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Question 1
Incorrect
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A urologist makes a transverse suprapubic incision to retrieve a stone from the urinary bladder. Which of the following abdominal wall layers will the surgeon NOT traverse?
Your Answer: Anterior rectus sheath
Correct Answer: Posterior rectus sheath
Explanation:Pfannenstiel incision (a transverse suprapubic incision) is made below the arcuate line. Thus, there is no posterior layer of the rectus sheath here, only the transversalis fascia lines the inner layer of the rectus abdominis. The layers traversed include: skin, superficial fascia (fatty and membranous), deep fascia, anterior rectus sheath, rectus abdominis muscle, transversalis fascia, extraperitoneal connective tissue and peritoneum.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 2
Incorrect
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A 35 year old patient presenting with haematemesis, heart burn and bloody stool was diagnosed with a duodenal ulcer that had eroded the gastroduodenal artery. The patient was then rushed into theatre for an emergency procedure to control the haemorrhage. If the surgeon decided to ligate the gastroduodenal artery at its origin, which of the following arteries would most likely experience retrograde blood flow from collateral sources as a result of the ligation?
Your Answer: Left hepatic
Correct Answer: Right gastroepiploic
Explanation:In the stomach and around the duodenum, there are many arterial anastomoses. Ligation of the gastroduodenal artery would result in the retrograde flow of blood from the left gastroepiploic artery to the right gastroepiploic artery. The blood flows into the right gastroepiploic artery, a branch of the gastroduodenal artery from the left gastroepiploic artery that branches from the splenic artery. This retrograde blood flow is aimed at providing alternate blood flow to the greater curvature of the stomach.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 3
Incorrect
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Purkinje fibres in the heart conduct action potentials at the rate of:
Your Answer: 5.0–8.5 m/s
Correct Answer: 1.5–4.0 m/s
Explanation:Purkinje fibres control the heart rate along with the sinoatrial node (SA node) and the atrioventricular node (AV node). The QRS complex is associated with the impulse passing through the Purkinje fibres. These fibres conduct action potential about six times faster than the velocity in normal cardiac muscle.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 4
Incorrect
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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.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 5
Incorrect
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All the following statements are FALSE regarding the ophthalmic division of the trigeminal nerve, except:
Your Answer: It provides sensory innervation for most of the globe and motor innervation to smooth muscle in the globe
Correct Answer: The ophthalmic nerve is the smallest branch of the trigeminal nerve
Explanation:The ophthalmic nerve is the smallest of the three trigeminal divisions. The cutaneous branches of the ophthalmic nerve supply the conjunctiva, the skin over the forehead, the upper eyelid, and much of the external surface of the nose.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 6
Incorrect
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A 50-year-old female is being prepared for a Whipple's procedure. A right-sided subclavian line is inserted and anaesthesia is induced. Following intubation, the patient becomes progressively hypoxic and haemodynamically unstable. What is the most likely underlying explanation?
Your Answer: Simple pneumothorax
Correct Answer: Tension pneumothorax
Explanation:The complications of central vein catheterization (CVC) include infection, thrombosis, occlusion, and, in particular, mechanical complications which usually occur during insertion and are closely related to the anatomic location of the central veins. Infectious complications are reported to occur in 5% to 26% of patients, mechanical complications in 5% to 19%, and thrombotic complications in 2% to 26%. Mechanical complications associated with the insertion of central lines include arterial puncture, hematoma, haemothorax, pneumothorax, arterial-venous fistula, venous air embolism, nerve injury, thoracic duct injury (left side only), intraluminal dissection, and puncture of the aorta
Pneumothorax is one of the most common CVC insertion complications, reportedly representing up to 30% of all mechanical adverse events of CVC insertion.
Clinician-performed bedside US allows the diagnosis of pneumothorax to be made immediately, with a high degree of sensitivity and with better accuracy than supine chest films and equal to that of CT scan.
Tension pneumothorax is classically characterized by hypotension and hypoxia. On examination, breath sounds are absent on the affected haemothorax and the trachea deviates away from the affected side. The thorax may also be hyper resonant; jugular venous distention and tachycardia may be present.
If a pneumothorax is diagnosed the treatment strategy should be determined by the following factors: (I) size; (II) symptoms; (III) spontaneous breathing or use of mechanical ventilation; (IV) clinical diagnosis of a tension pneumothorax.Treatment consisted of: (I) observation; (II) outpatient insertion of a Heimlich valve; (III) inpatient tube thoracostomy.
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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 7
Incorrect
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Calculate the stroke volume in an adult male with the following parameters: Heart rate 70 beats/min, Arterial [O2] 0.24 ml O2/min, Venous [O2] 0.16 ml O2/min, Whole body O2 consumption 500 ml/min, Pulmonary diastolic pressure 15 mmHg, Pulmonary systolic pressure 25 mmHg, Wedge pressure 5 mmHg.
Your Answer: 75 ml
Correct Answer: 90 ml
Explanation:Fick’s principle states that, VO2 = (CO × CAO2) – (CO × CVO2) where VO2 = oxygen consumption, CO = cardiac output, CAO2 = oxygen concentration of arterial blood and CVO2 = oxygen concentration of venous blood. Thus, CO = VO2/CAO2– CVO2, CO = 500/0.24–0.16, CO = 500/0.8, CO = 6.25 l/min. Cardiac output is also given by product of stroke volume and heart rate. Thus, stroke volume = cardiac output / heart rate = 6.25/70 × 1000 stroke volume = 90 ml approximately.
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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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A 25-year-old woman complains of generalised swelling and particularly puffiness around the eyes which is worst in the morning. Laboratory studies showed: Blood urea nitrogen (BUN) = 30 mg/dl, Creatinine = 2. 8 mg/dl, Albumin = 2. 0 mg/dl, Alanine transaminase (ALT) = 25 U/l, Bilirubin = 1 mg/dl. Urine analysis shows 3+ albumin and no cells.Which of the following is the most likely diagnosis?
Your Answer: Congestive heart failure
Correct Answer: Nephrotic syndrome
Explanation:Nephrotic syndrome is a disorder in which the glomeruli have been damaged, characterized by:
– Proteinuria (>3.5 g per 1.73 m2 body surface area per day, or > 40 mg per square meter body surface area per hour in children)
– Hypoalbuminemia (< 2,5 g/dl)
– Hyperlipidaemia, and oedema (generalized anasarca). -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 9
Correct
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A 30 year old female suffered from mismatched transfusion induced haemolysis. Which substance will be raised in the plasma of this patient?
Your Answer: Bilirubin
Explanation:Bilirubin is a yellow pigment that is formed due to the break down of RBCs. Haemolysis results in haemoglobin that is broken down into a haem portion and globin which is converted into amino acids and used again. Haem is converted into unconjugated bilirubin in the macrophages and shunted to the liver. In the liver it is conjugated with glucuronic acid making it water soluble and thus excreted in the urine. Its normal levels are from 0.2-1 mg/dl. Increased bilirubin causes jaundice and yellowish discoloration of the skin.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 10
Correct
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Rapid Eye Movement (REM) sleep is typically associated with:
Your Answer: Penile erections
Explanation:Normal sleep comprises of alternate cycles between slow-wave sleep (non-REM sleep) and REM sleep. REM sleep is characterized by increased metabolic brain activity and EEG desynchronization. Somnambulism (sleepwalking), enuresis (bedwetting) and night terrors all occur during slow-wave sleep or during arousal from slow-wave sleep. In comparison, REM sleep is characterized by hypotonia of major muscle groups (excluding ocular muscles), dreams, nightmares and penile erection.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 11
Incorrect
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A 64 year old woman with metastatic breast cancer presents with bone pain. Radiological reports show a metastatic lytic lesion in her femoral shaft. The lesion occupies 75 percent of the bone diameter. Which of the following would be the most appropriate step in the management of this patient?
Your Answer: Radical radiotherapy
Correct Answer: Fixation with intramedullary nail
Explanation:The role of surgery for bone metastasis can be divided into (i) prophylactic fixation to prevent impending pathological fractures, (ii) stabilization of a pathological fractures, (iii) segmental resection of tumours, and (iv) arthroplasty for replacing joints that have been destroyed by a tumour. To this end, orthopaedic surgeons have a vast array of surgical devices and implants in their surgical armamentarium at their disposal. These include plates and screws, intramedullary fixation devices, and tumour endoprostheses.
Even with surgical fixation only 30% of pathological fractures unite. -
This question is part of the following fields:
- Oncology
- Principles Of Surgery-in-General
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Question 12
Incorrect
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What is the role of ICAM-1 and VCAM-1 in the inflammatory process?
Your Answer: Leukocyte transmigration
Correct Answer: Leukocyte adhesion
Explanation:Steps involved in leukocyte arrival and function include:
1. margination: cells migrate from the centre to the periphery of the vessel.
2. rolling: selectins are upregulated on the vessel walls.
3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes. Interaction of these results in adhesion.
4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product.
5. phagocytosis: engulfing the offending substance/cell. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 13
Incorrect
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A 34 year old woman underwent a wide local excision for her breast carcinoma. Histology reveals an invasive lobular carcinoma present at three of the resection margins. Cavity shavings that were taken at the original operation are also involved. The sentinel lymph node biopsy was reported to be negative. Which of the following management plans would be the most appropriate for this patient?
Your Answer: Arrange for completion mastectomy and axillary node clearance
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.
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This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 14
Incorrect
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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.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 15
Correct
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A 4-year-old boy inserts a crayon into his external auditory meatus. Attempts to remove it have not been successful. What is the best course of action?
Your Answer: Operate on the next emergency operating list
Explanation:The removal of foreign bodies from the ear is a common procedure in the emergency department.
Abandon attempts to retrieve a foreign body if complications arise. If the object migrates farther into the canal or if bleeding, oedema, or increasing pain develops, consult an ENT specialist. Repeated attempts to remove a foreign body from the ear may result in infection, perforation, or another morbidity.
The presence of a tympanic membrane (TM) perforation, contact of a foreign body with the tympanic membrane, or incomplete visualization of the auditory canal are indications for urgent-emergent ENT consultation for removal by operative microscope and speculum.
Local anaesthesia is invasive and is not generally used for uncomplicated ear foreign body removal because of the complex innervations of the external ear canal. -
This question is part of the following fields:
- Generic Surgical Topics
- Paediatric Surgery
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Question 16
Correct
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Following a bee sting, a women develops a 2cm red, raised, swollen lesion at the site of the sting . Which of the following findings is likely to be seen in this lesion?
Your Answer: Vasodilation
Explanation:Inflammation is the immediate response of the body towards infections or irritations. The cardinal signs of inflammation are 1. redness/rubor, 2. tumour/swelling, 3.dolar/pain, 4.calor/heat and organ dysfunction (function laesa). Inflammation has 2 components; vascular and cellular. Blood vessels dilate upstream of the inflamed area leading to the rubor and calor and constrict downstream, increasing pressure and causing fluid to leak out of the capillary, resulting in swelling. The cellular component includes infiltration by neutrophils. Leukocyte arrival and functions include; 1. margination: cells marginated from the centre to the periphery of the vessel, 2. rolling: selectins are upregulated on the vessel walls, 3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes resulting in adhesion, 4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product and 5. phagocytosis: engulfing the offending substance/cell.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 17
Incorrect
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The dural venous sinuses are venous channels that drain blood from the brain. This sinuses are located between which structures?
Your Answer: Carotid sheath and prevertebral fascia
Correct Answer: Meningeal and periosteal layers of the dura mater
Explanation:The dural venous sinuses lies between the periosteal and meningeal layer of the dura mater. Dural venous sinuses is unique because it does not run parallel with arteries and allows bidirectional flow of blood intracranially as it is valve-less.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 18
Incorrect
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The physician suggested lifestyle modification for his patient because his present condition could increase his risk for the development of adenocarcinoma of the oesophagus. What is the most common predisposing factor for the development of adenocarcinoma of the oesophagus?
Your Answer: Exposure to nitrosamines
Correct Answer: Gastro-oesophageal reflux disease
Explanation:Barret’s oesophagus is attributed primarily to gastro-oesophageal reflux disease. The chronic acidic environment damages the squamous epithelial lining of the oesophagus, and subsequently undifferentiated pluripotent stem cells develop into columnar epithelium, this is then known as Barret’s oesophagitis.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 19
Incorrect
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Increased resistance to flow of blood in cerebral vessels is most likely seen in:
Your Answer: Epileptic seizure
Correct Answer: Elevation in systemic arterial pressure from 100 to 130 mmHg
Explanation:Constant cerebral blood flow is maintained by autoregulation in the brain, which causes an increase in local vascular resistance to offset an increase in blood pressure. There will be an increase in cerebral blood flow (and decrease in resistance to cerebral blood flow) with a decrease in arterial oxygen or an increase in arterial CO2. Similarly, a decrease in viscosity will also increase the blood flow. Due to increased brain metabolism and activity during a seizure, there will also be an increase in the cerebral blood flow.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 20
Incorrect
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A 40-year-old woman is in the surgical intensive care unit. She suffered a flail chest injury several hours ago and was, subsequently, intubated and ventilated. However, for the past few minutes, she has become increasingly hypoxic and now requires increased ventilation pressures. What is the most likely cause of such deterioration?
Your Answer: Pulmonary embolism
Correct Answer: Tension pneumothorax
Explanation:A flail chest segment may lacerate the underlying lung and create a flap valve. Tension pneumothorax can, therefore, occur by intubation and ventilation in this situation.
Tension pneumothorax is a life-threatening condition that develops when air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function. The development of a tension pneumothorax can be life-threatening during mechanical ventilation, since with each breath, the pressure within the pneumothorax becomes greater, compromising both ventilatory and cardiovascular function.
Signs and symptoms of tension pneumothorax include:
1. Chest pain that usually has a sudden onset, is sharp, and may lead to feeling of tightness in the chest
2. Dyspnoea and progressive hypoxia
3. Tachycardia
4. Hyperventilation
5. Cough
6. FatigueOn examination, hyper-resonant percussion note and tracheal deviation are typically found.
CXR shows:
1. Lung collapse towards the hilum
2. Contralateral mediastinal deviation
3. Diaphragmatic depression and increased rib separation
4. Increased thoracic volume
5. Ipsilateral flattening of the heart borderManagement options for tension pneumothorax include
immediate needle decompression followed by definitive wide-bore chest drain insertion (without waiting for CXR results). -
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 21
Incorrect
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A 62-year-old male patient in the intensive care unit was found to have a low serum phosphate level. What is the serum level of phosphate which is considered as normal in adults?
Your Answer: 1.50–3.0 mmol/l
Correct Answer: 0.8–1.45 mmol/l
Explanation:After calcium, phosphorus is the most plentiful mineral in the human body. It is an important and vital element which our body needs to complete many physiologic processes , such as filtering waste and repairing cells. Phosphorus helps with bone growth and approximately 85% of phosphate in the body is contained in bone. Phosphate is involved in energy storage, and nerve and muscle production. A normal range of plasma phosphate in adults teenagers generally from 0.8 mmol/l to 1.45 mmol/l. The normal range varies depending on age. Infants and children have higher phosphorus levels because more of this mineral is needed for their normal growth and bone development.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 22
Incorrect
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A swimmer was struggling to finish his training following an injury to his right arm. On further examination it was found that any movements involving adduction, medial rotation and extension of her arm were particularly weak. Which nerve in this case was damaged?
Your Answer: Lateral pectoral
Correct Answer: Thoracodorsal
Explanation:Weakness on these particular movements indicate that there is a problem with the latissimus dorsi muscle. This muscle is very important particularly in swimming movements and is supplied by the thoracodorsal nerve.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 23
Incorrect
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A young lady is rushed to the A&E department after being stabbed on her way home. She coughs up blood and a drain is placed into the left chest which removes 750ml of frank blood. She fails to improve and has been given 4 units of blood. Her CVP is now 13. What is the best course of action?
Your Answer: MRI aortic arch
Correct Answer: Thoracotomy in theatre
Explanation:Answer: Thoracotomy in theatre
A high CVP of 13 indicates cardiac tamponade. Cardiac tamponade is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise. The condition is a medical emergency, the complications of which include pulmonary oedema, shock, and death.
A pericardiotomy via a thoracotomy is mandatory for lifesaving cardiac decompression in acute traumatic cardiac tamponade in cases of ineffective drainage due to clot formation within the pericardial space. Wherever possible a patient needing surgery for penetrating chest trauma should be moved to an operating theatre where optimal surgical expertise and facilities are available. -
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 24
Correct
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A 45-year-old man with short bowel syndrome requires parenteral nutrition. The solution of choice for parenteral nutrition is:
Your Answer: Crystalline amino acids
Explanation:Total parenteral nutrition (TPN), is the practice of feeding a person intravenously, circumventing the gut. It is normally used in the following situations: surgery, when feeding by mouth is not possible, when a person’s digestive system cannot absorb nutrients due to chronic disease or if a person’s nutrient requirement cannot be met by enteral feeding and supplementation. A sterile bag of nutrient solution, between 500 ml and 4L, is provided. The pump infuses a small amount (0.1–10 ml/h) continuously to keep the vein open. The nutrient solution consists of water, glucose, salts, amino acids, vitamins and sometimes emulsified fats. Ideally each patient is assessed individually before commencing on parenteral nutrition, and a team consisting of doctors, nurses, clinical pharmacists and dietitians evaluate the patient’s individual data and decide what formula to use and at what rate.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 25
Incorrect
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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:
Correct 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 26
Incorrect
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A young lady is taken to the A&E department after she falls from the 3rd floor balcony. A chest x-ray shows depression of the left main bronchus and deviation of the trachea to the right. What is the most likely injury that she sustained?
Your Answer:
Correct Answer: Aortic rupture
Explanation:Answer: Aortic rupture
Aortic rupture is typically the result of a blunt aortic injury in the context of rapid deceleration. After traumatic brain injury, blunt aortic rupture is the second leading cause of death following blunt trauma. Thus, this condition is commonly fatal as blood in the aorta is under great pressure and can quickly escape the vessel through a tear, resulting in rapid haemorrhagic shock, exsanguination, and death. Traumatic aortic transection or rupture is associated with a sudden and rapid deceleration of the heart and the aorta within the thoracic cavity.
Features on plain chest radiography that suggest aortic injury and can help guide the further use of angiography include; an abnormal aortic arch contour, left apical cap, loss of the aorticopulmonary window, rightward deviation of the trachea, depression of the left main stem bronchus, and a wide left paravertebral pleural stripe. Also, widening of the mediastinum (greater than 8 cm) has a reported sensitivity of 81% to 100% and a specificity of 60%. -
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 27
Incorrect
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A 24-year-old woman presents with an infected sebaceous cyst. On examination, it is swollen, erythematous, and discharging pus. What should be the most appropriate treatment?
Your Answer:
Correct Answer: Incision and drainage with excision of the cyst wall and packing of the defect
Explanation:The correct treatment for an infected sebaceous cyst is incision and drainage with removal of the cyst wall. Conservation of the cyst wall invariably leads to recurrence. Furthermore, the infected wound must not be primarily closed. The administration of antibiotics without drainage of sepsis is futile.
A sebaceous cyst is a rounded swollen area of the skin formed by an abnormal sac of retained excretion (sebum) from the sebaceous follicles. It can occur anywhere but is most commonly formed on scalp, ears, back, face, and upper arm (not on palms of the hands and soles of the feet). The correct treatment for an infected sebaceous cyst is incision and drainage with removal of the cyst wall. Excision of the cyst wall needs to be complete to prevent recurrence.
Cock’s peculiar tumour is a suppurating and ulcerated sebaceous cyst, which may resemble a squamous cell carcinoma.
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This question is part of the following fields:
- Generic Surgical Topics
- Skin Lesions
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Question 28
Incorrect
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During a clinical rotation in the ENT clinic, you observe a flexible bronchoscopy. As the scope is passed down the trachea, you see a cartilaginous structure that resembles a ship's keel and separates the right and the left main stem bronchi. This structure is the:
Your Answer:
Correct Answer: Carina
Explanation:The carina (a keel-like cartilage) is found at the bifurcation of the trachea separating the right from the left main stem bronchi. It is a little more to the left than to the right.
The cricoid cartilage is the inferior and posterior cartilage of the larynx.
The costal cartilage on the other hand elongates the ribs anteriorly and contribute to the elasticity of the thoracic cage.
The pulmonary ligament is a fold of pleura located below the root of the lung.
Tracheal rings are rings of cartilage that support the trachea.
Peritracheal fascia is a layer of connective tissue that invests the trachea from the outside and is not visible on bronchoscopy. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 29
Incorrect
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A 33 year old woman presents with a history of recurrent infections and abscesses in the neck. Examination reveals a midline defect with an overlying scab which moves upwards on tongue protrusion. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Thyroglossal cyst
Explanation:Congenital neck masses are developmental anomalies typically seen in infants or children. Common conditions include thyroglossal duct cysts, branchial cleft cysts, and cystic hygromas. These malformations present as painless neck masses, which can cause dysphagia, respiratory distress, and neck pain due to compression of surrounding structures. The location of the mass depends on the embryological structure the cysts arise from. Diagnosis is made based on clinical findings and imaging results (ultrasound, CT, MRI), which also help in surgical planning. Treatment consists of complete surgical resection to prevent recurrence and complications such as infection or abscess formation.
The thyroglossal cyst is present from birth and usually detected during early childhood. It presents as a painless, firm midline neck mass, usually near the hyoid bone, which elevates with swallowing and tongue protrusion. May cause dysphagia or neck/throat pain if the cyst enlarges. -
This question is part of the following fields:
- Generic Surgical Topics
- Head And Neck Surgery
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Question 30
Incorrect
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A 28-year old lady comes to the surgical clinic with a recently detected lump in her right breast. On examination, the lump is found to be 1cm, rubbery, mobile with no palpable axillary nodes. Mammography reveals no microcalcifications and the opposite breast appears normal. What is the likely diagnosis?
Your Answer:
Correct Answer: Fibroadenoma
Explanation:A benign breast tumour, fibroadenoma is common below the age of 30 years and occurs due to oestrogenic excess. It is characterised by proliferation of both glandular and stromal elements. Fibroadenomas are usually solitary and are mobile, not fixed to surrounding structures. The tumour is elastic, nodular and encapsulated with a grey-white cut surface. The two main histological types include intracanalicular and pericanalicular types, with both types often present in the same tumour. In the intracanalicular type, the stromal proliferation component predominates causing compression of ducts making them appear slit-like. In pericanalicular type, the fibrous stroma dominates around the ductal spaces so that they remain oval on cross section.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
