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  • Question 1 - A 66-year-old man complains of constant headaches. On physical examination, the only relevant...

    Correct

    • A 66-year-old man complains of constant headaches. On physical examination, the only relevant sign is a dark brown mole located on left his arm which has grown in size over the years and is itchy and painful. A MRI of the brain revealed a solitary lesion at the grey-white junction in the right frontal lobe, without ring enhancement. This lesion is most likely to be:

      Your Answer: Metastatic carcinoma

      Explanation:

      The location of the mass at the grey–white junction is typical of a metastasis. The most frequent types of metastatic brain tumours originate in the lung, skin, kidney, breast and colon. These tumour cells reach the brain via the bloodstream. This patient is likely to have skin cancer, which caused the metastatic brain tumour.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      62.7
      Seconds
  • Question 2 - The normal location of the major duodenal papilla: ...

    Correct

    • The normal location of the major duodenal papilla:

      Your Answer: Descending part of the duodenum

      Explanation:

      The major duodenal papilla is on the descending portion of the duodenum on the medial side, about 7-10cm from the pylorus. The pancreatic ducts and the common bile ducts unite and open by a common orifice on the summit of the duodenal papilla.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      70.6
      Seconds
  • Question 3 - A 66 year old woman undergoes an emergency hip hemiarthroplasty. The procedure is...

    Correct

    • A 66 year old woman undergoes an emergency hip hemiarthroplasty. The procedure is complicated by a fracture of the femoral shaft following the insertion of the prosthesis. She is seen postoperatively to be unsteady on her feet and she is depressed. She remains bedbound for 2 weeks and is slow to progress despite adequate physiotherapy. Which of the following physiological changes is not seen after prolonged immobilization?

      Your Answer: Bradycardia

      Explanation:

      Answer: Bradycardia

      Prolonged bed rest and immobilization inevitably lead to complications. Such complications are much easier to prevent than to treat. Musculoskeletal complications include loss of muscle strength and endurance, contractures and soft tissue changes, disuse osteoporosis, and degenerative joint disease. Cardiovascular complications include an increased heart rate (tachycardia), decreased cardiac reserve, orthostatic hypotension, and venous thromboembolism.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      24.1
      Seconds
  • Question 4 - A patients sciatic nerve has been severed following a stab injury. What would...

    Correct

    • A patients sciatic nerve has been severed following a stab injury. What would be affected?

      Your Answer: There would still be cutaneous sensation over the anteromedial surface of the thigh

      Explanation:

      The sciatic nerve supplies nearly all of the sensation of the skin of the leg and the muscles of the back of the thigh, leg and foot. A transection of the sciatic nerve at its exit from the pelvis will affect all the above-mentioned functions except cutaneous sensation over the anteromedial surface of the thigh, which comes from the femoral nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      14.3
      Seconds
  • Question 5 - What is the chief ligament preventing posterior sliding of the tibia on the...

    Incorrect

    • What is the chief ligament preventing posterior sliding of the tibia on the femur ?

      Your Answer: Anterior cruciate

      Correct Answer: Posterior cruciate

      Explanation:

      The posterior cruciate ligament is attached to the posterior intercondyloid fossa of the tibia and the lateral and front part of the medial condyle of the femur. It resists sliding of the tibia posteriorly.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      16.7
      Seconds
  • Question 6 - The nasolacrimal duct is a membranous canal. It extends from the lower part...

    Incorrect

    • The nasolacrimal duct is a membranous canal. It extends from the lower part of the lacrimal sac and drains into which structure?

      Your Answer: Maxillary sinus

      Correct Answer: Inferior meatus

      Explanation:

      The nasolacrimal duct carries tears from the lacrimal sac of the eye into the nasal cavity. The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. The opening of the nasolacrimal duct into the inferior nasal meatus of the nasal cavity is partially covered by a mucosal fold (valve of Hasner or plica lacrimalis). Excess tears flow through the nasolacrimal duct which drains into the inferior nasal meatus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      22.4
      Seconds
  • Question 7 - A patient is diagnosed with a tumour of the parotid gland. During surgical...

    Incorrect

    • A patient is diagnosed with a tumour of the parotid gland. During surgical removal of the gland, which artery is vulnerable to injury?

      Your Answer: Greater petrosal nerve

      Correct Answer: External carotid artery

      Explanation:

      The external carotid artery is a major artery of the head and neck. It arises from the common carotid artery when it splits into the external and internal carotid artery. It supplies blood to the face and neck. The external carotid artery begins opposite the upper border of the thyroid cartilage and, taking a slightly curved course, passes upward and forward and then inclines backward to the space behind the neck of the mandible, where it divides into the superficial temporal and internal maxillary arteries. It rapidly diminishes in size in its course up the neck, owing to the number and large size of the branches given off from it. At its origin, this artery is more superficial and placed nearer the midline than the internal carotid and is contained within the carotid triangle. The external carotid artery is covered by the skin, superficial fascia, platysma, deep fascia and anterior margin of the sternocleidomastoid. It is crossed by the hypoglossal nerve, by the lingual, ranine, common facial and superior thyroid veins; and by the digastric and stylohyoid; higher up it passes deeply into the substance of the parotid gland, where it lies deep to the facial nerve and the junction of the temporal and internal maxillary veins. It is here that it is in danger during surgery of the parotid gland.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      14.7
      Seconds
  • Question 8 - Which of the deep fasciae located in the anterolateral abdominal wall form the...

    Correct

    • Which of the deep fasciae located in the anterolateral abdominal wall form the inguinal ligament?

      Your Answer: External abdominal oblique aponeurosis

      Explanation:

      The inguinal ligament is the inferior border of the aponeurosis of the external oblique abdominis and extends from the anterior superior iliac spine to the pubic tubercle from whence it is reflected backward and laterally to attach to the pectineal line and form the lacunar ligament.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      25.6
      Seconds
  • Question 9 - A 6 week old preterm infant is scheduled for an inguinal hernia repair....

    Incorrect

    • A 6 week old preterm infant is scheduled for an inguinal hernia repair. Which of the following fluids should be ideally administered to him while he is on NPO?

      Your Answer: Hartmann's solution

      Correct Answer: 10% dextrose

      Explanation:

      There is a substantial risk of hypoglycaemia in neonates following surgery, therefore 10% dextrose should be administered to them to avoid the complications associated with hypoglycaemia.

    • This question is part of the following fields:

      • Post-operative Management And Critical Care
      • Principles Of Surgery-in-General
      10.2
      Seconds
  • Question 10 - The renal cortex and medulla, if seen under the microscope, is lacking one...

    Correct

    • The renal cortex and medulla, if seen under the microscope, is lacking one of the following:

      Your Answer: Squamous epithelium

      Explanation:

      Capillaries, Henle’s loop, collecting ducts, Bertin columns and type IV collagen in glomerular basement membrane are all structures present in the renal cortex or medulla. The squamous epithelium is the only one that is lacking in both the renal cortex and medulla, because normally it is not found above the outer urethra.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      5.4
      Seconds
  • Question 11 - What is the likely course of a pulmonary embolism arising from the leg...

    Correct

    • What is the likely course of a pulmonary embolism arising from the leg veins and ending in the apical segmental pulmonary artery that supplies the superior lobe of left lung?.

      Your Answer: Inferior vena cava – right atrium – tricuspid valve – right ventricle – pulmonary trunk – left pulmonary artery – left superior lobar artery – left apical segmental artery

      Explanation:

      A clot originating in the leg vein will go to the inferior vena cava, into the right atrium, through the tricuspid valve, into the right ventricle, through the pulmonary trunk, into the left pulmonary artery, into the left superior lobar artery and then finally reach the left apical segmental artery.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      24
      Seconds
  • Question 12 - A 47-year-old male develops acute respiratory distress syndrome during an attack of severe...

    Correct

    • A 47-year-old male develops acute respiratory distress syndrome during an attack of severe acute pancreatitis. Which of the following is not a feature of adult respiratory distress syndrome?

      Your Answer: A Swann Ganz Catheter would typically have a reading in excess of 18mmHg.

      Explanation:

      Acute respiratory distress syndrome (ARDS) is an inflammatory process in the lungs that induces non-hydrostatic protein-rich pulmonary oedema. The immediate consequences are profound hypoxemia, decreased lung compliance, and increased intrapulmonary shunt and dead space. The clinicopathological aspects include severe inflammatory injury to the alveolar-capillary barrier, surfactant depletion, and loss of aerated lung tissue.

      The most recent definition of ARDS, the Berlin definition, was proposed by a working group under the aegis of the European Society of Intensive Care Medicine. It defines ARDS by the presence within 7 days of a known clinical insult or new or worsening respiratory symptoms of a combination of acute hypoxemia (PaO2/FiO2 ≤ 300 mmHg), in a ventilated patient with a positive end-expiratory pressure (PEEP) of at least 5 cmH2O, and bilateral opacities not fully explained by heart failure or volume overload i.e. the heart pressure is norma. The Berlin definition uses the PaO2/FiO2 ratio to distinguish mild ARDS (200 < PaO2/FiO2 ≤ 300 mmHg), moderate ARDS (100 < PaO2/FiO2 ≤ 200 mmHg), and severe ARDS (PaO2/FiO2 ≤ 100 mmHg).
      Most cases of ARDS in adults are associated with pulmonary sepsis (46 percent) or nonpulmonary sepsis (33 percent). Risk factors include those causing direct lung injury (e.g., pneumonia, inhalation injury, pulmonary contusion) and those causing indirect lung injury (e.g., nonpulmonary sepsis, burns, transfusion-related acute lung injury)

      Most patients with ARDS need sedation, intubation, and ventilation while the underlying injury is treated. Any ventilator mode may be used, according to the Surviving Sepsis Clinical Practice Guideline and the National Heart, Lung, and Blood Institute’s ARDS Network (ARDSNet). Respiratory rate, expiratory time, positive end-expiratory pressure, and FiO2 are set following ARDSNet protocols. Settings are adjusted to maintain an oxygen saturation of 88 to 95 percent and a plateau pressure of 30 cm H2O or less to avoid barotrauma. Clinical practice guidelines recommend maintaining an arterial pH of 7.30 to 7.45, although patients in some research trials have tolerated permissive hypercapnia and a pH as low as 7.15

    • This question is part of the following fields:

      • Post-operative Management And Critical Care
      • Principles Of Surgery-in-General
      17.5
      Seconds
  • Question 13 - A 40-year-old man is brought to the A&E department following a motorcycle accident....

    Correct

    • A 40-year-old man is brought to the A&E department following a motorcycle accident. He sustained a closed, unstable spiral tibial fracture and has been managed with an intramedullary nail. However, after being transferred to the ward, he is noted to have increasing pain in the affected limb. On examination, the limb is swollen and tender with pain felt on passive stretching of the toes.What is the most likely diagnosis?

      Your Answer: Compartment syndrome

      Explanation:

      Severe pain in the limb following fixation with intramedullary devices should raise suspicion of compartment syndrome, especially in tibial fractures.

      Compartment syndrome is a particular complication that may occur following fractures, especially supracondylar fractures and tibial shaft injuries. It is characterised by raised pressure within a closed anatomical space which may, eventually, compromise tissue perfusion, resulting in necrosis.

      The clinical features of compartment syndrome include:
      1. Pain, especially on movement
      2. Paraesthesia
      3. Pallor
      4. Paralysis of the muscle group may also occur

      Diagnosis is made by measurement of intracompartmental pressure. Pressures >20mmHg are abnormal and >40mmHg are diagnostic.

      Compartment syndrome requires prompt and extensive fasciotomy. Myoglobinuria may occur following fasciotomy, resulting in renal failure. Therefore, aggressive IV fluids are required. If muscle groups are frankly necrotic at fasciotomy, they should be debrided, and amputation may have to be considered.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      11.2
      Seconds
  • Question 14 - A 50-year-old woman goes to the doctor complaining of myalgia, muscle cramps, and...

    Incorrect

    • A 50-year-old woman goes to the doctor complaining of myalgia, muscle cramps, and weakness; she is diagnosed with severe hypokalaemia. Which of the following is the most common cause of hypokalaemia?

      Your Answer: Diabetic ketoacidosis

      Correct Answer: Prolonged vomiting

      Explanation:

      Potassium is one of the body’s major ions. Nearly 98% of the body’s potassium is intracellular. The ratio of intracellular to extracellular potassium is important in determining the cellular membrane potential. Small changes in the extracellular potassium level can have profound effects on the function of the cardiovascular and neuromuscular systems. Hypokalaemia may result from conditions as varied as renal or gastrointestinal (GI) losses, inadequate diet, transcellular shift (movement of potassium from serum into cells) and medications. The important causes of hypokalaemia are:
      Renal losses: renal tubular acidosis, hyperaldosteronism, magnesium depletion, leukaemia (mechanism uncertain).
      GI losses: vomiting or nasogastric suctioning, diarrhoea, enemas or laxative use, ileal loop.
      Medication effects: diuretics (most common cause), β-adrenergic agonists, steroids, theophylline, aminoglycosides.
      Transcellular shift: insulin, alkalosis.
      Severe hypokalaemia, with serum potassium concentrations of 2.5–3 meq/l, may cause muscle weakness, myalgia, tremor, muscle cramps and constipation.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      20.1
      Seconds
  • Question 15 - Which of the following conditions can present with multiple abscesses that may discharge...

    Correct

    • Which of the following conditions can present with multiple abscesses that may discharge sulphur granules?

      Your Answer: Actinomycosis

      Explanation:

      Actinomycosis is primarily caused by any of the several members of the bacterial genus Actinomyces. These bacteria are generally anaerobes. And can cause multiple abscesses that may discharge sulphur granules.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      7
      Seconds
  • Question 16 - A 35-year-old aid worker becomes unwell whilst helping at the scene of a...

    Correct

    • A 35-year-old aid worker becomes unwell whilst helping at the scene of a recent earthquake. He develops vomiting and soon afterwards, profuse watery diarrhoea. What is the most likely infective organism?

      Your Answer: Vibrio cholera

      Explanation:

      The passage of extremely loose and watery stools is characteristic of Vibrio cholera infection. Most of the other gastroenteric infections do not produce such watery motions.

      Vibrio cholerae is a Gram-negative, comma-shaped bacterium. It’s natural habitat is brackish or saltwater. Some strains of V. cholerae cause the disease cholera.

      Transmission occurs through the ingestion of contaminated water or food. Sudden large outbreaks are usually caused by a contaminated water supply. Outbreaks and endemic and sporadic cases are often attributed to raw or undercooked seafood.

      Symptoms of the disease include sudden onset of effortless vomiting and profuse watery diarrhoea. Correction of fluid and electrolyte losses are the mainstay of treatment. Most cases resolve shortly afterwards, and therefore, antibiotics are not generally indicated.

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
      298.8
      Seconds
  • Question 17 - A 42 year old man slips while walking down the stairs and injures...

    Correct

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

      Your Answer: Application of below knee plaster cast

      Explanation:

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

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

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

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

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      41.4
      Seconds
  • Question 18 - Which is the correct order of tendons passing from medial to lateral-posterior to...

    Correct

    • Which is the correct order of tendons passing from medial to lateral-posterior to the medial malleolus?

      Your Answer: Posterior tibial, flexor digitorum longus, flexor hallucis longus

      Explanation:

      The correct order of structures is the tendon of tibialis posterior, tendon of flexor digitorum longus, posterior tibial artery (and vein), tibial nerve and tendon of flexor hallucis longus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      6.5
      Seconds
  • Question 19 - A 45-year-old female with a metallic heart valve has just undergone an elective...

    Correct

    • A 45-year-old female with a metallic heart valve has just undergone an elective paraumbilical hernia repair. In view of her metallic valve, she is given unfractionated heparin perioperatively. How should the therapeutic efficacy be monitored, assuming her renal function is normal?

      Your Answer: Measurement of APTT

      Explanation:

      Because of the substantial risk of thromboembolism early after valve replacement, perioperative initiation of anticoagulation is necessary, despite the increased risk for bleeding. Anticoagulation should be initiated within 24 h after the procedure with unfractionated heparin or low-molecular-weight heparin (LMWH).
      Heparin is monitored by checking the activated partial thromboplastin time or anti-Xa activity.
      Oral anticoagulants are monitored by INR.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      14.9
      Seconds
  • Question 20 - During a normal respiratory exhalation, what is the recoil alveolar pressure? ...

    Correct

    • During a normal respiratory exhalation, what is the recoil alveolar pressure?

      Your Answer: +10 cmH2O

      Explanation:

      To determine compliance of the respiratory system, changes in transmural pressures (in and out) immediately across the lung or chest cage (or both) are measured simultaneously with changes in lung or thoracic cavity volume. Changes in lung or thoracic cage volume are determined using a spirometer with transmural pressures measured by pressure transducers. For the lung alone, transmural pressure is calculated as the difference between alveolar (pA; inside) and intrapleural (ppl; outside) pressure. To calculate chest cage compliance, transmural pressure is ppl (inside) minus atmospheric pressure (pB; outside). For the combined lung–chest cage, transmural pressure or transpulmonary pressure is computed as pA – pB. pA pressure is determined by having the subject deeply inhale a measured volume of air from a spirometer. Under physiological conditions the transpulmonary or recoil pressure is always positive; intrapleural pressure is always negative and relatively large, while alveolar pressure moves from slightly negative to slightly positive as a person breathes.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      4.8
      Seconds
  • Question 21 - A 20-year old involved in a brawl was stabbed in the anterior chest...

    Correct

    • A 20-year old involved in a brawl was stabbed in the anterior chest in a structure that is in close proximity to where the first rib articulates with the sternum. What is the structure that was most likely injured?

      Your Answer: Sternoclavicular joint

      Explanation:

      The first rib articulates with the sternum right below the sternoclavicular joint.
      The sternal angle articulates with the costal cartilage of the second rib.
      The nipple is found between the fourth and the fifth ribs, in the fourth intercostal space.
      The xiphoid process is located right below the point of articulation of the costal cartilage of rib 7 with the sternum.
      The root of the lung is the part of the lung where neurovascular structures enter and leave the lung.
      Acromioclavicular joint is the point of articulation between the acromion process and the clavicle, near the shoulder.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      7.4
      Seconds
  • Question 22 - Which of the following can occur even in the absence of brainstem co-ordination?...

    Correct

    • Which of the following can occur even in the absence of brainstem co-ordination?

      Your Answer: Gastric emptying

      Explanation:

      Although gastric emptying is under both neural and hormonal control, it does not require brainstem co-ordination. Increased motility of the orad stomach (decreased distensibility) or of the distal stomach (increased peristalsis), decreased pyloric tone, decreased duodenal motility or a combination of these, all increase the rate of gastric emptying. The major control mechanism for gastric emptying is through duodenal gastric feedback. The duodenum has receptors for the presence of acid, carbohydrate, fat and protein digestion products, osmolarity different from that of plasma, and distension. Activating these receptors decreases the rate of gastric emptying. Neural mechanisms involve both enteric and vagal pathways and a vagotomy impairs the gastric emptying regulation. CCK (cholecystokinin) slows gastric emptying at physiological levels of the hormone. Gastrin, secretin and glucose-1-phosphate also slow gastric emptying, but require higher doses.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      4
      Seconds
  • Question 23 - Production of pain is most likely associated with: ...

    Incorrect

    • Production of pain is most likely associated with:

      Your Answer: Acetylcholine

      Correct Answer: Substance P

      Explanation:

      Substance P is a short-chain polypeptide that functions as a neurotransmitter and as a neuromodulator, and is thus, a neuropeptide. It has been linked with pain regulation, mood disorders, stress, reinforcement, neurogenesis, respiratory rhythm, neurotoxicity, nausea and emesis. It is also a potent vasodilator as it brings about release of nitric oxide from the endothelium. Its release can also cause hypotension.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      5.6
      Seconds
  • Question 24 - In the glomerulus of the kidney, the mesangium is a structure associated with the capillaries. It has extraglomerular mesangial...

    Correct

    • In the glomerulus of the kidney, the mesangium is a structure associated with the capillaries. It has extraglomerular mesangial cells that:

      Your Answer: Form the juxtaglomerular apparatus in combination with the macula densa and juxtaglomerular cells

      Explanation:

      The mesangium is an inner layer of the glomerulus, within the basement membrane surrounding the glomerular capillaries. The mesangial cells are phagocytic and secrete the amorphous basement membrane-like material known as the mesangial matrix. They are typically separated from the lumen of the capillaries by endothelial cells. The other type of cells in the mesangium are the extraglomerular mesangial cells which form the juxtaglomerular apparatus in combination with two other types of cells: the macula densa of the distal convoluted tubule and juxtaglomerular cells of the afferent arteriole. This apparatus controls blood pressure through the renin–angiotensin–aldosterone system.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      23.7
      Seconds
  • Question 25 - A teenager is taken to his doctor because his mother noticed a patch...

    Correct

    • 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.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      9
      Seconds
  • Question 26 - A 44 year old woman suffers 20% partial and full thickness burns in...

    Correct

    • A 44 year old woman suffers 20% partial and full thickness burns in a garage fire. There is also an associated inhalational injury. Her doctors have decided to administer intravenous fluids to replace fluid loss. Which of the following intravenous fluids should be used for initial resuscitation?

      Your Answer: Hartmann's solution

      Explanation:

      The goal of fluid management in major burn injuries is to maintain the tissue perfusion in the early phase of burn shock, in which hypovolemia finally occurs due to steady fluid extravasation from the intravascular compartment.

      Burn injuries of less than 20% are associated with minimal fluid shifts and can generally be resuscitated with oral hydration, except in cases of facial, hand and genital burns, as well as burns in children and the elderly. As the total body surface area (TBSA) involved in the burn approaches 15–20%, the systemic inflammatory response syndrome is initiated and massive fluid shifts, which result in burn oedema and burn shock, can be expected.

      The ideal burn resuscitation is the one that effectively restores plasma volume, with no adverse effects. Isotonic crystalloids, hypertonic solutions and colloids have been used for this purpose, but every solution has its advantages and disadvantages. None of them is ideal, and none is superior to any of the others.
      Crystalloids are readily available and cheaper than some of the other alternatives. RL solution, Hartmann solution (a solution similar to RL solution) and normal saline are commonly used. There are some adverse effects of the crystalloids: high volume administration of normal saline produces hyperchloremic acidosis, RL increases the neutrophil activation after resuscitation for haemorrhage or after infusion without haemorrhage. d-lactate in RL solution containing a racemic mixture of the d-lactate and l-lactate isomers has been found to be responsible for increased production of ROS. RL used in the majority of hospitals contains this mixture. Another adverse effect that has been demonstrated is that crystalloids have a substantial influence on coagulation. Recent studies have demonstrated that in vivo dilution with crystalloids (independent of the type of the crystalloid) resulted in a hypercoagulable state.
      Despite these adverse effects, the most commonly used fluid for burn resuscitation in the UK and Ireland is Hartmann’s solution (adult units 76%, paediatric units 75%). Another study has revealed that RL is the most popular type of fluid in burn units located in USA and Canada.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      4.5
      Seconds
  • Question 27 - A middle aged man who is reported to have a penicillin allergy is...

    Correct

    • A middle aged man who is reported to have a penicillin allergy is given a dose of intravenous co-amoxiclav before undergoing an inguinal hernia repair. His vital signs a few minutes after are: pulse 131bpm and blood pressure 61/42mmHg. Which of the following is the first line treatment?

      Your Answer: Adrenaline 1:1000 IM

      Explanation:

      Answer: Adrenaline 1:1000 IM

      Early treatment with intramuscular adrenaline is the treatment of choice for patients having an anaphylactic reaction. IM Injection:

      Adults: The usual dose is 500 micrograms (0.5ml of adrenaline 1/1000). If necessary, this dose may be repeated several times at 5-minute intervals according to blood pressure, pulse and respiratory function.

      Additional measures

      Beta2-agonists for bronchospasm: administer salbutamol or terbutaline by aerosol or nebuliser.

      Antihistamines: administer both H1and H2receptor blockers slowly intravenously:
      promethazine 0.5-1 mg/kg
      and
      ranitidine 1 mg/kg or famotidine 0.4 mg/kg or cimetidine 4 mg/kg
      Corticosteroids: administer intravenously: hydrocortisone 2-6 mg/kg or dexamethasone 0.1-0.4 mg/kg
      Nebulised adrenaline (5 mL of 1:1000) may be tried in laryngeal oedema and often will ease upper airways obstruction. However, do not delay intubation if upper airways obstruction is progressive.

      Anaphylaxis is an acute, potentially fatal, multiorgan system reaction caused by the release of chemical mediators from mast cells and basophils. The classic form involves prior sensitization to an allergen with later reexposure, producing symptoms via an immunologic mechanism.

      Anaphylaxis most commonly affects the cutaneous, respiratory, cardiovascular, and gastrointestinal systems. The skin or mucous membranes are involved in 80-90% of cases. A majority of adult patients have some combination of urticaria, erythema, pruritus, or angioedema. However, for poorly understood reasons, children may present more commonly with respiratory symptoms followed by cutaneous symptoms. It is also important to note that some of the most severe cases of anaphylaxis present in the absence of skin findings.

      Initially, patients often experience pruritus and flushing. Other symptoms can evolve rapidly, such as the following:

      Dermatologic/ocular: Flushing, urticaria, angioedema, cutaneous and/or conjunctival injection or pruritus, warmth, and swelling

      Respiratory: Nasal congestion, coryza, rhinorrhoea, sneezing, throat tightness, wheezing, shortness of breath, cough, hoarseness, dyspnoea

      Cardiovascular: Dizziness, weakness, syncope, chest pain, palpitations

      Gastrointestinal: Dysphagia, nausea, vomiting, diarrhoea, bloating, cramps

      Neurologic: Headache, dizziness, blurred vision, and seizure (very rare and often associated with hypotension)

      Other: Metallic taste, feeling of impending doom

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      2.1
      Seconds
  • Question 28 - A patient is unable to move the mandible to the left. Which muscle...

    Correct

    • A patient is unable to move the mandible to the left. Which muscle is affected in this case?

      Your Answer: Right lateral pterygoid muscle

      Explanation:

      Patients with paralysis of the right pterygoid muscle are unable to move their mandible laterally to the left.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      47.2
      Seconds
  • Question 29 - Which of the following diseases causes abrupt vertigo, nausea, vomiting, tinnitus, and nystagmus?...

    Correct

    • Which of the following diseases causes abrupt vertigo, nausea, vomiting, tinnitus, and nystagmus?

      Your Answer: Vestibular neuronitis

      Explanation:

      Vestibular neuronitis or labyrinthitis causes a self-limited episode of vertigo, presumably due to inflammation of the vestibular division of cranial nerve VIII. Its causes are unknown, It may be due to a virus, but it can be related to a bacterial infection, head injury, stress, allergy, or as a reaction to medication. Symptoms can last up to 7-10 days.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      6.9
      Seconds
  • Question 30 - A 53 year old male presents with generalised right upper quadrant pain which...

    Correct

    • A 53 year old male presents with generalised right upper quadrant pain which started from the previous day. On admission, he is septic and jaundiced and there is tenderness in the right upper quadrant. What is the most likely diagnosis?

      Your Answer: Cholangitis

      Explanation:

      Acute cholangitis is a bacterial infection superimposed on an obstruction of the biliary tree most commonly from a gallstone, but it may be associated with neoplasm or stricture. The classic triad of findings is right upper quadrant (RUQ) pain, fever, and jaundice. A pentad may also be seen, in which mental status changes and sepsis are added to the triad.

      A spectrum of cholangitis exists, ranging from mild symptoms to fulminant overwhelming sepsis. Thus, therapeutic options for patient management include broad-spectrum antibiotics and, potentially, emergency decompression of the biliary tree.
      The main factors in the pathogenesis of acute cholangitis are biliary tract obstruction, elevated intraluminal pressure, and infection of bile. A biliary system that is colonized by bacteria but is unobstructed, typically does not result in cholangitis. It is believed that biliary obstruction diminishes host antibacterial defences, causes immune dysfunction, and subsequently increases small bowel bacterial colonization. Although the exact mechanism is unclear, it is believed that bacteria gain access to the biliary tree by retrograde ascent from the duodenum or from portal venous blood. As a result, infection ascends into the hepatic ducts, causing serious infection. Increased biliary pressure pushes the infection into the biliary canaliculi, hepatic veins, and perihepatic lymphatics, leading to bacteraemia (25-40%). The infection can be suppurative in the biliary tract.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
      5.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Basic Sciences (14/19) 74%
Pathology (4/4) 100%
Anatomy (7/10) 70%
Peri-operative Care (2/2) 100%
Principles Of Surgery-in-General (7/8) 88%
Post-operative Management And Critical Care (1/2) 50%
Emergency Medicine And Management Of Trauma (3/3) 100%
Physiology (3/5) 60%
Clinical Microbiology (1/1) 100%
Generic Surgical Topics (3/3) 100%
Orthopaedics (2/2) 100%
Hepatobiliary And Pancreatic Surgery (1/1) 100%
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