Which of the following substances should...

    Incorrect

    • Different substances have different renal clearance rates. Which of the following substances should have the lowest renal clearance rate in a healthy patient?

      Your Answer: Sodium

      Correct Answer: Glucose

      Explanation:

      Under normal conditions the renal clearance of glucose is zero, since glucose is completely reabsorbed in the renal tubules and not excreted. Glycosuria – the excretion of glucose into the urine- is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      25.2
      Seconds
  • Question 39 - A histological examination of a lump showed an abnormal amount and arrangement of...

    Correct

    • A histological examination of a lump showed an abnormal amount and arrangement of normal tissue in an otherwise normal area. This condition is known as?

      Your Answer: Hamartoma

      Explanation:

      A hamartoma is a condition best described as tissue normally present in an area arranged haphazardly in an disorganized, abnormal fashion. They are never malignant and do not metastasis.
      All the neoplastic, cancerous lesions comprise of a mixture of different cells that are not normal to that area.
      Metaplasia is a change in the type of the epithelium.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      464
      Seconds
  • Question 40 - What class of drugs does buspirone belong to? ...

    Correct

    • What class of drugs does buspirone belong to?

      Your Answer: Anxiolytic

      Explanation:

      Buspirone is an anxiolytic agent and a serotonin-receptor agonist that belongs to the azaspirodecanedione class of compounds. It shows no potential for addiction compared with other drugs commonly prescribed for anxiety, especially the benzodiazepines. The development of tolerance has not been noted. It is primarily used to treat generalized anxiety disorders. It is also commonly used to augment antidepressants in the treatment of major depressive disorder.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      45.4
      Seconds
  • Question 41 - Which of these structures does NOT pass posterior to the medial malleolus? ...

    Correct

    • Which of these structures does NOT pass posterior to the medial malleolus?

      Your Answer: Saphenous vein

      Explanation:

      The saphenous vein passes anterior to the medial malleolus. The structures passing posterior, from nearest to furthest include: tibial, posterior tendon, flexor digitorum longus tendon, posterior tibial artery, posterior tibial vein, posterior tibial nerve and the flexor hallucis longus tendon.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      22
      Seconds
  • Question 42 - Which of the following is a true statement regarding the pupil? ...

    Correct

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

      Your 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
      45.2
      Seconds
  • Question 43 - During a procedure to treat an ulcer in the first part of the...

    Correct

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

      Your Answer: Epigastric region

      Explanation:

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

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      128
      Seconds
  • Question 44 - A 50-year old gentleman was recently diagnosed with hypertension, with no other abnormality...

    Correct

    • 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: 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
      69.1
      Seconds
  • Question 45 - If your EEG shows waves with a frequency range of 8-12 Hz, the...

    Incorrect

    • If your EEG shows waves with a frequency range of 8-12 Hz, the waves most likely to be seen are:

      Your Answer: Delta

      Correct Answer: Alpha

      Explanation:

      Electroencephalography (EEG) is the neurophysiological measurement of the electrical activity of the brain. It is done by placing electrodes on the scalp or subdurally. In reality, the electrical currents are not measured, but rather the voltage differences between different parts of the brain. Four major types of EEG activity are recognized, which are alpha, beta, delta and theta.
      Alpha waves, also known as Berger’s waves ranges in frequency from 8-12 Hz. Best detected with eyes closed, alpha waves are characteristic of a relaxed, alert state of consciousness. An alpha-like normal variant called mu is sometimes seen over the motor cortex (central scalp) and attenuates with movement or, rather, with the intention to move.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      15
      Seconds
  • Question 46 - A 50-year-old female undergoes a laparotomy and a retroperitoneal tumour is identified. The...

    Incorrect

    • A 50-year-old female undergoes a laparotomy and a retroperitoneal tumour is identified. The surgeons suspect that the lesion is a liposarcoma. Which of the following is not typical of liposarcomas?

      Your Answer: It is unlikely in a lesion measuring less than 5cm

      Correct Answer: They are the most common variant of sarcoma in adults

      Explanation:

      Retroperitoneal liposarcoma (RLS) is a rare, biologically heterogeneous tumour that presents considerable challenges due to its size and deep location.
      RPS generally measure >5 cm, and mostly >10 cm diameter at presentation

      Liposarcoma occurs in three main biologic forms: (1) well-differentiated liposarcoma; (2) myxoid and/or round cell; and (3) pleomorphic. The latter is a rare high-grade type with a high recurrence rate and poor prognosis.

      CT scanning is superior to MRI in detailing cortical bone erosion and tumour mineralization, whereas MRI is useful in providing views of the long axis of the limb and in depicting the fatty nature of the tumour.
      Most liposarcomas have well-defined and mostly lobulated margins. The well-differentiated liposarcomas are composed of mainly fat with septa or nodules.
      Chest radiography may be used as an initial screening for pulmonary metastases; however, the definitive test for detection of pulmonary metastases is chest CT scanning.

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Principles Of Surgical Oncology
      211.2
      Seconds
  • Question 47 - The orbicularis oculi us a muscle that closes the eyelids. What is the...

    Incorrect

    • The orbicularis oculi us a muscle that closes the eyelids. What is the motor innervation of this muscle?

      Your Answer: A branch of the same nerve that innervates the orbicularis oris muscle

      Correct Answer: A branch of a nerve that exits through the stylomastoid foramen

      Explanation:

      The orbicularis oculi is a muscle in the face that closes the eyelids. It is supplied by zygomatic branch of the facial nerve (cranial nerve VII), which exits through the stylomastoid foramen.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      15.8
      Seconds
  • Question 48 - When at rest, which of the following will be higher in a marathon...

    Incorrect

    • When at rest, which of the following will be higher in a marathon runner compared to an untrained individual?

      Your Answer: Cardiac output

      Correct Answer: Cardiac stroke volume

      Explanation:

      Cardiac muscle hypertrophy is seen in trained athletes as compared to the normal population. This hypertrophy results in higher stroke volume at rest and increased cardiac reserve (maximum cardiac output during exercise). However, the cardiac output at rest is almost the same in both trained and untrained people. This is because in trained athletes, the heart rate is slower, even up to 40-50 beats/min. There is minimal affect of athletic training on oxygen consumption and respiratory rate.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      17
      Seconds
  • Question 49 - A 34 year old mechanic suffers from a Gustilo and Anderson type IIIA...

    Correct

    • A 34 year old mechanic suffers from a Gustilo and Anderson type IIIA fracture of the femoral shaft after being hit by a fork lift truck. What would be the most suitable step in the management of this patient?

      Your Answer: Debridement and external fixation

      Explanation:

      Perhaps the most important aspect in the treatment of open fractures is the initial surgical intervention with irrigation and meticulous debridement of the injury zone. Irrigation, along with debridement, is absolutely crucial in the management of open fractures.
      Early stabilization of open fractures provides many benefits to the injured patient. It protects the soft tissues around the zone of injury by preventing further damage from mobile fracture fragments. It also restores length, alignment, and rotation—all vital principles of fracture fixation. Skeletal traction and external fixation are the quickest fixation constructs to employ. The use of skeletal traction should be reserved only for selected open fracture types (i.e., pelvis fractures and very proximal femur fractures) and if used, it should only be for a short selected time. External fixation is a valuable tool in the surgeon’s arsenal for acute open fracture management. Indications for external fixation are grossly contaminated open fractures with extensive soft-tissue compromise, the Type IIIA-C injuries, and when immediate fixation is needed for physiologically unstable patients.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      28.6
      Seconds
  • Question 50 - A 15 year old girl is taken to the A&E after complaining of...

    Correct

    • A 15 year old girl is taken to the A&E after complaining of right iliac fossa pain which started suddenly. She is well other than having some right iliac fossa tenderness but no guarding. She has no fever and the urinary dipstick result is normal. Her last menstrual cycle was 14 days ago which was also normal and the pregnancy test done is negative. What is the most likely underlying condition?

      Your Answer: Mittelschmerz

      Explanation:

      Answer: Mittelschmerz

      Mittelschmerz is midcycle abdominal pain due to leakage of prostaglandin-containing follicular fluid at the time of ovulation. It is self-limited, and a theoretical concern is treatment of pain with prostaglandin synthetase inhibitors, which could prevent ovulation. The pain of mittelschmerz usually occurs in the lower abdomen and pelvis, either in the middle or to one side. The pain can range from a mild twinge to severe discomfort and usually lasts from minutes to hours. In some cases, a small amount of vaginal bleeding or discharge might occur. Some women have nausea, especially if the pain is very strong.
      Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, ovarian torsion) must be considered.
      Many women never have pain at ovulation. Some women, however, have mid-cycle pain every month, and can tell by the pain that they are ovulating.
      As an egg develops in the ovary, it is surrounded by follicular fluid. During ovulation, the egg and the fluid, as well as some blood, are released from the ovary. While the exact cause of mittelschmerz is not known, it is believed to be caused by the normal enlargement of the egg in the ovary just before ovulation. Also, the pain could be caused by the normal bleeding that comes with ovulation.
      Pelvic inflammatory disease can be ruled out if the patient is not sexually active.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      16.4
      Seconds
  • Question 51 - A 55-year-old alcoholic male presents with acute pancreatitis. He is clinically dehydrated. His...

    Incorrect

    • A 55-year-old alcoholic male presents with acute pancreatitis. He is clinically dehydrated. His blood results show normal renal function and electrolytes. Which of the intravenous fluids below should be prescribed?

      Your Answer: 5% dextrose

      Correct Answer: Hartmann's solution

      Explanation:

      Management of Acute Pancreatitis revolves around supportive care, adequate nutrition, and intravenous hydration. The rationale for hydration is based on the need to resolve the hypovolemia that occurs secondary to vomiting, reduced oral intake, third space extravasation, respiratory losses and diaphoresis. Besides, early hydration provides macrocirculatory and microcirculatory support to prevent the cascade of events leading to pancreatic necrosis.
      There is a lack of high level evidence to guide the choice of fluid in AP. Crystalloids are recommended by the American Gastroenterological Association, and colloids (packed red blood cells) are considered in cases of low haematocrit (< 25%) and low serum albumin (< 2 g/dL). Among the crystalloids, Ringer's lactate solution is preferred over Normal saline. However, there is an urgent need of studies on this issue.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      179.2
      Seconds
  • Question 52 - A 47 year old accountant presents with symptoms of biliary colic and tests...

    Incorrect

    • A 47 year old accountant presents with symptoms of biliary colic and tests confirmed the diagnosis of gallstones. Which of the procedures listed below would most likely increase the risk of gallstone formation?

      Your Answer: Liver lobectomy

      Correct Answer: Ileal resection

      Explanation:

      Ileal resection may lead to bile acid malabsorption and an altered biliary lipid composition. A “bile acid deficiency” in the enterohepatic circulation with a relative excess of cholesterol and cholesterol supersaturated bile might ensue, causing cholesterol gallstone formation.

      In patients with Crohn’s disease involving the small
      intestine, the prevalence of gall-bladder stones is higher
      than that in the general population. One hypothesis
      for this increased risk is that bile acid malabsorption,
      secondary to impaired active bile acid transport as a
      consequence of ileal disease/resection, leads to a
      reduction in the total bile acid pool size and an increase
      in biliary cholesterol saturation. In patients with
      ulcerative or Crohn’s colitis, or who have undergone
      colectomy, the bile acid malabsorption is less than that
      in those with ileal dysfunction or resection, but the risk
      of gallstone formation is still increased, allegedly by the
      same mechanism.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
      64.6
      Seconds
  • Question 53 - Rapid eye movement (REM) sleep is likely to be affected by a lesion...

    Incorrect

    • Rapid eye movement (REM) sleep is likely to be affected by a lesion in the:

      Your Answer: Cerebellum

      Correct Answer: Pons

      Explanation:

      Rapid eye movement (REM) sleep is also known as paradoxical sleep, as the summed activity of the brain’s neurons is quite similar to that during waking hours. Characterised by rapid movements of the eyes, most of the vividly recalled dreams occur during this stage of sleep. The total time of REM sleep for an adult is about 90–120 min per night.
      Certain neurones in the brainstem, known as REM sleep-on cells, which are located in the pontine tegmentum, are particularly active during REM sleep and are probably responsible for its occurrence. The eye movements associated with REM are generated by the pontine nucleus with projections to the superior colliculus and are associated with PGO (pons, geniculate, occipital) waves.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      38.6
      Seconds
  • Question 54 - A 30-year-old male undergoes an ileocaecal resection and end ileostomy for Crohn's disease....

    Correct

    • A 30-year-old male undergoes an ileocaecal resection and end ileostomy for Crohn's disease. One year later he presents with a deep painful ulcer at his stoma site. What is the most likely diagnosis?

      Your Answer: Pyoderma gangrenosum

      Explanation:

      One of the less common but more challenging issues is ulceration of the skin or pyoderma gangrenosum (PG). Although PG was initially thought to be associated with Crohn’s or inflammatory bowel disease, it is now also known to be associated with malignancies, blood dyscrasias, diabetes, and hepatitis. Pyoderma has been described in several forms, but the ulcerative presentation usually occurs on the abdomen, perineum, and lower extremities. The lesions begin as discrete pustules that erupt and coalesce into a classic painful ulcer with a violaceous border and undermined edge. Multiple lesions are common.
      PG is a significant complication associated with prolonged pain and increased morbidity.
      As its aetiology and pathophysiology are poorly understood, multiple treatments have been employed. These include multiple topical therapies and corticosteroids given topically, intralesionally, or orally. Cyclosporin has also been tried, but Fauld and associates noted weak evidence for its use in pyoderma gangrenosum.
      Peristomal pyoderma presents challenges to successful pouching. The size of the ulceration and its proximity to the stoma affects the seal of the appliance to the skin. The goal for management is to promote healing while maintaining adequate wear time of the pouch. The painful nature of PG ulcerations influences the options for topical care. Small ulcerations can usually be treated with stoma powder or antimicrobial powder covered by a piece of hydrocolloid. A foam dressing over the ulceration is helpful if the ulcer is particularly moist. Silver dressings in sheet form or calcium alginates have also been effective. The goal of topical therapy is to use a modality that can absorb the moisture and allow for appliance adhesion.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Skin Lesions
      99.1
      Seconds
  • Question 55 - A 45-year old gentleman presented to the emergency department at 5.00 AM with...

    Incorrect

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

      Your Answer: Transitional cell carcinoma of bladder

      Correct Answer: Ureteric calculus

      Explanation:

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

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      29.7
      Seconds
  • Question 56 - A glycogen storage disorder is characterised by increased liver glycogen with a normal...

    Incorrect

    • A glycogen storage disorder is characterised by increased liver glycogen with a normal structure and no increase in serum glucose after oral intake of a protein-rich diet. Deficiency of which of the following enzymes is responsible for this disorder?

      Your Answer: Glucokinase

      Correct Answer: Glucose-6-phosphatase

      Explanation:

      The most common glycogen storage disorder is von Gierke’s disease or glycogen storage disease type I. It results from a deficiency of enzyme glucose-6-phosphatase which affects the ability of liver to produce free glucose from glycogen and gluconeogenesis; leading to severe hypoglycaemia. There is also increased glycogen storage in the liver and kidneys causing enlargement and various problems in their functioning. The disease also causes lactic acidosis and hyperlipidaemia. The main treatment includes frequent or continuous feedings of corn-starch or other carbohydrates.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      102.4
      Seconds
  • Question 57 - What is the normal duration of the ST segment? ...

    Incorrect

    • What is the normal duration of the ST segment?

      Your Answer: 0.4 s

      Correct Answer: 0.08 s

      Explanation:

      The ST segment lies between the QRS complex and the T-wave. The normal duration of the ST segment is 0.08 s. ST-segment elevation or depression may indicate myocardial ischaemia or infarction.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      16
      Seconds
  • Question 58 - Which is the correct statement regarding gonadal venous drainage: ...

    Incorrect

    • Which is the correct statement regarding gonadal venous drainage:

      Your Answer: The right and left ovarian or testicular veins drain into the same vessel

      Correct Answer: The left ovarian vein drains into the left renal vein

      Explanation:

      Spermatic or testicular veins arise from the posterior aspect of the testis and receive tributaries from the epididymis. Upon uniting, they form the pampiniform plexus that makes up the greater mass of the spermatic cord. The vessels that make up this plexus rise up the spermatic cord in front of the ductus deferens. They then unite, below the superficial ring, to form three or four veins that traverse the inguinal canal and enter the abdomen through the deep inguinal ring. They further unite to form 2 veins that ascend up the psoas major muscle behind the peritoneum each lying on either side of the testicular artery. These further unite to form one vein that empties on the right side of the inferior vena cava at an acute angle and on the left side into the renal vein, at a right angle. The left testicular vein courses behind the iliac colon and is thus exposed to pressure from the contents of this part of the bowel. The ovarian vein is the equivalent of the testicular vein in women. They form a plexus in the broad ligament near the ovary and uterine tube and communicate with the uterine plexus. They drain into similar vessels as in a man.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      42.5
      Seconds
  • Question 59 - A 23-year-old woman decides to donate a kidney through a kidney chain. Which...

    Incorrect

    • A 23-year-old woman decides to donate a kidney through a kidney chain. Which of the following indices would be expected to be decreased in the donor after full recovery from the operation?

      Your Answer: Creatinine production

      Correct Answer: Creatinine clearance

      Explanation:

      Since medication to prevent rejection is so effective, donors do not need to be similar to their recipient. Most donated kidneys come from deceased donors; however, the utilisation of living donors is on the rise. Most problems encountered with live donation are associated with the donor. Firstly, there are the potentially harmful investigative procedures carried out in the assessment phase, the most hazardous being renal angiography, where there is cannulation of the artery and injection of a radio-opaque dye to determine the blood supply to the kidney. Secondly, there are the short-term risks of nephrectomy surgery. According to the literature, there is a mortality rate of between 1 in 1600 and 1 in 3000, but this is no more than is associated with any anaesthetic. In the initial postoperative period creatinine clearance may be decreased but this recovers fully over a few weeks to months. Long-term complications include prolonged wound pain.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      41.5
      Seconds
  • Question 60 - A patient with chronic renal disease, missed a day of his dialysis schedule.,...

    Incorrect

    • A patient with chronic renal disease, missed a day of his dialysis schedule., His serum potassium was 7.6 mmol/L when his electrolytes were checked. What is the ECG finding expected in this patient?

      Your Answer:

      Correct Answer: Tented T waves

      Explanation:

      ECG characteristics of hyperkalaemia may show the following changes: P-waves are widened and of low amplitude due to slowing of conduction, widened QRS complex, QRS-T fusion, loss of ST segment and tall tented T waves.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Generic Surgical Topics (15/16) 94%
Urology (2/2) 100%
Basic Sciences (25/40) 63%
Physiology (9/15) 60%
Post-operative Management And Critical Care (1/1) 100%
Principles Of Surgery-in-General (1/3) 33%
Pathology (9/14) 64%
Breast And Endocrine Surgery (2/3) 67%
Anatomy (7/11) 64%
Paediatric Surgery (1/1) 100%
Upper Gastrointestinal Surgery (2/2) 100%
The Abdomen (3/3) 100%
Emergency Medicine And Management Of Trauma (0/1) 0%
Colorectal Surgery (2/2) 100%
Principles Of Surgical Oncology (0/1) 0%
Orthopaedics (1/1) 100%
Hepatobiliary And Pancreatic Surgery (1/1) 100%
Skin Lesions (1/1) 100%
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