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Question 1
Incorrect
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What is correct regarding the obturator artery?
Your Answer: It enters the thigh immediately deep to the inguinal ligament
Correct Answer: It is found in the medial compartment of the thigh
Explanation:The obturator artery is a branch of the internal iliac artery, which passes antero-inferiorly on the lateral wall of the pelvis, to the upper part of the obturator foramen. The posterior branch follows the posterior margin of the foramen and turns forward on the inferior ramus of the ischium. It also supplies an articular branch, which enters the hip joint through the acetabular notch, sending a branch along the ligamentum teres to the head of the femur. It is the main source of arterial supply to the medial compartment of the thigh
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 2
Correct
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A 32-year-old man presented with a metabolic acidosis and increased anion gap. What is the most likely cause of the changes of the anion gap in this patient?
Your Answer: Lactic acidosis
Explanation:High anion gap in metabolic acidosis is caused generally by the elevation of the levels of acids like ketones, lactate, sulphates in the body, which consume the bicarbonate ions. Other causes of a high anion gap include overdosing on salicylates, uraemia, rhabdomyolysis, hypocalcaemia, hypomagnesaemia, or ingestion of toxins such as ethylene glycol, methanol, propyl alcohol, cyanide and iron.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 3
Correct
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A man was stabbed in the thigh following a bar brawl. A superficial vein was injured which terminates in the femoral vein. This superficial vein is?
Your Answer: Great saphenous
Explanation:The great saphenous vein is considered the longest vein in the body. It terminates in the femoral vein nearly 3cm below the inguinal ligament. It begins at the dorsum of the foot in the medial marginal vein and ascends at the medial side of the leg in relation with the saphenous nerve.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 4
Incorrect
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A 36 year old woman who smokes heavily arrives at the clinic complaining of frequent stools and crampy abdominal pain that has been occurring for some time. She undergoes colonoscopy (which is macroscopically normal) and several pan colonic biopsies are taken. Histologic analysis reveals a thickened sub apical collagen layer and increased lymphocytes in the lamina propria. Which of the following diagnosis is most likely?
Your Answer: Irritable bowel syndrome
Correct Answer: Microscopic colitis
Explanation:Microscopic colitis is an inflammation of the large intestine (colon) that causes persistent watery diarrhoea. The disorder gets its name from the fact that it’s necessary to examine the colon tissue under a microscope to identify it, since the tissue may appear normal with a colonoscopy or flexible sigmoidoscopy. It is characterised by normal endoscopic appearances, microscopic features of colonic inflammation and thickening of the sub epithelial collagen layer. Features such as granulomas are absent. It is the normal endoscopic appearance that makes the other options less likely.
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This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 5
Incorrect
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A 40 year old man sustained a fracture to the surgical neck of his left humerus. Which of the following arteries is suspected to be injured in this case?
Your Answer:
Correct Answer: Posterior humeral circumflex
Explanation:The posterior humeral circumflex artery arises from the axillary artery and runs with the axillary nerve through the quadrangular space which is bounded laterally by the surgical neck of the humerus. After winding around the surgical neck of the humerus, it is distributed to the deltoid muscle and the shoulder joint. Thus fractures in the surgical neck of the humerus could result in an injury to this artery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 6
Incorrect
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Which of the following substances brings about a dilatation of the gastrointestinal resistance vessels?
Your Answer:
Correct Answer: Vasoactive intestinal peptide
Explanation:Gastric vasoconstrictors include catecholamines, angiotensin II and vasopressin. Vasodilators include vasoactive intestinal peptide and the hormones; gastrin, cholecystokinin and glucagon.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 7
Incorrect
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The collaborative effort of the lateral pterygoid muscles produces which action on the jaw?
Your Answer:
Correct Answer: Protrude the mandible
Explanation:The combined effort of the lateral pterygoid muscles results in the protrusion of the mandible. The lateral pterygoid muscle is a muscle of mastication located superiorly to the medial pterygoid muscle and has two heads. The superior head originates on the infratemporal surface and infratemporal crest of the greater wing of the sphenoid bone, and the inferior head on the lateral surface of the lateral pterygoid plate. The insertion of this muscle is on the front margin of the articular disc of the temporomandibular joint. The unilateral contraction of the pterygoid muscle results in the laterotrusion of the mandible. It is important to note that the lateral pterygoid muscle is the only muscle of mastication that can open the jaw.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 8
Incorrect
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A premenopausal woman has an ovarian tumour. Which is the most common benign germ-cell tumour that could occur in a premenopausal woman?
Your Answer:
Correct Answer: Dermoid cyst
Explanation:A dermoid cyst is a teratoma of a cystic nature that contains an array of developmentally mature and solid tissues. Dermoid cysts grow slowly and this type of cystic teratoma is nearly always benign.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 9
Incorrect
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A patient under went repair of a lingual artery aneurysm in the floor of the mouth. During surgical dissection from the inside of the mouth which muscle would you have to pass through to reach the main portion of the lingual artery?
Your Answer:
Correct Answer: Hyoglossus
Explanation:The lingual artery first runs obliquely upward and medialward to the greater horns of the hyoid bone. It then curves downward and forward, forming a loop which is crossed by the hypoglossal nerve, and passing beneath the digastric muscle and stylohyoid muscle it runs horizontally forward, beneath the hyoglossus, and finally, ascending almost perpendicularly to the tongue, turns forward on its lower surface as far as the tip, to become the deep lingual artery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 10
Incorrect
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Which of the following is a large artery that runs immediately posterior to the stomach?
Your Answer:
Correct Answer: Splenic
Explanation:The splenic artery is the large artery that would be found running off the posterior wall of the stomach. It is a branch of the coeliac trunk and sends off branches to the pancreas before reaching the spleen. The gastroduodenal artery on the other hand is found inferior to the stomach, posterior to the first portion of the duodenum. The left gastroepiploic artery runs from the left to the right of the greater curvature of the stomach. The common hepatic artery runs on the superior aspect of the lesser curvature of the stomach, and is a branch of the coeliac trunk. The superior mesenteric artery arises from the abdominal aorta just below the junction of the coeliac trunk.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 11
Incorrect
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A 77-year-old woman's renal function is tested. The following results were obtained during a 24-h period: Urine flow rate: 2. 0 ml/min, Urine inulin: 0.5 mg/ml, Plasma inulin: 0.02 mg/ml, Urine urea: 220 mmol/l, Plasma urea: 5 mmol/l. What is the urea clearance?
Your Answer:
Correct Answer: 88 ml/min
Explanation:Urea is reabsorbed in the inner medullary collecting ducts of the nephrons. The clearance (C) of any substance can be calculated as follows: C = (U × V)/P, where U and P are the urine and plasma concentrations of the substance, respectively and V is the urine flow rate. So, glomerular filtration rate = (0.220 × 2. 0)/0.005 = 88 ml/min.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 12
Incorrect
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Which of these infectious agents tends to affect people under 20 and over 40 years old, can cause acute encephalitis with cerebral oedema and petechial haemorrhages, along with haemorrhagic lesions of the temporal lobe. A lumbar puncture will reveal clear cerebrospinal fluid with an elevated lymphocyte count?
Your Answer:
Correct Answer: Herpes simplex virus
Explanation:Haemorrhagic lesions of the temporal lobe are typical of Herpes simplex encephalitis (HSE). It tends to affect patients aged under 20 or over 40 years, and is often fatal if left untreated. In acute encephalitis, cerebral oedema and petechial haemorrhages occur and direct viral invasion of the brain usually damages neurones. The majority of cases of herpes encephalitis are caused by herpes simplex virus-1 (HSV-1), and about 10% of cases of herpes encephalitis are due to HSV-2, which is typically spread through sexual contact.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 13
Incorrect
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A 35-year-old male presents with recurrent episodes of knife-like pain within his rectum. On examination, there is no abnormality to find on either proctoscopy or palpation. What is the most likely diagnosis?
Your Answer:
Correct Answer: Proctalgia fugax
Explanation:Proctalgia fugax or functional recurrent anorectal pain is part of a spectrum of functional gastrointestinal disorders defined by the Rome III diagnostic criteria as episodes of sharp fleeting pain that recur over weeks, are localized to the anus or lower rectum, and last from seconds to several minutes with no pain between episodes. There is no diurnal variation. There are numerous precipitants including sexual activity, stress, constipation, defecation and menstruation, although the condition can occur without a trigger. It should be differentiated from chronic proctalgia, a functional anorectal pain disorder with a vague, dull ache or pressure sensation high in the rectum, often worse when sitting than when standing or lying down, and lasts at least 20 minutes.
Most treatments for proctalgia fugax (e.g., oral diltiazem, topical glyceryl nitrate, nerve blocks) act by relaxing the anal sphincter spasm, but the effectiveness of these treatments are supported only by case reports or case series, with the exception of a single randomized controlled trial of salbutamol, making the value of most treatment options, including salbutamol, difficult to judge. -
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 14
Incorrect
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The following joint has an anastomotic circulation that is provided by branches of the brachial artery:
Your Answer:
Correct Answer: Elbow joint
Explanation:The arterial anastomoses of the elbow joint is contributed by branches of the brachial artery and the Profunda brachii artery. The brachial artery gives off the superior ulnar collateral artery and the inferior collateral artery. On the other hand, the Profunda brachii gives off the radial and medial recurrent arteries.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 15
Incorrect
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A 23 year old woman is Rh -ve and she delivered a baby with a Rh+ blood group. What measure can be performed to prevent Rh incompatibility in the next pregnancy?
Your Answer:
Correct Answer: Immunoglobulin D
Explanation:Rh disease is also known as erythroblastosis fetalis and is a disease of the new-born. In mild states it can cause anaemia with reticulocytosis and in severe forms causes severe anaemia, morbus hemolytcus new-born and hydrops fetalis. RBCs of the Rh+ baby can cross the placenta and enter into the maternal blood. As she is Rh- her body will form antibodies against the D antigen which will pass through the placenta in subsequent pregnancies.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 16
Incorrect
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A 53-year-old woman is diagnosed with cellulitis surrounding her leg ulcer. A swab is taken and oral flucloxacillin is started. The following result is obtained:
Your Answer:
Correct Answer: Add penicillin
Explanation:Streptococci may be divided into alpha and beta haemolytic types
Alpha haemolytic streptococci
The most important alpha haemolytic streptococcus is Streptococcus pneumoniae (pneumococcus). Pneumococcus is a common cause of pneumonia, meningitis and otitis media. Another clinical example is Streptococcus viridans
Beta haemolytic streptococci
These can be subdivided into group A and B
Group A
most important organism is Streptococcus pyogenes
responsible for erysipelas, impetigo, cellulitis, type 2 necrotizing fasciitis and pharyngitis/tonsillitis
immunological reactions can cause rheumatic fever or post-streptococcal glomerulonephritis
erythrogenic toxins cause scarlet feverGroup B
Streptococcus agalactiae may lead to neonatal meningitis and septicaemia
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This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 17
Incorrect
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A 32 year old man is brought to the emergency department in a collapsed state with an episode of melaena. Previous history is significant for post prandial abdominal pain for 5 weeks and is usually worse after having a meal. Which of the following is the most likely cause of this presentation?
Your Answer:
Correct Answer: Posterior duodenal ulcer
Explanation:Duodenal ulcers are more common than gastric ulcers and unlike gastric ulcers, are caused by increased gastric acid secretion. Duodenal ulcers are commonly located anteriorly, and rarely posteriorly. Anterior ulcers can be complicated by perforation, while the posterior ones bleed. The reason for that is explained by their location. The peritoneal or abdominal cavity is located anterior to the duodenum. Therefore, if the ulcer grows deep enough, it will perforate, whereas if a posterior ulcer grows deep enough, it will perforate the gastroduodenal artery and bleed.
Patients with duodenal ulcers will usually have a history of epigastric pain that occurs several hours after eating. The pain is often improved by eating food. -
This question is part of the following fields:
- Generic Surgical Topics
- Upper Gastrointestinal Surgery
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Question 18
Incorrect
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A 33 year old man with fulminant ulcerative colitis underwent a subtotal colectomy. Which type of stoma would most likely be fashioned?
Your Answer:
Correct Answer: End ileostomy
Explanation:Subtotal colectomy is resection of the entire right, transverse, left and part of the sigmoid colon. The rectal stump is closed and an end ileostomy fashioned in the right iliac fossa.
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This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 19
Incorrect
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A 65 year old man is scheduled to undergo an elective femoral-popliteal bypass. He presents to the physician with sudden onset of central crushing chest pain that radiates to his left arm. ECG is significant for some ischemic changes. The nursing staff initiates high flow oxygen and gives a spray of glyceryl trinitrate. However, this has resulted in no relief of his symptoms. Which of the following drugs should be administered next to this patient?
Your Answer:
Correct Answer: Aspirin 300mg
Explanation:Unstable angina is a common cardiovascular condition associated with major adverse clinical events. Over the last 15 years, therapeutic advances have dramatically reduced the complication and mortality rates of this serious condition. The standard of therapy in patients with unstable angina now incorporates the combined use of a potent antithrombotic (aspirin, clopidogrel, heparin and glycoprotein IIb/IIIa receptor antagonists) and anti-anginal (β-blockade and intravenous nitrates) regimens complemented by the selective and judicious application of coronary revascularisation strategies.
Increasingly, these invasive and non-invasive therapeutic interventions are being guided not only by the clinical risk profile but also by the determination of serum cardiac and inflammatory markers.
Moreover, rapid and intensive management of associated risk factors, such as hypercholesterolaemia, would appear to have potentially substantial benefits even within the acute in-hospital phase of unstable angina. Aspirin 300mg should be given as soon as possible. If the patient has a moderate to high risk of myocardial infarction, then Clopidogrel should be given with a low molecular weight heparin. Thrombolysis or urgent percutaneous intervention should be given if there are significant ECG changes. -
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 20
Incorrect
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A 30 year old male has a painless and transilluminant swelling at the upper pole of his left testi. There is a negative cough test. Which of the following is the likely diagnosis?
Your Answer:
Correct Answer: Spermatocoele
Explanation:Spermatocele, also known as a spermatic cyst is a cystic mass usually occurring at the upper pole of the testis. Differential diagnosis included hydrocele as both are cystic, painless and transilluminant. Ultrasound is a useful modality. If symptomatic or large, surgical excision can be done.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 21
Incorrect
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A 45-year-old man with short bowel syndrome requires parenteral nutrition. The solution of choice for parenteral nutrition is:
Your Answer:
Correct Answer: Crystalline amino acids
Explanation:Total parenteral nutrition (TPN), is the practice of feeding a person intravenously, circumventing the gut. It is normally used in the following situations: surgery, when feeding by mouth is not possible, when a person’s digestive system cannot absorb nutrients due to chronic disease or if a person’s nutrient requirement cannot be met by enteral feeding and supplementation. A sterile bag of nutrient solution, between 500 ml and 4L, is provided. The pump infuses a small amount (0.1–10 ml/h) continuously to keep the vein open. The nutrient solution consists of water, glucose, salts, amino acids, vitamins and sometimes emulsified fats. Ideally each patient is assessed individually before commencing on parenteral nutrition, and a team consisting of doctors, nurses, clinical pharmacists and dietitians evaluate the patient’s individual data and decide what formula to use and at what rate.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 22
Incorrect
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A 43-year-old male with no significant medical history is currently being kept nil-by-mouth for an elective bilateral inguinal hernia repair. Which of the following describes the best fluid regimen for this patient over the following 24 hours?
Your Answer:
Correct Answer: 1 L normal saline with 20 mmol potassium and 2 L 5% dextrose with 20 mmol potassium in each bag
Explanation:If patients need IV fluids for routine maintenance alone, restrict the initial prescription to:
25–30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50–100 g/day of glucose to limit starvation ketosis.
Weight-based potassium prescriptions should be rounded to the nearest common fluids available (for example, a 67 kg person should have fluids containing 20 mmol and 40 mmol of potassium in 24 hours). Potassium should not be added to intravenous fluid bags as this is dangerous.Sodium chloride 0.9%, with or without additional potassium, is one of the most commonly used IV fluids in UK practice.
Glucose 5% solution provides a useful means of giving free water for, once the glucose is metabolised, the fluid is distributed throughout total body water. It is, therefore, a potentially useful means of correcting or preventing simple dehydration and the glucose content will also help to prevent starvation ketosis, although it is important to recognize that it will not make much of a contribution to covering patients overall nutritional needs. The use of 5% glucose, will increase risks of significant hyponatraemia, particularly in children, the elderly, patients on diuretics and those with excess ADH due to osmotic and non-osmotic stimuli (a problem is seen quite frequently in hospitalized patients). Nevertheless, hyponatremia is likely to be avoided by not exceeding recommended volumes of maintenance IV fluids and by careful monitoring of patients’ clinical volume status and electrolyte measurements.
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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 23
Incorrect
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A 21 year old intravenous drug abuser is recovering following surgical drainage of a psoas abscess. She is found collapsed and unresponsive in the bathroom with pinpoint pupils. Which of the following is the best step in immediate management?
Your Answer:
Correct Answer: Intravenous naloxone
Explanation:Answer: Intravenous naloxone
Naloxone is a medication approved by the Food and Drug Administration (FDA) to prevent overdose by opioids such as heroin, morphine, and oxycodone. It blocks opioid receptor sites, reversing the toxic effects of the overdose. Naloxone is administered when a patient is showing signs of opioid overdose. The medication can be given by intranasal spray, intramuscular (into the muscle), subcutaneous (under the skin), or intravenous injection.
Several conditions and drugs can cause pinpoint pupils, including:
Prescription opioids or narcotics
Some medications have opioids or narcotics in them. Opioids, including morphine, are drugs commonly used for pain relief. Opioids can affect a person psychologically and are highly addictive.People often take prescription opioids in pill form to treat severe post-surgical pain, such as from dental surgery, or for long-term pain, as with some cancers.
Prescription opioids that may cause pinpoint pupils include:
oxycodone
morphine
hydrocodone
codeine
methadone -
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 24
Incorrect
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A 26-year-old woman presents with right iliac fossa pain and history of some bloodstained vaginal discharge. On examination, she has diffuse lower abdominal tenderness and is afebrile with a heart rate of 97 bpm and blood pressure of 120/70 mmHg. Considering these signs and symptoms, what should be the most appropriate course of action?
Your Answer:
Correct Answer: Abdominal and pelvic USS
Explanation:The history of bloodstained vaginal discharge and lower abdominal tenderness makes ectopic pregnancy a strong possibility. Therefore, a pregnancy test (for beta hCG) and abdominal and pelvic USS should be performed. If the beta HCG is high, that is an indication for intrauterine pregnancy. If it is not, then an ectopic pregnancy is likely, and surgery should be considered.
Generally, the differential diagnosis of right iliac fossa (RIF) pain includes:
1. Appendicitis
2. Crohn’s disease
3. Mesenteric adenitis
4. Diverticulitis
5. Meckel’s diverticulitis
6. Perforated peptic ulcer
7. Incarcerated right inguinal or femoral hernia
8. Bowel perforation secondary to caecal or colon carcinoma
9. Gynaecological causes—pelvic inflammatory disease/salpingitis/pelvic abscess/ectopic pregnancy/ovarian torsion/threatened or complete abortion
10. Urological causes—ureteric colic/urinary tract infection/Testicular torsion
11. Other causes—tuberculosis/typhoid/ infection with herpes zoster -
This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 25
Incorrect
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Which of the following veins empties into the left renal vein?
Your Answer:
Correct Answer: Left suprarenal
Explanation:The left suprarenal vein empties into the left renal vein which crosses the vertebral column to reach the inferior vena cava. The left renal vein also receives the left gonadal vein.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 26
Incorrect
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A 65 year old man develops persistent pyrexia on his 2nd postoperative day. He has undergone an open extended right hemicolectomy for carcinoma of the colonic-splenic flexure. What is the least likely cause?
Your Answer:
Correct Answer: Ileus
Explanation:Pyrexia is a very common post operative finding and can most likely result from an infection. However, it is highly unlikely to occur as a result of ileus. Anastomotic leaks are uncommon after right sided colonic surgery. In this scenario atelectasis would be the most likely underlying cause, as open extended right hemicolectomies will necessitate a long midline incision.
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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 27
Incorrect
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A patient is unable to move the mandible to the left. Which muscle is affected in this case?
Your Answer:
Correct Answer: Right lateral pterygoid muscle
Explanation:Patients with paralysis of the right pterygoid muscle are unable to move their mandible laterally to the left.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 28
Incorrect
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Which of the following substances is most likely to cause pulmonary vasodilatation?
Your Answer:
Correct Answer: Nitric oxide
Explanation:In the body, nitric oxide is synthesised from arginine and oxygen by various nitric oxide synthase (NOS) enzymes and by sequential reduction of inorganic nitrate. The endothelium of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, so dilating the artery and increasing blood flow. Nitric oxide/oxygen blends are used in critical care to promote capillary and pulmonary dilation to treat primary pulmonary hypertension in neonatal patients post-meconium aspiration and related to birth defects.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 29
Incorrect
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Regarding innervation to the peroneus brevis muscle:
Your Answer:
Correct Answer: Could be damaged by a fracture of the neck of the fibula
Explanation:The peroneus brevis is supplied by the fourth and fifth lumbar and first sacral nerves through the superficial peroneal nerve which is one of the two terminal branches of the common peroneal nerve. The common peroneal nerve winds around the neck of the fibula and can be injured in cases of fractured neck of fibula.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 30
Incorrect
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A histopathological analysis of a specimen showed loss of individual cell structure with karyorrhexis and fragmentation. The overall integrity of the tissue structure is preserved. This is typical of which of the following pathologies?
Your Answer:
Correct Answer: Viral hepatitis
Explanation:Viral infections will cause necrosis of the hepatocytes with characteristic changes of karyorrhexis and cell fragmentation.
Brown atrophy of the heart is due to accumulation of lipofuscin in the myocardium.
Tissue destruction associated with transplant rejection leads to widespread loss of structural integrity.
Single cell necrosis is not characteristically seen in chronic alcoholic liver.
Barbiturate overdose will result in hypertrophy of the smooth endoplasmic reticulum.
Carcinoma insitu will cause dysplastic cells without the overall structural integrity being disrupted.
Atrophy is due to apoptosis with ordered cellular fragmentation and phagocytosis and will not induce an inflammatory process unlike necrosis. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
