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Question 1
Incorrect
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A 47-year-old male is referred to a clinic for consideration of resection of lung malignancy. He reports shortness of breath and haemoptysis. Investigations reveal corrected calcium of 2.84 mmol/l, FEV 1 of 1.9L and histology of squamous cell carcinoma. The patient is noted to have hoarseness of voice. Which one of the following is a contraindication to surgical resection in lung cancer?
Your Answer: FEV 1 of 1.9 litres
Correct Answer: Vocal cord paralysis
Explanation:The hoarseness of voice implies vocal cord paralysis denoting the spread of malignancy which is a contraindication to surgery.
Summary of Guidelines on the selection of patients with lung cancer for surgery (Related to this case)
PART I: FITNESS FOR SURGERY
Age:
1. Perioperative morbidity increases with advancing age. Elderly patients undergoing lung resection are more likely to require intensive perioperative support. Preoperatively, a careful assessment of co-morbidity needs to be made.
2. Surgery for clinically stage I and II disease can be as effective in patients over 70 years as in younger patients. Such patients should be considered for surgical treatment regardless of age.
3. Age over 80 alone is not a contraindication to lobectomy or wedge resection for clinical stage I disease.
4. Pneumonectomy is associated with higher mortality risk in the elderly. Age should be a factor in deciding suitability for pneumonectomy.Pulmonary function:
There should be a formal liaison in borderline cases between the referring chest physician and the thoracic surgical team.
2.No further respiratory function tests are required for a lobectomy if the post-bronchodilator FEV1 is >1.5 litres and for a pneumonectomy, if the post-bronchodilator FEV1 is >2.0 litres, provided that there is no evidence of interstitial lung disease or unexpected disability due to shortness of breath.
STEP 1
3.All patients not clearly operable on the basis of spirometry should have: (a) full pulmonary function tests including estimation of transfer factor (TLCO); (b) measurement of oxygen saturation on air at rest; and (c) a quantitative isotope perfusion scan if a pneumonectomy is being considered.
4.These data should be used to calculate estimated postoperative FEV1 expressed as % predicted and the estimated postoperative TLCO expressed as % predicted, using either the lung scan for pneumonectomy or an anatomical equation for lobectomy, taking account of whether the segments to be removed are ventilated or obstructed.
STEP 2
5.(a) Estimated postoperative FEV1 >40% predicted and estimated postoperative TLCO >40% predicted and oxygen saturation (SaO 2) >90% on air: average risk.
(b)Estimated postoperative FEV1 <40% predicted and estimated postoperative TLCO <40% predicted: high risk.
(c)All other combinations: consider exercise testing.
6.Patients for whom the risk of resection is still unclear after step 2 tests should be referred for exercise testing.
STEP 3
7.(a) The best distance on two shuttle walk tests of <25 shuttles (250 m) or desaturation during the test of more than 4% SaO 2 indicates a patient is a high risk for surgery.
(b)Other patients should be referred for a formal cardiopulmonary exercise test. For cardiopulmonary exercise testing peak oxygen consumption (V˙O 2peak) of more than 15 ml/kg/min indicates that a patient is an average risk for surgery.
(c)A V˙O 2peak of <15 ml/kg/min indicates that a patient is a high risk for surgery. PART II: OPERABILITY
Diagnosis and staging
1.All patients being considered for surgery should have a plain chest radiograph and a computed tomographic (CT) scan of the thorax including the liver and adrenal glands.
2.Confirmatory diagnostic percutaneous needle biopsy in patients presenting with peripheral lesions is not mandatory in patients who are otherwise fit, particularly if there are previous chest radiographs showing no evidence of a lesion.
3.Patients with mediastinal nodes greater than 1 cm in short-axis diameter on the CT scan should undergo biopsy by staging mediastinoscopy, anterior mediastinotomy, or needle biopsy as appropriate.
Operability and adjuvant therapy
1.The proportion of patients found to be inoperable at operation should be 5–10%.
2.Patients with stage I (cT1N0 and cT2N0) and stage II (cT1N1, cT2N1 and cT3N0) tumours should be considered operable.
3.Patients with stage I tumours have a high chance and those with stage II tumours a reasonable chance of being cured by surgery alone.
4.Patients who are known preoperatively to have stage IIIA (cT3N1 and cT1–3N2) tumours have a low chance of being cured by surgery alone but might be considered operable in the context of a trial of surgery and adjuvant chemotherapy.
5.Participation in prospective trials of multimodality treatment for locally advanced disease is strongly recommended.
6.Some small individual studies indicate a place for surgery in T4N0 and T4N1 tumours within stage IIIB, few long term data are available. Generally, stage IIIB tumours with node involvement and stage IV tumours should be considered inoperable.
7.There is no place for postoperative radiotherapy following complete primary tumour resection. -
This question is part of the following fields:
- Oncology
- Principles Of Surgery-in-General
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Question 2
Incorrect
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The muscle that depresses the glenoid fossa directly is the:
Your Answer: Latissimus dorsi
Correct Answer: Pectoralis minor
Explanation:Situated at the upper part of the thorax beneath the pectoralis major, is a thin pectoralis minor, triangular muscle. It originates from the third, fourth and fifth ribs, near the cartilage and from the aponeurosis which covers the intercostals. These fibres move upwards and laterally to join and form a flat tendon. This is inserted into the medial border and upper surface of the coracoid process of the scapula. Through this medial anterior thoracic nerve, fibres from the pectoralis minor are received from the eighth cervical and first thoracic nerves. This pectoralis minor pushes down on the point of the shoulder (glenoid fossa), drawing the scapula downward and medially towards the thorax which throws the inferior angle backwards.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 3
Correct
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A 25-year-old man is involved in vigorous intercourse and suddenly feels a snap. His penis becomes swollen and painful immediately after. The admitting surgeon suspects a penile fracture. Which of the following is the most appropriate initial management?
Your Answer: Immediate surgical exploration
Explanation:Suspected penile fractures should be surgically explored and the injury repaired.
Penile fractures are a rare type of urological trauma. The injury is usually in the proximal part of the penile shaft and may involve the urethra. A classical history of a snapping sensation followed by immediate pain is usually given by the patient (usually during vigorous intercourse). On examination, a tense haematoma is most commonly noted, and if the urethra is injured, blood may be seen at the meatus.
The correct management involves surgical exploration and repair of the injury. A circumferential incision is made immediately inferior to the glans and the penile shaft is inspected. Injuries are usually sutured and the urethra is repaired over a catheter.
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This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 4
Incorrect
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When a penile tumour invades the subepithelial connective tissue of the penis, what is its stage?
Your Answer: T2
Correct Answer: T1
Explanation:The TNM staging used for penile cancer is as follows:
TX: primary tumour cannot be assessed
T0: primary tumour is not evident
Tis: carcinoma in situ is present
Ta: non-invasive verrucous carcinoma is present
T1: tumour is invading subepithelial connective tissue
T2: tumour is invading the corpora spongiosum or cavernosum
T3: tumour invading the urethra or prostate
T4: tumour invading other adjacent structures.
In this case, the patient has a T1 tumour. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 5
Correct
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A 50-year old, obese gentleman with a compression fracture of T11 vertebra was admitted in the hospital. Examination revealed a raised blood pressure 165/112 mmHg and blood glucose 8.5 mmol/l. His abdomen had the presence of purplish striae. What condition is he likely to be suffering from?
Your Answer: Adrenal cortical carcinoma
Explanation:Adrenocortical carcinomas are rare tumours with reported incidence being only two in a million. However, they have a poor prognosis. These are large tumours and range from 4-10 cm in diameter. They arise from the adrenal cortex and 10% cases are bilateral. 50-80% are known to be functional, leading to Cushing syndrome. Even though the tumour affects both sexes equally, functional tumours are slightly commoner in women and non-functional tumours are commoner in men. As compared to women, men also develop this tumour at an older age and seem to have a poorer prognosis.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 6
Correct
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A 31 year old rugby player is brought to the ER after being crushed in a scrum. He briefly lost consciousness, regained it and collapsed again. On arrival, his GCS was noted to be 6/15 with dilatation of the left pupil. What would be the best definitive management in his case?
Your Answer: Parietotemporal craniotomy
Explanation:Epidural hematoma (EDH) is a traumatic accumulation of blood between the inner table of the skull and the stripped-off dural membrane. EDH results from a traumatic head injury, usually with an associated skull fracture and arterial laceration. The inciting event often is a focused blow to the head, such as that produced by a hammer or baseball bat. In 85-95% of patients, this type of trauma results in an overlying fracture of the skull. Blood vessels in close proximity to the fracture are the sources of the haemorrhage in the formation of an epidural hematoma. Because the underlying brain has usually been minimally injured, prognosis is excellent if treated aggressively. Outcome from surgical decompression and repair is related directly to patient’s preoperative neurologic condition.
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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 7
Correct
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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: 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 8
Incorrect
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A 50 year old lawyer is admitted to the medical ward for an endarterectomy. His CT report confirms a left temporal lobe infarct. Which visual defect is most likely to be encountered?
Your Answer: Right homonymous hemianopia
Correct Answer: Right superior quadranopia
Explanation:Quadrantanopia refers to an anopia affecting a quarter of the field of vision. While quadrantanopia can be caused by lesions in the temporal and parietal lobes, it is most commonly associated with lesions in the occipital lobe.
A lesion affecting one side of the temporal lobe may cause damage to the inferior optic radiations (known as the temporal pathway or Meyer’s loop) which can lead to superior quadrantanopia on the contralateral side of both eyes (colloquially referred to as pie in the sky).Therefore, a left temporal lobe infarct will affect the right superior quadrantanopia.
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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 9
Incorrect
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A 51-year-old man is brought to the A&E department following a road traffic accident. He complains of lower abdominal pain. On examination, fracture of the pelvis along with distended, tender bladder is observed. What is the most likely diagnosis?
Your Answer: Clot retention
Correct Answer: Urethral injury
Explanation:Pelvic fractures may cause laceration of the urethra. Urinary retention, blood at the urethral meatus, and a high-riding prostate on digital rectal examination are the typical features of urethral injury.
Up to 10% of male pelvic fractures are associated with urethral or bladder injuries. Urethral injury occurs mainly in males. It has two types.
1.Bulbar rupture:
a. most common
b. mostly associated with straddle-type injury, e.g. from bicycles
c. presentation with a triad of urinary retention, perineal haematoma, and blood at the meatus2. Membranous rupture:
a. can be extra- or intraperitoneal
b. occurs commonly due to pelvic fracture
c. symptomology may include penile or perineal oedema/haematoma
d. prostate displaced upwards (high-riding prostate)Ascending urethrogram is carried out in patients of suspected urethral injury. Suprapubic catheter is surgically placed and is indicated in:
1. External genitalia injuries (i.e. the penis and the scrotum)
2. Injury to the urethra caused by penetration, blunt trauma, continence- or sexual pleasure–enhancing devices, and mutilation. -
This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 10
Incorrect
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A 62 year old man presents with sudden onset of palpitations. ECG shows broad complex tachycardia at a rate of 150 beats per minute. The blood pressure is 120/82 mmHg and there is no evidence of heart failure. The doctor wants to prescribe a rate controlling medication. Which of the following should be avoided in this case?
Your Answer: Lidocaine
Correct Answer: Verapamil
Explanation:The use of intravenous diltiazem or verapamil is contraindicated in patients with ventricular tachycardia. The IV administration of a calcium channel blocker can precipitate cardiac arrest in such patients.
Marked hemodynamic deterioration and ventricular fibrillation have occurred in patients with wide-complex ventricular tachycardia (QRS >= 0.12 seconds) treated with IV verapamil. -
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 11
Correct
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A 30-year-old male presents to the clinic with a recurrent thyroid cyst. It has been drained on three different occasions. Each time the cyst is aspirated and cytology is reassuring. What is the most appropriate course of action?
Your Answer: Resection of the ipsilateral thyroid lobe
Explanation:Aspiration is the treatment of choice in thyroid cysts, but the recurrence rates are high (60%–90% of patients), particularly with repeated aspirations and large-volume cysts.
Percutaneous ethanol injection (PEI) has been studied in several large randomized controlled studies, with reported success in 82–85% of the cases after an average of 2 sessions, with a volume reduction of more than 85% from baseline size.
PEI may also be considered for hyperfunctioning nodules, particularly if a large fluid component is present. It has a success rate ranging from 64% to 95%, with a mean volume reduction of 66%, but recurrences are more common and the number of sessions required to achieve good response is higher (about 4 sessions per patient). PEI is a safe procedure, with the most common reported adverse effects being local pain, dysphonia, flushing, dizziness, and, rarely, recurrent laryngeal nerve damage.
Surgery, Lobectomy is also a reasonable therapy for cystic lesions, as an alternative to the previously mentioned procedures. -
This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 12
Correct
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The pattern of drainage of the lymphatic and venous systems of the anterior abdominal wall is arranged around a horizontal plane above which drainage is in a cranial direction and below which drainage is in a caudal direction. Which horizontal plane is being referred to?
Your Answer: Level of the umbilicus
Explanation:The umbilicus is a key landmark for the lymphatic and venous drainage of the abdominal wall. Above it, lymphatics drain into the axillary lymph nodes and the venous blood drains into the superior epigastric vein, into the internal thoracic vein. Below it, lymphatics drain into the superficial inguinal lymph nodes while venous blood drains into the inferior epigastric vein and the external iliac vein.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 13
Correct
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Chronic obstructive pulmonary disease (COPD) is likely to result in:
Your Answer: Respiratory acidosis
Explanation:COPD leads to respiratory acidosis (chronic). This occurs due to hypoventilation which involves multiple causes, such as poor responsiveness to hypoxia and hypercapnia, increased ventilation/perfusion mismatch leading to increased dead space ventilation and decreased diaphragm function.
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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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The lateral thoracic artery:
Your Answer: Accompanies the long thoracic nerve to the serratus anterior muscle
Explanation:The thoracic nerve, along with the lateral thoracic artery, follow the pectoralis minor to the side of the chest which supplies the serratus anterior and the pectoralis. It then sends branches across the axilla to the axillary glands and subscapularis. The pectoral branch of the thoraco-acromial anastomoses with the internal mammary, subscapular and intercostal arteries, which in women, supply an external mammary branch.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 15
Correct
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A 61 year old man is admitted with sepsis secondary to an infected diabetic foot ulcer. He is seen with a necrotic and infected forefoot with necrosis of the heel. There is a boggy indurated swelling anterior to the ankle joint. The pulses however, are normal. What is the best course of action?
Your Answer: Below knee amputation
Explanation:The presence of a necrotic and infected forefoot with necrosis of the heel and a boggy indurated swelling anterior to the ankle joint in a patient with sepsis secondary to diabetic foot ulcer indicates that a below knee amputation is the best option.
Based on Wagner’s Classification of Diabetic Foot Ulcers, this patient has a grade of 5 where there is gangrene or necrosis of large portion of the foot
requiring major limb amputation.Infection in a diabetic foot is usually secondary to ulceration. Rarely, infection itself causes ulceration. It can either be local or systemic. Treatment requires early incision and drainage or debridement and empirical broad-spectrum antibiotic therapy. If there is co-exiting gangrene or extensive tissue loss, early amputation at the appropriate level should be considered to remove the focus of infection.
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This question is part of the following fields:
- Generic Surgical Topics
- Vascular
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Question 16
Correct
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During a normal respiratory exhalation, what is the recoil alveolar pressure?
Your Answer: +10 cmH2O
Explanation:To determine compliance of the respiratory system, changes in transmural pressures (in and out) immediately across the lung or chest cage (or both) are measured simultaneously with changes in lung or thoracic cavity volume. Changes in lung or thoracic cage volume are determined using a spirometer with transmural pressures measured by pressure transducers. For the lung alone, transmural pressure is calculated as the difference between alveolar (pA; inside) and intrapleural (ppl; outside) pressure. To calculate chest cage compliance, transmural pressure is ppl (inside) minus atmospheric pressure (pB; outside). For the combined lung–chest cage, transmural pressure or transpulmonary pressure is computed as pA – pB. pA pressure is determined by having the subject deeply inhale a measured volume of air from a spirometer. Under physiological conditions the transpulmonary or recoil pressure is always positive; intrapleural pressure is always negative and relatively large, while alveolar pressure moves from slightly negative to slightly positive as a person breathes.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 17
Correct
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Which of the following is NOT a Gram-negative rod?
Your Answer: Clostridium tetani
Explanation:Gram-positive rods include Clostridia, Listeria and diphtheroids.
Gram-negative rods include Escherichia coli, Klebsiella, Yersinia, Haemohilus, Pseudomonas, Shigella, Legionella, proteus and Salmonella -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 18
Correct
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What is the basic chemical reaction that takes place in the breakdown of complex foodstuffs?
Your Answer: Hydrolysis
Explanation:Breakdown of complex food into simpler compounds is achieved by hydrolysis, with the help of different enzymes specific for different compounds.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 19
Correct
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A 21-year-old man is admitted to the hospital with diarrhoea and severe abdominal pain for the past 18 hours. He was asymptomatic before that.Which of the following is the likely cause?
Your Answer: Campylobacter jejuni infection
Explanation:Severe abdominal pain tends to favour infection with Campylobacter jejuni.
Infection with Campylobacter jejuni is one of the most common causes of gastroenteritis worldwide. In developed countries, the incidence of Campylobacter jejuni infections peaks during infancy and, again, during early adulthood. Most infections are acquired by the consumption and handling of poultry. A typical case is characterized by diarrhoea, fever, and severe abdominal cramps. Obtaining cultures of the organism from stool samples remains the best way to diagnose this infection. Complications of C. jejuni infections are rare, and most patients do not require antibiotics. Careful food preparation and cooking practices may prevent some Campylobacter infections.
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This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 20
Correct
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A 41 year old woman presents with severe anal pain on defecation and fresh blood which is only seen on the tissue. She states that she is too sore to tolerate a rectal examination at clinic. What would be the most appropriate initial management?
Your Answer: Glyceryl trinitrate (0.2–0.4%) applied topically
Explanation:An anal fissure is a painful linear tear or crack in the distal anal canal, which, in the short term, usually involves only the epithelium and, in the long term, involves the full thickness of the anal mucosa. Typically, the patient reports severe pain during a bowel movement, with the pain lasting several minutes to hours afterward. The pain recurs with every bowel movement, and the patient commonly becomes afraid or unwilling to have a bowel movement, leading to a cycle of worsening constipation, harder stools, and more anal pain. Approximately 70% of patients note bright-red blood on the toilet paper or stool. Occasionally, a few drops may fall in the toilet bowl, but significant bleeding does not usually occur with an anal fissure.
Second-line medical therapy consists of intra-anal application of 0.4% nitro-glycerine (NTG; also called glycerol trinitrate) ointment directly to the internal sphincter. Nitro-glycerine rectal ointment is approved by the US Food and Drug Administration (FDA) for moderate-to-severe pain associated with anal fissures and may be considered when conservative therapies have failed. -
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 21
Correct
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A 7-year-old boys undergoes a testicular biopsy after a tumour is found in his right testis. Elements similar to hair and teeth are found in it. What kind of tumour is this?
Your Answer: Teratoma
Explanation:A teratoma is a tumour containing tissue elements that are similar to normal derivatives of more than one germ layer. They usually contain skin, hair, teeth and bone tissue and are more common in children, behaving as a benign tumour. After puberty, they are regarded as malignant and can metastasise.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 22
Correct
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A 32 year old woman presents to the ER with recurrent episodes of non specific abdominal pain. The labs including blood tests appear to be normal. Ct scan is done for further evaluation. The CT reveals a 1.5 cm nodule in the right adrenal gland that is associated with a lipid rich core. Urinary VMA is found to be within the normal range. Which of the following is the most likely diagnosis?
Your Answer: Benign non functional adenoma
Explanation:Adrenal adenomas are benign tumours of the adrenal glands, which can be either functioning or non-functioning. Though the majority are clinically silent, functional adenomas from the cortex of medulla can lead to overproduction of any of their associated hormones. Benign adenomas often have a lipid rich core that is readily identifiable on CT scanning. In addition the nodules are often well circumscribed.
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This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 23
Correct
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A 78-year-old woman was brought to the emergency department with decreased consciousness, weakness and dehydration. Which serum electrolyte would most likely be low in this patient?
Your Answer: Na+
Explanation:Hyponatremia is a sodium level below 135 mEq/L. Signs and symptoms may include: nausea with vomiting, fatigue, headache or confusion, cramps or spasm, irritability and restlessness and severe cases may lead to seizures and comma.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 24
Correct
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After a total colectomy and ileotomy, a 50-year old diabetic man who was a known case of diabetic nephropathy had persistent metabolic acidosis. The patient appeared well perfused, with normal vital signs and normal fluid balance. Investigations revealed:Sodium = 132 mmol/l, Potassium = 6.6 mmol/l, Creatinine = 185 μmol/l (2.16 mg/dl), Chloride = 109 μmol/l, 8am cortisol = 500 nmol/l (18 μg/dl), pH = 7.29, p(CO2) = 27 mmHg, p(O2) = 107 mmHg, standard bicarbonate = 12 mmol/l. What is the likely causes of his acidosis?
Your Answer: Renal tubular acidosis
Explanation:Acidosis here is due to low bicarbonate. The low p(CO2) is seen in compensation. The anion gap is normal, ruling out intra-abdominal ischaemia (which leads to metabolic acidosis). If it was a gastrointestinal aetiology, low potassium would be seen. The history of diabetic nephropathy predisposes to renal tubular acidosis. Type 4 (hyporeninaemic hypoaldosteronism) is associated with high potassium and is found in diabetic and hypertensive renal disease.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 25
Correct
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Which tumour occurs in young adults, affecting the epiphyses of the bones and sometimes extending to the soft tissues?
Your Answer: Benign giant-cell tumour
Explanation:Benign giant-cell tumours tend to affect adults in their twenties and thirties, occur in the epiphyses and can erode the bone and extend into the soft tissues. These tumours have a strong tendency to recur.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 26
Correct
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A 30-year-old man is admitted to the hospital with an embolus in the brachial artery. A cervical rib is suspected as being the underlying cause. From which of the following vertebral levels does the cervical rib arise?
Your Answer: C7
Explanation:A cervical rib in humans is an extra rib which arises from the C7 vertebra. Its presence is a congenital abnormality located above the normal first rib, and it consists of an anomalous fibrous band that often originates from C7 and may arc towards but rarely reaches the sternum. It is estimated to occur in 0.2% to 0.5% of the population. People may have a cervical rib on the right, left, or both sides.
Most cases of cervical ribs are not clinically relevant and do not have symptoms; cervical ribs are generally discovered incidentally. However, they vary widely in size and shape, and in rare cases, they may cause problems such as contributing to thoracic outlet syndrome due to compression of the lower trunk of the brachial plexus or subclavian artery.
Compression of the brachial plexus may be identified by weakness of the muscles near the base of the thumb. Compression of the subclavian artery is often diagnosed by finding a positive Adson’s sign on examination, where the radial pulse in the arm is lost during abduction and external rotation of the shoulder.
Treatment is most commonly undertaken when there is evidence of neurovascular compromise. A transaxillary approach is the traditional operative method for excision of the cervical rib.
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This question is part of the following fields:
- Generic Surgical Topics
- Vascular
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Question 27
Correct
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A 55 year old man undergoes a live donor related renal transplant for end stage renal failure. He had good urine output following surgery but it was noticed while he was on the ward that his urinary catheter is not draining despite the urostomy continuing to drain urine. Which intervention would be appropriate in this case?
Your Answer: Bladder wash out
Explanation:In this patient, a blocked catheter is the case because the urine is flowing into the urostomy bag but it is not able to pass through the catheter.
It is recommended that in cases without hypotension, a bladder washout should be done if there is clot retention. The catheter may also be changed. -
This question is part of the following fields:
- Generic Surgical Topics
- Organ Transplantation
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Question 28
Incorrect
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A 60-year-old male who was admitted due to cerebrovascular disease on his 5th hospital stay developed pneumonia. The most likely organism that causes hospital acquired pneumonia is pseudomonas aeruginosa. What is the most likely mechanism for the pathogenesis on pseudomonas infection?
Your Answer: Endotoxin
Correct Answer: Exotoxin
Explanation:Pseudomonas aeruginosa is a common Gram-negative, rod-shaped bacterium that can cause disease in plants and animals, including humans. It is citrate, catalase, and oxidase positive. P. aeruginosa uses the virulence factor exotoxin A to inactivate eukaryotic elongation factor 2 via ADP-ribosylation in the host cell, much the same as the diphtheria toxin does. Without elongation factor 2, eukaryotic cells cannot synthesize proteins and necrotise. The release of intracellular contents induces an immunologic response in immunocompetent patients.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 29
Incorrect
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A 48-year-old female with haematemesis is admitted to accident and emergency in hypovolaemic shock. She undergoes resuscitation including administration of packed red cells. The blood transfusion centre will not release certain blood products unless a ‘massive bleeding’ protocol is initiated. Which of the following is not a definition of massive bleeding?
Your Answer: Blood loss of half the patient’s circulating volume in a 3-hour period
Correct Answer: Ongoing blood loss of 100 mL/min
Explanation:Various definitions of massive blood transfusion (MBT) have been published in the medical literature such as:
– Replacement of one entire blood volume within 24 h
– Transfusion of >10 units of packed red blood cells (PRBCs) in 24 h
– Transfusion of >20 units of PRBCs in 24 h
– Transfusion of >4 units of PRBCs in 1 h when on-going need is foreseeable
– Replacement of 50% of total blood volume (TBV) within 3 h.
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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 30
Incorrect
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Injury to the supraspinatus muscle will affect:
Your Answer:
Correct Answer: Initiation of abduction of the humerus
Explanation:This muscle arises from the medial two-thirds of the supraspinatus fossa and from the supraspinatus fascia. It is inserted into the highest impression on the greater tubercle of the humerus after passing over the upper part of the shoulder joint. It works with the deltoid to raise the arm from the side of the trunk and initiate abduction. It also assists in fixation of the head of the humerus in the glenoid cavity.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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SESSION STATS - PERFORMANCE PER SPECIALTY
