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  • Question 1 - Which of the following arteries is the posterior branch of the external carotid...

    Incorrect

    • Which of the following arteries is the posterior branch of the external carotid artery?

      Your Answer: Posterior cerebral

      Correct Answer: Superficial temporal

      Explanation:

      The external carotid artery is a branch of the common carotid artery that supplies parts of the neck, head and face. It branches off from the common carotid artery at the level of the thyroid cartilage. The external carotid, at the level of the mandible divides into the maxillary artery and the superficial temporal. The superficial temporal artery is the posterior branch of these two arteries. It starts off, somewhat, as a continuation of the external carotid artery at the substance of the parotid gland. Anterior cerebral and middle cerebral arteries are branches of the internal carotid artery.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      18.1
      Seconds

  • Question 2 - A 34 year old athlete presents to the clinic after receiving a hard...

    Incorrect

    • A 34 year old athlete presents to the clinic after receiving a hard blow to his palm that has resulted into a painful swelling over the volar aspect of his hand. On examination, pain is felt on wrist movement and longitudinal compression of the thumb. Which of the following is the most likely injury?

      Your Answer: Bennets fracture

      Correct Answer: Scaphoid fracture

      Explanation:

      The scaphoid bone is the most commonly fractured carpal bone. Fractures are most often localized in the middle third of the scaphoid bone.
      Generally, scaphoid bone fractures result from indirect trauma when an individual falls onto the outstretched hand with a hyperextended and radially deviated wrist. Pain when applying pressure to the anatomical snuffbox is highly suggestive of a scaphoid bone fracture.
      X-ray is the initial test of choice for diagnosis. Computer tomography and magnetic resonance imaging may be indicated, if x-ray findings are negative but clinical suspicion is high.
      Treatment can be conservative (e.g., wrist immobilization) or in certain cases surgical (e.g., proximal pole fracture). Complications include non-union and avascular necrosis.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      23.1
      Seconds

  • Question 3 - An explorative laparotomy is done on a 23 year old following a gunshot...

    Incorrect

    • An explorative laparotomy is done on a 23 year old following a gunshot abdominal injury through the right iliac fossa. It is found that the ileocolic artery is severed and the bullet had perforated the caecum. From which branch does the ileocolic artery originate?

      Your Answer: Inferior mesenteric artery

      Correct Answer: Superior mesenteric artery

      Explanation:

      Ileocolic artery branches off from the superior mesenteric artery. It then divides to give a superior and inferior branch.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      15.7
      Seconds

  • Question 4 - A 27-year-old cyclist is hit by a bus travelling at 30mph. He was...

    Incorrect

    • A 27-year-old cyclist is hit by a bus travelling at 30mph. He was not wearing a helmet. He arrives with a GCS of 3/15 and is intubated. A CT scan shows evidence of cerebral contusion but no localising clinical signs are present. What is the most appropriate course of action?

      Your Answer: Decompressive craniotomy

      Correct Answer: Insertion of intra cranial pressure monitoring device

      Explanation:

      This patient may well develop raised ICP over the next few days and intracranial pressure monitoring will help with the
      management.

      Summary of guidelines:

      For adults who have sustained a head injury and have any of the following risk factors, perform a CT head scan within 1 hour of the risk factor being identified:
      – GCS less than 13 on initial assessment in the emergency department.
      – GCS less than 15 at 2 hours after the injury on assessment in the emergency department.
      – Suspected open or depressed skull fracture.
      – Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
      – Post-traumatic seizure.
      – Focal neurological deficit.
      – More than 1 episode of vomiting.
      A provisional written radiology report should be made available within 1 hour of the scan being performed

      For adults with any of the following risk factors who have experienced some loss of consciousness or amnesia since the injury, perform a CT head scan within 8 hours of the head injury:
      – Age 65 years or older.
      – Any history of bleeding or clotting disorders.
      – Dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs).
      – More than 30 minutes’ retrograde amnesia of events immediately before the head injury.
      A provisional written radiology report should be made available within 1 hour of the scan being performed.

      – Intubate and ventilate all patients with GCS 8 or less requiring transfer to a neuroscience unit.
      Intubate and ventilate the patient immediately in the following circumstances:
      – Coma – not obeying commands, not speaking, not eye opening (that is, GCS 8 or less).
      – Loss of protective laryngeal reflexes.
      – Ventilatory insufficiency as judged by blood gases: hypoxaemia (PaO2 < 13 kPa on oxygen) or hypercarbia (PaCO2 > 6 kPa).
      – Spontaneous hyperventilation causing PaCO2 < 4 kPa.
      – Irregular respirations.

      Use the criteria below for admitting patients to hospital following a head injury:
      – Patients with new, clinically significant abnormalities on imaging.
      – Patients whose GCS has not returned to 15 after imaging, regardless of the imaging results.
      – When a patient has indications for CT scanning but this cannot be done within the appropriate period, either because CT is not available or because the patient is not sufficiently cooperative to allow scanning.
      – Continuing worrying signs (for example, persistent vomiting, severe headaches) of concern to the clinician.
      – Other sources of concern to the clinician (for example, drug or alcohol intoxication, other injuries, shock, suspected non-accidental injury, meningism, cerebrospinal fluid leak).
      – Perform and record observations on a half-hourly basis until GCS equal to 15 has been achieved.
      – Do not discharge patients presenting with head injury until they have achieved GCS equal to 15

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Surgical Disorders Of The Brain
      24.1
      Seconds

  • Question 5 - Which of the following will increase blood pressure and cause hypokalaemia? ...

    Incorrect

    • Which of the following will increase blood pressure and cause hypokalaemia?

      Your Answer: Endorphin

      Correct Answer: Angiotensin II

      Explanation:

      Angiotensin is a peptide that is released in response to a decrease in blood volume and blood pressure. It has multiple functions but mainly acts to cause vasoconstriction, increase BP and release aldosterone from the adrenal cortex. It is a powerful vasoconstrictor and release of aldosterone causes increased retention of sodium and excretion of potassium.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      13.2
      Seconds

  • Question 6 - Which of the following is a true statement regarding secretion of gastric acid?...

    Incorrect

    • Which of the following is a true statement regarding secretion of gastric acid?

      Your Answer: Acetylcholine decreases gastric acid secretion

      Correct Answer: Acetylcholine increases gastric acid secretion

      Explanation:

      Gastric acid secretion is increased by acetylcholine, histamine and gastrin, with the help of cAMP as a secondary messenger. They increase H+ and Cl- secretion by increasing the number of H+/K+ ATPase molecules and Cl- channels. In contrast, gastric acid secretion is decreased by somatostatin, epidermal growth factor and prostaglandins.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      24.3
      Seconds

  • Question 7 - An experiment is carried out to observe engulfment and phagocytosis of microbes. Strep...

    Incorrect

    • An experiment is carried out to observe engulfment and phagocytosis of microbes. Strep pneumoniae are added to a solution of leukocytes with a substance added to enhance the process of phagocytosis. What is this substance?

      Your Answer: P-selectin

      Correct Answer: Complement C3b

      Explanation:

      C3b is cleaved from C3 complement with the help of the enzyme C3- convertase. It binds to the cell surface of the offending substance and opsonizes it. This makes it easy for the phagocytes to detect and eliminate them.
      IgM does not act as an opsonin but igG does.
      Selectins aid leukocytes to bind to the endothelial surfaces.
      C5a is a chemo-attractant and histamine a vasodilator.
      NADPH oxidises offending substance after phagocytosis within the macrophage.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      19.1
      Seconds

  • Question 8 - Vincristine is a chemotherapy agent used to treat a number of types of...

    Correct

    • Vincristine is a chemotherapy agent used to treat a number of types of cancer. Which of the following is a recognised major side-effect of vincristine?

      Your Answer: Peripheral neuropathy

      Explanation:

      Vincristine is an alkaloid chemotherapeutic agent. It is used to treat a number of types of cancer including acute lymphocytic leukaemia, acute myeloid leukaemia, Hodgkin’s disease, neuroblastoma, and small cell lung cancer among others. The main side-effects of vincristine are peripheral neuropathy and constipation.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      6.5
      Seconds

  • Question 9 - A 50 year old man on warfarin therapy following insertion of a pacemaker...

    Incorrect

    • A 50 year old man on warfarin therapy following insertion of a pacemaker presented with epistaxis. Which of the following is true regarding blood coagulation?

      Your Answer:

      Correct Answer: Patients with haemophilia A usually have a normal bleeding time

      Explanation:

      A prolonged bleeding time is seen in platelet disorders like thrombocytopenia. Patients with haemophilia A or B have a prolonged PTT but not a prolonged bleeding time.
      Ca2+ is necessary for coagulation.
      von Willebrand factor is an important part of the factor VIII complex and promotes platelet adhesion and aggregation.
      DIC results in depleted coagulation factors and accumulation of fibrin.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 10 - During a clinical rotation in the ENT clinic, you observe a flexible bronchoscopy....

    Incorrect

    • During a clinical rotation in the ENT clinic, you observe a flexible bronchoscopy. As the scope is passed down the trachea, you see a cartilaginous structure that resembles a ship's keel and separates the right and the left main stem bronchi. This structure is the:

      Your Answer:

      Correct Answer: Carina

      Explanation:

      The carina (a keel-like cartilage) is found at the bifurcation of the trachea separating the right from the left main stem bronchi. It is a little more to the left than to the right.
      The cricoid cartilage is the inferior and posterior cartilage of the larynx.
      The costal cartilage on the other hand elongates the ribs anteriorly and contribute to the elasticity of the thoracic cage.
      The pulmonary ligament is a fold of pleura located below the root of the lung.
      Tracheal rings are rings of cartilage that support the trachea.
      Peritracheal fascia is a layer of connective tissue that invests the trachea from the outside and is not visible on bronchoscopy.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 11 - A 51-year-old male sustained a severe blunt injury just below the bridge of...

    Incorrect

    • A 51-year-old male sustained a severe blunt injury just below the bridge of the nose with industrial machinery. Imaging demonstrates a fracture involving the superior orbital fissure. On examination, an ipsilateral pupillary defect is present and loss of the corneal reflexes. In addition to these examination findings, all of the following are present except?

      Your Answer:

      Correct Answer: Nystagmus

      Explanation:

      The clinical symptoms of Superior Orbital Fissure Syndrome can be explained by the nerve involvement on an anatomic basis.
      External ophthalmoplegia is secondary to impairment of the oculomotor, trochlear, and abducens nerves.
      Ptosis develops because of lost tension and function of the levator palpebrae superior muscle involving the superior branch of the oculomotor nerve, and loss of tone in Muller’s muscle involving the sympathetic fibre arising from the cavernous sinus.
      Proptosis is caused by a decreased tension of the extraocular muscles, which normally are globe retractors, thereby allowing forward movement of the globe.
      The fixed dilated pupil with loss of accommodation arises from disruption of the parasympathetic fibres coursing with the oculomotor nerve.
      Compromise of the lacrimal and frontal nerves of the ophthalmic branches of the trigeminal nerve results in anaesthesia of the forehead and upper eyelid, lacrimal hyposecretion, and possibly in retro-orbital pain and neuralgia along the path of the nerve.
      Because of the disruption of the sensory nasociliary nerve, there may be anaesthesia of the cornea and the bridge of the nose with loss of the corneal reflex. When the disruption is partial, the corneal reflex remains intact.
      If the optic nerve is also involved including the above-mentioned symptoms, it is known as the orbital apex syndrome.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      0
      Seconds

  • Question 12 - A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and...

    Incorrect

    • A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and oliguria. She is diagnosed with chronic renal failure. Dipstick testing shows no protein, glucose, nitrite or ketones but a semi-quantitative sulphosalicylic acid test for urine protein is positive. Which of the following is the most probable cause of chronic renal failure in this patient.

      Your Answer:

      Correct Answer: Multiple myeloma

      Explanation:

      Dipstick results are negative because the proteins found in the urine of this patient are not albumin but Bence Jones proteins. A Bence Jones protein is a monoclonal globulin protein commonly detected in patients affected by multiple myeloma. Multiple myeloma is a malignancy of plasma cells characterised by the production of monoclonal immunoglobulin. Symptoms include bone pain, bone fractures, bleeding, neurologic symptoms, fatigue, frequent infections and weight loss.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 13 - What are the derivatives of the first brachial arch? ...

    Incorrect

    • What are the derivatives of the first brachial arch?

      Your Answer:

      Correct Answer: Gives rise to the sphenomandibular ligament

      Explanation:

      The first brachial arch (mandibular) gives rise to the mandibular and maxillary processes. Muscles and bones of this process originate within the arch’s mesoderm. The first arch cartilage (Meckel’s) ossifies to form the incus and malleus of the middle ear. Its perichondrium gives rise to he sphenomandibular ligament and through intermembraneous ossification after the mandible forms, the rest of the cartilage disappears. Muscles of the first arch include: mylohyoid, tensor tympany and palati, temporalis, masseter and lateral pterygoids and the anterior belly of the epigastric. This first arch is supplied by the trigeminal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 14 - Which of the following structures is not easily palpable? ...

    Incorrect

    • Which of the following structures is not easily palpable?

      Your Answer:

      Correct Answer: Styloid process of the temporal bone

      Explanation:

      The styloid process is a thin, pointed process that projects antero-inferiorly from the base of the petrous temporal bone. It can vary in length from a short, stubby process to a slender, four to five centimetre rod. It forms from the cranial elements of the second pharyngeal arch. The tympanic plate of the temporal bone ensheathes the base of this process. The pointed, projecting portion of the process provides attachment to the stylohyoid and stylomandibular ligaments, and to three muscles – the styloglossus, stylohyoid, and stylopharyngeus. As the styloid process is covered by the various muscles, it is not easily palpable in live subjects.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 15 - A 35-year-old ultra marathon runner becomes severely dehydrated and collapses. This patient most...

    Incorrect

    • A 35-year-old ultra marathon runner becomes severely dehydrated and collapses. This patient most likely has:

      Your Answer:

      Correct Answer: Decreased baroreceptor firing rate

      Explanation:

      Baroreceptors are sensors located in the blood vessels of all vertebrate animals. They sense the blood pressure and relay the information to the brain, so that a proper blood pressure can be maintained. Acute dehydration results in decreased plasma volume and increased plasma osmolarity, since more water than salt is lost in sweat. The decrease in plasma volume leads to an inhibition of the baroreceptors and a lower firing rate. The increase in plasma osmolarity leads to increased ADH secretion and high plasma ADH levels, which increases water permeability of collecting duct cells. Therefore more water is reabsorbed by the kidneys and renal water excretion is low.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 16 - During a radical mastectomy for advanced breast cancer, the surgeon injured the long...

    Incorrect

    • During a radical mastectomy for advanced breast cancer, the surgeon injured the long thoracic nerve. Which among the following muscles is likely to be affected?

      Your Answer:

      Correct Answer: Serratus anterior

      Explanation:

      The long thoracic nerve innervates the serratus anterior muscle which holds the scapula forward and balances the rhomboids and the trapezius muscles which retract the scapula. Injury to this nerve results in a ‘winged scapula’ with a posterior protrusion.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 17 - Following a bee sting, a women develops a 2cm red, raised, swollen lesion...

    Incorrect

    • Following a bee sting, a women develops a 2cm red, raised, swollen lesion at the site of the sting . Which of the following findings is likely to be seen in this lesion?

      Your Answer:

      Correct Answer: Vasodilation

      Explanation:

      Inflammation is the immediate response of the body towards infections or irritations. The cardinal signs of inflammation are 1. redness/rubor, 2. tumour/swelling, 3.dolar/pain, 4.calor/heat and organ dysfunction (function laesa). Inflammation has 2 components; vascular and cellular. Blood vessels dilate upstream of the inflamed area leading to the rubor and calor and constrict downstream, increasing pressure and causing fluid to leak out of the capillary, resulting in swelling. The cellular component includes infiltration by neutrophils. Leukocyte arrival and functions include; 1. margination: cells marginated from the centre to the periphery of the vessel, 2. rolling: selectins are upregulated on the vessel walls, 3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes resulting in adhesion, 4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product and 5. phagocytosis: engulfing the offending substance/cell.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 18 - 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:

      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
      0
      Seconds

  • Question 19 - Regarding the venous drainage of the heart which of these is correct? ...

    Incorrect

    • Regarding the venous drainage of the heart which of these is correct?

      Your Answer:

      Correct Answer: The great cardiac vein is the largest tributary of the coronary sinus and this vein starts at the apex of the heart and ascends with the anterior ventricular branch of the left coronary artery

      Explanation:

      Most of the veins of the heart open into the coronary sinus. This is a wide venous channel, about 2.25 cm in length, situated in the posterior part of the coronary sulcus and covered by muscular fibres from the left atrium. Its tributaries are the great, small and middle cardiac veins, the posterior vein of the left ventricle and the oblique vein of the left atrium. The great cardiac vein is the largest tributary of the coronary sinus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 20 - A 70-year-old male who has smoked since his teens complains of progressive shortness...

    Incorrect

    • A 70-year-old male who has smoked since his teens complains of progressive shortness of breath and a persistent cough. Which of the following abnormalities is most likely to be present in his pulmonary function tests?

      Your Answer:

      Correct Answer: Increased residual volume

      Explanation:

      Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by long-term poor airflow. The main symptoms include shortness of breath and cough with sputum production. The best diagnostic test for evaluating patients with suspected chronic obstructive pulmonary disease (COPD) is lung function measured with spirometry. Key spirometrical measures may be obtained with a portable office spirometer and should include forced vital capacity (FVC) and the normal forced expiratory volume in the first second of expiration (FEV1). The ratio of FEV1 to forced vital capacity (FEV1/FVC) normally exceeds 0.75. Patients with COPD typically present with obstructive airflow. Complete pulmonary function testing may show increased total lung capacity, functional residual capacity and residual volume. A substantial loss of lung surface area available for effective oxygen exchange causes diminished carbon monoxide diffusion in the lung (DLco) in patients with emphysema. Tobacco smoking is the most common cause of COPD, with factors such as air pollution and genetics playing a smaller role.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 21 - A 3 year old boy is taken to the doctor by his mother...

    Incorrect

    • A 3 year old boy is taken to the doctor by his mother who has noticed that he has been having rectal bleeding for a few months and a cherry red lesion appeared at the anal verge after defecation. Which of the following is most likely the diagnosis?

      Your Answer:

      Correct Answer: Juvenile polyp

      Explanation:

      Juvenile polyps are benign hamartomas with neoplastic potential that are the most frequent gastrointestinal polyp of childhood, with the peak incidence between 3 and 5 years of age.. The presence of multiple juvenile polyps may indicate a premalignant condition commonly named juvenile polyposis coli or juvenile polyposis syndrome (JPS). In contrast, single or solitary juvenile polyps generally are considered benign sporadic lesions that confer little to no future risk of malignancy. Most frequent presentation is painless rectal bleeding. Other features include a prolapsing rectal mass and abdominal pain.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Paediatric Surgery
      0
      Seconds

  • Question 22 - Calculate the cardiac stroke volume of a patient whose oxygen consumption (measured by...

    Incorrect

    • Calculate the cardiac stroke volume of a patient whose oxygen consumption (measured by analysis of mixed expired gas) is 300 ml/min, arterial O2 content is 20 ml/100 ml blood, pulmonary arterial O2 content is 15 ml/100 ml blood and heart rate is 60/min.

      Your Answer:

      Correct Answer: 100 ml

      Explanation:

      By Fick’s principle, VO2 = Q × (CA (O2) − CV (O2)) where VO2 = O2 consumption, Q = cardiac output and CA(O2) and CV(O2) are arterial and mixed venous O2 content respectively. Thus, in the given problem, 300 ml O2/min = Q × (20−15) ml O2/100 ml. Thus, Q = 6000 ml blood/min. Then, we can calculate stroke volume by dividing the cardiac output with heart rate. Thus, stroke volume = 6000 ml/min divided by 60/min stroke volume = 100 ml.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 23 - Which of the following is NOT a Gram-negative rod? ...

    Incorrect

    • Which of the following is NOT a Gram-negative rod?

      Your Answer:

      Correct Answer: Clostridium tetani

      Explanation:

      Gram-positive rods include Clostridia, Listeria and diphtheroids.
      Gram-negative rods include Escherichia coli, Klebsiella, Yersinia, Haemohilus, Pseudomonas, Shigella, Legionella, proteus and Salmonella

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 24 - A 11 year girl presents to the A&E department with a full thickness...

    Incorrect

    • A 11 year girl presents to the A&E department with a full thickness burn to her right arm, which she got when a firework that she was playing with exploded. Which statement is not characteristic of the situation?

      Your Answer:

      Correct Answer: The burn area is extremely painful until skin grafted

      Explanation:

      Answer: The burn area is extremely painful until skin grafted

      Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. The burn site appears white or charred. There is no sensation in the area since the nerve endings are destroyed. These are not normally painful until after skin grafting is done since the nerve endings have been destroyed.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      0
      Seconds

  • Question 25 - When you rest your elbows on a desk, what bony landmark of the...

    Incorrect

    • When you rest your elbows on a desk, what bony landmark of the upper limb are you resting on?

      Your Answer:

      Correct Answer: Olecranon process of the ulna

      Explanation:

      At the upper and back part of the ulna, there exists a curved eminence which is the olecranon process. This process lodges in the olecranon fossa of the humerus. It’s posterior surface is subcutaneous and this triangular area is what you rest your elbow upon.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 26 - A 63-year old lady presents with pain in multiple bones and renal failure....

    Incorrect

    • A 63-year old lady presents with pain in multiple bones and renal failure. On enquiry, there is history of recurrent pneumonia in the past. What will be the likely finding on her bone marrow biopsy?

      Your Answer:

      Correct Answer: Plasma cells

      Explanation:

      Multiple myeloma is a plasma cell malignancy that produce excessive monoclonal immunoglobulins. The disease presents with bone pains, renal dysfunction, increased calcium, anaemia and recurrent infections. Diagnosis is by demonstrating the presence of M-protein in urine or serum, lytic bone lesions, light chain proteinuria or excessive plasma cells on marrow biopsy.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 27 - A patient is unable to move the mandible to the left. Which muscle...

    Incorrect

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

      Your Answer:

      Correct Answer: Right lateral pterygoid muscle

      Explanation:

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

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 28 - A 40-year-old man has a tissue defect measuring 3 x 1 cm, following...

    Incorrect

    • A 40-year-old man has a tissue defect measuring 3 x 1 cm, following the excision of a lipoma from the scapula. What should be the best option for managing the wound?

      Your Answer:

      Correct Answer: Direct primary closure

      Explanation:

      This wound should be managed by primary closure as there is minimal associated tissue loss and the surgery is minor and uncontaminated.

      Primary wound closure is the fastest type of closures, and is also known as healing by primary intention. Wounds that heal by primary closure have a small, clean defect that minimizes the risk of infection and requires new blood vessels and keratinocytes to migrate only a small distance. Standard methods of suturing are usually sufficient for primary wound closure.

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Surgical Technique And Technology
      0
      Seconds

  • Question 29 - A 38-year-old woman undergoes a subtotal thyroidectomy. Five days postoperatively, the wound becomes...

    Incorrect

    • A 38-year-old woman undergoes a subtotal thyroidectomy. Five days postoperatively, the wound becomes erythematous and purulent.Which of the following is most likely to be the causative agent?

      Your Answer:

      Correct Answer: Staphylococcus aureus

      Explanation:

      Surgical site infection (SSI) by Staphylococcus aureus is the most likely cause in this scenario. In the UK from 2010–2011, 23% of wound infections were due to S. aureus. Infection with the other organisms, including Streptococcus pyogenes, are much rarer.

      Surgical site infections (SSI) comprise up to 20% of all healthcare-associated infections and at least 5% of patients undergoing surgery will develop an SSI as a result. SSIs may occur following a breach in tissue surfaces and allow normal commensals and other pathogens to initiate infection. The organisms are mostly derived from the patient’s own body.

      SSIs are a major cause of morbidity and mortality.
      Some preoperative measures that may increase the risk of SSI include:
      1. Shaving the wound using a razor (disposable clipper preferred)
      2. Tissue hypoxia
      3. Delayed administration of prophylactic antibiotics in tourniquet surgery

      SSIs can be prevented by taking certain precautionary steps pre-, intra-, and postoperatively.

      1. Preoperatively:
      a. Do not remove body hair routinely
      b. If hair needs removal, use electrical clippers (razors increase the risk of infection)
      c. Antibiotic prophylaxis if:
      – placement of prosthesis or valve
      – clean-contaminated surgery
      – contaminated surgery

      2. Intraoperatively:
      a. Prepare the skin with alcoholic chlorhexidine (Lowest incidence of SSI)
      b. Cover surgical site with dressing

      3. Postoperatively:
      a. Prevention of incisional infection by appropriate cleansing, skin care, and moisture management
      b.Tissue viability advice for management of surgical wound healing by secondary intention

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
      0
      Seconds

  • Question 30 - A 42 year old man presents with end stage renal failure and is...

    Incorrect

    • A 42 year old man presents with end stage renal failure and is prepared to receive a kidney from his best friend. HLA testing showed that they are not a 100% match and he is given immunosuppressant therapy for this. Three months later when his renal function is assessed, he showed signs of deteriorating renal function, with decreased renal output, proteinuria of +++ and RBCs in the urine. He was given antilymphocyte globulins and his condition reversed. During the crisis period the patient is likely to be suffering from?

      Your Answer:

      Correct Answer: Acute rejection

      Explanation:

      This patients is most likely experiencing an acute rejection. It is a cell mediated attack against the organ that has been transplanted. Antigens are either presented by blood borne cells with in the graft or antigen presenting cells in the body may be presenting class I and class II molecules that have been shed by the graft. Class I will activate CD8 and class II, CD4 cells, both of which will attack the graft.
      Chronic rejection is a slow process which occurs months to years after the transplant. The exact mechanism is not very well understood but it probably involves a combination of Type III and Type IV hypersensitivity directed against the foreign MHC molecules which look like self-MHC presenting a foreign antigen.
      Hyperacute Transplant Rejection occurs almost immediately and is often evident while you are still in surgery. It is caused by accidental ABO Blood type mismatching of the donor and recipient which almost never happens anymore. This means the host has preformed antibodies against the donated tissue.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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Physiology (0/2) 0%
Pathology (1/2) 50%
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