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Question 1
Correct
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A 56 year old man is scheduled for flexible sigmoidoscopy to investigate bright red rectal bleeding. Which of the following would be the most appropriate preparation for this procedure?
Your Answer: Single phosphate enema 30 minutes pre procedure
Explanation:Bowel preparation is a significant aspect of the flexible sigmoidoscopy procedure. Clear visibility of the bowel mucosa is critical for a thorough examination. The combination of a light breakfast in the morning and the application of 1 or 2 phosphate enemas a few hours before the examination is a safe and commonly used method of preparing a patient for a flexible sigmoidoscopy procedure.
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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 2
Incorrect
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A 60 year old woman with Crohn's disease presents with a high output enterocutaneous fistula. She is started on total parenteral nutrition (TPN) to reduce the output of the fistula and improve her nutritional status. Which of the following statements regarding TPN is incorrect?
Your Answer: Sepsis due to fungal infections is especially common in patients receiving TPN
Correct Answer: It may result in metabolic complications such a refeeding syndrome, resulting in hyperkalaemia, hypermagnesemia, and hyperphosphatemia
Explanation:Answer: It may result in metabolic complications such a refeeding syndrome, resulting in hyperkalaemia, hypermagnesemia, and hyperphosphatemia.
Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally. These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.
During refeeding, glycaemia leads to increased insulin and decreased secretion of glucagon. Insulin stimulates glycogen, fat, and protein synthesis. This process requires minerals such as phosphate and magnesium and cofactors such as thiamine. Insulin stimulates the absorption of potassium into the cells through the sodium-potassium ATPase symporter, which also transports glucose into the cells. Magnesium and phosphate are also taken up into the cells. Water follows by osmosis. These processes result in a decrease in the serum levels of phosphate, potassium, and magnesium, all of which are already depleted. The clinical features of the refeeding syndrome occur as a result of the functional deficits of these electrolytes and the rapid change in basal metabolic rate. -
This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
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Question 3
Correct
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A 55-year-old male presents with central chest pain. On examination, he has a mitral regurgitation murmur. An ECG shows ST elevation in leads V1 to V6. There is no ST elevation in leads II, III and aVF. What is the diagnosis?
Your Answer: Anterior myocardial infarct
Explanation:High-probability ECG features of MI are the following:
ST-segment elevation greater than 1 mm in two anatomically contiguous leads
The presence of new Q wavesIntermediate-probability ECG features of MI are the following:
ST-segment depression
T-wave inversion
Other nonspecific ST-T wave abnormalities
Low-probability ECG features of MI are normal ECG findings. However, normal or nonspecific findings on ECGs do not exclude the possibility of MI.Special attention should be made if there is diffuse ST depression in the precordial and extremity leads associated with more than 1 mm ST elevation in lead aVR, as this may indicate stenosis of the left main coronary artery or the proximal section of the left anterior descending coronary artery.
Localization of the involved myocardium based on the distribution of ECG abnormalities in MI is as follows:
– Inferior wall – II, III, aVF
– Lateral wall – I, aVL, V4 through V6
– Anteroseptal – V1 through V3
– Anterolateral – V1 through V6
– Right ventricular – RV4, RV5
– Posterior wall – R/S ratio greater than 1 in V1 and V2, and – T-wave changes in V1, V8, and V9
– True posterior-wall MIs may cause precordial ST depressions, inverted and hyperacute T waves, or both. ST-segment elevation and upright hyperacute T waves may be evident with the use of right-sided chest leads.Hyperacute (symmetrical and, often, but not necessarily pointed) T waves are frequently an early sign of MI at any locus.
The appearance of abnormalities in a large number of ECG leads often indicates extensive injury or concomitant pericarditis.
The characteristic ECG changes may be seen in conditions other than acute MI. For example, patients with previous MI and left ventricular aneurysm may have persistent ST elevations resulting from dyskinetic wall motion, rather than from acute myocardial injury. ST-segment changes may also be the result of misplaced precordial leads, early repolarization abnormalities, hypothermia (elevated J point or Osborne waves), or hypothyroidism.
False Q waves may be seen in septal leads in hypertrophic cardiomyopathy (HCM). They may also result from cardiac rotation.
Substantial T-wave inversion may be seen in left ventricular hypertrophy with secondary repolarization changes.
The QT segment may be prolonged because of ischemia or electrolyte disturbances.
Saddleback ST-segment elevation (Brugada epsilon waves) may be seen in leads V1-V3 in patients with a congenital predisposition to life-threatening arrhythmias. This elevation may be confused with that observed in acute anterior MI.
Diffuse brain injuries and haemorrhagic stroke may also trigger changes in T waves, which are usually widespread and global, involving all leads.
Convex ST-segment elevation with upright or inverted T waves is generally indicative of MI in the appropriate clinical setting. ST depression and T-wave changes may also indicate the evolution of NSTEMI.
Patients with a permanent pacemaker may confound recognition of STEMI by 12-lead ECG due to the presence of paced ventricular contractions.
To summarize, non-ischemic causes of ST-segment elevation include left ventricular hypertrophy, pericarditis, ventricular-paced rhythms, hypothermia, hyperkalaemia and other electrolyte imbalances, and left ventricular aneurysm. -
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
Correct
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A 28 year old man presents to his doctor with a painful mass underneath his left mandible. The mass has appeared over the previous week with the pain worsening as the lump has increased in size. On examination, a 3 cm mass underneath his mandible is seen but there is no associated lymphadenopathy. What is the most likely diagnosis?
Your Answer: Submandibular gland calculus
Explanation:Sialolithiasis (also termed salivary calculi, or salivary stones), is a condition where a calcified mass or sialolith forms within a salivary gland, usually in the duct of the submandibular gland (also termed Wharton’s duct).
Signs and symptoms are variable and depend largely upon whether the obstruction of the duct is complete or partial, and how much resultant pressure is created within the gland.
The development of infection in the gland also influences the signs and symptoms:
– Pain, which is intermittent, and may suddenly get worse before mealtimes, and then slowly get better (partial obstruction).
– Swelling of the gland, also usually intermittent, often suddenly appearing or increasing before mealtimes, and then slowly going down (partial obstruction).
– Tenderness of the involved gland.
– Palpable hard lump, if the stone is located near the end of the duct. If the stone is near the submandibular duct orifice, the lump may be felt under the tongue.
– Lack of saliva coming from the duct (total obstruction).
– Erythema (redness) of the floor of the mouth (infection).
– Pus discharging from the duct (infection).
– Cervical lymphadenitis (infection).
– Bad Breath.
– Rarely, when stones form in the minor salivary glands, there is usually only slight local swelling in the form of a small nodule and tenderness. -
This question is part of the following fields:
- Generic Surgical Topics
- Head And Neck Surgery
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Question 5
Correct
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A 45-year old male, who was a chronic smoker presented to the clinic with backache and dry, incessant cough. On examination, he was found to have raised blood pressure, purplish striae on his abdomen, truncal obesity and tenderness over the lower thoracic spine. These findings are suggestive of which condition?
Your Answer: Small-cell anaplastic (oat cell) carcinoma
Explanation:The symptoms suggest Cushing syndrome due to increased glucocorticoid levels. One cause of Cushing syndrome is ectopic production of adrenocorticotrophic hormone from oat cell carcinoma. As oat cell carcinoma is known to be highly metastatic, the tenderness in lower back could represent metastatic involvement.
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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 15-day old male baby was brought to the emergency department with sweating and his lips turning blue while feeding. He was born full term. On examination, his temperature was 37.9°C, blood pressure 75/45 mmHg, pulse was 175/min, and respiratory rate was 42/min. A harsh systolic ejection murmur could be heard at the left upper sternal border. X-ray chest showed small, boot-shaped heart with decreased pulmonary vascular markings. He most likely has:
Your Answer: Tetralogy of Fallot
Explanation:The most common congenital cyanotic heart disease and the most common cause of blue baby syndrome, Tetralogy of Fallot shows four cardiac malformations occurring together. These are ventricular septal defect (VSD), pulmonary stenosis (right ventricular outflow obstruction), overriding aorta (degree of which is variable), and right ventricular hypertrophy. The primary determinant of severity of disease is the degree of pulmonary stenosis. Tetralogy of Fallot is seen in 3-6 per 10,000 births and is responsible for 5-7% congenital heart defects, with slightly higher incidence in males. It has also been associated with chromosome 22 deletions and DiGeorge syndrome. It gives rise to right-to-left shunt leading to poor oxygenation of blood. Primary symptom is low oxygen saturation in the blood with or without cyanosis at birth of within first year of life. Affected children ay develop acute severe cyanosis or ‘tet spells’ (sudden, marked increase in cyanosis, with syncope, and may result in hypoxic brain injury and death). Other symptoms include heart murmur, failure to gain weight, poor development, clubbing, dyspnoea on exertion and polycythaemia. Chest X-ray reveals characteristic coeur-en-sabot (boot-shaped) appearance of the heart. Treatment consists of immediate care for cyanotic spells and Blalock–Taussig shunt (BT shunt) followed by corrective surgery.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 7
Correct
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After a severe asthma attack, a 26-year-old woman is left in a markedly hypoxic state. In which of the following organs are the arterial beds most likely to be vasoconstricted due to the hypoxia?
Your Answer: Lungs
Explanation:Hypoxic pulmonary vasoconstriction is a local response to hypoxia resulting primarily from constriction of small muscular pulmonary arteries in response to reduced alveolar oxygen tension. This unique response of pulmonary arterioles results in a local adjustment of perfusion to ventilation. This means that if a bronchiole is obstructed, the lack of oxygen causes contraction of the pulmonary vascular smooth muscle in the corresponding area, shunting blood away from the hypoxic region to better-ventilated regions. The purpose of hypoxic pulmonary vasoconstriction is to distribute blood flow regionally to increase the overall efficiency of gas exchange between air and blood.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 8
Correct
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A medical student is told a substance is freely filtered but is not metabolised, secreted, or stored in the kidney. It has a plasma concentration of 1000 mg/l and its urine excretion rate is 25 mg/min, and the inulin clearance is 100 ml/min. What is the rate of tubular reabsorption of the substance?
Your Answer: 75 mg/min
Explanation:Reabsorption or tubular reabsorption is the process by which the nephron removes water and solutes from the tubular fluid (pre-urine) and returns them to the circulating blood. To calculate the reabsorption rate of substance Z we use the following equation: excretion = (filtration + secretion) – reabsorption. As this substance is freely filtered, its filtration rate is equal to that of inulin. So 25 = (100 + 0) – reabsorption. Reabsorption = 100 – 25 therefore reabsorption = 75 mg/min.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 9
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 10
Correct
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Destruction of the ventromedial nucleus of the hypothalamus will result in:
Your Answer: Loss of satiety
Explanation:The ventromedial nucleus of the hypothalamus is divided into an anterior and a superior part. The anterior part controls the female sexual drive, whereas the superior part is responsible for satiety. Destruction of the superior part of the nucleus will result in overeating, as no signal tells the body that it is satisfied.
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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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Skin infiltration by neoplastic T lymphocytes is seen in:
Your Answer: Mycosis fungoides
Explanation:Mycosis fungoides is a chronic T-cell lymphoma that involves the skin and less commonly, the internal organs such as nodes, liver, spleen and lungs. It is usually diagnosed in patients above 50 years and the average life expectancy is 7-10 years. It is insidious in onset and presents as a chronic, itchy rash, eventually spreading to involve most of the skin. Lesions are commonly plaque-like, but can be nodular or ulcerated. Symptoms include fever, night sweats and weight loss. Skin biopsy is diagnostic. However, early cases may pose a challenge due to fewer lymphoma cells. The malignant cells are mature T cells (T4+, T11+, T12+). The epidermis shows presence of characteristic Pautrier’s micro abscesses are present in the epidermis.
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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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During laparoscopic surgery to repair a direct inguinal hernia in a 68-year old man, the surgeon asked the registrar to look at the medial inguinal fossa to identify the direct inguinal hernia. To do so, she would have to look at the area that is between the:
Your Answer: Medial umbilical ligament and inferior epigastric artery
Explanation:The medial umbilical fold is made by the medial umbilical ligament-which is the obliterated portion of the umbilical artery, while the lateral umbilical fold is a fold of peritoneum over the inferior epigastric vessels. The median umbilical fold is a midline structure made by the median umbilical ligament i.e. the obliterated urachus. The medial inguinal fossa is the space on the inner abdominal wall between the medial umbilical fold and the lateral umbilical fold. It is place in the abdominal wall where there is an area of weak fascia i.e. the inguinal triangle through which direct inguinal hernias break through. The lateral inguinal fossa on the other hand is a space lateral to the lateral umbilical fold. Indirect inguinal hernias push through this space.
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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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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 14
Correct
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A 21-year-old woman presents with an episode of greenish discharge from the left nipple. Clinical examination of the breast is normal. Her breast USS report is U1 (normal). What should be the best course of action?
Your Answer: Reassure and discharge
Explanation:This is likely to be a case of simple duct ectasia. Normal USS report coupled with normal examination would favour discharge from the clinic. Mammography is generally not helpful in this age group.
Possible causes of nipple discharge include:
1. Abscess
2. Birth control pills
3. Breast cancer
4. Ductal carcinoma in situ (DCIS)
5. Endocrine disorders
6. Excessive breast stimulation
7. Fibrocystic breasts (lumpy or rope-like breast tissue)
8. Galactorrhoea
9. Injury or trauma to the breast
10. Intraductal papilloma (benign, wart-like growth in a milk duct)
11. Mammary duct ectasia
12. Mastitis (an infection in breast tissue that most commonly affects women who are breast-feeding)
13. Medication use
14. Menstrual cycle hormone changes
15. Paget’s disease of the breast
16. Periductal mastitis
17. Pregnancy and breast-feeding
18. ProlactinomaAssessment and management of non-malignant nipple discharge includes:
1. Exclude endocrine disease
2. Nipple cytology is not carried out as it would be unhelpful
3. Smoking cessation advice given for duct ectasia
4. Total duct excision may be warranted for duct ectasia with severe symptoms -
This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 15
Incorrect
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A 25 year old man presented with a history of headache and peripheral cyanosis. He had been living in the Himalayas for 6 months prior to this. What is the reason for his condition?
Your Answer: Polycythaemia vera
Correct Answer: Physiological polycythaemia
Explanation:Polycythaemia is a condition that results in an increase in the total number of red blood cells (RBCs) in the blood. It can be due to myeloproliferative syndrome or due to chronically low oxygen levels or rarely malignancy. In primary polycythaemia/polycythaemia vera the increase is due to an abnormality in the bone marrow, resulting in increases RBCs, white blood cells (WBCs) and platelets. In secondary polycythaemia the increase occurs due to high levels of erythropoietin either artificially or naturally. The increase is about 6-8 million/cm3 of blood. A type of secondary polycythaemia is physiological polycythaemia where people living in high altitudes who are exposed to hypoxic conditions produce more erythropoietin as a compensatory mechanism for thin oxygen and low oxygen partial pressure.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 16
Correct
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In an anatomy demonstration, the instructor asked one of the medical students to pass his index finger inferior to the root of the left lung. The student notices that his finger is blocked by a structure. Which structure do you think is responsible for this?
Your Answer: Pulmonary ligament
Explanation:The pulmonary ligament is dual layer of pleura stretching from the inferior part of the hilar reflection toward the diaphragm.
The costodiaphragmatic recess is the cavity at the inferior border of the lung where the costal pleura becomes the diaphragmatic pleura.
The cupola: is part of the pleura that extends superiorly above the first rib and has no association with the root of the lung.
Inferior vena cava is located in the mediastinum, not near the root of the lung.
Left pulmonary veins being part of the root of the lung, would not block access to behind the lung. Costomediastinal recess is the part of the pleura where the costal pleura become the mediastinal pleura. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 17
Correct
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A young boy fell from a tree, sustaining an injury to the elbow area and damaging the nerve behind the medial epicondyle of the humerus. What is the most likely result from that injury?
Your Answer: Flexion in the distal interphalangeal joint of digit 5
Explanation:The nerve injured in this situation is the ulnar nerve. It passes posterior to the medial epicondyle of the humerus before going between the two heads of the flexor carpi ulnaris muscle. This nerve supplies the muscles and skin of forearm and hand. At the level of medial epicondyle, the injury will led to paralysis in flexor carpi ulnaris and the ulnar half of the flexor digitorum profundus as well as the palmar interossei and hypothenar muscles in the hand. The correct answer will be that the boy will suffer from inability to flex the distal interphalangeal joint of digit 5
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 18
Correct
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A 64 year old man who sustained an iatrogenic injury to both the ureters after undergoing a subtotal colectomy, develops renal failure. Labs show an elevated serum potassium level of 6.9 mmol/L. The ECG is most likely to show which of the following abnormalities?
Your Answer: Peaked T waves
Explanation:Early ECG changes of hyperkalaemia, typically seen at a serum potassium levels of 5.5-6.5 mEq/L, include the following:
– Tall, peaked T waves with a narrow base (best seen in precordial leads)
– Shortened QT interval
– ST-segment depression -
This question is part of the following fields:
- Post-operative Management And Critical Care
- Principles Of Surgery-in-General
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Question 19
Incorrect
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Cranial nerve XII, the hypoglossal nerve, innervates which one of the following muscles in the list?
Your Answer: Stylopharyngeus
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 20
Correct
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Calculate the cardiac stroke volume of a patient whose oxygen consumption (measured by analysis of mixed expired gas) is 300 ml/min, arterial O2 content is 20 ml/100 ml blood, pulmonary arterial O2 content is 15 ml/100 ml blood and heart rate is 60/min.
Your Answer: 100 ml
Explanation:By Fick’s principle, VO2 = Q × (CA (O2) − CV (O2)) where VO2 = O2 consumption, Q = cardiac output and CA(O2) and CV(O2) are arterial and mixed venous O2 content respectively. Thus, in the given problem, 300 ml O2/min = Q × (20−15) ml O2/100 ml. Thus, Q = 6000 ml blood/min. Then, we can calculate stroke volume by dividing the cardiac output with heart rate. Thus, stroke volume = 6000 ml/min divided by 60/min stroke volume = 100 ml.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 21
Correct
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A 22-year-old male is diagnosed with an intersphincteric fistula-in-ano during an examination under anaesthetic. Which is the most appropriate treatment?
Your Answer: Insertion of a ‘loose’ seton
Explanation:An anal fistula is an abnormal tract between the anal canal and the skin around the anus.
Anal fistulas can be classified according to their relationship with the external sphincter. A fistula may be complex, with several openings onto the perianal skin. Intersphincteric fistulas are the most common type and cross only the internal anal sphincter. Trans-sphincteric fistulas pass through both the internal and external sphincters.The aim is to drain the infected material and encourage healing.
For simple intersphincteric and low trans-sphincteric anal fistulas, the most common treatment is a fistulotomy or laying open of the fistula tract.
For high and complex (deeper) fistulas that involve more muscle, with a high risk of faecal incontinence or recurrence, surgery aims to treat the fistula and preserve sphincter-muscle function. Techniques include a 1‑stage or 2‑stage seton (suture material or rubber sling) either alone or in combination with fistulotomy, ligation of an intersphincteric fistula tract, creating a mucosal advancement flap, injecting glue or paste, or inserting a fistula plug . -
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 22
Correct
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Which statement is correct regarding coagulation?
Your Answer: Thrombin converts fibrinogen to fibrin
Explanation:Coagulation of blood is a complex process and an important part of haemostasis. There are two main pathways related to coagulation: the contact activation pathway/intrinsic pathway and tissue factor/extrinsic pathway. The extrinsic pathway is activated by external trauma that causes blood to escape from the vascular system. This pathway is quicker than the intrinsic pathway and involves factor VII. The intrinsic pathway is activated by trauma inside the vascular system, and initiated by platelets, exposed endothelium, chemicals, or collagen. This pathway is slower than the extrinsic pathway, but more important. It involves factors XII, XI, IX, VIII. Both pathways meet to finish the formation of a clot in what is known as the common pathway. The common pathway involves factors I, II, V, and X. They converge on the common pathway in which activation of prothrombin to thrombin leads to conversion of fibrinogen to fibrin and clot formation.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 23
Incorrect
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Question 24
Correct
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A 24 year old mother is breastfeeding her first child. Which of the following cellular adaptations occurred in her breast tissue to allow her to do this?
Your Answer: Lobular hyperplasia
Explanation:Under the influence of oestrogen in pregnancy, there is an increase in the number of lobules which will facilitate lactation.
Steatocytes occur due to loss of weight and nutritional deficit.
Metaplasia is a normal physiological process which is due to a change in normal epithelium with another type.
Lobular atrophy will result in a decreased capacity to provide milk. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 25
Correct
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A young man came to the emergency room after an accident. The anterior surface of his wrist was lacerated with loss of sensation over the thumb side of his palm. Which nerves have been damaged?
Your Answer: Median
Explanation:The median nerve provides cutaneous innervation to the skin of the palmar radial three and a half fingers. Also the site of injury indicates that the medial nerve may have been injured as it passes into the hand by crossing over the anterior wrist.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 26
Correct
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A 32-year-old man presents to the doctor complaining of pain in his left calf whilst walking. He says that the pain goes away after a short period of rest but starts again during exercise or walking. The man reveals he has been a smoker for the last 15 years. His blood pressure, blood sugar and cholesterol level are normal. Artery biopsy shows intraluminal thrombosis and vasculitis. What's is the most likely cause of these findings?
Your Answer: Buerger's disease
Explanation:Thromboangiitis obliterans, also known as Buerger’s disease, is a rare type of occlusive peripheral arterial disease, usually seen in smokers, most commonly in men aged 20 to 40. Symptoms most often include intermittent claudication, skin changes, painful ulcers on extremities, pain in the extremities during rest and gangrene. Diagnosis is based on clinical findings, arteriography, echocardiography, and computed tomography angiography. A difference in blood pressure between arms, or between the arms and legs is a common finding. Electrocardiographic findings include nonspecific abnormality or normal results.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 27
Correct
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A 64 year old man with a history of recurrent anal cancer undergoes a salvage abdominoperineal excision of the anus and rectum. He was treated with radical chemotherapy prior to the procedure. At the conclusion of the surgery, there is a 10cm by 10cm perineal skin defect. Which of the following closure options would be most appropriate in this case?
Your Answer: Pedicled myocutaneous flap
Explanation:As a reconstructive option after extensive surgery, pedicled musculocutaneous flaps offer several advantages in the setting of previous radiotherapy. Rotational skin flaps will comprise of irradiated tissue and thus won’t heal well.
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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 28
Correct
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An 8 year old boy presents with bleeding from the nose. From which area did the bleeding most likely originate?
Your Answer: Kiesselbach's plexus
Explanation:Answer: Kiesselbach’s plexus
Epistaxis is defined as acute haemorrhage from the nostril, nasal cavity, or nasopharynx. The source of 90% of anterior nosebleeds within the Kiesselbach’s plexus (also known as Little’s area) on the anterior nasal septum.
Kiesselbach’s plexus (Kiesselbach’s area or Little’s area) is a vascular region of the anteroinferior nasal septum that comprises four arterial anastomoses:
1)anterior ethmoidal artery – a branch of the ophthalmic artery
2)sphenopalatine artery -
This question is part of the following fields:
- Generic Surgical Topics
- Head And Neck Surgery
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Question 29
Correct
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A 40-year old woman presents with tightening of the skin over her fingers which makes movement of her fingers difficult.. She also gives a history of her fingers turning blue on exposure to low temperatures. She admits to gradual weight loss. Investigations reveal negative rheumatoid factor, negative antinuclear antibody and a positive anticentromere body. Which of the following conditions is she likely to have?
Your Answer: Oesophageal stricture
Explanation:Scleroderma is a connective tissue disorder that ranges in severity and progression. The disease could show generalised skin thickening with rapid, fatal, visceral involvement; or only cutaneous involvement (typically fingers and face). The slow progressive form is also known as ‘limited cutaneous scleroderma’ or CREST syndrome (calcinosis cutis, Raynaud’s phenomenon, (o)oesophageal dysmotility, sclerodactyly, and telangiectasia).
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 30
Correct
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A 50 year old female patient with an history of chronic headache was scheduled for CT scan. If the CT scan revealed a tumour at the horn of the lateral ventricle, which of the following structures is most likely to be compressed by this tumour?
Your Answer: Fibres of the corpus callosum
Explanation:The ventricular system of the brain is made up of four ventricles namely; two lateral and a third and forth ventricle. The ventricles are the site of the development of the cerebrospinal fluid. The left and right lateral ventricles are located in each of the brain’s hemispheres. The roof of the lateral ventricles are made up of the fibres of the corpus callosum. This is the structure that would be compressed by the a tumour on the roof of the lateral ventricles.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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SESSION STATS - PERFORMANCE PER SPECIALTY
