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  • Question 1 - A 30 year old man is diagnosed on oesophageal biopsies to have loss...

    Correct

    • A 30 year old man is diagnosed on oesophageal biopsies to have loss of ganglion cells in the myenteric plexus. Which of the following would be the most appropriate diagnosis?

      Your Answer: Achalasia

      Explanation:

      Achalasia is an oesophageal motor disorder characterized by aperistalsis of the oesophageal body and lack of relaxation of the lower sphincter in response to swallows.
      Achalasia cardia is one of the common causes of motor dysphagia. Pathophysiologically, achalasia cardia is caused by loss of inhibitory ganglion in the myenteric plexus of the oesophagus. In the initial stage, degeneration of inhibitory nerves in the oesophagus results in unopposed action of excitatory neurotransmitters such as acetylcholine, resulting in high amplitude non-peristaltic contractions (vigorous achalasia); progressive loss of cholinergic neurons over time results in dilation and low amplitude simultaneous contractions in the oesophageal body (classic achalasia).

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Upper Gastrointestinal Surgery
      4.3
      Seconds
  • Question 2 - A 24 year old female is rushed to the emergency room after complaining...

    Correct

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

      Your Answer: Fitz Hugh Curtis Syndrome

      Explanation:

      Answer: Fitz Hugh Curtis syndrome

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

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

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

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

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

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

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

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      7.9
      Seconds
  • Question 3 - A 30-year-old woman feels thirsty. This thirst is probably due to: ...

    Correct

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

      Your Answer: Increased level of angiotensin II

      Explanation:

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

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      4.1
      Seconds
  • Question 4 - A 32-year old gentleman came to the emergency department, complaining of progressively increasing...

    Correct

    • A 32-year old gentleman came to the emergency department, complaining of progressively increasing weakness in his arms and legs over 5 days. On examination, there is symmetrical weakness on both sides of his face, along with weakness of the proximal and distal muscles of all four limbs. No loss of sensation noted. Deep tendon reflexes could not be elicited and plantar responses were downward. On enquiry, it was revealed that he had an upper respiratory tract infection 10 days ago. The likely diagnosis is:

      Your Answer: Guillain–Barré syndrome

      Explanation:

      Guillain–Barré syndrome (GBS) is an acute, autoimmune polyradiculoneuropathy which affects the peripheral nervous system and is usually triggered by an acute infectious process. 75% patients have a history of acute infection within the past 1–4 weeks, usually respiratory or gastrointestinal. immunisations have also been implicated. The most common form is acute inflammatory demyelinating polyneuropathy. It results in an ascending paralysis with complete loss of deep tendon reflexes. Treatment includes immunoglobulins and supportive care. However, the disease may be fatal due to severe pulmonary complications and dysautonomia.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      27.4
      Seconds
  • Question 5 - A 34-year-old Asian male presents with cervical lymphadenopathy. The patient is suspected to...

    Correct

    • A 34-year-old Asian male presents with cervical lymphadenopathy. The patient is suspected to have tuberculous lymphadenopathy. Excision biopsy of one of the nodes showed granulomatous inflammation. Which histopathologic feature is most likely consistent with the diagnosis of tuberculosis?

      Your Answer: Caseation necrosis

      Explanation:

      The granulomas of tuberculosis tend to contain necrosis (caseating tubercles), but non-necrotizing granulomas may also be present. Multinucleated giant cells with nuclei arranged like a horseshoe (Langhans giant cells) and foreign body giant cells are often present, but are not specific for tuberculosis. A definitive diagnosis of tuberculosis requires identification of the causative organism by microbiological cultures.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      21.1
      Seconds
  • Question 6 - A 56-year-old woman weighs 75 kg. In this patient, total body water, intracellular...

    Correct

    • A 56-year-old woman weighs 75 kg. In this patient, total body water, intracellular fluid and extracellular fluid are respectively:

      Your Answer: 45 l, 30 l, 15 l

      Explanation:

      The percentages of body water contained in various fluid compartments add up to total body water (TBW). This water makes up a significant fraction of the human body, both by weight and by volume. The total body water (TBW) content of humans is approximately 60% of body weight. Two-thirds is located in the intracellular and one-third in the extracellular compartment. So, in a 75-kg individual, TBW = 60 × 75/100 = 45 l. Intracellular content = 2/3 × 45 = 30 l and extracellular content = 1/3 × 45 = 15 l.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      83.8
      Seconds
  • Question 7 - A 6 week old baby who is developing well starts having profuse and...

    Correct

    • A 6 week old baby who is developing well starts having profuse and projectile vomiting after feeding. She has been losing weight and the vomit is non-bilious. Which of the following is the most likely cause?

      Your Answer: Hypertrophy of the pyloric sphincter

      Explanation:

      Pyloric stenosis is a narrowing of the opening from the stomach to the first part of the small intestine (the pylorus). Symptoms include projectile vomiting without the presence of bile. This most often occurs after the baby is fed. The typical age that symptoms become obvious is two to twelve weeks old.

      The cause of pyloric stenosis is unclear. Risk factors in babies include birth by caesarean section, preterm birth, bottle feeding, and being first born. The diagnosis may be made by feeling an olive-shaped mass in the baby’s abdomen. This is often confirmed with ultrasound. It is four times more likely to occur in males, and is also more common in the first born. Rarely, infantile pyloric stenosis can occur as an autosomal dominant condition.

      It is uncertain whether it is a congenital anatomic narrowing or a functional hypertrophy of the pyloric sphincter muscle.
      Babies with this condition usually present any time in the first weeks to months of life with progressively worsening vomiting. The vomiting is often described as non-bile stained (non bilious) and projectile vomiting, because it is more forceful than the usual spitting up (gastroesophageal reflux) seen at this age. Some infants present with poor feeding and weight loss but others demonstrate normal weight gain. Dehydration may occur which causes a baby to cry without having tears and to produce less wet or dirty diapers due to not urinating for hours or for a few days. Symptoms usually begin between 3 to 12 weeks of age. Findings include epigastric fullness with visible peristalsis in the upper abdomen from the person’s left to right. Constant hunger, belching, and colic are other possible signs that the baby is unable to eat properly.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Paediatric Surgery
      30.8
      Seconds
  • Question 8 - A 25 year-old female medical student presents with fever, lack of appetite, rashes,...

    Correct

    • A 25 year-old female medical student presents with fever, lack of appetite, rashes, sore throat and lymphadenopathy. Peripheral smear shows atypical lymphocytes. Which is the most likely organism responsible for this patient's condition?

      Your Answer: Epstein–Barr virus

      Explanation:

      Epstein-Barr virus is in the herpes family of viruses and most people will become infected with EBV sometime during their lives. EBV commonly causes infectious mononucleosis, or mono, a contagious viral illness that initially attacks the lymph nodes in the neck and throat. When these tissues become less effective in fighting infection, sore throats, swelling of the nodes and fever may result.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      17.3
      Seconds
  • Question 9 - During laparoscopic surgery to repair a direct inguinal hernia in a 68-year old...

    Correct

    • 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.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      19.5
      Seconds
  • Question 10 - After finding elevated PSA levels, a 69-year-old man undergoes a needle biopsy and...

    Correct

    • After finding elevated PSA levels, a 69-year-old man undergoes a needle biopsy and is diagnosed with prostatic cancer. What is the stage of this primary tumour?

      Your Answer: T1c

      Explanation:

      The AJCC uses a TNM system to stage prostatic cancer, with categories for the primary tumour, regional lymph nodes and distant metastases:
      TX: cannot evaluate the primary tumour T0: no evidence of tumour
      T1: tumour present, but not detectable clinically or with imaging T1a: tumour was incidentally found in less than 5% of prostate tissue resected (for other reasons)
      T1b: tumour was incidentally found in more than 5% of prostate tissue resected
      T1c: tumour was found in a needle biopsy performed due to an elevated serum prostate-specific antigen
      T2: the tumour can be felt (palpated) on examination, but has not spread outside the prostate
      T2a: the tumour is in half or less than half of one of the prostate gland’s two lobes
      T2b: the tumour is in more than half of one lobe, but not both
      T2c: the tumour is in both lobes
      T3: the tumour has spread through the prostatic capsule (if it is only part-way through, it is still T2)
      T3a: the tumour has spread through the capsule on one or both sides
      T3b: the tumour has invaded one or both seminal vesicles
      T4: the tumour has invaded other nearby structures.
      In this case, the tumour has a T1c stage.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      4
      Seconds
  • Question 11 - A 28-year old lady comes to the surgical clinic with a recently detected...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      12.4
      Seconds
  • Question 12 - A 60 year old woman develops an enterocutaneous fistula which is high output...

    Correct

    • A 60 year old woman develops an enterocutaneous fistula which is high output following a recent stricturoplasty. Her medical history shows that she has been suffering from small bowel Crohn's disease for the past 17 years. A small bowel follow through shows it to be 14 cm from the DJ flexure and her overlying skin is becoming excoriated. What is the most appropriate course of action?

      Your Answer: Commence TPN and octreotide

      Explanation:

      Total parenteral nutrition (TPN) is usually indicated with suspected gastric, duodenal, or small-bowel fistula. When the fistula output is very high, discontinuance of oral intake is recommended because oral intake stimulates further losses of fluids, electrolytes, and protein via the fistula. A decrease in fistula output frequently occurs with the initiation of TPN.

      Volume depletion from a proximal high-output fistula can be controlled with the use of the long-acting somatostatin analogue octreotide, which acts by inhibiting GI hormones. The administration of octreotide reportedly diminishes fistula output, but whether it shortens the time required for fistula closure remains to be determined.
      Draus et al recommended a 3-day trial of octreotide, maintaining that if the fistula output is reduced during this time, then administration of the drug should be continued. Two meta-analyses showed that somatostatin and its analogues decreased the time for fistula closure and increased the closure rate.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      37.2
      Seconds
  • Question 13 - Intracellular shifting of hydrogen ions can generate a metabolic alkalosis. In which of...

    Correct

    • Intracellular shifting of hydrogen ions can generate a metabolic alkalosis. In which of the following conditions is metabolic alkalosis caused by this mechanism ?

      Your Answer: Hypokalaemia

      Explanation:

      Metabolic alkalosis is characterized by a primary increase in the concentration of serum bicarbonate ions. This may occur as a consequence of a loss of hydrogen ions or a gain in bicarbonate. Hydrogen ions may be lost through the kidneys or the GI tract, as for example during vomiting, nasogastric suction or use of diuretics. Intracellular shifting of hydrogen ions develops mainly during hypokalaemia to maintain neutrality. Gain in bicarbonate ions may develop during administration of sodium bicarbonate in high amounts or in amounts that exceed the capacity of excretion of the kidneys, as seen in renal failure. Fluid losses may be another cause of metabolic alkalosis, causing the reduction of extracellular fluid volume.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      15.6
      Seconds
  • Question 14 - A 20 year old female is rushed to the hospital after developing severe...

    Incorrect

    • A 20 year old female is rushed to the hospital after developing severe back pain and weakness in both legs after completing the long jump. She is seen with a prominent sacrum on examination and her lower back pain is severe. Which of the following is the underlying cause?

      Your Answer: Spondylolysis

      Correct Answer: Spondylolisthesis

      Explanation:

      Answer: Spondylolisthesis

      Spondylolisthesis is a condition in which a bone (vertebra) in the spine moves forward out of the proper position onto the bone below it.

      Causes
      In children, spondylolisthesis usually occurs between the fifth bone in the lower back (lumbar vertebra) and the first bone in the sacrum (pelvis) area. It is often due to a birth defect in that area of the spine or sudden injury (acute trauma).

      In adults, the most common cause is abnormal wear on the cartilage and bones, such as arthritis. The condition mostly affects people over 50 years old. It is more common in women than in men.

      Bone disease and fractures can also cause spondylolisthesis. Certain sports activities, such as gymnastics, weightlifting, and football, greatly stress the bones in the lower back. They also require that the athlete constantly overstretch (hyperextend) the spine. This can lead to a stress fracture on one or both sides of the vertebra. A stress fracture can cause a spinal bone to become weak and shift out of place.

      Symptoms
      Symptoms of spondylolisthesis may vary from mild to severe. A person with spondylolisthesis may have no symptoms. Children may not show symptoms until they’re 18 years old.

      The condition can lead to increased lordosis (also called swayback). In later stages, it may result in kyphosis (round back) as the upper spine falls off the lower spine.

      Symptoms may include any of the following:

      Lower back pain
      Muscle tightness (tight hamstring muscle)
      Pain, numbness, or tingling in the thighs and buttocks
      Stiffness
      Tenderness in the area of the vertebra that is out of place
      Weakness in the legs

      Ankylosing spondylitis (AS) is a type of arthritis in which there is a long-term inflammation of the joints of the spine.[2] Typically the joints where the spine joins the pelvis are also affected. Occasionally other joints such as the shoulders or hips are involved. Eye and bowel problems may also occur. Back pain is a characteristic symptom of AS, and it often comes and goes. Stiffness of the affected joints generally worsens over time.

      Although the cause of ankylosing spondylitis is unknown, it is believed to involve a combination of genetic and environmental factors. More than 90% of those affected in the UK have a specific human leukocyte antigen known as the HLA-B27 antigen. The underlying mechanism is believed to be autoimmune or autoinflammatory. Diagnosis is typically based on the symptoms with support from medical imaging and blood tests. AS is a type of seronegative spondyloarthropathy, meaning that tests show no presence of rheumatoid factor (RF) antibodies. It is also within a broader category known as axial spondylarthritis.

      The signs and symptoms of ankylosing spondylitis often appear gradually, with peak onset being between 20 and 30 years of age. Initial symptoms are usually a chronic dull pain in the lower back or gluteal region combined with stiffness of the lower back. Individuals often experience pain and stiffness that awakens them in the early morning hours.

      As the disease progresses, loss of spinal mobility and chest expansion, with a limitation of anterior flexion, lateral flexion, and extension of the lumbar spine, are seen. Systemic features are common, with weight loss, fever, or fatigue often present. Pain is often severe at rest but may improve with physical activity, but inflammation and pain to varying degrees may recur regardless of rest and movement.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      30.8
      Seconds
  • Question 15 - A 20-year old gentleman was brought to the emergency department with headache and...

    Correct

    • A 20-year old gentleman was brought to the emergency department with headache and nausea for 2 days. He also complained of intolerance to bright light and loud sounds. Lumbar puncture showed glucose < 45 mg/dl, protein > 5 mg/dl and neutrophil leucocytosis. The likely diagnosis is:

      Your Answer: Meningitis

      Explanation:

      Diagnosis of meningitis can be carried out with examination of cerebrospinal fluid (CSF) with a lumbar puncture (LP). In a case of bacterial meningitis, the CSF analysis will show:
      – Opening pressure: > 180 mmH2O
      – White blood cell count: 10–10 000/μl with neutrophil predominance
      – Glucose: < 40 mg/dl
      – CSF glucose to serum glucose ratio: < 0.4
      – Protein: > 4.5 mg/dl
      – Gram stain: positive in > 60%
      – Culture: positive in > 80%
      – Latex agglutination: may be positive in meningitis due to Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Escherichia coli and group B streptococci
      – Limulus, lysates: positive in Gram-negative meningitis

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      13.8
      Seconds
  • Question 16 - A 60 year old female patient who has suffered an embolic stroke that...

    Correct

    • A 60 year old female patient who has suffered an embolic stroke that affected her middle cerebral artery as revealed by a CT scan is likely to exhibit which of the following neurologic conditions?

      Your Answer: Contralateral hemiplegia

      Explanation:

      The middle cerebral artery is a major artery that supplies blood to the cerebrum. It continues from the internal carotid artery up into the lateral sulcus. The middle cerebral artery mainly supplies the lateral aspect of the cerebral cortex, anterior aspect of the temporal lobes and the insular cortices.
      Functional areas supplied by this vein are as follows:
      The motor and pre-motor areas
      The somato-sensory
      Auditory areas
      Motor speech
      Sensory speech
      Pre-frontal area
      Occlusion of the middle cerebral artery results in:
      i) A severe contralateral hemiplegia, most marked in the upper extremity and face
      ii) A contralateral sensory impairment worse in the upper part of the body

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      43.8
      Seconds
  • Question 17 - Which of these structures is most likely to be damaged if a patient...

    Correct

    • Which of these structures is most likely to be damaged if a patient loses consciousness days or weeks after an otherwise insignificant head trauma, especially in elderly patients?

      Your Answer: Dural bridging vein

      Explanation:

      A subdural haematoma is a type of hematoma, usually associated with traumatic brain injury, in which blood collects between the dura mater and the pia-arachnoid mater. Symptoms of subdural haemorrhage have a slower onset than those of epidural haemorrhages because the lower pressure veins bleed more slowly than arteries. These injuries are more common in elderly patients, especially those taking antiplatelet or anticoagulant drugs. Oedema and increased intracranial pressure are unusual.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      21
      Seconds
  • Question 18 - A patient presents with loss of pain and temperature sensation in the left...

    Incorrect

    • A patient presents with loss of pain and temperature sensation in the left leg. He is likely to have a lesion involving:

      Your Answer: Right anterior spinothalamic tract

      Correct Answer: Right lateral spinothalamic tract

      Explanation:

      The spinothalamic tract is a sensory pathway originating in the spinal cord that transmits information to the thalamus. There are two main parts of the spinothalamic tract: the lateral spinothalamic tract transmits pain and temperature and the anterior spinothalamic tract transmits touch (crude touch). The decussation of this pathway occurs at the level of the spinal cord. Hence, a unilateral lesion of the lateral spinothalamic tract causes contralateral loss of pain and temperature.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      15.3
      Seconds
  • Question 19 - A chef, whilst preparing food, cut her thumb with a knife. She transected...

    Correct

    • A chef, whilst preparing food, cut her thumb with a knife. She transected the arteria princeps pollicis. This artery is a branch of the?

      Your Answer: Radial artery

      Explanation:

      The radial artery branches into the arteria princeps pollicis as it turns medially into the deep part of the hand. The arteria princeps pollicis is distributed to the skin and subcutaneous tissue of the thumb.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      5.2
      Seconds
  • Question 20 - When a patient is standing erect, pleural fluid would tend to accumulate in...

    Correct

    • When a patient is standing erect, pleural fluid would tend to accumulate in which part of the pleural space?

      Your Answer: Costodiaphragmatic recess

      Explanation:

      The costo-diaphragmatic recess is the lowest extent of the pleural cavity or sac. Any fluid in the pleura will by gravity accumulate here when a patient is standing erect.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      9.4
      Seconds
  • Question 21 - Paracentesis of ascetic fluid in a 45-year old woman revealed the following :...

    Correct

    • Paracentesis of ascetic fluid in a 45-year old woman revealed the following : clear, yellow fluid with protein 2.0 g/dl and a few mesothelial and mononuclear cells seen. No malignant cells seen. What is the likely diagnosis?

      Your Answer: Micronodular cirrhosis

      Explanation:

      Cirrhosis is disease of the liver that is characterized by fibrosis leading to disorganization of the hepatic architecture. It shows the development of regenerative nodules surrounded by dense fibrotic tissue. Cirrhosis shows non-specific symptoms initially, which include fatigue, anorexia and weight loss. It can later progress to portal hypertension, ascites and liver failure.
      Micronodular cirrhosis is named so, due to the uniformly small nodules (<3 mm in diameter) and thick regular bands of connective tissue. These nodules lack lobular organization with distortion of central hepatic venules and portal triads. Over a period of time, macronodular cirrhosis develops, with bigger nodules (3 mm to 5 cm in diameter) surrounded by broad fibrous bands, and some amount of lobular organization. Mixed cirrhosis combines features of both micronodular and macronodular cirrhosis.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      14.4
      Seconds
  • Question 22 - A 20 year lady is brought to the A&E following a road accident....

    Correct

    • A 20 year lady is brought to the A&E following a road accident. She is hypotensive and a CT scan of the abdomen reveals a shattered spleen. An emergency splenectomy is performed where the splenic artery is ligated right at its origin. Which of the following arteries will have a diminished blood flow owing to ligation of the splenic artery at its origin?

      Your Answer: Left gastroepiploic

      Explanation:

      Ligation of the splenic artery right at its point of origin should cut off blood flow in its branches. The following are the branches of the splenic artery: pancreatic branches, short gastric branches and left gastroepiploic arteries.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      22.9
      Seconds
  • Question 23 - The bronchial circulation is a part of the circulatory system that supplies nutrients and oxygen to the pulmonary...

    Correct

    • The bronchial circulation is a part of the circulatory system that supplies nutrients and oxygen to the pulmonary parenchyma. What percentage of cardiac output is received by bronchial circulation?

      Your Answer: 2%

      Explanation:

      The bronchial circulation is part of the systemic circulation and receives about 2% of the cardiac output from the left heart. Bronchial arteries arise from branches of the aorta, intercostal, subclavian or internal mammary arteries. The bronchial arteries supply the tracheobronchial tree with both nutrients and O2. It is complementary to the pulmonary circulation that brings deoxygenated blood to the lungs and carries oxygenated blood away from them in order to oxygenate the rest of the body.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      7
      Seconds
  • Question 24 - In the emergency room, a nurse was introducing a catheter into the patients...

    Correct

    • In the emergency room, a nurse was introducing a catheter into the patients femoral vein for rapid fluid therapy. The femoral vein is situated inside the femoral sheath. Which of the following is true about that sheath?

      Your Answer: The medial compartment is called the femoral canal

      Explanation:

      The femoral sheath is situated ,4cm below the inguinal ligament. It is a prolongation of the abdominal fascia. The anterior wall is a prolongation of the transversalis fascia and the posterior wall, the iliac fascia. It is divided by two vertical septa into 3 compartments, lateral, intermediate, and medial. The medial compartment is known as the femoral canal and contains some lymphatic vessels. The lateral one contains the femoral artery and the intermediate one contains the femoral vein.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      26.7
      Seconds
  • Question 25 - Which of the following structures lying posterior to the ovary are at risk...

    Incorrect

    • Which of the following structures lying posterior to the ovary are at risk of injury in excision of a malignant tumour in the right ovary?

      Your Answer: Obturator nerve

      Correct Answer: Ureter

      Explanation:

      The ovaries are two nodular structures situated one on either side of the uterus in relation to the lateral wall of the pelvis and attached to the back of the broad ligament of the uterus, lying posteroinferiorly to the fallopian tubes. Each ovary has a lateral and medial surface. The ureter is at greater risk of iatrogenic injury at this location.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      15.6
      Seconds
  • Question 26 - As per the Poiseuille-Hagen formula, doubling the diameter of a vessel will change...

    Incorrect

    • As per the Poiseuille-Hagen formula, doubling the diameter of a vessel will change the resistance of the vessel from 16 peripheral resistance units (PRU) to:

      Your Answer: 2 PRU

      Correct Answer: 1 PRU

      Explanation:

      Poiseuille-Hagen formula for flow in along narrow tube states that F = (PA– PB) × (Π/8) × (1/η) × (r4/l) where F = flow, PA– PB = pressure difference between the two ends of the tube, η = viscosity, r = radius of tube and L = length of tube. Also, flow is given by pressure difference divided by resistance. Hence, R = 8ηL ÷ Πr4. Hence, the resistance of the vessel changes in inverse proportion to the fourth power of the diameter. So, if the diameter of the vessel is increased to twice the original, it will lead to decrease in resistance to one-sixteenth its initial value.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      27.3
      Seconds
  • Question 27 - A 31-year-old woman is diagnosed with adrenal hyperplasia, and laboratory samples are taken...

    Incorrect

    • A 31-year-old woman is diagnosed with adrenal hyperplasia, and laboratory samples are taken to measure serum aldosterone and another substance. Which is most likely to be the other test that was prescribed to this patient?

      Your Answer: Plasma adrenocorticotrophic hormone (ACTH)

      Correct Answer: Plasma renin

      Explanation:

      The evaluation of a patient in whom hyperaldosteronism is first to determine that hyperaldosteronism is present (serum aldosterone) and, if it is present, to differentiate primary from secondary causes of hyperaldosteronism. The aldosterone-to-renin ratio (ARR) is the most sensitive means of differentiating primary from secondary causes of hyperaldosteronism as it is abnormally increased in primary hyperaldosteronism, and decreased or normal but with high renin levels in secondary hyperaldosteronism.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      25.3
      Seconds
  • Question 28 - A 40 year old male presents with jaundice and is diagnosed as having...

    Correct

    • A 40 year old male presents with jaundice and is diagnosed as having a carcinoma of the head of the pancreas. Despite being deeply jaundiced, his staging investigations are negative for metastatic disease. What is the best method of biliary decompression in this case?

      Your Answer: ERCP and placement of stent

      Explanation:

      ERCP is a highly sensitive means of detecting pancreatic and/or biliary ductal abnormalities in pancreatic carcinoma. Among patients with pancreatic adenocarcinoma, 90-95% have abnormalities on ERCP findings.
      ERCP is more invasive than the other diagnostic imaging modalities available for pancreatic carcinoma. ERCP also carries a 5-10% risk of significant complications. Because of this morbidity, it is usually reserved as a therapeutic procedure for biliary obstruction or for the diagnosis of unusual pancreatic neoplasms, such as intraductal pancreatic mucinous neoplasms (IPMN).
      ERCP findings provide only limited staging information, but ERCP does have the advantage of allowing for therapeutic palliation of obstructive jaundice with either a plastic or metal biliary stent.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
      17.2
      Seconds
  • Question 29 - Which of the following is an anion? ...

    Incorrect

    • Which of the following is an anion?

      Your Answer: Magnesium

      Correct Answer: Phosphate

      Explanation:

      Cations: sodium, magnesium, calcium and potassium
      Anions: chloride, phosphate, bicarbonate, lactate, sulphate and albumin

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      72.4
      Seconds
  • Question 30 - Which of the following is the most likely cause of massive splenomegaly in...

    Correct

    • Which of the following is the most likely cause of massive splenomegaly in a 35-year old gentleman?

      Your Answer: Myelofibrosis

      Explanation:

      Causes of massive splenomegaly include chronic myelogenous leukaemia, chronic lymphocytic leukaemia, lymphoma, hairy cell leukaemia, myelofibrosis, polycythaemia vera, sarcoidosis, Gaucher’s disease and malaria.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      14.1
      Seconds
  • Question 31 - A 27-year-old woman, who had been taking a combined oral contraceptive for 6...

    Incorrect

    • A 27-year-old woman, who had been taking a combined oral contraceptive for 6 months, presented with inguinal pain and oedema of the left leg. Which of the following investigations would you recommend to help confirm the diagnosis?

      Your Answer: D-dimer test

      Correct Answer: Duplex scan

      Explanation:

      Oral combined contraceptive pill (OCCP) is a drug used for birth control and treating a number of other conditions. Women who take the OCP have a higher risk of developing deep vein thrombosis (DVT), usually in the legs. Duplex ultrasonography is a safe and non-invasive technique which is used for diagnosing the presence of lower extremity thrombi.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      22.2
      Seconds
  • Question 32 - Where do the seminal vesicles lie? ...

    Incorrect

    • Where do the seminal vesicles lie?

      Your Answer: Prostate and rectum

      Correct Answer: Base of the bladder and rectum

      Explanation:

      The seminal vesicles are two lobulated membranous pouches situated between the fundus of the bladder and rectum and act as a reservoir for the semen and secrete a fluid that is added to the seminal fluid. Each sac is pyramidal in shape but they all vary in size not only in different individuals but also in the same individuals. The anterior surface is in contact with the fundus of the bladder, extending from near the termination of the ureter to the base of the prostate. Each vesicle consist of single tube, which gives off several irregular caecal diverticula. These separate coils and the diverticula are connected by fibrous tissue.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      8.2
      Seconds
  • Question 33 - A 51 year old man undergoes a live donor renal transplant. The donor's...

    Incorrect

    • A 51 year old man undergoes a live donor renal transplant. The donor's right kidney is anastomosed to the recipient. On removal of the arterial clamps there is good urinary flow and the wounds are closed. While he is in the ward, it is observed that the he suddenly becomes anuric. Irrigation of the bladder does not improve the situation. What is the most likely cause?

      Your Answer: Blocked catheter

      Correct Answer: Renal artery thrombosis

      Explanation:

      Renal vein thrombosis (RVT) is the formation of a clot in the vein that drains blood from the kidneys, ultimately leading to a reduction in the drainage of one or both kidneys and the possible migration of the clot to other parts of the body.

      Venous thrombosis is a rare occurrence, occurring in 0.5% of kidney transplants. With aggressive treatment,
      i.e. thrombectomy, the chances of success are very poor, but treatment is successful in rare cases. More often, patients are treated with transplantectomy.

      The left side is preferred for live donor transplants due to longer renal vein while right side has been associated with renal vein thrombosis and shorter vessels.

      With the iliac artery anatomically located lateral to iliac vein, one would need a longer vein in the graft to enable the graft placement in the iliac fossa, its final location. Most renal transplant surgeons would intuitively prefer to implant a graft harvested from the left side. The right kidney has a simpler anatomy for retrieval, with no adrenal or lumbar veins to tackle. However, a long artery and short vein make this kidney’s anatomy skewed for grafting. Studies on cadavers have shown significantly shorter right renal vein length (average 13.7%) on the right side. With its weak posterior wall, there is an added risk of tear of the right renal vein if there is tension during anastomosis. Overzealous manoeuvres and stretching of a short vein during retrieval, or handling during allografting may also risk intimal damage, a possible aetiology for some early reports of right grafts lost to renal vein thrombosis following laparoscopic harvest.

      Recommendations:
      • On the right, lengthen the renal vein with the infra renal vena cava in order to avoid an anastomosis
      under tension.
      • Carry out a large venous anastomosis; at declamping, if the renal vein is tight, re-do the venous anastomosis.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Organ Transplantation
      16.4
      Seconds
  • Question 34 - Multiple, non-tender lymphadenopathy with biopsy showing several crowded follicles of small, monomorphic lymphocytes...

    Correct

    • Multiple, non-tender lymphadenopathy with biopsy showing several crowded follicles of small, monomorphic lymphocytes and the absence of Reed-Sternberg cells is seen in which of the following?

      Your Answer: Poorly differentiated lymphocytic lymphoma

      Explanation:

      Malignant lymphoma usually causes non-tender lymphadenopathy, unlike the tender lymphadenopathy caused by infections (including infectious mononucleosis caused by Epstein-Barr virus). Also, the lymphoid hyperplasia seen in infectious mononucleosis is benign and polyclonal.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      295
      Seconds
  • Question 35 - A 42 year old women presents with end stage renal failure and is...

    Incorrect

    • A 42 year old women presents with end stage renal failure and is prepared to receive a kidney from her husband. HLA testing showed that they are not a 100% match and she is given immunosuppressant therapy for this. Three months later when her renal function tests were performed she showed signs of deteriorating renal function, with decreased renal output, proteinuria of +++ and RBCs in the urine. She was given antilymphocyte globulins and her condition reversed. What type of graft did this patient receive?

      Your Answer: Syngraft

      Correct Answer: Allograft

      Explanation:

      Allograft describes a graft between two of the same species. As the donor and the recipients are history-incompatible, rejection of the graft is common and is controlled by immunosuppressive drug therapy. Isograft and syngraft are synonymous and referred to a graft transferred between genetically identical individuals e.g. identical twins. In this case rejection is rare as they are history-compatible.
      Autograft refers to transfer of one part of the body to another location.
      Xenograft is transfer of tissue from another species e.g. pig to human in valve replacement surgeries and rejection is very high.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      15.5
      Seconds
  • Question 36 - A 15-day old baby was brought to the emergency department with constipation for...

    Incorrect

    • A 15-day old baby was brought to the emergency department with constipation for 4 days. On examination, the abdomen of the baby was found to be distended and tender all over. No bowel sounds were heard. A sigmoid colon biopsy was carried out, which showed absent ganglion cells. What is the diagnosis?

      Your Answer:

      Correct Answer: Hirschsprung’s disease

      Explanation:

      Hirschsprung’s disease is characterized by congenital absence of the autonomic plexus (Meissner’s and Auerbach’s plexus) in the intestinal wall. Usually limited to the distal colon, it can occasionally involve the entire colon or even the small bowel. There is abnormal or absent peristalsis in the affected segment, resulting in continuous spasm of smooth muscle and partial/complete obstruction. This causes accumulation of intestinal contents and dilatation of proximal segment. Skip lesions are highly uncommon. This disease is seen early in life with 15% patients presenting in first month, 60% by 1 year of age and 85% by the age of 4 years. Symptoms include severe and complete constipation, abdominal distension and vomiting. Patients with involvement of ultra-short segments might have mild constipation with intervening diarrhoea. In older children, symptoms include failure to thrive, anorexia, and lack of an urge to defecate. On examination, an empty rectum is revealed with stool palpable high up in the colon. If not diagnosed in time, it can lead to Hirschsprung’s enterocolitis (toxic megacolon), which can be fulminant and lead to death. Diagnosis involves a barium enema or a rectal suction biopsy. Barium enema shows a transition in diameter between the dilated, normal colon proximal to the narrowed, affected distal segment. It is to be noted that barium enema should be done without prior preparation, which can dilate the abnormal segment, leading to a false-negative result. A 24-hour post-evacuation film can be obtained in the neonatal period – if the colon is still filled with barium, there is a high likelihood of Hirschsprung’s disease. Full-thickness rectal biopsy is diagnostic by showing the absence of ganglion cells. Acetylcholinesterase staining can be done to highlight the enlarged nerve trunks. Abnormal innervation can also be demonstrated by rectal manometry.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds
  • Question 37 - A 68 year old woman has undergone surgical repair of her femoral hernia....

    Incorrect

    • A 68 year old woman has undergone surgical repair of her femoral hernia. The surgeon used bipolar diathermy for haemostasis. Which of the following options would be regarded as the greatest risk with the usage of bipolar diathermy?

      Your Answer:

      Correct Answer: Fires when used near alcoholic skin preparations that have pooled

      Explanation:

      An operating room fire is rare but a well-known hazard that can result in significant patient morbidity. When it comes to the disposal of surgical spirits, the SPC for chlorhexidine states: ‘The solution is flammable. The risk of surgical fires due to spirit-based skin preparation fluid should be actively reduced. Data from the US show that up to 650 surgical fires occur each year, with up to 5% causing death or serious harm.

      Diathermy use electric currents to produce local heat and thereby facilitate haemostasis or surgical dissection. There are two major types of diathermy:
      1. Monopolar – current flows through a handheld device, from the tip of the device into the patient. The earth electrode is located some distance away.
      2. Bipolar – current flows from one electrode to another however, both electrodes are usually contained within the same device e.g. a pair of forceps. The result is that heating is localised to the area between the two electrodes and surrounding tissue damage is minimised. However this may create a spark and ignite flammable solutions.

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Surgical Technique And Technology
      0
      Seconds
  • Question 38 - A elderly patient with bulbar palsy is bed ridden. While swallowing he aspirates...

    Incorrect

    • A elderly patient with bulbar palsy is bed ridden. While swallowing he aspirates one of his tablets into his lungs. In which bronchopulmonary segments is it most likely to end up?

      Your Answer:

      Correct Answer: Superior segmental bronchus of the right inferior lobe

      Explanation:

      Inhaled objects are more likely to enter the right lung for several reasons. First the right bronchus is shorter, wider and more vertical than the left bronchus. Also, the carina (a ridge-like structure at the point of tracheal bifurcation) is set a little towards the left. The superior segmental bronchus branches posteriorly off the intermediate bronchus or the inferior lobe bronchus and is thus more likely to receive the foreign body that enters the right main bronchus. The lingula is only found on the left lung. The terminal bronchiole is a very small space almost impossible for the tablet to lodge here.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 39 - A 42 year old man slips while walking down the stairs and injures...

    Incorrect

    • A 42 year old man slips while walking down the stairs and injures his ankle. He is rushed to the doctor's office and on examination, he has tenderness over the lateral and medial malleolus. X-rays demonstrate an undisplaced fracture of the distal fibula at the level of the syndesmosis and a congruent ankle mortise. What is the best course of management?

      Your Answer:

      Correct Answer: Application of below knee plaster cast

      Explanation:

      Fractures of the distal tibia and fibula may result in loss of stability of the ankle joint. They may present as a fracture only, fracture and ligamentous injury, multiple fractures or a fracture dislocation.

      Isolated fibular fractures at the level of the syndesmosis (Weber B) without associated medial injury should be placed in a short leg backslab (ankle at plantargrade) and remain NWB (non-weight bearing).

      With medial malleolus fractures care should be taken to rule out any other fracture or injury around the ankle. The entire length of the fibula should be palpated and x-rayed to rule out any Maisonneuve type injuries. Any other fracture, ligament injury or talar shift indicate the fracture is likely to be unstable and should be reviewed by orthopaedics.

      If medial malleolar injury is truly isolated then a short leg backslab (below knee plaster cast) should be applied and the patient is to remain NWB until orthopaedic review.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      0
      Seconds
  • Question 40 - A 27-year-old ski instructor who falls off a ski lift and sustains a...

    Incorrect

    • A 27-year-old ski instructor who falls off a ski lift and sustains a spiral fracture of the midshaft of the tibia. Attempts to achieve a satisfactory position in plaster have failed. Overlying tissues are healthy. What is the most appropriate course of action?

      Your Answer:

      Correct Answer: Intramedullary nail

      Explanation:

      Initially, all tibial shaft fractures should be stabilized with a long posterior splint with the knee in 10-15° of flexion and the ankle flexed at 90°
      Closed fractures with minimal displacement or stable reduction may be treated nonoperatively with a long leg cast, but cast application should be delayed for 3-5 days to allow early swelling to diminish. The cast should extend from the midthigh to the metatarsal heads, with the ankle at 90° of flexion and the knee extended. The cast increases tibial stability and can decrease pain and swelling.
      Despite proper casting techniques and adequate follow-up, not all nonoperatively treated tibial shaft fractures heal successfully.
      Operative fixation is required when fractures are unstable. Surgical options include plating, external fixation, intramedullary nailing, and, in some cases, amputation.
      Intramedullary nailing with locking screws (see the image below) has become the treatment of choice for most tibial shaft fractures. The prevalence of non-union and malunion is greatly decreased in comparison with the other methods of fixation. Patients are also able to return to low-impact activities much sooner than they can with the other treatments.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      0
      Seconds
  • Question 41 - Which among the following vertebrae marks the lowest extent of the superior mediastinum?...

    Incorrect

    • Which among the following vertebrae marks the lowest extent of the superior mediastinum?

      Your Answer:

      Correct Answer: Fourth thoracic

      Explanation:

      The superior mediastinum lies between the manubrium anteriorly and the upper vertebrae of the thorax posteriorly. Below, it is bound by a slightly oblique plane that passes backward from the sternal angle to the lower part of the body of T4 and laterally by the pleura.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 42 - Which of these structures does NOT pass posterior to the medial malleolus? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Saphenous vein

      Explanation:

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

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 43 - An 11 year old girl undergoes a delayed open reduction and fixation of...

    Incorrect

    • An 11 year old girl undergoes a delayed open reduction and fixation of a significantly displaced supracondylar fracture. She complains of paraesthesia of the hand and significant forearm pain. The radial pulse is normal. What is the best course of action?

      Your Answer:

      Correct Answer: Fasciotomy

      Explanation:

      Answer: Fasciotomy

      Fasciotomy is a surgical procedure where the fascia is cut to relieve tension or pressure commonly to treat the resulting loss of circulation to an area of tissue or muscle. Fasciotomy is a limb-saving procedure when used to treat acute compartment syndrome. A delay in performing the procedure can lead to neurovascular complications or lead to the need for amputation of a limb. Complications can also involve the formation of scar tissue after the operation. A thickening of the surgical scars can result in the loss of mobility of the joint involved. This can be addressed through occupational or physical therapy.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      0
      Seconds
  • Question 44 - A histological examination of a lump showed an abnormal amount and arrangement of...

    Incorrect

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

      Your Answer:

      Correct Answer: Hamartoma

      Explanation:

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

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds
  • Question 45 - During pregnancy the uterus enlarges however after delivery it regresses to its original...

    Incorrect

    • During pregnancy the uterus enlarges however after delivery it regresses to its original size. Which of the following organelles is responsible for this regression?

      Your Answer:

      Correct Answer: Lysosomes

      Explanation:

      Lysosomes are formed by budding of the Golgi apparatus and contain enzymes which digest macromolecules. They are found in both plants and animals and are active in autophagic cell death, digestion after phagocytosis and for the cells own recycling process. They fuse with the molecules and release their content resulting in digestion.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds
  • Question 46 - A Jewish man was diagnosed with haemophilia C. Which of the following factors...

    Incorrect

    • A Jewish man was diagnosed with haemophilia C. Which of the following factors is deficient in this form of haemophilia?

      Your Answer:

      Correct Answer: Factor XI

      Explanation:

      Haemophilia C, also known as plasma thromboplastin antecedent (PTA) deficiency or Rosenthal syndrome, is a condition caused by the deficiency of the coagulation factor XI. The condition is rare and it is usually found in Ashkenazi Jews.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds
  • Question 47 - An abdominal aortogram shows occlusion of the inferior mesenteric artery. Which of the...

    Incorrect

    • An abdominal aortogram shows occlusion of the inferior mesenteric artery. Which of the following segments of bowel is most likely to have preserved arterial supply?

      Your Answer:

      Correct Answer: Caecum

      Explanation:

      The inferior mesenteric artery supplies blood to the end of the transverse colon and all distal structures in the gastrointestinal tract i.e. splenic flexure, descending colon, sigmoid colon and rectum would all be deprived of blood if it were occluded. The caecum receives blood from the superior mesenteric artery so it would not be affected.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 48 - A 67 year old man brought to the emergency department with acute pancreatitis...

    Incorrect

    • A 67 year old man brought to the emergency department with acute pancreatitis is immediately intubated and put on a ventilator. His intra-abdominal pressure is measured using a bladder catheter connected to manometry. Which of the following would most likely represent the pressure effect seen in abdominal compartment syndrome?

      Your Answer:

      Correct Answer: Bladder pressure of 16–25 mmHg does not require decompression

      Explanation:

      Bladder pressures below 5mm Hg are expected in healthy patients. Pressures between 10 to 15 mmHg can be expected following abdominal surgery and in obese patients. Bladder pressures over 25 mmHg are highly suspicious of abdominal compartment syndrome and should be correlated clinically. It is recommended that pressure measurements be trended to show and recognize the worsening of intra-abdominal hypertension. Recommended management at this stage includes fluid resuscitation and if the pressure rises beyond the critical threshold of 25 mmHg, abdominal decompression is required.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 49 - A 25 year old women is pregnant with her second child. She is...

    Incorrect

    • A 25 year old women is pregnant with her second child. She is A- blood group. Her first child was Rh+ and the father is also Rh+. The second child is at a risk of developing which condition?

      Your Answer:

      Correct Answer: Haemolytic disease of the new-born

      Explanation:

      This infant is at risk for haemolytic disease of the new born also known as erythroblastosis fetalis. In the pregnancy, Rh-positive RBC’s cross the placenta and enter the mothers blood system. She then becomes sensitised and forms IgG antibodies/anti-Rh antibodies against them. The second child is at a greater risk for this disease than the first child with Rh-positive blood group as during the second pregnancy, a more powerful response is produced. IgG has the ability to cross the placenta and bind to the fetal RBCs (type II hypersensitivity reaction) which are phagocytosed by the macrophages.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds
  • Question 50 - Which of the following is found to be elevated in a case of...

    Incorrect

    • Which of the following is found to be elevated in a case of hepatocellular carcinoma?

      Your Answer:

      Correct Answer: AFP

      Explanation:

      Alpha-fetoprotein (AFP) is a glycoprotein that is normally produced by the yolk sac of the embryo, and then the fetal liver. It is elevated in the new-born and thus, also in the pregnant women. Eventually, it decreases in the first year of life to reach the adult normal value of < 20 ng/ml by 1 year of age. Markedly elevated levels (>500 ng/ml) in a high-risk patient is considered diagnostic for primary hepatocellular carcinoma (HCC). Moreover, due to smaller tumours secreting less quantities of AFP, rising levels can be a better indication. However, not all hepatocellular carcinomas produce AFP. Also, the level of AFP is not a prognostic factor. Populations where hepatitis B and HCC are common (e.g.: sub-Saharan Africans, ethnic Chinese) can see AFP levels as high as 100,000 ng/ml, whereas levels are low (about 3000 ng/ml) in regions with lesser incidences of HCC.
      AFP can also be elevated up to 500 ng/ml in conditions like embryonic teratocarcinomas, hepatoblastomas, fulminant hepatitis, hepatic metastases from gastrointestinal tract cancers, some cholangiocarcinomas). Lesser values are seen in acute and chronic hepatitis.
      Overall, the sensitivity of AFP value ≥20 ng/ml is 39-64% and the specificity is 76%–91%. Value of 500 ng/ml is considered as the diagnostic cut-off level for HCC.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds
  • Question 51 - A 36 year old woman arrives at the emergency department with signs of...

    Incorrect

    • A 36 year old woman arrives at the emergency department with signs of hypovolemic shock. Abdominal CT reveals a haemorrhagic lesion in the right kidney. Surgical resection of this lesion is carried out followed by a biopsy which reveals an angiomyolipomata. which of the following would be the most likely diagnosis?

      Your Answer:

      Correct Answer: Tuberous sclerosis

      Explanation:

      Tuberous sclerosis is a genetic disorder characterized by the growth of numerous noncancerous (benign) tumours in many parts of the body. These tumours can occur in the skin, brain, kidneys, and other organs, in some cases leading to significant health problems. Tuberous sclerosis also causes developmental problems, and the signs and symptoms of the condition vary from person to person.

      Virtually all affected people have skin abnormalities, including patches of unusually light-coloured skin, areas of raised and thickened skin, and growths under the nails. Tumours on the face called facial angiofibromas are also common beginning in childhood.

      Tuberous sclerosis often affects the brain, causing seizures, behavioural problems such as hyperactivity and aggression, and intellectual disability or learning problems. Some affected children have the characteristic features of autism, a developmental disorder that affects communication and social interaction. Benign brain tumours can also develop and these tumours can cause serious or life-threatening complications.

      Kidney tumours are common in people with tuberous sclerosis; these growths can cause severe problems with kidney function and may be life-threatening in some cases. Additionally, tumours can develop in the heart, lungs, and the retina.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
      0
      Seconds
  • Question 52 - During an operation for a sigmoid colectomy the surgeon ligates the sigmoid arteries....

    Incorrect

    • During an operation for a sigmoid colectomy the surgeon ligates the sigmoid arteries. From which artery do the sigmoid arteries branch?

      Your Answer:

      Correct Answer: Inferior mesenteric artery

      Explanation:

      Sigmoid arteries are branches of the inferior mesenteric artery (IMA). Sigmoid artery gives off branches that supply the lower descending colon, the iliac colon and the sigmoid colon.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 53 - A teenager presents to her family doctor with recurrent throat and chest infections,...

    Incorrect

    • A teenager presents to her family doctor with recurrent throat and chest infections, fatigue and gradual loss of vision. X-rays are done which show brittle bones with no differentiation between the cortex and the medulla. What is her diagnosis?

      Your Answer:

      Correct Answer: Osteopetrosis

      Explanation:

      Answer: Osteopetrosis

      Osteopetrosis is a clinical syndrome characterized by the failure of osteoclasts to resorb bone. As a consequence, bone modelling and remodelling are impaired. The defect in bone turnover characteristically results in skeletal fragility despite increased bone mass, and it may also cause hematopoietic insufficiency, disturbed tooth eruption, nerve entrapment syndromes, and growth impairment.
      Many patients have bone pains. Bony defects are common and include neuropathies due to cranial nerve entrapment (e.g., with deafness, with facial palsy), carpal tunnel syndrome, and osteoarthritis. Bones are fragile and may fracture easily. Approximately 40% of patients have recurrent fractures. Osteomyelitis of the mandible occurs in 10% of patients.

      Other manifestations include visual impairment due to retinal degeneration and psychomotor retardation. Bone marrow function is not compromised.

      Osteogenesis imperfecta (OI), also known as brittle bone disease, is a group of genetic disorders that mainly affect the bones. It results in bones that break easily. The severity may be mild to severe. Other symptoms may include a blue tinge to the whites of the eye, short height, loose joints, hearing loss, breathing problems and problems with the teeth. Complications may include cervical artery dissection and aortic dissection.

      The underlying mechanism is usually a problem with connective tissue due to a lack of type I collagen. This occurs in more than 90% of cases due to mutations in the COL1A1 or COL1A2 genes. These genetic problems are often inherited from a person’s parents in an autosomal dominant manner or occur via a new mutation. There are at least eight main types, with type I being the least severe and type II the most severe.

      Osteomalacia it is the disease in which softening of the bones caused by impaired bone metabolism primarily due to inadequate levels of available phosphate, calcium, and vitamin D, or because of resorption of calcium. The impairment of bone metabolism causes inadequate bone mineralization. Osteomalacia in children is known as rickets, and because of this, use of the term Osteomalacia is often restricted to the milder, adult form of the disease. Signs and symptoms can include diffuse body pains, muscle weakness, and fragility of the bones. In addition to low systemic levels of circulating mineral ions necessary for bone and tooth mineralization, accumulation of mineralization-inhibiting proteins and peptides (such as osteopontin and ASARM peptides) occurs in the extracellular matrix of bones and teeth, likely contributing locally to cause matrix hypomineralization (Osteomalacia).

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      0
      Seconds
  • Question 54 - A drug abuser developed an infection which spread from the dorsum of the...

    Incorrect

    • A drug abuser developed an infection which spread from the dorsum of the hand to the medial side of the arm along the course of the large cutaneous vein. Which vein is involved?

      Your Answer:

      Correct Answer: Basilic

      Explanation:

      The basilic vein is one of two veins found in the forearm, the other is the cephalic vein. These veins originate from the deep venous arch of the hand. The cephalic vein ascends along the lateral side of the forearm, and the basilic vein runs up the medial side of the forearm.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 55 - A neurotransmitter of the nigrostriatal pathway is: ...

    Incorrect

    • A neurotransmitter of the nigrostriatal pathway is:

      Your Answer:

      Correct Answer: Dopamine

      Explanation:

      Dopamine acts as a neurotransmitter in the brain, activating dopamine receptors. It is also a neurohormone released from the hypothalamus. It plays an important role in the reward system. It is believed that dopamine provides a teaching signal to parts of the brain responsible for acquiring new motor sequences (behaviours), by activation of dopamine neurons when an unexpected reward is presented. Loss of dopamine neurones in the nigrostriatal pathway causes Parkinson’s disease. In the frontal lobes, dopamine controls the flow of information from other areas of the brain, and thus, dopamine disorders in this region can cause a decline in neurocognitive functions, especially memory, attention and problem solving. Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention-deficit disorder and some symptoms of schizophrenia. Dopamine is also the primary neuroendocrine regulator of the secretion of prolactin from the anterior pituitary gland. Dopamine is also commonly associated with the pleasure system of the brain. This plays a key role in understanding the mechanism of action of drugs (such as cocaine and the amphetamines), which seem to be directly or indirectly related to the increase of dopamine.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 56 - A 35 year-old man presents with high grade fever for 7 days after...

    Incorrect

    • A 35 year-old man presents with high grade fever for 7 days after returning from a trip to India. He tested positive for widal test. What is the most likely organism that caused his fever?

      Your Answer:

      Correct Answer: Salmonella typhi

      Explanation:

      Typhoid fever is caused by virulent bacteria called Salmonella typhi. Salmonella typhi spread through contaminated food or water and occasionally through direct contact with someone who is infected.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 57 - A 45-year-old female is receiving chemotherapy for the treatment of metastatic breast cancer....

    Incorrect

    • A 45-year-old female is receiving chemotherapy for the treatment of metastatic breast cancer. You are called because it has become apparent that her doxorubicin infusion has extravasated. What is the most appropriate course of action?

      Your Answer:

      Correct Answer: Stop the infusion and apply a cold compress to the site

      Explanation:

      Extravasation is the process by which any liquid (fluid or drug) accidentally leaks into the surrounding tissue. In terms of cancer therapy, extravasation refers to the inadvertent infiltration of chemotherapy into the subcutaneous or subdermal tissues surrounding the intravenous or intra-arterial administration site.
      Extravasated drugs are classified according to their potential for causing damage as ‘vesicant’, ‘irritant’ and ‘non-vesicant’.
      Doxorubicin is one of the vesicant drugs.
      Regardless of the chemotherapy drug, early initiation of treatment is considered mandatory. In this context, patient education is crucial for prompt identification of the extravasation.
      Step 1: Stop the infusion and leave the needle in place
      Step 2: Identify the extravasated agent
      Step 3: Leave the cannula in place, gently aspirate the agent and avoid manual compression, then remove the cannula
      Step 4: Use a pen to outline the extravasated area
      Step 5: Start Specific measures
      Step 5A: For Anthracyclines (Doxorubicin), Apply cold compressions for 20 minutes, 4 times daily for 1-2 days.
      Step 5B: Using Specific Antidotes as Topical Dimethyl sulfoxide (DMSO) or Dexrazoxane

    • This question is part of the following fields:

      • Oncology
      • Principles Of Surgery-in-General
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  • Question 58 - Which muscles are attached to the tibial tuberosity? ...

    Incorrect

    • Which muscles are attached to the tibial tuberosity?

      Your Answer:

      Correct Answer: Vastus intermedius

      Explanation:

      The tuberosity of the tibia is the site of attachment to the ligamentum patella (the tendon of the quadriceps femoris muscle which include four heads: rectus femoris, vastus medialis, intermedius and lateralis).

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 59 - A young boy fell from a tree, sustaining an injury to the elbow...

    Incorrect

    • 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:

      Correct 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

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 60 - In a splenectomy procedure, special care is emphasized on the preservation of the...

    Incorrect

    • In a splenectomy procedure, special care is emphasized on the preservation of the tail of the pancreas that is closely associated with the spleen to avoid post operative pancreatic fistula. As a general surgeon conducting a splenectomy where are you most likely to find the tail of the pancreas in the abdominal cavity?

      Your Answer:

      Correct Answer: Splenorenal ligament

      Explanation:

      The tail of the pancreas is the only intraperitoneal part of the pancreas and is found contained in the splenorenal ligament of the peritoneal cavity. The splenorenal ligament is derived from the peritoneum where the wall of the general peritoneal cavity connects to the omental bursa between the spleen and the left kidney. This ligament contains the splenic vessels and the tail of the pancreas.
      The gastrocolic ligament stretches from the greater curvature of the stomach to the transverse colon, connecting the two.
      The gastrosplenic ligament is derived from the greater omentum and is the structure that connects the stomach to the hilum of the spleen. The gastrosplenic ligament continues from the splenic flexure of the colon to the diaphragm and acts as a support to the spleen.
      The transverse colon is connected to the abdominal wall by the mesocolon ligament.
      The falciform ligament on the other hand, attaches the liver to the ventral wall of the abdomen.
      The hepatoduodenal ligament connects the porta hepatis of the liver to the superior part of the duodenum.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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SESSION STATS - PERFORMANCE PER SPECIALTY

Generic Surgical Topics (6/7) 86%
Upper Gastrointestinal Surgery (1/1) 100%
The Abdomen (2/2) 100%
Basic Sciences (21/28) 75%
Physiology (5/8) 63%
Pathology (10/12) 83%
Paediatric Surgery (1/1) 100%
Anatomy (6/8) 75%
Orthopaedics (0/1) 0%
Hepatobiliary And Pancreatic Surgery (1/1) 100%
Organ Transplantation (1/1) 100%
Passmed