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  • Question 1 - A 78-year-old woman was brought to the emergency department with decreased consciousness, weakness...

    Correct

    • A 78-year-old woman was brought to the emergency department with decreased consciousness, weakness and dehydration. Which serum electrolyte would most likely be low in this patient?

      Your Answer: Na+

      Explanation:

      Hyponatremia is a sodium level below 135 mEq/L. Signs and symptoms may include: nausea with vomiting, fatigue, headache or confusion, cramps or spasm, irritability and restlessness and severe cases may lead to seizures and comma.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      11.1
      Seconds
  • Question 2 - What is the name of the cutaneous branch of the posterior primary ramus...

    Correct

    • What is the name of the cutaneous branch of the posterior primary ramus of C2?

      Your Answer: Greater occipital nerve

      Explanation:

      The dorsal primary ramus of the spinal nerve C2 is the greater occipital nerve which provides cutaneous innervation to the skin of the back of the head. The ventral primary ramus gives off the great auricular nerve, the lesser occipital nerve and the ansa cervicalis.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      12.9
      Seconds
  • Question 3 - Hepatomegaly with greatly increased serum alpha-fetoprotein is seen in which of the following...

    Correct

    • Hepatomegaly with greatly increased serum alpha-fetoprotein is seen in which of the following conditions?

      Your Answer: Hepatocellular carcinoma

      Explanation:

      Hepatocellular carcinoma or hepatoma affects people with pre-existing cirrhosis and is more common in areas with higher prevalence of hepatitis B and C. Diagnosis include raise alpha-fetoprotein levels, imaging and liver biopsy if needed. Patients at high-risk for developing this disease can undergo screening by periodic AFP measurement and abdominal ultrasonography. The malignancy carries poor prognosis (see also Answer to 10.4).

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      7.1
      Seconds
  • Question 4 - A 24-year-old woman sustains a simple rib fracture resulting from a fall. On...

    Correct

    • A 24-year-old woman sustains a simple rib fracture resulting from a fall. On examination, a small pneumothorax is found. What should be the most appropriate course of action?

      Your Answer: Insertion of chest drain

      Explanation:

      For a rib fracture to cause pneumothorax, there must also be laceration to the underlying lung parenchyma. This has the risk of developing into a tension pneumothorax. Therefore, a chest drain should be inserted and the patient admitted.

      Pneumothorax is a collection of free air in the chest cavity that causes the lung to collapse. The most common cause of pneumothorax is lung laceration with air leakage. In some instances, the lung continues to leak air into the chest cavity and results in compression of the chest structures, including vessels that return blood to the heart. This is known as a tension pneumothorax and can be fatal if not treated immediately. Blunt or penetrating chest trauma that creates a flap-type defect on the surface of the lung can result in this life-threatening condition.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      25.5
      Seconds
  • Question 5 - A 55-year-old male undergoes a laparotomy for perforated bowel after a colonoscopy. 2...

    Correct

    • A 55-year-old male undergoes a laparotomy for perforated bowel after a colonoscopy. 2 days after surgery the nursing staff report there is pink, serous fluid discharging from the wound. What is the next most appropriate management step?

      Your Answer: Examine the wound for separation of the rectus fascia

      Explanation:

      Surgical wound dehiscence (SWD) is the separation of the margins of a closed surgical incision that
      has been made in the skin, with or without exposure or protrusion of underlying tissue, organs or implants. Separation may occur at single or multiple regions, or involve the full length of the incision, and may affect some or all tissue layers. A dehisced incision may, or may not, display clinical signs and symptoms of infection.
      SWD can occur without warning. Incisions at risk of dehiscence may show signs of inflammation beyond the time and extent expected for normal healing, e.g. more exaggerated incisional redness, swelling, warmth and pain that extend beyond postoperative day 5. Palpation of the incision and surrounding area may reveal the warmth and a collection of fluid under some or all of the incision (a seroma, haematoma or abscess). A sudden increase in pain or discharge of serosanguineous fluid from the incision may herald SWD.

      Prior to assessment of SWD, the events, if any, leading to the dehiscence, e.g. coughing, vomiting, trauma, suture/clip removal, purulent drainage, should be ascertained. The duration of the dehiscence should also be determined: SWD occurring very soon after surgery and of very recent occurrence may be suitable for re-suturing.
      The entire length of an incision with SWD should be fully assessed: the factors that led to the SWD may also be affecting other regions of the incision that remain closed.

    • This question is part of the following fields:

      • Post-operative Management And Critical Care
      • Principles Of Surgery-in-General
      19.7
      Seconds
  • Question 6 - With respect to far accommodation, which of the following is a TRUE statement?...

    Correct

    • With respect to far accommodation, which of the following is a TRUE statement?

      Your Answer: The ciliary muscles are relaxed

      Explanation:

      Myopia or near-sightedness is a disease due to elongated eyeballs or too strong a lens. For far accommodation (focus of a distant object onto the retina), the lens needs to decrease its refractive power, or in other words, increase its focal length. This is done by relaxation of ciliary muscles which tightens the zonular fibres and flattening of the lens. Relaxation of the zonular fibres, rounding of the lens, shortening of the focal length and constriction of the pupil occurs during near accommodation.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      32
      Seconds
  • Question 7 - Which organ is responsible for the secretion of enzymes that aid in digestion...

    Incorrect

    • Which organ is responsible for the secretion of enzymes that aid in digestion of complex starches?

      Your Answer: Small intestine

      Correct Answer: Pancreas

      Explanation:

      α-amylase is secreted by the pancreas, which is responsible for hydrolysis of starch, glycogen and other carbohydrates into simpler compounds.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      38.5
      Seconds
  • Question 8 - A 34-year-old Asian male presents with cervical lymphadenopathy. The patient is suspected to...

    Correct

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

      Your Answer: Caseation necrosis

      Explanation:

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

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      13.1
      Seconds
  • Question 9 - Which of the following chemotherapy regimens is most likely to be used in...

    Correct

    • Which of the following chemotherapy regimens is most likely to be used in colorectal cancer?

      Your Answer: FOLFOX

      Explanation:

      Chemotherapy regimens are often identified by acronyms, identifying the agents used in the drug combination. However, the letters used are not consistent across regimens. FOLFOX is a chemotherapy regimen used for the treatment of colorectal cancer, made up of the following drugs: • FOL: fluorouracil (5-fluorouracil or 5-FU) • F: folinic acid (leucovorin) • OX: oxaliplatin (Eloxatin®).

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      9.9
      Seconds
  • Question 10 - A 22-year old man presented with a mass in his left scrotum which...

    Correct

    • A 22-year old man presented with a mass in his left scrotum which was more prominent when standing and felt like a 'bag of worms'. Examination revealed a non-tender mass along the spermatic cord. Also, the right testis was larger than the left testis. What is the likely diagnosis?

      Your Answer: Varicocele

      Explanation:

      Varicocele refers to dilatation and increased tortuosity of the pampiniform plexus – which is a network of veins found in spermatic cord that drain the testicle. Defective valves or extrinsic compression can result in outflow obstruction and cause dilatation near the testis. Normal diameter of the small vessels ranges from 0.5 – 1.5mm. A varicocele is a dilatation more than 2mm.
      The plexus travels from the posterior aspect of testis into the inguinal canal with other structures forming the spermatic cord. They then form the testicular veins out of which the right testicular vein drains into the inferior vena cava and the left into the left renal vein.
      It affects 15-20% men, and 40% of infertile males. Usually diagnosed in 15-25 years of age, they are rarely seen after 40 years of age. Because of the vertical path taken by the left testicular vein to drain into left renal vein, 98% idiopathic varicoceles occur on the left side. It is bilateral in 70% cases. Right-sided varicoceles are rare.
      Symptoms include pain or heaviness in the testis, infertility, testicular atrophy, a palpable mass, which is non-tender and along the spermatic cord (resembling a ‘bag of worms’). The testis on the affected side might be smaller.
      Diagnosis can be made by ultrasound. Provocative measures such as Valsalva manoeuvre or making the patient stand up to increase the dilatation by increasing the intra-abdominal venous pressure.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      14.9
      Seconds
  • Question 11 - An anatomy instructor is giving a demonstration of the right lung. Which of...

    Incorrect

    • An anatomy instructor is giving a demonstration of the right lung. Which of the statements about the right lung made by the demonstrator is correct?

      Your Answer: Its upper lobar bronchus lies behind and below the right pulmonary artery

      Correct Answer: Its upper lobar bronchus lies behind and above the right pulmonary artery

      Explanation:

      The root of the lungs on both sides are similar in that the pulmonary veins are anterior and inferior while the bronchus is posterior. However, on the right side, the pulmonary arteries are anterior to the bronchus while on the left side the pulmonary arteries are superior to the bronchus. The lingual is only found on the left lung. The mediastinum is the space in the thorax between the two pleural sacs and does not contain any lung. The right lung, having three lobes, is slightly larger than the left lung. On both sides, the phrenic nerves passes in front of the root of the lung.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      159.6
      Seconds
  • Question 12 - Which is the correct superficial to deep order of structures that would be...

    Incorrect

    • Which is the correct superficial to deep order of structures that would be affected following a knife wound to the lateral aspect of the knee?

      Your Answer: Skin, popliteus tendon, fibular collateral ligament, lateral meniscus

      Correct Answer: skin, fibular collateral ligament, popliteus muscle tendon, lateral meniscus

      Explanation:

      Skin, fibular collateral ligament, popliteus muscle tendon and lateral meniscus is the correct order of structures covering the lateral aspect of the knee joint from a superficial to deep.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      17.9
      Seconds
  • Question 13 - Macrolides are a group of antibiotics commonly used to treat respiratory tract and...

    Correct

    • Macrolides are a group of antibiotics commonly used to treat respiratory tract and soft-tissue infections. Which of the following antibiotics is a macrolide?

      Your Answer: Erythromycin

      Explanation:

      Erythromycin is a macrolide antibiotic used in the treatment of several bacterial infections, including respiratory tract infections, skin infections, chlamydia infections, pelvic inflammatory disease, and syphilis. It may also be used during pregnancy to prevent Group B streptococcal infection in the new-born.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      6
      Seconds
  • Question 14 - Which name is given to the inferior fascia of the urogenital diaphragm? ...

    Incorrect

    • Which name is given to the inferior fascia of the urogenital diaphragm?

      Your Answer: Scarpa’s fascia

      Correct Answer: Perineal membrane

      Explanation:

      The urogenital fascia is mostly commonly referred to as the perineal membrane. This term refers to an anatomical fibrous membrane in the perineum. It is triangular in shape, and thus at times referred to as the triangular ligament. It is about 4 cm in depth. Its The perineal membrane’s apex is anterior and is separated from the arcuate pubic ligament by an oval opening for the passage of the deep dorsal vein of the penis. The lateral marginas of this triangular ligament are attached on either side to the inferior rami of the pubis and ischium, above the crus penis. Its base faces the rectum, and connects to the central tendinous point of the perineum. The pelvic fascia and Colle’s fascia is fused to the base of this triangle.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      16
      Seconds
  • Question 15 - A 32 year old man has had a total pancreatectomy done. He has...

    Correct

    • A 32 year old man has had a total pancreatectomy done. He has severe necrotizing pancreatitis that is unresponsive to conservative therapy. Which statement regarding the physiological effects of a total pancreatectomy on this patient is false?

      Your Answer: Loss of fat emulsification will result in the malabsorption of vitamins A, C, D, and K

      Explanation:

      Answer: Loss of fat emulsification will result in the malabsorption of vitamins A, C, D, and K

      Vitamins are classified as either fat soluble (vitamins A, D, E and K) or water soluble (vitamins B and C). This difference between the two groups is very important. It determines how each vitamin acts within the body. The fat soluble vitamins are soluble in lipids (fats). These vitamins are usually absorbed in fat globules (called chylomicrons) that travel through the lymphatic system of the small intestines and into the general blood circulation within the body. These fat soluble vitamins, especially vitamins A and E, are then stored in body tissues.
      Vitamin C is a water soluble vitamin which makes the statement false.
      Primary pancreatic maldigestion of carbohydrate, protein, and fat is caused by decreased activity of amylase, trypsin, and lipase. Pancreatic lipase is an enzyme secreted from the pancreas. As the primary lipase enzyme that hydrolyses dietary fat molecules in the human digestive system, it is one of the main digestive enzymes, converting triglyceride substrates found in ingested oils to monoglycerides and free fatty acids.
      The duodenum plays a key role in absorption of vitamins and minerals, and is removed in PD resections. This, in combination with malabsorption and increased metabolic demand, results in increased risk of micronutrient deficiencies. Routine supplementation of fat soluble vitamin and trace elements are recommended following resection.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      3.3
      Seconds
  • Question 16 - A 30-year-old man is brought to the emergency department suffering from extreme dehydration,...

    Incorrect

    • A 30-year-old man is brought to the emergency department suffering from extreme dehydration, and subsequent hypotension and tachycardia. Which part of the kidney will compensate for this loss?

      Your Answer: Proximal convoluted tubule

      Correct Answer: Collecting ducts

      Explanation:

      The collecting duct system of the kidney consists of a series of tubules and ducts that physically connect nephrons to a minor calyx or directly to the renal pelvis. The collecting duct system is the last component of the kidney to influence the body’s electrolyte and fluid balance. In humans, the system accounts for 4–5% of the kidney’s reabsorption of sodium and 5% of the kidney’s reabsorption of water. At times of extreme dehydration, over 24% of the filtered water may be reabsorbed in the collecting duct system.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      18.1
      Seconds
  • Question 17 - A 20-year old cyclist falls off a speeding bike and fractures a structure...

    Correct

    • A 20-year old cyclist falls off a speeding bike and fractures a structure that articulates with the tubercle of the 7th rib. Which structure is fractured?

      Your Answer: Transverse process of vertebra T7

      Explanation:

      A rib tubercle is a projection that is postero-inferior and lateral to the neck of a rib which articulates with the transverse process of the corresponding vertebra i.e. of the same number. Therefore, the tubercle of rib 7 articulates with the transverse process of T7 vertebra. The head of the rib 7, on the other hand, articulates with the 6th vertebra superiorly and the 7th vertebra inferiorly.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      11.5
      Seconds
  • Question 18 - Which of these conditions is mithramycin used for? ...

    Correct

    • Which of these conditions is mithramycin used for?

      Your Answer: Hypercalcaemia of malignancy

      Explanation:

      Mithramycin or Plicamycin is a tricyclic pentaglycosidic antibiotic derived from Streptomyces strains. It inhibits RNA and protein synthesis by adhering to DNA. It is used as a fluorescent dye and as an antineoplastic agent. It is also used to reduce hypercalcaemia, especially caused by malignancy. Plicamycin is currently used in multiple areas of research, including cancer cell apoptosis and as a metastasis inhibitor.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      7.5
      Seconds
  • Question 19 - Gastric acid secretion is stimulated by which of the following? ...

    Correct

    • Gastric acid secretion is stimulated by which of the following?

      Your Answer: Gastrin

      Explanation:

      Gastric acid secretion is stimulated by three factors:
      – Acetylcholine, from parasympathetic neurones of the vagus nerve that innervate parietal cells directly
      – Gastrin, produced by pyloric G-cells
      – Histamine, produced by mast cells.
      Gastric acid is inhibited by three factors:
      – Somatostatin
      – Secretin
      – Cholecystokinin

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      5.7
      Seconds
  • Question 20 - A 46 year old politician with chronic hepatitis for several years visits the...

    Incorrect

    • A 46 year old politician with chronic hepatitis for several years visits the clinic for a review. Recently, his AFP is noted to be increased and an abdominal ultrasound demonstrates a 2.2cm lesion in segment V of the liver. What is the most appropriate course of action?

      Your Answer: USS guided liver biopsy

      Correct Answer: Liver MRI

      Explanation:

      In patients with liver tumours, it is crucial to detect and stage the tumours at an early stage (to select patients who will benefit from curative liver resection, and avoid unnecessary surgery). Therefore, an optimal preoperative evaluation of the liver is necessary, and a contrast-enhanced MRI is widely considered the state-of-the-art method. Liver MRI without contrast administration is appropriate for cholelithiasis but not sufficient for most liver tumour diagnoses.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
      31.1
      Seconds
  • Question 21 - Which of the following is likely to induce secretion of glucagon? ...

    Correct

    • Which of the following is likely to induce secretion of glucagon?

      Your Answer: Low serum concentration of glucose

      Explanation:

      The most potent stimulus for secretion of glucagon is hypoglycaemia whereas hyperglycaemia is a stimulus for insulin release. Glucagon secretion also occurs in response to high levels of amino acids. Somatostatin inhibits glucagon secretion. Parasympathetic stimulation increases pancreatic acinar secretion, but not of α-cells.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      133.1
      Seconds
  • Question 22 - A patient gives a history of dull discomfort in her abdomen associated with...

    Incorrect

    • A patient gives a history of dull discomfort in her abdomen associated with pain that she points to be on her right shoulder and right scapula. The following organs are most likely to be source of her pain:

      Your Answer: Stomach

      Correct Answer: Liver, duodenum and gallbladder

      Explanation:

      Referred pain is felt at a point away from the source of the pain or the unpleasant sensation. It arises when a nerve is damaged or compressed at a point but the pain is felt at another site that is the territory of that nerve. Common abdominal causes of referred pain to the shoulder and the shoulder blade are the liver, duodenum and gall bladder.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      25.2
      Seconds
  • Question 23 - A patient sustained an injury to the facial nerve after it emerges from...

    Incorrect

    • A patient sustained an injury to the facial nerve after it emerges from the stylomastoid foramen. What is the clinical impact of this injury?

      Your Answer: Taste from the anterior two-thirds of the tongue

      Correct Answer: Facial expression

      Explanation:

      The facial nerve is the seventh of the twelve paired cranial nerves. It emerges from the brainstem between the pons and the medulla. It controls the muscles of facial expression and supplies taste fibres to the anterior two-thirds of the tongue. It also supplies preganglionic parasympathetic fibres to several head and neck ganglia. Its branches and distribution are as follows:
      Inside the facial canal (proximal to the stylomastoid foramen):
      – Greater petrosal nerve – provides parasympathetic innervation to the lacrimal gland, as well as special taste sensory fibres to the palate via the nerve of pterygoid canal
      – Nerve to stapedius – provides motor innervation for the stapedius muscle in the middle ear
      – Chord tympani – provides parasympathetic innervation to the submandibular and sublingual glands and special sensory taste fibres for the anterior two-thirds of the tongue
      Outside the skull (distal to the stylomastoid foramen):
      – Posterior auricular nerve – controls the movements of some of the scalp muscles around the ear
      – Five major facial branches (in the parotid gland), from top to bottom: temporal branch, zygomatic branch, buccal branch, marginal mandibular branch and cervical branch. From the description given above it is obvious that injury to the facial nerve distal to the stylomastoid foramen will affect facial expression.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      20.1
      Seconds
  • Question 24 - A 47 year old accountant presents with symptoms of biliary colic and tests...

    Incorrect

    • A 47 year old accountant presents with symptoms of biliary colic and tests confirmed the diagnosis of gallstones. Which of the procedures listed below would most likely increase the risk of gallstone formation?

      Your Answer: Liver lobectomy

      Correct Answer: Ileal resection

      Explanation:

      Ileal resection may lead to bile acid malabsorption and an altered biliary lipid composition. A “bile acid deficiency” in the enterohepatic circulation with a relative excess of cholesterol and cholesterol supersaturated bile might ensue, causing cholesterol gallstone formation.

      In patients with Crohn’s disease involving the small
      intestine, the prevalence of gall-bladder stones is higher
      than that in the general population. One hypothesis
      for this increased risk is that bile acid malabsorption,
      secondary to impaired active bile acid transport as a
      consequence of ileal disease/resection, leads to a
      reduction in the total bile acid pool size and an increase
      in biliary cholesterol saturation. In patients with
      ulcerative or Crohn’s colitis, or who have undergone
      colectomy, the bile acid malabsorption is less than that
      in those with ileal dysfunction or resection, but the risk
      of gallstone formation is still increased, allegedly by the
      same mechanism.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
      58.6
      Seconds
  • Question 25 - In the human body, veins often run a course parallel to the artery...

    Correct

    • In the human body, veins often run a course parallel to the artery that has the same name. Which of the following listed veins doesn't run parallel to the artery of the same name?

      Your Answer: Inferior mesenteric

      Explanation:

      The inferior mesenteric artery and inferior mesenteric vein don’t run in tandem because the vein is part of the portal venous system-draining into the splenic vein which drains into the hepatic portal vein. The inferior mesenteric artery is a branch of the descending aorta at the level of L3. The inferior mesenteric vein and artery, however, drain the same region i.e. the descending and sigmoid colon and rectum.
      Superior epigastric vessels course together and are the continuation of the internal thoracic artery and vein.
      Superficial circumflex iliac vessels course together in the superficial fat of the abdominal wall.
      Superior rectal vessels are the terminal ends of the inferior mesenteric vessels, located on the posterior surface of the rectum.
      The ileocolic artery and vein are branches off the superior mesenteric vessels. Both course in the mesentery, supplying/draining the caecum, appendix, terminal portion of the ileum. The inferior epigastric vessels run together.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      10.1
      Seconds
  • Question 26 - Etoposide is a chemotherapeutic agent used in the treatment of different types of...

    Incorrect

    • Etoposide is a chemotherapeutic agent used in the treatment of different types of cancer. Which of the following is the correct indication for this drug?

      Your Answer: Colon cancer

      Correct Answer: Lung cancer

      Explanation:

      Etoposide phosphate is an inhibitor of the enzyme topoisomerase II. It is used as a form of chemotherapy for malignancies such as lung cancer, testicular cancer, lymphoma, non-lymphocytic leukaemia and glioblastoma multiforme. Side effects are very common and can include low blood cell counts, vomiting, loss of appetite, diarrhoea, hair loss, and fever.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      5.6
      Seconds
  • Question 27 - 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
      4.1
      Seconds
  • Question 28 - A 4-year-old boy inserts a crayon into his external auditory meatus. Attempts to...

    Incorrect

    • A 4-year-old boy inserts a crayon into his external auditory meatus. Attempts to remove it have not been successful. What is the best course of action?

      Your Answer: Manage conservatively

      Correct Answer: Operate on the next emergency operating list

      Explanation:

      The removal of foreign bodies from the ear is a common procedure in the emergency department.
      Abandon attempts to retrieve a foreign body if complications arise. If the object migrates farther into the canal or if bleeding, oedema, or increasing pain develops, consult an ENT specialist. Repeated attempts to remove a foreign body from the ear may result in infection, perforation, or another morbidity.
      The presence of a tympanic membrane (TM) perforation, contact of a foreign body with the tympanic membrane, or incomplete visualization of the auditory canal are indications for urgent-emergent ENT consultation for removal by operative microscope and speculum.
      Local anaesthesia is invasive and is not generally used for uncomplicated ear foreign body removal because of the complex innervations of the external ear canal.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Paediatric Surgery
      11.6
      Seconds
  • Question 29 - A lesion involving the lateral portion of the dorsal columns at the level...

    Correct

    • A lesion involving the lateral portion of the dorsal columns at the level of the nape of the neck will most likely affect:

      Your Answer: Vibratory sensations from the ipsilateral arm

      Explanation:

      At the level mentioned in the question, the lateral portion of dorsal columns comprises of the fasciculus cuneatus. Axons carrying the sensations of touch, vibration and proprioception from the ipsilateral arm enter the spinal cord and ascend in the fasciculus cuneatus, synapsing in the nucleus cuneatus of the caudal medulla. Secondary neurons from this nucleus give rise to internal arcuate fibres, which decussate and ascend to the thalamus as the medial lemniscus. Tertiary neurons from there project to the ipsilateral somatosensory cortex. Thus, any damage to the fasciculus cuneatus will result in a deficit in tactile, proprioceptive and vibratory sensations in the ipsilateral arm, and not the contralateral arm.
      Fine motor control of the fingers is mainly carried by the ipsilateral lateral corticospinal tract in the lateral funiculus of the cord. Motor control of the contralateral foot is carried by the ipsilateral corticospinal tract in the lateral funiculus of the cord. Lack of sweating of the face could be produced by interruption of sympathetic innervation. Proprioception from the ipsilateral leg is carried by the fasciculus gracilis in the medial part of the dorsal columns.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      5.7
      Seconds
  • Question 30 - A 12 year old girl is admitted with severe (35%) burns following a...

    Incorrect

    • A 12 year old girl is admitted with severe (35%) burns following a fire at home. She was transferred to the critical care unit after the wound was cleaned and dressed. She became tachycardic and hypotensive one day after skin grafts were done. She has vomited three times and blood was seen in it. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Curling's ulcers

      Explanation:

      Answer: Curling’s ulcers

      Curling’s ulcer is an acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa. The most common mode of presentation of stress ulcer is the onset of acute upper GI bleed like hematemesis or melena in a patient with the acute critical illness.

      A similar condition involving elevated intracranial pressure is known as Cushing’s ulcer. Cushing’s ulcer is a gastro-duodenal ulcer produced by elevated intracranial pressure caused by an intracranial tumour, head injury or other space-occupying lesions. The ulcer, usually single and deep, may involve the oesophagus, stomach, and duodenum. Increased intracranial pressure may affect different areas of the hypothalamic nuclei or brainstem leading to overstimulation of the vagus nerve or paralysis of the sympathetic system. Both of these circumstances increase secretion of gastric acid and the likelihood of ulceration of gastro-duodenal mucosa.

      Mallory-Weiss syndrome is characterized by upper gastrointestinal bleeding secondary to longitudinal mucosal lacerations (known as Mallory-Weiss tears) at the gastroesophageal junction or gastric cardia. However, Mallory-Weiss syndrome may occur after any event that provokes a sudden rise in the intragastric pressure or gastric prolapse into the oesophagus, including antecedent transoesophageal echocardiography. Precipitating factors include retching, vomiting, straining, hiccupping, coughing, primal scream therapy, blunt abdominal trauma, and cardiopulmonary resuscitation. In a few cases, no apparent precipitating factor can be identified. One study reported that 25% of patients had no identifiable risk factors.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
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SESSION STATS - PERFORMANCE PER SPECIALTY

Basic Sciences (15/22) 68%
Pathology (8/9) 89%
Anatomy (3/7) 43%
Emergency Medicine And Management Of Trauma (2/2) 100%
Principles Of Surgery-in-General (4/4) 100%
Post-operative Management And Critical Care (1/1) 100%
Physiology (4/6) 67%
Peri-operative Care (1/1) 100%
Generic Surgical Topics (2/3) 67%
Hepatobiliary And Pancreatic Surgery (1/2) 50%
Paediatric Surgery (1/1) 100%
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