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Question 1
Correct
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An amateur body-builder complains of increasing pain in his right shoulder after a few days of intense training. A surgeon aspirates clear fluid from his subdeltoid region. What's the most likely diagnosis?
Your Answer: Bursitis
Explanation:Bursae are potential cavities that contain synovial fluid, found in areas where friction occurs. Their function is to minimise friction and facilitate movement. Bursitis is the inflammation of one or more bursae, and they can occur in the shoulder, elbow, knee, ischium, amongst other joints. Acute bursitis can appear after strenuous exercise or activity, and chronic bursitis can develop following previous bursitis or trauma. Acute bursitis causes pain, tenderness, and swelling.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 2
Correct
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A patient presents with loss of fine touch and sense of proprioception in the lower part of the body (below T6). He is likely to have a lesion involving:
Your Answer: Gracile nucleus
Explanation:The gracile nucleus is located in the medulla oblongata and is one of the dorsal column nuclei involved in the sensation of fine touch and proprioception. It contains second-order neurons of the dorsal column–medial lemniscus system, that receive inputs from sensory neurones of the dorsal root ganglia and send axons that synapse in the thalamus.
The gracile nucleus and fasciculus carry epicritic, kinaesthetic and conscious proprioceptive information from the lower part of the body (below the level of T6 in the spinal cord). Similar information from the upper part of body (above T6, except for face and ear) is carried by the cuneate nucleus and fasciculus. The information from face and ear is carried by the primary sensory trigeminal nucleus. -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 3
Incorrect
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A young man is involved in a motorcycle accident in which he is thrown several metres in the air before dropping to the ground. He is found with two fractures in the 2nd and 3rd rib and his chest movements are irregular. Which of the following is the most likely underlying condition?
Your Answer: Aortic rupture
Correct Answer: Flail chest injury
Explanation:Answer: Flail chest injury
Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. Two of the symptoms of flail chest are chest pain and shortness of breath.
It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently. The number of ribs that must be broken varies by differing definitions: some sources say at least two adjacent ribs are broken in at least two places, some require three or more ribs in two or more places. The flail segment moves in the opposite direction to the rest of the chest wall: because of the ambient pressure in comparison to the pressure inside the lungs, it goes in while the rest of the chest is moving out, and vice versa. This so-called paradoxical breathing is painful and increases the work involved in breathing.
Flail chest is usually accompanied by a pulmonary contusion, a bruise of the lung tissue that can interfere with blood oxygenation. Often, it is the contusion, not the flail segment, that is the main cause of respiratory problems in people with both injuries.
Surgery to fix the fractures appears to result in better outcomes.
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This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 4
Incorrect
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Which lymph nodes are likely to be enlarged in a patient who has malignant growth involving the anus?
Your Answer: Periaortic
Correct Answer: Superficial inguinal
Explanation:The lymphatics from the anus, skin of the perineum and the scrotum end in the superficial inguinal nodes. In case of a malignant growth of the anus, the superficial inguinal lymph nodes would most likely be enlarge.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 5
Incorrect
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A middle aged man presented in OPD with a low grade fever and a persistent cough. His blood smear showed an increase in cells with large bi-lobed nuclei. Which of these cells represent the one seen on the smear?
Your Answer: Neutrophils
Correct Answer: Monocytes
Explanation:Monocytes are white cells that protect the body against harmful pathogens. They are mobile and are produced in the bone marrow, mature there and circulate in the blood for about 1-3 days, where they enter the tissues and transform into macrophages. They are characteristically identified by their large bi-lobed nuclei.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 6
Incorrect
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A patient with a long standing lower motor neuron lesion will have:
Your Answer: Hyperaesthesia
Correct Answer: Muscle wasting
Explanation:Lower motor neurons (LMNs) connect the brainstem and spinal cord to muscle fibres. Damage to lower motor neurons is indicated by abnormal electromyographic potentials, fasciculations, paralysis, weakening and wasting of skeletal muscles.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 7
Incorrect
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What is the reason for a deranged thrombin clotting time?
Your Answer: Warfarin therapy
Correct Answer: Heparin therapy
Explanation:Thrombic clotting time is also known as thrombin time. It is clinically performed to determine the therapeutic levels of heparin. After plasma is isolated from the blood, bovine thrombin is added to it and the time it takes from the addition to clot is recorded. The reference interval is usually <21s. deranged results are indicative of heparin therapy, hypofibrinogenemia, hyperfibrinogenaemia or lupus anticoagulant.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 8
Incorrect
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Cranial nerve XII, the hypoglossal nerve, innervates which one of the following muscles in the list?
Your Answer: Palatoglossus
Correct Answer: Hyoglossus
Explanation:The cranial nerve XII, hypoglossal nerve, innervates all the intrinsic and extrinsic muscles of the tongue except the palatoglossus. The muscles of the tongue innervated by this nerve include the extrinsic muscles; hyoglossus, styloglossus, genioglossus and the intrinsic muscles; superior longitudinal, inferior longitudinal, vertical and transverse muscles. The salpingopharyngeus, palatoglossus and the palatopharyngeus muscles are innervated by the vagus nerve. The stylopharyngeus muscle is innervated by the glossopharyngeal nerve (CN IX). The mylohyoid muscle is innervated by the inferior alveolar nerve, a branch of the mandibular nerve. Finally, the geniohyoid muscle is innervated by the olfactory nerve (CN I) via the hypoglossal nerve.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 9
Incorrect
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A 56 year old gentleman, who is a chronic smoker presents to the clinic with dyspnoea. His Chest X-ray shows intercostal space widening with increased blackening bilaterally. What is the most likely finding on his pulmonary function test?
Your Answer: Decreased residual volume
Correct Answer: Increased total lung capacity
Explanation:In patients suspected of having chronic obstructive pulmonary disease, pulmonary function testing (PFT) is useful to confirm airway obstruction, to quantify its severity and reversibility, for following disease progression and monitoring response to treatment. These tests include:
FEV1 – volume of air forcefully expired during the first second after a full breath
Forced vital capacity (FVC) – total volume of air expired with maximal force and flow-volume loops. The hallmark of airway obstruction is reduction of FEV1, FVC and the ratio of FEV1/FVC, with a concave pattern in expiratory tracing on the flow-volume loop. FEV1 and forced vital capacity (FVC) are easily measured with office spirometry and are useful to assess the severity of disease. Other parameters include increased total lung capacity, functional residual capacity and residual volume, which can help distinguish chronic obstructive pulmonary disease (COPD) from restrictive pulmonary disease where these values are lower than normal. Along with these, other tests are decreased vital capacity; and decreased diffusing capacity for carbon monoxide (DLCO). DLCO is non-specific and can be low in other disorders that affect the pulmonary vascular bed, such as interstitial lung disease. DLCO is however useful to distinguish COPD from asthma, in which DLCO is normal or elevated. -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 10
Incorrect
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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: 50 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.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 11
Correct
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The extent of cancer growth can be described through staging. What is taken into consideration when staging a cancer?
Your Answer: Local invasion
Explanation:Cancer stage is based on four characteristics: the size of cancer, whether the cancer is invasive or non-invasive, whether the cancer has spread to the lymph nodes, and whether the cancer has spread to other parts of the body, in this case beyond the breast. Staging is important as it is often a good predictor of outcomes and treatment is adjusted accordingly.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 12
Correct
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A 63-year old lady presents with pain in multiple bones and renal failure. On enquiry, there is history of recurrent pneumonia in the past. What will be the likely finding on her bone marrow biopsy?
Your Answer: Plasma cells
Explanation:Multiple myeloma is a plasma cell malignancy that produce excessive monoclonal immunoglobulins. The disease presents with bone pains, renal dysfunction, increased calcium, anaemia and recurrent infections. Diagnosis is by demonstrating the presence of M-protein in urine or serum, lytic bone lesions, light chain proteinuria or excessive plasma cells on marrow biopsy.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 13
Incorrect
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A 26-year-old female patient had the following blood report: RBC count = 4. 0 × 106/μl, haematocrit = 27% and haemoglobin = 11 g/dl, mean corpuscular volume (MCV) = 80–100 fl, mean corpuscular haemoglobin concentration (MCHC) = 31–37 g/dl. Which of the following is correct regarding this patient’s erythrocytes:
Your Answer: Decreased MCHC
Correct Answer: Normal MCV
Explanation:MCV is the mean corpuscular volume and it is calculated from the haematocrit and the RBC count. It is normally 90 fl. Mean corpuscular haemoglobin concentration (MCHC) [g/dl] = haemoglobin [g/dl]/haematocrit = 11/0.27 = 41 g/dl and is higher than normal range (32 to 36 g/dL).
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 14
Correct
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A 33 year old man is diagnosed with CA caecum. Thorough history taking reveals that his mother developed uterine cancer at 39 years of age and his maternal uncle died at 38 due to colonic cancer. Which of the following operative options would be the most suitable for this patient?
Your Answer: Panproctocolectomy
Explanation:Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), is a type of inherited cancer syndrome associated with a genetic predisposition to different cancer types. People who have Lynch syndrome have a significantly increased risk of developing colorectal cancer. There is also an increased risk of developing other types of cancers, such as endometrial (uterine), stomach, breast, ovarian, small bowel (intestinal), pancreatic, prostate, urinary tract, liver, kidney, and bile duct cancers. Alterations in several genes involved in DNA mismatch repair that have been linked to Lynch syndrome. They include the genes of MLH1, MSH2, MSH6, PMS2, and EPCAM. A mutation (alteration) in any of these genes gives a person an increased lifetime risk of developing colorectal cancer and other related cancers.
Women also have an increased risk of developing endometrial and ovarian cancers. The safest operative strategy is a pancolectomy and end ileostomy.
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This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 15
Incorrect
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A 28 year gang member was shot in the chest. The bullet hit a vessel that courses horizontally across the mediastinum. Which of the following vessels is it likely to be?
Your Answer:
Correct Answer: Left brachiocephalic vein
Explanation:The superior vena cava that empties blood into the right atrium is formed by the right and the left brachiocephalic veins. Hence, the left brachiocephalic has to course across the mediastinum horizontally to join with its right ‘counterpart’. The left subclavian artery and vein being lateral to the mediastinum do not cross the mediastinum while the left jugular and the common carotid artery course vertically.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 16
Incorrect
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A 27-year-old male is admitted with left-sided loin pain that radiates to his groin. His investigations demonstrate a 9mm left-sided calculus within the proximal ureter. What is the most appropriate course of action?
Your Answer:
Correct Answer: Arrange a percutaneous extra corporeal shock wave lithotripsy
Explanation:EAU Guidelines on Urolithiasis recommend that
Proximal Ureteral Stone:
< 10 mm: shock wave lithotripsy (SWL) or ureterorenoscopy (URS)
> 10 mm: 1. URS (ante- or retrograde) 2. SWLContraindications of extracorporeal shock wave lithotripsy:
– Pregnancy, due to the potential effects on the foetus.
– Bleeding diatheses, which should be compensated for at least 24 hours before and 48 hours after
treatment.
– Uncontrolled UTIs
– Severe skeletal malformations and severe obesity, which prevent targeting of the stone.
– Arterial aneurysm in the vicinity of the stone.
– Anatomical obstruction distal to the stone.Lowering shock wave frequency from 120 to 60-90 shock waves/min improves SFRs.
The number of shock waves that can be delivered at each session depends on the type of lithotripter and shock wave power. There is no consensus on the maximum number of shock waves.
Starting SWL on a lower energy setting with stepwise power (and SWL sequence) ramping can achieve vasoconstriction during treatment, which prevents renal injury. -
This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 17
Incorrect
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Which of the following structures, is the area in which the superior cerebral veins drain into?
Your Answer:
Correct Answer: Superior sagittal sinus
Explanation:The superior cerebral veins are predominantly located on the superior aspect of the brain. They are 8 to 12 in number and they drain the lateral, medial and superior aspects of the cerebral hemispheres.
These veins drain into the superior sagittal sinus, also known as the superior longitudinal sinus – which is located along the attached margin of the falx cerebri. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 18
Incorrect
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A 20-year old gentleman was brought to the emergency department with headache and nausea for 2 days. He also complained of intolerance to bright light and loud sounds. Lumbar puncture showed glucose < 45 mg/dl, protein > 5 mg/dl and neutrophil leucocytosis. The likely diagnosis is:
Your Answer:
Correct Answer: Meningitis
Explanation:Diagnosis of meningitis can be carried out with examination of cerebrospinal fluid (CSF) with a lumbar puncture (LP). In a case of bacterial meningitis, the CSF analysis will show:
– Opening pressure: > 180 mmH2O
– White blood cell count: 10–10 000/μl with neutrophil predominance
– Glucose: < 40 mg/dl
– CSF glucose to serum glucose ratio: < 0.4
– Protein: > 4.5 mg/dl
– Gram stain: positive in > 60%
– Culture: positive in > 80%
– Latex agglutination: may be positive in meningitis due to Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Escherichia coli and group B streptococci
– Limulus, lysates: positive in Gram-negative meningitis -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 19
Incorrect
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A 46 year old politician with chronic hepatitis for several years visits the clinic for a review. Recently, his AFP is noted to be increased and an abdominal ultrasound demonstrates a 2.2cm lesion in segment V of the liver. What is the most appropriate course of action?
Your Answer:
Correct Answer: Liver MRI
Explanation:In patients with liver tumours, it is crucial to detect and stage the tumours at an early stage (to select patients who will benefit from curative liver resection, and avoid unnecessary surgery). Therefore, an optimal preoperative evaluation of the liver is necessary, and a contrast-enhanced MRI is widely considered the state-of-the-art method. Liver MRI without contrast administration is appropriate for cholelithiasis but not sufficient for most liver tumour diagnoses.
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This question is part of the following fields:
- Generic Surgical Topics
- Hepatobiliary And Pancreatic Surgery
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Question 20
Incorrect
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A 4 year old girl falls off the monkey bars in the park and lands on her left forearm. She is rushed to the hospital and on examination, she has bony tenderness and bruising. X-ray shows unilateral cortical disruption and development of periosteal haematoma. What is the most likely diagnosis?
Your Answer:
Correct Answer: Greenstick fracture
Explanation:A greenstick fracture is a fracture in a young, soft bone in which the bone bends and breaks. Greenstick fractures occur most often during infancy and childhood when bones are soft.
Some clinical features of a greenstick fracture are similar to those of a standard long bone fracture – greenstick fractures normally cause pain at the injured area. As these fractures are specifically a paediatric problem, an older child will be protective of the fractured part and babies may cry inconsolably. As per a standard fracture, the area may be swollen and either red or bruised. Greenstick fractures are stable fractures as a part of the bone remains intact and unbroken so this type of fracture normally causes a bend to the injured part, rather than a distinct deformity, which is problematic.
Radiographic features
-usually mid-diaphyseal
-occur in tandem with angulation
-incomplete fracture, with cortical breach of only one side of the bone -
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 21
Incorrect
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An abdominal aortogram shows occlusion of the inferior mesenteric artery. Which of the following segments of bowel is most likely to have preserved arterial supply?
Your Answer:
Correct Answer: Caecum
Explanation:The inferior mesenteric artery supplies blood to the end of the transverse colon and all distal structures in the gastrointestinal tract i.e. splenic flexure, descending colon, sigmoid colon and rectum would all be deprived of blood if it were occluded. The caecum receives blood from the superior mesenteric artery so it would not be affected.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 22
Incorrect
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A 23-year-old man presents to the hospital with complaints of pain in the lower limbs after walking for five minutes, which improves after three minutes of stopping. On examination, he is found to have reduced hair growth on the lower limbs, and his calf muscles appear atrophied. There is a weak popliteal pulse and it remains intact when the knee is fully extended. What could be the most likely diagnosis?
Your Answer:
Correct Answer: Adductor canal compression syndrome
Explanation:Adductor canal compression syndrome most commonly presents in young males, and it is important to differentiate it from acute limb ischaemia on exertion. Of the listed options, popliteal fossa entrapment is the main differential diagnosis. However, the popliteal pulse disappears when the knee is fully extended in popliteal fossa entrapment.
Adductor canal compression syndrome is caused by compression of the femoral artery by the musculotendinous band of adductor magnus muscle. The treatment consists of division of the abnormal band and restoration of the arterial circulation.
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This question is part of the following fields:
- Generic Surgical Topics
- Vascular
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Question 23
Incorrect
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A 40-year-old man is brought to the A&E department in an unconscious state, following a car collision. He was driving at a high speed of 140 km/hr, wearing a seat belt, when his car collided with a brick wall. CT scan of the brain appears to be normal. However, he remains in a persistent vegetative state. What is the most likely underlying cause?
Your Answer:
Correct Answer: Diffuse axonal injury
Explanation:This is a case of diffuse axonal injury (DAI) which occurs when the head is rapidly accelerated or decelerated.
DAI is a form of traumatic brain injury which occurs when the brain rapidly shifts inside the skull as an injury is occurring. The long connecting fibres in the brain called axons are sheared as the brain rapidly accelerates and decelerates inside the hard bone of the skull. There are two components of DAI:
1. Multiple haemorrhages
2. Diffuse axonal damage in the white matterUp to two-thirds of the changes occurs at the junction of the grey and white matter due to the different densities of the tissue. These are mainly histological and axonal damage is secondary to biochemical cascades. Often, there are no signs of a fracture or contusion. DAI typically causes widespread injury to the brain leading to loss of consciousness. The changes in the brain are often very tiny and can be difficult to detect using CT or MRI scans.
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This question is part of the following fields:
- Generic Surgical Topics
- Surgical Disorders Of The Brain
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Question 24
Incorrect
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A 35 year-old woman is undergoing thyroidectomy. The external laryngeal nerve may be injured whilst ligating this artery during the procedure due to its close relationship?
Your Answer:
Correct Answer: Superior thyroid artery
Explanation:The superior thyroid artery arises from the external carotid artery just below the level of the greater cornu of the hyoid bone and ends in the thyroid gland. This artery must be ligated at the thyroid when conducting a thyroidectomy. If the artery is severed, but not ligated, it will bleed profusely. In order to gain control of the bleeding, the surgeon may need to extend the original incision laterally to ligate the artery at its origin at the external carotid artery. The external laryngeal branch of the superior laryngeal nerve courses in close proximity to the superior thyroid artery, making it at risk for injury during surgery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 25
Incorrect
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An abnormal opening of the urethra on the under surface of the penis (ventral surface) is known as:
Your Answer:
Correct Answer: Hypospadias
Explanation:Hypospadias is the condition where the urethra opens along the underside or ventral aspect of penile shaft. First-degree hypospadias is seen in 50-75% cases, where the urethra open on the glans penis. Second-degree hypospadias is seen in 20% cases where the urethra opens on the shaft, and third-degree in 30% cases with the urethra opening on the perineum. The severe cases are usually associated with undescended testis (cryptorchidism) or chordee, where the penis is tethered downwards and not completely separated from the perineum.
It is a common male genital birth defect but varying incidences are noted in different countries. There is no obvious inheritance pattern noted. No exact cause has been determined, however several hypotheses include poor response to androgen, or interference by environmental factors. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 26
Incorrect
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Which of the following is likely to result in hematocolpos in a 12-year old girl?
Your Answer:
Correct Answer: Imperforate hymen
Explanation:Hematocolpos means accumulation of blood in vagina and hematometra is accumulation of blood in the uterus. These are most likely seen with an imperforate hymen; which is seen I 1 in 2000 females. If spontaneous resolution does not occur, treatment involves making a hole in the hymen to allow discharge of menstrual blood.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 27
Incorrect
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A 69 Year old lady presented to the emergency department following a massive myocardial infarction. She was found to be in hypotensive shock with focal neurological signs. Unfortunately the patient demised. What would be the expected findings on the brain biopsy?
Your Answer:
Correct Answer: Liquefactive necrosis
Explanation:Liquefactive necrosis is often associated with bacterial or fungal infections. However, hypoxic death of cells within the central nervous system can also result in liquefactive necrosis. The focal area is soft with a liquefied centre containing necrotic debris and dead white cells. This may later be enclosed by a cystic wall
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 28
Incorrect
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An 80 year old woman is undergoing excision of a basal cell carcinoma from her periorbital region under local anaesthesia. Medical history reveals multiple medical comorbities. Which medication should be stopped prior to surgery?
Your Answer:
Correct Answer: Aspirin
Explanation:Answer: Aspirin
Aspirin increases bleeding time when taken orally. Aspirin causes several different effects in the body, mainly the reduction of inflammation, analgesia (relief of pain), the prevention of clotting, and the reduction of fever. Much of this is believed to be due to decreased production of prostaglandins and TXA2. Aspirin’s ability to suppress the production of prostaglandins and thromboxanes is due to its irreversible inactivation of the cyclooxygenase (COX) enzyme. Cyclooxygenase is required for prostaglandin and thromboxane synthesis. Prostaglandins are local chemical messengers that exert multiple effects including but not limited to the transmission of pain information to the brain, modulation of the hypothalamic thermostat, and inflammation. They are produced in response to the stimulation of phospholipids within the plasma membrane of cells resulting in the release of arachidonic acid (prostaglandin precursor). Thromboxanes are responsible for the aggregation of platelets that form blood clots.
Low-dose, long-term aspirin use irreversibly blocks the formation of thromboxane A2 in platelets, producing an inhibitory effect on platelet aggregation.Antihypertensive and antidiabetic medications do not need to be stopped when a patient is undergoing local anaesthesia. Steroid (Prednisolone) use cannot be stopped abruptly; tapering the drug gives the adrenal glands time to return to their normal patterns of secretion. Withdrawal symptoms and signs (weakness, fatigue, decreased appetite, weight loss, nausea, vomiting, diarrhoea, abdominal pain) can mimic many other medical problems. Some may be life-threatening.
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This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
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Question 29
Incorrect
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A cancer patient was found to have a radio resistant tumour. Which tumour does the patient most likely have?
Your Answer:
Correct Answer: Liposarcoma
Explanation:Liposarcoma is a cancer that arises in fat cells in deep soft tissue. Commonly it occurs inside the thigh or retroperitoneum. It usually affects middle-aged and older adults, over 40 years. Liposarcoma is the most common soft-tissue sarcoma. It is very radio resistant. Five-year survival rates vary from 100% to 56% based on histological subtype.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 30
Incorrect
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An 18 year old man is admitted to the intensive care unit with severe meningococcal sepsis. He is on maximal inotropic support and a CT scan of his chest and abdomen is performed. The adrenal glands show evidence of diffuse haemorrhage. Which of the following is the best explanation?
Your Answer:
Correct Answer: Waterhouse- Friderichsen syndrome
Explanation:Answer: Waterhouse- Friderichsen syndrome
Waterhouse-Friderichsen syndrome is a condition characterized by the abrupt onset of fever, petechiae, arthralgia, weakness, and myalgias, followed by acute haemorrhagic necrosis of the adrenal glands and severe cardiovascular dysfunction. The syndrome is most often associated with meningococcal septicaemia but may occur as a complication of sepsis caused by other organisms, including certain streptococcal species. This disorder may be associated with a history of splenectomy.
Fulminant infection from meningococcal bacteria in the bloodstream is a medical emergency and requires emergent treatment with vasopressors, fluid resuscitation, and appropriate antibiotics. Benzylpenicillin was once the drug of choice with chloramphenicol as a good alternative in allergic patients. Ceftriaxone is an antibiotic commonly employed today. Hydrocortisone can sometimes reverse the adrenal insufficiency. Amputations, reconstructive surgery, and tissue grafting are sometimes needed as a result of tissue necrosis (typically of the extremities) caused by the infection.
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This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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SESSION STATS - PERFORMANCE PER SPECIALTY
