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Question 1
Correct
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A 63 year old woman reports colicky abdominal pain and foul smelling diarrhoea on the 4th day following a cholecystectomy for acute cholecystitis. Her surgery was complicated as the gallbladder spilled stones intraoperatively. She has been on ciprofloxacin therapy ever since her surgery. Which of the following organisms is most likely responsible for her symptoms?
Your Answer: Clostridium difficile
Explanation:Clostridioides difficile (C. difficile; formerly known as Clostridium difficile) is a gram-positive rod-shaped bacillus that is commonly involved in antibiotic-associated diarrhoea. As the bacterial spores are difficult to eradicate and easily transmitted (via faecal-oral transmission), the C. difficile infection rate is particularly high among hospitalized patients and residents in long-term care facilities.
Colonization with C. difficile occurs following antibiotic treatment of other diseases, as the bacteria is particularly resistant to antibiotics. The resulting damage to the intestinal flora promotes infection, which may be accompanied by high fever, abdominal pain, and characteristically foul-smelling diarrhoea. The most severe form of C. difficile infection is pseudomembranous colitis, which may lead to ileus, sepsis, and toxic megacolon. In most cases, however, colonization results in asymptomatic carriage rather than symptomatic infection.
Diagnosis is usually made via detection of the C. difficile toxin and/or corresponding genes in stool samples. C. difficile infections are treated with oral vancomycin or oral fidaxomicin. Following diagnosis, strict adherence to hygiene measures and patient isolation is essential, especially in hospitals and other healthcare settings. -
This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 2
Correct
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A 55-year old patient with signs and symptoms of internal haemorrhage was brought in for emergency surgery to control the bleeding. Angiography results revealed an advanced duodenal tumour that had perforated the blood vessel immediately behind the first part of the duodenum. Which of the following is the most likely blood vessel that was ruptured by the cancer?
Your Answer: Gastroduodenal artery
Explanation:The gastroduodenal artery is the artery that lies just behind the first portion of the duodenum. The gastroduodenal artery would be the most likely artery to be perforated by a cancer in this area. The perforation is as a result of the spillage of the acidic content of the chyme in the duodenum. All the other blood vessels in the list would less likely be affected by the gastric expellant from the duodenum. The coronary vein is located in the lesser curvature of the stomach. The inferior pancreaticoduodenal arcade is located inferiorly to the first part of the duodenum on the head of the pancreas. The hepatic artery proper is a branch of the common hepatic artery that is located superior to the first portion of the duodenum. The splenic vein arises from the spleen; it forms the portal vein by joining the superior mesenteric vein. It is laterally detached from the duodenum. Both the left gastric vein and the splenic vein are located superior to the first portion of the duodenum.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 3
Correct
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A young lady is stabbed in the chest when she was leaving a party and she develops a cardiac arrest in the A&E department. What is the best course of action?
Your Answer: Thoracotomy
Explanation:Answer: Thoracotomy
Cardiac arrest after penetrating chest trauma may be an indication for emergency thoracotomy. A successful outcome is possible if the patient has a cardiac tamponade and the definitive intervention is performed within 10 minutes of loss of cardiac output.
EMERGENCY “CLAM SHELL” THORACOTOMYIndication:
Penetrating chest/epigastric trauma associated with cardiac arrest (any rhythm).
Contraindications:
Definite loss of cardiac output for greater than 10 minutes.Any patient who has a cardiac output, including hypotensive patients.
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This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 4
Incorrect
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A 45-year-old male has symptoms of carcinoid syndrome. Which of the following is the most effective therapeutic agent in controlling the symptoms?
Your Answer: Somatostatin
Correct Answer: Octreotide
Explanation:Carcinoid syndrome occurs in ∼20% of cases of well-differentiated endocrine tumours of the jejunum or ileum (midgut neuroendocrine tumours (NET) and consists of (usually) dry flushing (without sweating; 70% of cases) with or without palpitations, diarrhoea (50% of cases) and intermittent abdominal pain (40% of cases); in some patients, there is also lacrimation and rhinorrhoea.
Carcinoid syndrome occurs less often with NETs of other origins and is very rare in association with rectal NETs. It is usually due to metastasis to the liver, with the release of vasoactive compounds, including biogenic amines (e.g., serotonin and tachykinins), into the systemic circulation. However, it may also occur in the absence of liver metastases if there is direct retroperitoneal involvement, with venous drainage bypassing the liver. Pain due to hepatic enlargement may also be a presenting feature, as may upper right abdominal pain (similar to that of pulmonary infarction) secondary to either haemorrhage into, or necrosis of, a hepatic secondary tumour. Wheezing and pellagra are less common presenting features. CHD is present in ∼20% of patients at presentation and usually indicates that the syndrome has been present for several years.The aim of treatment should be curative where possible but it is palliative in the majority of cases.
Surgery is the only curative treatment.
Administration of specific medications to treat symptoms should, therefore, start as soon as clinical and biochemical signs indicate the presence of hypersecretory NETs, even before the precise localisation of primary and metastatic lesions is confirmed.The only proven hormonal management of NETs is by the administration of somatostatin analogues.
Somatostatin analogues bind principally to SSTR subtypes 2 (with high affinity) and 5 (with lower affinity), thus inhibiting the release of various peptide hormones in the gut, pancreas and pituitary; they also antagonise growth factor effects on tumour cells, and, at very high dosage, may induce apoptosis. The effects of somatostatin analogues are demonstrable as biochemical response rates (inhibition of hormone production) in 30–70% of patients and as symptomatic control in the majority of patients.
There are two commercially available somatostatin analogues: octreotide and lanreotide. -
This question is part of the following fields:
- Principles Of Surgery-in-General
- Surgical Technique And Technology
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Question 5
Incorrect
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After total thyroidectomy, which of the following investigations is recommended in the immediate post-operative period?
Your Answer: Free catecholamines
Correct Answer: Serum calcium
Explanation:Total thyroidectomy might sometimes result in inadvertent excision or damage of parathyroid glands, leading to hypoparathyroidism. Monitoring serum calcium levels in the post-operative period to detect hypocalcaemia is essential to diagnose and prevent this condition.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 6
Correct
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A teenager is taken to his doctor because his mother noticed a patch of hair overlying his lower lumbar spine and a birth mark at the same location. Neurological examination of the lower limbs is normal. What is the likely diagnosis?
Your Answer: Spina bifida occulta
Explanation:Answer: Spina bifida occulta
Spina Bifida Occulta is the mildest type of spina bifida. It is sometimes called “hidden” spina bifida. With it, there is a small gap in the spine, but no opening or sac on the back. The spinal cord and the nerves usually are normal. Many times, Spina Bifida Occulta is not discovered until late childhood or adulthood. This type of spina bifida usually does not cause any disabilities.
Eighty percent of those with a spinal cord problem will have skin over the defect with:
a hairy patch
a fatty lump
a haemangioma—a red or purple spot made up of blood vessels
a dark spot or a birthmark—these are red and don’t include blue-black marks, called “Mongolian spots”
a skin tract (tunnel) or sinus—this can look like a deep dimple, especially if it’s too high (higher than the top of the buttocks crease), or if its bottom can’t be seen
a hypopigmented spot—an area with less skin colour.Myelocele is herniation of spinal cord tissue through a defect in a region of the vertebral column. The protrusion of the tissue is flush with the level of the skin surface. In myelocele, the spinal cord is exposed so that nerve tissue lies exposed on the surface of the back without even a covering of skin or of the meninges, the membranous tissue surrounding the brain and spinal cord.
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This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 7
Incorrect
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A patient underwent surgical excision of mass in the right carotid triangle. One day after the surgery patient complained of numbness of the skin over the right side of the neck. Injury to the cervical plexus of nerves is suspected. What is the possible nerve affected in this patient?
Your Answer: Spinal accessory
Correct Answer: Transverse cervical
Explanation:The transverse cervical nerve (superficial cervical or cutaneous cervical) arises from the second and third spinal nerves, turns around the posterior border of the sternocleidomastoid and, passing obliquely forward beneath the external jugular vein to the anterior border of the muscle, it perforates the deep cervical fascia, and divides beneath the platysma into the ascending and descending branches. It provides cutaneous innervation to this area.
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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 27-year-old professional tennis player presents to the A&E department with a swollen, painful right arm. On examination, his fingers are dusky. Out of the following, which is the most appropriate investigation?
Your Answer: Venous Doppler test
Correct Answer: Venous duplex scan
Explanation:This patient has an axillary vein thrombosis. It classically presents with pain and swelling of the affected limb. Venous duplex scan is needed to exclude a thrombus.
Primary proximal upper-extremity deep vein thrombosis (UEDVT) is less common than its secondary forms. The most common primary form is effort-related thrombosis, also called Paget-Schroetter syndrome. It usually occurs in, otherwise, healthy young men who report, before the onset of thrombosis, vigorous arm exercise such as lifting weights, playing badminton/tennis, pitching a baseball, or performing repetitive overhead activities, such as painting or car repair. Most patients with effort-related UEDVT have an underlying venous thoracic outlet syndrome (VTOS). Secondary causes of UEDVT include central line insertion, malignancy, or pacemakers.
Patients with UEDVT typically present with heaviness, discomfort, pain, paraesthesia, and swelling of the affected arm. Physical examination may reveal pitting oedema, redness, or cyanosis of the involved extremity; visible collateral veins at the shoulder or upper arm; and fever.
Diagnosis is made by:
1. FBC: platelet function
2. Coagulation profile
3. Liver function tests
4. Venous duplex scan: investigation of choice, provides information relating to flow and characteristics of the vessels.
5. D-dimer testing
6. CT scan: for VTOSTreatment options for primary UEDVT are as follows:
1. Anticoagulation therapy should be undertaken with a once-daily regimen of LMWH or fondaparinux for at least five days, followed by vitamin K antagonists for at least three months. Unfractionated heparin instead of LMWH is recommended for patients with renal failure or for those treated with CDT.2. Early thrombus removal and restoration of venous patency aim should be done immediately after starting the patient on heparin. Catheter-based therapy is recommended for patients with proximal UEDVT of recent onset and severe symptoms, low risk for bleeding complications, and good functional status.
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This question is part of the following fields:
- Generic Surgical Topics
- Vascular
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Question 9
Incorrect
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An operation to remove a segment of the oesophagus through a right thoracotomy is complicated when a tear develops in a large venous structure in the posterior mediastinum that empties into the superior vena cava. Which of the following structures is likely to be injured?
Your Answer: Brachiocephalic vein
Correct Answer: Azygos vein
Explanation:The azygos vein is formed by the union of the right subcostal veins and the ascending lumbar veins at the level of the 12th thoracic vertebra. It enters the thorax through the aortic hiatus to ascend in the posterior mediastinum and arching over the right main bronchus posteriorly at the root of the right lung to join the superior vena cava before it pierces the pericardium.
The basilic vein is a vein on the medial aspect of the arm that ascends to become the axillary vein.
The cephalic vein is also a vein of the arm.
The external jugular and brachiocephalic vein are not in the posterior mediastinum.
The median cubital vein is found in the cubital fossa of the arm. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 10
Correct
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A 28 year gang member was shot in the chest. The bullet hit a vessel that courses horizontally across the mediastinum. Which of the following vessels is it likely to be?
Your Answer: Left brachiocephalic vein
Explanation:The superior vena cava that empties blood into the right atrium is formed by the right and the left brachiocephalic veins. Hence, the left brachiocephalic has to course across the mediastinum horizontally to join with its right ‘counterpart’. The left subclavian artery and vein being lateral to the mediastinum do not cross the mediastinum while the left jugular and the common carotid artery course vertically.
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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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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: Descending colon
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.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 12
Incorrect
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A 45-year-old man has a long history of ulcerative colitis. His symptoms are well-controlled with steroids. However, attempts at steroid weaning and use of steroid-sparing drugs have repeatedly failed. He wishes to avoid a permanent stoma. Which of the following should be the best operative strategy?
Your Answer: Abdominoperineal excision of the colon and rectum and construction of an ileoanal pouch
Correct Answer:
Explanation:In patients with ulcerative colitis (UC) where medical management is not successful, surgical resection (pan-proctocolectomy) may offer a chance of cure. Those patients wishing to avoid a permanent stoma may be considered for an ileoanal pouch. However, this procedure is only offered in the elective setting.
Patients with inflammatory bowel disease (UC and Crohn’s disease) frequently present in surgical practice. Elective indications for surgery in UC include disease that requires maximal therapy or prolonged courses of steroids.
Long-standing UC is associated with a risk of malignant transformation. Dysplastic transformation of the colonic epithelium with associated mass lesions is an absolute indication for a proctocolectomy. Restorative options in UC include an ileoanal pouch. Complications of such a pouch include anastomotic dehiscence, pouchitis, and poor physiological function with seepage and soiling.
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Emergency presentation of poorly-controlled colitis that fails to respond to medical therapy should usually be managed with a subtotal colectomy. Excision of the rectum is a procedure with a higher morbidity and is not generally performed in the emergency setting. -
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 13
Incorrect
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A 26 year old female student presents with diarrhoea, bloating and crampy abdominal pain after returning from a student exchange trip in Nigeria. She states that she had been swimming in a public pool in the afternoons after class and she has had bowel movements four to five times per day. She notices that her stools float on top of the toilet water but there is no presence of blood. Which of the following is the most likely cause?
Your Answer: Salmonella sp
Correct Answer: Giardia lamblia
Explanation:Giardia is a microscopic parasite that causes the diarrheal illness known as giardiasis. Giardia (also known as Giardia intestinalis, Giardia lamblia, or Giardia duodenalis) is found on surfaces or in soil, food, or water that has been contaminated with faeces from infected humans or animals.
Giardia is protected by an outer shell that allows it to survive outside the body for long periods of time and makes it tolerant to chlorine disinfection. While the parasite can be spread in different ways, water (drinking water and recreational water) is the most common mode of transmission.
Signs and symptoms may vary and can last for 1 to 2 weeks or longer. In some cases, people infected with Giardia have no symptoms.
Acute symptoms include:
Diarrhoea
Gas
Greasy stools that tend to float
Stomach or abdominal cramps
Upset stomach or nausea/vomiting
Dehydration (loss of fluids)
Other, less common symptoms include itchy skin, hives, and swelling of the eye and joints. Sometimes, the symptoms of giardiasis might seem to resolve, only to come back again after several days or weeks. Giardiasis can cause weight loss and failure to absorb fat, lactose, vitamin A and vitamin B12.In children, severe giardiasis might delay physical and mental growth, slow development, and cause malnutrition.
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This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 14
Incorrect
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A 27-yeaar-old woman is diagnosed with candidiasis and prescribed fluconazole. What is the mechanism of action of fluconazole?
Your Answer: Inhibits viral DNA polymerase
Correct Answer: Inhibits cytochrome P450
Explanation:Fluconazole is a triazole antifungal drug used in the treatment and prevention of superficial and systemic fungal infections. Like other imidazole- and triazole-class antifungals, fluconazole inhibits the fungal cytochrome P450 enzyme, 14-demethylase. It is used to treat candidiasis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, dermatophytosis, and pityriasis versicolor.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 15
Incorrect
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A patient is suspected to have Blastomyces dermatidis infection. The patient contracted the disease most likely through which port of entry?
Your Answer: Circulatory system
Correct Answer: Respiratory tract
Explanation:Blastomycosis disease is a fungal infection acquired through inhalation of the spores. It caused by the organism Blastomyces dermatitidis and manifests as a primary lung infection in about 70% of cases. The onset is relatively slow and symptoms are suggestive of pneumonia.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 16
Incorrect
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Which of the following muscles attaches to the pterygomandibular raphe?
Your Answer: Medial pterygoid muscle
Correct Answer: Superior pharyngeal constrictor muscle
Explanation:The pterygomandibular raphé (pterygomandibular ligament) provides attachment on its posterior border to the superior pharyngeal constrictor and on its anterior border to the buccinator muscle.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 17
Incorrect
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A 29-year-old woman is due to undergo a laparoscopic cholecystectomy. Which of the following intra-abdominal pressures should typically be set on the gas insufflation system?
Your Answer: 4 mmHg
Correct Answer: 10 mmHg
Explanation:A pressure of 10 mmHg should be set on the gas insufflation system.
Laparoscopic surgery may be performed in a number of body cavities. In some areas, irrigation solutions are preferred. In the abdomen, however, insufflation with carbon dioxide gas is commonly used. The amount of gas delivered is adjusted to maintain a constant intra-abdominal pressure of 12–15 mmHg. Excessive intra-abdominal pressure may reduce venous return and lead to hypotension. Too little insufflation will risk obscuring the surgical view.
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This question is part of the following fields:
- Principles Of Surgery-in-General
- Surgical Technique And Technology
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Question 18
Incorrect
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If a 68-year-old man is diagnosed with a testicular seminoma that reaches the tunica albuginea and involves the tunica vaginalis, with retroperitoneal lymph nodes greater than 5cm, LDH 1.4 times the reference levels, β-hCG 4250 mIU/ml and AFP 780 ng/ml, what's the clinical stage in this case?
Your Answer: Stage IIB
Correct Answer: Stage IIC
Explanation:According to the AJCC, the clinical staging for testicular seminoma is:
Stage IA: T1 N0 M0 S0
Stage IB: T2/3/4 N0 M0 S0
Stage IC: any T N0 M0 S1/2/3
Stage IIA: any T N1 M0 S0/1
Stage IIB: any T N2 M0 S0/1
Stage IIC: any T N3 M0 S0/1
Stage IIIA: any T any N M1a S0/1
Stage IIIB: any T any N M0/1a S2
Stage IIIC: any T any N M1a/1b S3.
The patient in this case has IIC stage -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 19
Incorrect
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During an operation to repair an indirect inguinal hernia, it is noticed that the hernial sac is protruding out of the superficial inguinal ring. The superficial inguinal ring is an opening in which structure?
Your Answer: Scarpa’s fascia
Correct Answer: External abdominal oblique aponeurosis
Explanation:The superficial inguinal ring is an opening in the aponeurosis of the external oblique just above and lateral to the pubic crest. The opening is oblique and corresponds to the fibres of the aponeurosis. It is bound inferiorly by the pubic crest, on either side by the margins of the opening in the aponeurosis and superiorly by the curved intercrural fibres.
The inferior crus is formed by the portion of the inguinal ligament that is inserted into the pubic tubercle.
The falx inguinalis is made of arching fibres of the transversalis fascia and the internal abdominal oblique muscle. It forms the posterior wall of the inguinal canal.
The internal abdominal oblique forms the root of the inguinal canal.
Scarpa’s and Camper’s fascia are the membranous and fatty layers, respectively of subcutaneous fascia.
Transversalis fascia covers the posterior surface of the rectus abdominis muscle inferior to the arcuate line. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 20
Incorrect
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During a procedure in the mediastinum, the surgeon accidentally injured a key structure that lies immediately anterior to the thoracic duct. Which structure is likely to be injured?
Your Answer: Superior vena cava
Correct Answer: Oesophagus
Explanation:In the mid-thorax, the azygos vein, thoracic duct and aorta (in this order from right to the left) are all located posterior to the oesophagus. The superior vena cava, left internal jugular vein and trachea are not found in the mid thorax.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 21
Incorrect
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Which of the following arteries, that runs on the superior aspect of the first part of the duodenum, forms the lower boundary of the epiploic foramen (also known as the foramen of Winslow)?
Your Answer: Splenic
Correct Answer: Hepatic
Explanation:The epiploic foramen is an important anatomical opening that allows for the communication between the greater peritoneal sac and the lesser peritoneal sac. Its boundaries are formed; superiorly by the caudate lobe of the liver, anteriorly by the hepatoduodenal ligament (containing the components of the portal triad), inferiorly by the first part of the duodenum and posteriorly by the peritoneum covering the inferior vena cava. The superior aspect of the first part of the duodenum, which forms the inferior boundary of the foramen of Winslow, forms the course of the hepatic artery before it ascends to the porta hepatis where it divides into its right and left branches.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 22
Incorrect
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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: 4 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.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 23
Incorrect
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The superior rectal artery is a continuation of the:
Your Answer: Left colic artery
Correct Answer: Inferior mesenteric artery
Explanation:The superior rectal artery or superior haemorrhoidal artery is the continuation of the inferior mesenteric artery. It descends into the pelvis between the layers of the mesentery of the sigmoid colon, crossing the left common iliac artery and vein.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 24
Correct
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A 60 year old patient with a history of carcinoma of the head of the pancreas, and obstructive jaundice presents with a spontaneous nose bleed and easy bruising. What is the most likely reason for this?
Your Answer: Vitamin-K-dependent clotting factors deficiency
Explanation:Vitamin K is a fat soluble vitamin requiring fat metabolism to function properly to allow for its absorption. People with obstructive jaundice develop vitamin k deficiency as fat digestion is impaired. Vit K causes carboxylation of glutamate residue and hence regulates blood coagulation including: prothrombin (factor II), factors VII, IX, X, protein C, protein S and protein Z.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 25
Incorrect
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A 31 year old woman presents to the clinic for assessment of varicose veins that she developed several years ago. Examination reveals marked truncal varicosities with a long tortuous saphenous vein. Which of the following would be the next most appropriate step in her management?
Your Answer: List her for a Trendelenburg procedure
Correct Answer: Arrange a venous duplex scan
Explanation:Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein of the legs, thigh, or pelvis. Thrombosis is most often seen in individuals with a history of immobilization, obesity, malignancy, or hereditary thrombophilia. Vascular endothelial damage, venous stasis, and hypercoagulability, collectively referred to as the Virchow triad, are the main factors contributing to the development of DVT.
Symptoms usually occur unilaterally and include swelling, tenderness, and redness or discoloration. Pulmonary embolism (PE), a severe complication of DVT, should be suspected in patients with dizziness, dyspnoea, and fever. The diagnostic test of choice for DVT is compression ultrasound. In most cases, a negative D-dimer test allows thrombosis or PE to be ruled out, but a positive test is nonspecific.
Initial acute treatment of DVT consists of anticoagulation with heparin and, if the thrombus is large or unresponsive to anticoagulation, may also include thrombolysis or thrombectomy. Secondary prophylaxis is achieved with oral warfarin or direct factor Xa inhibitors and supportive measures such as regular exercise and compression stockings. -
This question is part of the following fields:
- Generic Surgical Topics
- Vascular
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Question 26
Incorrect
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A 64 year old woman with metastatic breast cancer presents with bone pain. Radiological reports show a metastatic lytic lesion in her femoral shaft. The lesion occupies 75 percent of the bone diameter. Which of the following would be the most appropriate step in the management of this patient?
Your Answer: Radical radiotherapy
Correct Answer: Fixation with intramedullary nail
Explanation:The role of surgery for bone metastasis can be divided into (i) prophylactic fixation to prevent impending pathological fractures, (ii) stabilization of a pathological fractures, (iii) segmental resection of tumours, and (iv) arthroplasty for replacing joints that have been destroyed by a tumour. To this end, orthopaedic surgeons have a vast array of surgical devices and implants in their surgical armamentarium at their disposal. These include plates and screws, intramedullary fixation devices, and tumour endoprostheses.
Even with surgical fixation only 30% of pathological fractures unite. -
This question is part of the following fields:
- Oncology
- Principles Of Surgery-in-General
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Question 27
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: Geniohyoid
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 28
Incorrect
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Increased resistance to flow of blood in cerebral vessels is most likely seen in:
Your Answer: Reduction in systemic arterial pressure
Correct Answer: Elevation in systemic arterial pressure from 100 to 130 mmHg
Explanation:Constant cerebral blood flow is maintained by autoregulation in the brain, which causes an increase in local vascular resistance to offset an increase in blood pressure. There will be an increase in cerebral blood flow (and decrease in resistance to cerebral blood flow) with a decrease in arterial oxygen or an increase in arterial CO2. Similarly, a decrease in viscosity will also increase the blood flow. Due to increased brain metabolism and activity during a seizure, there will also be an increase in the cerebral blood flow.
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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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An 18 year-old with an iron deficient diet was prescribed an iron supplement by her GP. Lack of iron often results in:
Your Answer: Polycythaemia
Correct Answer: Hypochromic anaemia
Explanation:Iron deficiency anaemia is the most common type of anaemia. It can occur due to deficiency of iron from decreased intake, increased loss or inadequate absorption. An MCV less than 80 will indicated iron deficiency anaemia. On the smear the RBCs will be microcytic hypochromic and will also show poikilocytosis. Iron profile tests are important to make a diagnosis. Clinically the patient will be pale and lethargic.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 30
Incorrect
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A blood sample from a patient with polycythaemia vera will show which of the following abnormalities?
Your Answer:
Correct Answer: High platelet count
Explanation:Polycythaemia is a condition that results in an increase in the total number of red blood cells (RBCs) in the blood. It can be due to a myeloproliferative syndrome, chronically low oxygen levels or rarely malignancy. In primary polycythaemia/ polycythaemia vera the increase is due to an abnormality in the bone marrow, resulting in increased RBCs, white blood cells (WBCs) and platelets. In secondary polycythaemia the increase occurs due to high levels of erythropoietin either artificially or naturally. The increase is about 6-8 million/cm3 of blood. A type of secondary polycythaemia is physiological polycythaemia where people living in high altitudes who are exposed to hypoxic conditions produce more erythropoietin as a compensatory mechanism for thin oxygen and low oxygen partial pressure.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
