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  • Question 1 - Which of the following muscles may be affected by a fracture to the...

    Correct

    • Which of the following muscles may be affected by a fracture to the tuberosity on the medial surface of the right navicular bone?

      Your Answer: Tibialis posterior

      Explanation:

      The navicular bone is situated at the medial side of the tarsus, between the talus and the cuneiform bones. Its medial surface presents a rounded tuberosity, the lower part of which gives attachment to part of the tendon of the tibialis posterior.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      5.6
      Seconds
  • Question 2 - A 41 year old paediatrician presents with right upper quadrant pain and a...

    Correct

    • A 41 year old paediatrician presents with right upper quadrant pain and a sensation of abdominal fullness. A 6.7 cm hyperechoic lesion in the right lobe of the liver is detected when an ultrasound scan is done. Tests show that the serum AFP is normal. What is the most likely underlying lesion?

      Your Answer: Haemangioma

      Explanation:

      A cavernous liver haemangioma or hepatic haemangioma is a benign tumour of the liver composed of hepatic endothelial cells. It is the most common liver tumour, and is usually asymptomatic and diagnosed incidentally on radiological imaging. Liver haemangiomas are thought to be congenital in origin. Several subtypes exist, including the giant hepatic haemangioma, which can cause significant complications. This large, atypical haemangioma of the liver may present with abdominal pain or fullness due to haemorrhage, thrombosis or mass effect. It may also lead to left ventricular volume overload and heart failure due to the increase in cardiac output which it causes. Further complications are Kasabach-Merritt syndrome, a form of consumptive coagulopathy due to thrombocytopaenia, and rupture.

      As one of the benign neoplasms, the AFP level of hepatic cavernous haemangioma patients is not usually outside the normal range.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
      6.3
      Seconds
  • Question 3 - A young man is brought to the doctor and a lesion is seen...

    Correct

    • A young man is brought to the doctor and a lesion is seen on the dorsal surface of his right hand. It is examined and it is found to be a soft fluctuant swelling which is more pronounced when he is making a fist. What is the possible nature of the lesion?

      Your Answer: Ganglion

      Explanation:

      Answer: Ganglion

      A ganglion cyst is a fluid-filled swelling that usually develops near a joint or tendon. The cyst can range from the size of a pea to the size of a golf ball. Ganglion cysts look and feel like a smooth lump under the skin.

      They’re made up of a thick, jelly-like fluid called synovial fluid, which surrounds joints and tendons to lubricate and cushion them during movement.

      Ganglions can occur alongside any joint in the body, but are most common on the wrists (particularly the back of the wrist), hands and fingers.

      Ganglions are harmless, but can sometimes be painful. If they do not cause any pain or discomfort, they can be left alone and may disappear without treatment, although this can take a number of years.

      It’s not clear why ganglions form. They seem to happen when the synovial fluid that surrounds a joint or tendon leaks out and collects in a sac.
      They are most common in younger people between the ages of 15 and 40 years, and women are more likely to be affected than men. These cysts are also common among gymnasts, who repeatedly apply stress to the wrist.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      2.1
      Seconds
  • Question 4 - A 51-year-old man is brought to the A&E department following a road traffic...

    Correct

    • A 51-year-old man is brought to the A&E department following a road traffic accident. He complains of lower abdominal pain. On examination, fracture of the pelvis along with distended, tender bladder is observed. What is the most likely diagnosis?

      Your Answer: Urethral injury

      Explanation:

      Pelvic fractures may cause laceration of the urethra. Urinary retention, blood at the urethral meatus, and a high-riding prostate on digital rectal examination are the typical features of urethral injury.

      Up to 10% of male pelvic fractures are associated with urethral or bladder injuries. Urethral injury occurs mainly in males. It has two types.
      1.Bulbar rupture:
      a. most common
      b. mostly associated with straddle-type injury, e.g. from bicycles
      c. presentation with a triad of urinary retention, perineal haematoma, and blood at the meatus

      2. Membranous rupture:
      a. can be extra- or intraperitoneal
      b. occurs commonly due to pelvic fracture
      c. symptomology may include penile or perineal oedema/haematoma
      d. prostate displaced upwards (high-riding prostate)

      Ascending urethrogram is carried out in patients of suspected urethral injury. Suprapubic catheter is surgically placed and is indicated in:
      1. External genitalia injuries (i.e. the penis and the scrotum)
      2. Injury to the urethra caused by penetration, blunt trauma, continence- or sexual pleasure–enhancing devices, and mutilation.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
      5.9
      Seconds
  • Question 5 - During an anatomy revision session, medical students are told that the posterior wall...

    Correct

    • During an anatomy revision session, medical students are told that the posterior wall of the rectus sheath ends in a thin curved margin whose concavity is directed downwards. What is the name of this inferior border of the rectus sheath?

      Your Answer: Arcuate line

      Explanation:

      The rectus sheath is a tendinous sheath that encloses the rectus abdominis muscle. It covers the entire anterior surface however on the posterior surface of the muscle the sheath is incomplete ending inferiorly at the arcuate line. Below the arcuate line, the rectus abdominis is covered by the transversalis fascia. The linea alba is a band of aponeurosis on the midline of the anterior abdominal wall, which extends from the xiphoid process to the pubic symphysis. It is formed by the combined abdominal muscle aponeuroses. This is a useful site for midline incision during abdominal surgery because it does not carry many blood vessels. All of the other answer choices are related to the inguinal canal.
      The falx inguinalis (sometimes called the inguinal falx or conjoint tendon), is the inferomedial attachment of the transversus abdominis with some fibres of the internal abdominal oblique – it contributes to the posterior wall of the inguinal canal.
      The inguinal ligament is the ligament that connects the anterior superior iliac spine with the pubic tubercle – it makes the floor of the inguinal canal.
      The internal (deep) inguinal ring is the entrance to the inguinal canal, where the transversalis fascia pouches out and creates an opening through which structures can leave the abdominal cavity.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      8.9
      Seconds
  • Question 6 - What is formed when the ductus deferens unites with the duct of the...

    Correct

    • What is formed when the ductus deferens unites with the duct of the seminal vesicle?

      Your Answer: Ejaculatory duct

      Explanation:

      The deferens is a cylindrical structure​ with dense walls and an extremely small lumen It is joined at an acute angle by the duct of the seminal vesicles to form the ejaculatory duct, which traverses the prostate behind it’s middle lobe and opens into the prostatic portion of the urethra, close to the orifice of the prostatic utricle.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      2.9
      Seconds
  • Question 7 - A 42 year old truck driver undergoes a live related renal transplant and...

    Correct

    • A 42 year old truck driver undergoes a live related renal transplant and he was progressing well until 15 days following the transplant. He is noted to have swelling overlying the transplant site and swelling of the ipsilateral limb. Urine output is acceptable and creatinine unchanged. Which of the following is the most likely cause?

      Your Answer: Lymphocele

      Explanation:

      Lymphocele has been defined as a lymph-filled collection in the retroperitoneum without an epithelial lining. In kidney transplanted patients, lymphocele is a pseudocystic entity with lymph content covered with a hard fibrous capsule frequently localized around the graft. Lymphocele is one of the most common complications after kidney transplantation. It is usually asymptomatic, but can cause pressure on the kidney transplant, ureter, bladder, and adjacent vessels with deterioration of graft function, ipsilateral leg oedema, and external iliac vein thrombosis. Peritoneal fenestration is a well-established method for treatment.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Organ Transplantation
      5.5
      Seconds
  • Question 8 - A young man is hit in the head with a bar stool and...

    Correct

    • A young man is hit in the head with a bar stool and is rushed to the A&E department. On arrival, he opens his eyes in response to pain, his only verbal responses are in the form of groans and grunts. He flexes his forearms away from the painful stimuli when it is applied. Calculate his Glasgow coma score.

      Your Answer: 8

      Explanation:

      Answer: 8

      Eye Opening Response
      Spontaneous–open with blinking at baseline – 4 points
      Opens to verbal command, speech, or shout – 3 points
      Opens to pain, not applied to face – 2 point
      None – 1 point

      Verbal Response
      Oriented – 5 points
      Confused conversation, but able to answer questions – 4 points
      Inappropriate responses, words discernible – 3 points
      Incomprehensible speech – 2 points
      None – 1 point

      Motor Response
      Obeys commands for movement – 6 points
      Purposeful movement to painful stimulus – 5 points
      Withdraws from pain – 4 points
      Abnormal (spastic) flexion, decorticate posture – 3 points
      Extensor (rigid) response, decerebrate posture – 2 points
      None – 1 point

      He opens his eyes to pain and groans or grunts. He flexes his forearms away from the painful stimuli This gives him a Glasgow score of 8: eye opening response of 2, verbal response 2 and motor response 4.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      5.8
      Seconds
  • Question 9 - A 40-year-old male pedestrian is brought to the A&E department after being hit...

    Correct

    • A 40-year-old male pedestrian is brought to the A&E department after being hit by a car. On examination, he is found to be dyspnoeic and hypoxic despite administration of high flow oxygen therapy. Moreover, his pulse is 115bpm and blood pressure is 110/70 mmHg. The right side of his chest is hyper-resonant on percussion and has decreased breath sounds. His trachea is deviated to the left. What is the most likely underlying diagnosis?

      Your Answer: Tension pneumothorax

      Explanation:

      This patient has developed a tension pneumothorax following a blunt trauma.

      Tension pneumothorax is a life-threatening condition that develops when air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function. Blunt or penetrating chest trauma that creates a flap-type defect on the surface of the lung can result in this life-threatening condition.

      Signs and symptoms of tension pneumothorax include:
      1. Chest pain that usually has a sudden onset, is sharp, and may lead to feeling of tightness in the chest
      2. Dyspnoea and progressive hypoxia
      3. Tachycardia
      4. Hyperventilation
      5. Cough
      6. Fatigue

      On examination, hyper-resonant percussion note and tracheal deviation are typically found. Treatment is immediate without waiting for the CXR result and includes needle decompression and chest tube insertion.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      2
      Seconds
  • Question 10 - A 45-year-old woman was brought to the emergency department due to fever and...

    Correct

    • A 45-year-old woman was brought to the emergency department due to fever and chills. She has a history of recurrent UTI and complains of dysuria and urinary frequency. Urinary white blood cell count is >200 cell/high power field. If urine culture is performed, what is the most likely organism that will grow?

      Your Answer: Escherichia coli

      Explanation:

      The pathogen that most likely causes recurrent urinary tract infection in young women are E. coli, Enterococcus and Staphylococcus saprophyticus.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      3.5
      Seconds
  • Question 11 - A 7 year old boy arrives at the clinic complaining of recurrent anal...

    Correct

    • A 7 year old boy arrives at the clinic complaining of recurrent anal pruritis. Examination reveals a small worm like structure protruding from the anal orifice. Which of the following organisms is most likely responsible for this presentation?

      Your Answer: Enterobius vermicularis

      Explanation:

      Pinworm infection is caused by a small, thin, white roundworm called Enterobius vermicularis. Although pinworm infection can affect all people, it most commonly occurs among children, institutionalized persons, and close-contacts. Pruritus is the main symptom, as there is a lack of tissue invasion. It is rare for individuals to have any signs of systemic sepsis. Pinworm infection is treatable with over-the-counter or prescription medication, but reinfection, which occurs easily, should be prevented

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
      2.9
      Seconds
  • Question 12 - Routine evaluation of a 38 year old gentleman showed a slightly lower arterial...

    Correct

    • Routine evaluation of a 38 year old gentleman showed a slightly lower arterial oxygen [pa(O2)] than the alveolar oxygen [pA(O2)]. This difference is:

      Your Answer: Is normal and due to shunted blood

      Explanation:

      Blood that bypasses the ventilated parts of lung and enters the arterial circulation directly is known as shunted blood. It happens in normal people due to mixing of arterial blood with bronchial and some myocardial venous blood (which drains into the left heart). Diffusion limitation and reaction velocity with haemoglobin are immeasurably small. CO2 unloading will not affect the difference between alveolar and arterial p(O2). A large VSD will result in much lower arterial O2 as compared to alveolar O2.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      2.9
      Seconds
  • Question 13 - A patient in the intensive care unit developed hyperphosphatemia. The phosphate level is...

    Correct

    • A patient in the intensive care unit developed hyperphosphatemia. The phosphate level is 160 mmol/L. Which of the following is most likely responsible for this abnormality?

      Your Answer: Renal insufficiency

      Explanation:

      Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood. It is caused by conditions that impair renal phosphate excretion (ex: renal insufficiency, hypoparathyroidism, parathyroid suppression) and conditions with massive extracellular fluid phosphate loads (ex: rapid administration of exogenous phosphate, extensive cellular injury or necrosis, transcellular phosphate shifts).

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      4.2
      Seconds
  • Question 14 - The vagus nerve passes through which of the following foramen? ...

    Correct

    • The vagus nerve passes through which of the following foramen?

      Your Answer: Jugular foramen

      Explanation:

      The jugular foramen is a large foramen in the base of the skull. It is located behind the carotid canal and is formed in front by the petrous portion of the temporal bone, and behind by the occipital bone. Cranial nerves IX, X, and XI and the internal jugular vein pass through the jugular foramen.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      6
      Seconds
  • Question 15 - Which of the following will be a seen in a patient with a...

    Correct

    • Which of the following will be a seen in a patient with a plasma thyroid-stimulating hormone (TSH) level of 14 mU/l (normal < 5 mU/l) and a low T3 resin uptake of 19% (normal 25–35%)?

      Your Answer: Periorbital swelling and lethargy

      Explanation:

      Low T3 resin uptake combined with raised TSH is indicative of hypothyroidism. Signs and symptoms include dull expression, facial puffiness, lethargy, periorbital swelling due to infiltration with mucopolysaccharides, bradycardia and cold intolerance. Anxiety, palpitations, tachycardia, raised body temperature, heat intolerance and weight loss are all seen in hyperthyroidism.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      15
      Seconds
  • Question 16 - Which of the following is NOT true regarding malignant hyperpyrexia ...

    Correct

    • Which of the following is NOT true regarding malignant hyperpyrexia

      Your Answer: It can be caused by nitrous oxide

      Explanation:

      Malignant hyerpyrexia occurs in 1 in 150,000. All inhalational anaesthetic agents and suxamethonium, except nitrous oxide can cause malignant hyperpyrexia.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      4.9
      Seconds
  • Question 17 - A 10 year old child presents with enlarged tonsils that meet in the...

    Correct

    • A 10 year old child presents with enlarged tonsils that meet in the midline. Oropharyngeal examination confirms this finding and you also notice petechial haemorrhages affecting the oropharynx. On systemic examination he is noted to have splenomegaly. What is the most likely cause?

      Your Answer: Acute Epstein Barr virus infection

      Explanation:

      Answer: Acute Epstein Barr virus infection

      The Epstein–Barr virus is one of eight known human herpesvirus types in the herpes family, and is one of the most common viruses in humans. Infection with Epstein-Barr virus (EBV) is common and usually occurs in childhood or early adulthood.
      EBV is the cause of infectious mononucleosis, an illness associated with symptoms and signs like:
      fever,
      fatigue,
      swollen tonsils,
      headache, and
      sweats,
      sore throat,
      swollen lymph nodes in the neck, and
      sometimes an enlarged spleen.
      Although EBV can cause mononucleosis, not everyone infected with the virus will get mononucleosis. White blood cells called B cells are the primary targets of EBV infection.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Head And Neck Surgery
      25.5
      Seconds
  • Question 18 - The pleural cavity is the space between the two pulmonary pleurae which cover...

    Correct

    • The pleural cavity is the space between the two pulmonary pleurae which cover the lungs. What is the normal amount of pleural fluid?

      Your Answer: 10 ml

      Explanation:

      Pleural fluid is a serous fluid produced by the serous membrane covering normal pleurae. Most fluid is produced by the parietal circulation (intercostal arteries) via bulk flow and reabsorbed by the lymphatic system. The total volume of fluid present in the intrapleural space is estimated to be only 2–10 ml. A small amount of protein is present in intrapleural fluid. Normally, the rate of reabsorption increases as a physiological response to accumulating fluid.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      1.9
      Seconds
  • Question 19 - What is the nerve supply to the muscles of the lateral compartment of...

    Correct

    • What is the nerve supply to the muscles of the lateral compartment of the leg ?

      Your Answer: Superficial peroneal nerve

      Explanation:

      The peroneus longus and peroneus brevis in the lateral compartment of the leg take nerve supply from the superficial peroneal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      4.3
      Seconds
  • Question 20 - An 11 month old baby boy is taken to the clinic with a...

    Correct

    • An 11 month old baby boy is taken to the clinic with a history of a right groin swelling. A photograph on the father's mobile phone, shows what looks like an inguinal hernia. What is the most appropriate course of action?

      Your Answer: Undertake an open inguinal herniotomy

      Explanation:

      Answer: Undertake an open inguinal herniotomy

      Inguinal hernia is a type of ventral hernia that occurs when an intra-abdominal structure, such as bowel or omentum, protrudes through a defect in the abdominal wall. Inguinal hernias do not spontaneously heal and must be surgically repaired because of the ever-present risk of incarceration. Generally, a surgical consultation should be made at the time of diagnosis, and repair (on an elective basis) should be performed very soon after the diagnosis is confirmed.

      The infant or child with an inguinal hernia generally presents with an obvious bulge at the internal or external ring or within the scrotum. The parents typically provide the history of a visible swelling or bulge, commonly intermittent, in the inguinoscrotal region in boys and inguinolabial region in girls. The swelling may or may not be associated with any pain or discomfort.

      Open herniotomy is its standard treatment against which all alternative modalities of treatment are evaluated. It is credited with being easy to perform, having a high success rate, and low rate of complications.
      The use of prosthetic mesh in these patients is rare, however not uncalled for. Laparoscopic inguinal herniotomy is significantly associated with longer operative time for unilateral cases and a reduction in metachronous hernia development when compared to open inguinal herniotomy. There was a trend towards higher recurrence rate for laparoscopic repairs and shorter operative time for bilateral cases. A well conducted randomized controlled trial is warranted to compare both approaches.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      10.3
      Seconds
  • Question 21 - A 35 year old man presented to the surgical OPD with a lump...

    Correct

    • A 35 year old man presented to the surgical OPD with a lump on his right forearm which appeared 3 weeks ago and was tender on examination. He gave a history was being in a car accident with pieces of glass from the windshield piercing his forearm removed manually and on further elective surgery. Which of these cells are characteristically found during inflammation in this situation?

      Your Answer: Giant cell

      Explanation:

      A foreign body reaction Is characteristic of giant cells. Glass being the foreign object initiates an inflammatory response in this condition.
      Mast cells are involved in allergic reactions.
      Eosinophils are characteristic of a parasitic infection and allergic inflammatory process but are not due to foreign bodies.
      Plasma cells are typical of chronic inflammation.
      Lymphocytes are involved in viral infections.
      Macrophages combine together to form giant cells.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      5
      Seconds
  • Question 22 - A 25 year old man presents to the A&E department with bloating, alternating...

    Correct

    • A 25 year old man presents to the A&E department with bloating, alternating constipation/diarrhoea and colicky abdominal pain. Family history shows that his grandfather died from colon cancer at the age of 84 years. The physical examination and digital rectal examination are normal. Which of the following is the best course of action?

      Your Answer: Measurement of faecal calprotectin

      Explanation:

      Answer: Measurement of faecal calprotectin

      Based on Rome criteria, this patient has Irritable Bowel Syndrome (IBS). Irritable bowel syndrome (IBS) is a group of symptoms—including abdominal pain and changes in the pattern of bowel movements without any evidence of underlying damage. These symptoms occur over a long time, often years. It has been classified into four main types depending on whether diarrhoea is common or constipation is common, or both are common, or neither occurs very often (IBS-D, IBS-C, IBS-M, or IBS-U respectively). IBS negatively affects quality of life and may result in missed school or work. Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS.

      The recommendations for physicians are to minimize the use of medical investigations. Rome criteria are usually used. They allow the diagnosis to be based only on symptoms, but no criteria based solely on symptoms is sufficiently accurate to diagnose IBS. Worrisome features include onset at greater than 50 years of age, weight loss, blood in the stool, iron-deficiency anaemia, or a family history of colon cancer, celiac disease, or inflammatory bowel disease. The criteria for selecting tests and investigations also depends on the level of available medical resources.

      Rome criteria
      The Rome IV criteria includes recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria:

      Related to defecation
      Associated with a change in frequency of stool
      Associated with a change in form (appearance) of stool.
      Physicians may choose to use one of these guidelines or may simply choose to rely on their own anecdotal experience with past patients. The algorithm may include additional tests to guard against misdiagnosis of other diseases as IBS. Such red flag symptoms may include weight loss, gastrointestinal bleeding, anaemia, or nocturnal symptoms. However, red flag conditions may not always contribute to accuracy in diagnosis; for instance, as many as 31% of people with IBS have blood in their stool, many possibly from hemorrhoidal bleeding.

      The diagnostic algorithm identifies a name that can be applied to the person’s condition based on the combination of symptoms of diarrhoea, abdominal pain, and constipation. For example, the statement 50% of returning travellers had developed functional diarrhoea while 25% had developed IBS would mean half the travellers had diarrhoea while a quarter had diarrhoea with abdominal pain. While some researchers believe this categorization system will help physicians understand IBS, others have questioned the value of the system and suggested all people with IBS have the same underlying disease but with different symptoms

      The main diseases that cause an increased excretion of faecal calprotectin are inflammatory bowel diseases, coeliac disease, infectious colitis, necrotizing enterocolitis, intestinal cystic fibrosis and colorectal cancer.

      Although a relatively new test, faecal calprotectin is regularly used as indicator for inflammatory bowel diseases (IBD) during treatment and as diagnostic marker. IBD are a group of conditions that cause a pathological inflammation of the bowel wall. Crohn’s disease and ulcerative colitis are the principal types of inflammatory bowel disease. Inflammatory processes result in an influx of neutrophils into the bowel lumen. Since calprotectin comprises as much as 60% of the soluble protein content of the cytosol of neutrophils, it can serve as a marker for the level of intestinal inflammation. Measurement of faecal calprotectin has been shown to be strongly correlated with 111-indium-labelled leucocytes – considered the gold standard measurement of intestinal inflammation. Levels of faecal calprotectin are usually normal in patients with irritable bowel syndrome (IBS). In untreated coeliac disease, concentration levels of faecal calprotectin correlate with the degree of intestinal mucosal lesion and normalize with a gluten-free diet.

      Faecal calprotectin is measured using immunochemical techniques such as ELISA or immunochromatographic assays. The antibodies used in these assays target specific epitopes of the calprotectin molecule.

      Gallbladder ultrasonography should be considered if the patient has recurrent dyspepsia or characteristic postprandial pain.

      Abdominal computed tomography (CT) scanning is appropriate to screen for tumours, obstruction, and pancreatic disease if these are diagnostic possibilities.

      CT and magnetic resonance (MR) enterography or wireless capsule endoscopy are employed if red flags exist to suggest enteritis (small bowel inflammation) or a tumour.

      Colonoscopy is appropriate if alarm symptoms are present and in patients who otherwise qualify for screening colonoscopy.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
      18.2
      Seconds
  • Question 23 - A 55-year-old cleaner is admitted after a fall. She is haemodynamically unstable and...

    Correct

    • A 55-year-old cleaner is admitted after a fall. She is haemodynamically unstable and a CT has shown a massive retroperitoneal haematoma. She is on warfarin. What is the most appropriate course of action?

      Your Answer: Infusion of human prothrombin complex and vitamin K

      Explanation:

      Active, serious haemorrhage due to Warfarin should be treated with four-factor prothrombin complex concentrate (PCC), if available.
      While costly, an essential advantage FFP confers to emergency care is that, in contrast to FFP, it results in a more rapid reversal of coagulopathy and does not require thawing or blood group typing. Additionally, it has a reduced risk of volume overload, transfusion-related acute lung injury, transfusion reactions, and infectious disease transmission. Despite these advantages, no mortality benefit has been proven for PCC compared with FFP.
      Alternatively, recombinant factor VIIa (rFVIIa) has been reported to be effective in rapidly lowering INR due to warfarin toxicity and may be considered if PCC is not available. FFP is effective at lowering the INR and was historically first-line therapy for warfarin toxicity with serious or life-threatening bleeding, although it has now been superseded by PCC, which lowers the INR more rapidly. If PCC or rFVIIa is not available, 4 units of FFP may be administered instead.
      Administer vitamin K1, 10 mg, by slow IV infusion,

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Surgical Technique And Technology
      6.7
      Seconds
  • Question 24 - A 32-year-old lady presents with a six-month history of an offensive discharge from...

    Correct

    • A 32-year-old lady presents with a six-month history of an offensive discharge from the anus. She is otherwise well but is annoyed at the need to wear pads. On examination, she has a small epithelial defect in the five o'clock position, approximately three centimetres from the anal verge. Out of the following, which is the most likely cause?

      Your Answer: Fistula-in-ano

      Explanation:

      This patient is a case of fistula-in-ano.

      A fistula-in-ano is an abnormal hollow tract or cavity that is lined with granulation tissue and that connects a primary opening inside the anal canal to a secondary opening in the perianal skin; secondary tracts may be multiple and can extend from the same primary opening. Fistulae usually occur following previous ano-rectal sepsis. The discharge may be foul smelling and troublesome.

      Fistula-in-ano is classified into two groups based on its anatomical location.
      1. Low fistula: relatively close to the skin and passes through a few or no sphincter muscle fibres, crosses <30% external sphincter
      2. High fistula: passes through a large amount of muscle

      Assessment of fistula-in-ano includes:
      1. Examination of the perineum
      2. Digital rectal examination (DRE)
      Low, uncomplicated fistulas may not require any further assessment. Other groups will usually require more detailed investigation.
      3. Endo-anal USS
      4. Ano-rectal MRI scan

      Treatment options include:
      1. Seton suture
      2. Fistulotomy: Low fistulas that are simple should be treated by fistulotomy once the acute sepsis has been controlled. Fistulotomy (where safe) provides the highest healing rates.
      3. Anal fistula plugs and fibrin glue
      4. Ano-rectal advancement flaps: primarily for high fistulae

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
      7.7
      Seconds
  • Question 25 - A 30-year-old man presents to the A&E department after being shot in the...

    Correct

    • A 30-year-old man presents to the A&E department after being shot in the back, in the lumbar region. On examination, he has increased tone and hyperreflexia of his right leg and hemianaesthesia of his left leg. What is the most likely diagnosis?

      Your Answer: Brown-Sequard syndrome

      Explanation:

      This is a case of Brown-Sequard syndrome.

      Brown-Sequard syndrome is caused by hemisection of the spinal cord following stab injuries or lateral vertebral fractures. It results in ipsilateral paralysis (pyramidal tract), and also loss of proprioception and fine discrimination(dorsal columns). Pain and temperature sensations are lost on the contralateral side. This is because the fibres of the spinothalamic tract have decussated below the level of the cord transection.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      3.2
      Seconds
  • Question 26 - A 45-year-old male who has a long term history of alcohol misuse is...

    Correct

    • A 45-year-old male who has a long term history of alcohol misuse is admitted with a history of an attack of vomiting after an episode of binge drinking. After vomiting, he developed sudden onset left-sided chest pain, which is pleuritic in nature. On examination, he is profoundly septic and drowsy with severe epigastric tenderness and left sided chest pain. What is the most likely cause?

      Your Answer: Boerhaaves syndrome

      Explanation:

      Boerhaave’s syndrome is also known as spontaneous oesophageal rupture or effort rupture of the oesophagus. Although vomiting is thought to be the most common cause, other causes include weightlifting, defecation, epileptic seizures, abdominal trauma, compressed air injury, and childbirth, all of which can increase the pressure in the oesophagus and cause a barogenic oesophageal rupture.
      It usually follows excessive alcohol intake or overeating, or both, because either of these can induce vomiting.
      The rupture is transmural.
      A provider should suspect Boerhaave’s syndrome when a patient presents with retrosternal chest pain with or without subcutaneous emphysema when associated with heavy alcohol intake and severe or repeated vomiting. Up to one-third of patients do not present with these symptoms. The actual clinical presentation of Boerhaave syndrome will depend on the level of the perforation, the degree of leakage, and the time since the onset of the injury. Typically, the patient will present with pain at the site of perforation, usually in the neck, chest, epigastric region, or upper abdomen. Cervical perforations can present with neck pain, dysphagia, or dysphonia; intra-thoracic perforations with chest pain; and intra-abdominal perforations with epigastric pain radiating to the shoulder or back. History of increased intra-oesophageal pressure for any reason followed by chest pain should prompt consideration of this condition. Physical exam findings may include abnormal vitals (tachycardia, tachypnoea, fever), decreased breath sounds on the perforated side, mediastinal emphysema, and Hamman’s sign (mediastinal “crackling” accompanying every heartbeat) in left lateral decubitus position.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      3.3
      Seconds
  • Question 27 - A 59 year old woman presents to the hospital with a 2.1cm mobile...

    Correct

    • A 59 year old woman presents to the hospital with a 2.1cm mobile breast mass. A mammogram is indeterminate (M3), an ultrasound scan shows benign changes (U2), and clinical examination is also indeterminate (P3). What is the next best course of action?

      Your Answer: Image guided core biopsy

      Explanation:

      Image guided core biopsy (US-directed biopsy) is performed for lesions that are palpable, but also for non-palpable, mammogram-detected lesions with a corresponding abnormality visualized on US. US-guided core biopsy is technically easier than stereotactic-guided biopsy as real-time imaging allows the surgeon to visualize the biopsy as it occurs. Using sterile technique and local anaesthesia, a small puncture is made with an 11-knife blade and the needle is placed near the edge of the lesion and fired, which inserts it into the lesion for a sample to be retrieved. When placed parallel to the needle the position of the needle can be visualized on US.

      If the core biopsy result is benign and is concordant with imaging findings, continued surveillance is acceptable. If the result is indeterminate or image-discordant, surgical excision is indicated to rule out malignancy. In order to determine the appropriate management and surveillance of a lesion, the histologic, imaging, and clinical findings must be taken into account for an assessment of concordance to be performed. In addition, surgical excision is indicated for a core biopsy that demonstrates atypical hyperplasia (lobular or ductal) or lobular carcinoma in situ or neoplasia as the incidence of coexisting ductal carcinoma in situ or invasive carcinoma may be as high as 30% due to potential sampling error.

    • This question is part of the following fields:

      • Breast And Endocrine Surgery
      • Generic Surgical Topics
      6.5
      Seconds
  • Question 28 - What is the 5-year survival rate of carcinoma of the pancreas? ...

    Incorrect

    • What is the 5-year survival rate of carcinoma of the pancreas?

      Your Answer: 15 per cent

      Correct Answer: 30 per cent

      Explanation:

      Pancreatic cancer typically has a poor prognosis, partly because the cancer usually initially remains symptomless, leading to locally advanced or metastatic disease at the time of diagnosis. Median survival from diagnosis is around 3–6 months. Even in those suitable for resectional surgery, 5-year survival rates are still only 30 per cent.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      2.3
      Seconds
  • Question 29 - The oesophagus is an important part of the alimentary canal. It receives blood...

    Correct

    • The oesophagus is an important part of the alimentary canal. It receives blood from various arteries in the body. Which one of the following is an artery that will lead to some level of ischaemia to the oesophagus when ligated?

      Your Answer: Left inferior phrenic

      Explanation:

      The oesophagus receives its blood supply from the following arteries: the inferior thyroid branch of the thyrocervical trunk, the descending thoracic aorta, the left gastric branch of the coeliac artery and the from the left inferior phrenic artery of the abdominal aorta. Hence ligation of the left inferior phrenic will lead to ischemia to some portions of the oesophagus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      15.1
      Seconds
  • Question 30 - Work of breathing (WOB) is the energy expended to inhale and exhale a breathing gas. Normally, maximal amount of work...

    Correct

    • Work of breathing (WOB) is the energy expended to inhale and exhale a breathing gas. Normally, maximal amount of work of breathing is required to overcome:

      Your Answer: Elastic lung compliance

      Explanation:

      The forces of elastance (compliance), frictional resistance and inertia have been identified as the forces that oppose lung inflation and deflation. The normal relaxed state of the lung and chest is partially empty. Further exhalation requires muscular work. Inhalation is an active process requiring work. About 60–66% of the total work performed by the respiratory muscles is used to overcome the elastic or compliance characteristics of the lung–chest cage, 30–35% is used to overcome frictional resistance and only 2–5% of the work is used for inertia.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      3.2
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (6/6) 100%
Basic Sciences (14/15) 93%
Generic Surgical Topics (10/10) 100%
Hepatobiliary And Pancreatic Surgery (1/1) 100%
Orthopaedics (2/2) 100%
Urology (1/1) 100%
Organ Transplantation (1/1) 100%
Emergency Medicine And Management Of Trauma (3/3) 100%
Principles Of Surgery-in-General (5/5) 100%
Pathology (4/5) 80%
Clinical Microbiology (1/1) 100%
Physiology (4/4) 100%
Head And Neck Surgery (1/1) 100%
The Abdomen (1/1) 100%
Colorectal Surgery (2/2) 100%
Surgical Technique And Technology (1/1) 100%
Breast And Endocrine Surgery (1/1) 100%
Passmed