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Question 1
Incorrect
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A 30-year-old female was alarmed when she started to experience hair loss and balding, however, she also noted increased hair on her face and body and developed an acne breakout. Deepening of her voice also became prominent. She was referred to an oncologist and was diagnosed with a hormone-producing tumour. What is the most likely diagnosis ?
Your Answer: Seminoma
Correct Answer: Arrhenoblastoma
Explanation:Arrhenoblastoma, known as ‘Sertoli–Leydig tumour’ is a rare ovarian stromal neoplasm that secretes testosterone. It is mostly seen in women in the reproductive years. The key clinical features of this tumour is due to excessive production of testosterone which leads to progressive masculinisation in a woman who was typical normal beforehand. The lesion tends to grow slowly and rarely metastasises. Treatment is surgical removal of the tumour and the prognosis is generally good.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 2
Incorrect
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A 30-year-old woman feels thirsty. This thirst is probably due to:
Your Answer: Hypoglycaemia
Correct Answer: Increased level of angiotensin II
Explanation:Thirst is the basic need or instinct to drink. It arises from a lack of fluids and/or an increase in the concentration of certain osmolites such as salt. If the water volume of the body falls below a certain threshold or the osmolite concentration becomes too high, the brain signals thirst. Excessive thirst, known as polydipsia, along with excessive urination, known as polyuria, may be an indication of diabetes. Angiotensin II is a hormone that is a powerful dipsogen (i.e. it stimulates thirst) that acts via the subfornical organ. It increases secretion of ADH in the posterior pituitary and secretion of ACTH in the anterior pituitary.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 3
Correct
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A 26-year-old male presents with intermittent dysphagia to both liquids and solids. An upper gastrointestinal endoscopy is unremarkable. What is the most appropriate next step?
Your Answer: Oesophageal manometry
Explanation:Oesophageal dysphagia occurs when there is a difficulty with the passage of solid or liquid material through the oesophagus, specifically the region between the upper and lower oesophageal sphincter. It results from either abnormal motility of this segment of the oesophagus or obstruction.
Common causes of dysphagia:
Gastro-oesophageal reflux—waterbrash, regurgitation, due to dysmotility or stricture
Achalasia—classically hold-up relieved by carbonated beverages
Motility disorders—may be associated with central chest pain, systemic disease (scleroderma, dermatomyositis)
Oesophageal cancer—progressive, weight loss
Head and neck cancer—pain, dysphagia, otalgia, >90% smokers, often excess alcohol consumption
Pharyngeal pouch—slowly progressive, regurgitation, gurgling
Web—able to swallow only small amounts, “can’t swallow tablets”
Stroke
Neurodegenerative disorders—parkinsonism, motor neurone disease, multiple sclerosis, myasthenia gravis
PresbyphagiaEndoscopy has the advantage of potentially yielding a histological diagnosis. The overall rate of oesophageal perforation after flexible endoscopy involving oesophageal instrumentation, biopsy, or dilatation is 2.6%
Oesophageal manometry remains the investigation of choice in suspected motility disorders. Manometry can classify oesophageal dysmotility into rare specific disorders such as achalasia and diffuse oesophageal spasm or more common non-specific motility disorders that do not respond directly to drug treatment but may improve if related reflux or psychiatric disturbances are treated. The symptoms of non-specific motility disorders may have an uncertain relation to the manometric abnormalities
Management is based on the history, findings of the clinical investigations, and prognosis for the individual patient. The underlying disorder is treated, but the impact of dysphagia on nutrition and hydration will compromise any intervention unless managed effectively. Poor physical condition from malnutrition or dehydration will lead to a suboptimal rehabilitation process, in both duration and completeness of recovery and inadequate management of dysphagia contributes to this. A malnourished person is at risk of decompensation of the swallow, leading to dysphagia. The clinical swallow assessment is used to determine safely modified diets that reduce malnutrition and dehydration. This may range from nil by mouth with total enteral support to full oral route or a balance of the two. Enteral feeding is essential to maintain nutritional status when oral feeding is suspended, even if only for a short time. Prompt involvement of a dietitian is thus essential.
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This question is part of the following fields:
- Generic Surgical Topics
- Upper Gastrointestinal Surgery
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Question 4
Incorrect
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Which portion of the renal tubule absorbs amino acids and glucose?
Your Answer: Distal convoluted tubule
Correct Answer: Proximal convoluted tubule
Explanation:In relation to the morphology of the kidney as a whole, the convoluted segments of the proximal tubules are confined entirely to the renal cortex. Glucose, amino acids, inorganic phosphate and some other solutes are reabsorbed via secondary active transport in the proximal renal tubule through co-transport channels driven by the sodium gradient.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 5
Correct
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A 39-year-old man is admitted with a tender mass in the right groin, fever, and sweating. He is on multi-drug therapy for HIV infection. On examination, a tender swelling is noted in his right groin. The pain is exacerbated by hip extension. What is the most likely diagnosis?
Your Answer: Psoas abscess
Explanation:The patient has a primary psoas abscess.
Psoas (or iliopsoas) abscess is a collection of pus in the iliopsoas muscle compartment. It may arise via contiguous spread from adjacent structures or by the haematogenous route from a distant site. Psoas abscesses may be either primary or secondary. Primary cases often develop in the immunosuppressed and may occur as a result of haematogenous spread. Secondary cases may occur as a complication of intra-abdominal diseases such as Crohn’s disease.
Patients usually present with lower back pain and if the abscess is extensive, a mass that may be localised to the inguinal region or femoral triangle. In most cases, the diagnosis can be made clinically. Where it is not clear, an ultrasound scan is often the most convenient investigation.
Smaller collections may be percutaneously drained. If the collection is larger, or the percutaneous route fails, then surgery (via a retroperitoneal approach) should be performed.
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This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 6
Correct
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Which nerve mediates the sensation to itch from the skin that is just over the base of the spine of your scapula?
Your Answer: Dorsal primary ramus of C7
Explanation:The first branches off spinal nerves are called the dorsal and ventral rami. The dorsal rami mediate sensation of the skin over the back and motor supply to the true muscles of the back whilst the ventral rami gives sensation to the skin over the limbs and the skin that is over the ventral side of the trunk. It also gives motor supply to the skeletal muscles of the neck, the trunk and extremities. Hence, itchiness of the part of the skin that is over the spine of the scapula would be mediated by the primary ramus of C7. Accessory nerve doesn’t have any sensory innervation.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 7
Correct
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An intern is attempting to put in an arterial line in an ICU patients left foot. Which is the best site to feel for the pulsation of the dorsalis pedis artery in the foot?
Your Answer: Just lateral to the tendon of extensor hallucis longus
Explanation:The dorsalis pedis artery is the continuation of the anterior tibial artery. The pulse of the posterior tibial artery, which comes from the posterior compartment of the leg, may be felt behind the medial malleolus just lateral to the tendon of the extensor hallucis longus.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 8
Correct
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A 47-year-old female with breast cancer started a chemotherapy regime containing epirubicin. What is the primary mode of action of this drug?
Your Answer: Intercalation of DNA
Explanation:Epirubicin is an anthracycline; intercalates between DNA base pairs and triggers cleavage by topoisomerase II, which results in cytocidal activity.
Inhibits DNA helicase and generates cytotoxic free radicals.Contraindications:
– Severe hypersensitivity to drug, other anthracyclines, or anthracenediones
– Baseline ANC<1500/mm³
– Cardiomyopathy and/or heart failure, recent MI, or severe arrhythmias
– Severe myocardial insufficiency
– Cumulative dose achieved in previous anthracycline treatment
– Severe persistent drug-induced myelosuppression
– Severe hepatic impairment (Child-Pugh Class C or serum bilirubin level greater than 5 mg/dL) -
This question is part of the following fields:
- Oncology
- Principles Of Surgery-in-General
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Question 9
Correct
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A 10-year-old boy was sent for an x-ray of the leg because he was complaining of pain and swelling. The x-ray showed the classic sign of Codman's triangle. What is the most likely diagnosis of this patient?
Your Answer: Osteosarcoma
Explanation:Codman’s triangle is the triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone. The main causes for this sign are osteosarcoma, Ewing’s sarcoma, eumycetoma, and a subperiosteal abscess.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 10
Incorrect
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Post-total gastrectomy, there will be a decreased production of which of the following enzymes?
Your Answer: Cholecystokinin
Correct Answer: Pepsin
Explanation:Pepsin is a protease that is released from the gastric chief cells and acts to degrade proteins into peptides. Released as pepsinogen, it is activated by hydrochloric acid and into pepsin itself. Gastrin and the vagus nerve trigger the release of pepsinogen and HCl when a meal is ingested. Pepsin functions optimally in an acidic environment, especially at a pH of 2.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 11
Correct
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Calculate the stroke volume in a patient admitted for coronary bypass surgery, with the following parameters pre-operatively: Oxygen consumption = 300 ml/min, Arterial oxygen content = 20 ml/100 ml blood, Pulmonary arterial oxygen content = 15 ml/100 ml blood and Heart rate = 100 beats/min.
Your Answer: 60 ml
Explanation:By Fick’s principle, cardiac output can be calculated as follows: VO2 = CO × (CAO2– CVO2) where VO2= oxygen consumption, CO = cardiac output, CAO2 = arterial oxygen content and CvO2 = mixed venous oxygen content. Thus, in the given problem, 300 ml/min = CO × (20 – 15) ml/100 ml CO = 300 × 100/5 ml/min CO = 6000 ml/min. Also, cardiac output = stroke volume × heart rate. Thus, 6000 ml/min = stroke volume × 100 beats/min. Hence, stroke volume = 6000/100 ml/min which is 60 ml/min.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 12
Incorrect
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What are the derivatives of the first brachial arch?
Your Answer: Gives rise to the styloid process and hyoid bone
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.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 13
Correct
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A 57 year old male who had previously undergone a sigmoid colectomy for carcinoma returns to the clinic for a follow up. Imaging shows that he has a 3.1cm foci of metastatic disease in segment IV of the liver. What is the most appropriate course of action?
Your Answer: Chemotherapy followed by surgical resection
Explanation:Colorectal cancer is one of the most common types of cancer in Western populations. The liver is the first location of metastatic disease; as the main mechanism of dissemination is through the portal system. In addition, the liver may be the sole site of metastasis in 30 to 40% of patients with advanced disease.
Unfortunately, 20% of these patients will develop metastasis in the lungs and >50% in liver. In 20 to 25% of patients at the time of diagnosis, hepatic metastatic disease can be identified clinically, and 40 to 50% will develop during the first 3 years after the primary tumour is diagnosed.
When metastatic lesions are localized in the liver, which corresponds to 30% of patients, there are several options for localized treatment, such as hepatic partial resection, localized ablative therapy, administration of chemotherapy by infusion of the hepatic artery, systemic chemotherapy, and isolated hepatic fusion for patients with high doses of chemotherapy. Surgical resection is the most effective treatment for hepatic metastasis in colorectal cancer, but only a few patients are candidates for initial surgery. Patients with hepatic metastasis that cannot be surgically resected are managed initially with chemotherapy and later are subject to surgery, and these patients present a similar survival rate to those undergoing surgery initially.
Prior to hepatic resection, patients with hepatic metastatic disease frequently receive neoadjuvant chemotherapy, which can aid in disappearing or hidden radiological lesions.
The 5-year survival rate after hepatic resection is 25-40%. -
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 14
Correct
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What principal artery that supplies the meninges is susceptible to rupture following trauma to the side of the head over the temporal region:
Your Answer: Middle meningeal artery
Explanation:The middle meningeal artery normally arises from the first or mandibular segment of the maxillary artery. The artery runs in a groove on the inside of the cranium, this can clearly be seen on a lateral skull X-ray. An injured middle meningeal artery is the most common cause of an epidural hematoma.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 15
Incorrect
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Glucose is the most important source of energy for cellular respiration. The transport of glucose in the renal tubular cells occurs via:
Your Answer: Facilitated diffusion
Correct Answer: Secondary active transport with sodium
Explanation:In 1960, Robert K. Crane presented for the first time his discovery of the sodium-glucose cotransport as the mechanism for glucose absorption. Glucose transport through biological membranes requires specific transport proteins. Transport of glucose through the apical membrane of renal tubular as well as intestinal epithelial cells depends on the presence of secondary active Na+–glucose symporters, SGLT-1 and SGLT-2, which concentrate glucose inside the cells, using the energy provided by co-transport of Na+ ions down their electrochemical gradient.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 16
Incorrect
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Which muscle is responsible for directing the gaze downward when the eye is abducted?
Your Answer: Superior oblique muscle
Correct Answer: Inferior rectus muscle
Explanation:The inferior rectus muscle is a muscle in the orbit. As with most of the muscles of the orbit, it is innervated by the inferior division of oculomotor nerve (Cranial Nerve III). It depresses, adducts, and helps laterally rotate the eye.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 17
Incorrect
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A 70-year-old man suffers an ischaemic stroke and develops a left homonymous hemianopia. Where is the likely infarct?
Your Answer: Right frontal lobe
Correct Answer: Right occipital lobe
Explanation:The man has a left homonymous hemianopia which means he is unable to view objects in the left visual field. This information is processed by the right primary visual cortex which lies in the right occipital lobe.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 18
Incorrect
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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.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 19
Correct
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A patient presents with loss of pain and temperature sensation in the left leg. He is likely to have a lesion involving:
Your Answer: Right lateral spinothalamic tract
Explanation:The spinothalamic tract is a sensory pathway originating in the spinal cord that transmits information to the thalamus. There are two main parts of the spinothalamic tract: the lateral spinothalamic tract transmits pain and temperature and the anterior spinothalamic tract transmits touch (crude touch). The decussation of this pathway occurs at the level of the spinal cord. Hence, a unilateral lesion of the lateral spinothalamic tract causes contralateral loss of pain and temperature.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 20
Incorrect
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Two boys were playing when one of them brought the forearm of the other behind his back. This resulted in a stretching of the lateral rotator of the arm. Which of the following muscles was most likely to have been involved?
Your Answer: Subscapularis
Correct Answer: Infraspinatus
Explanation:There are two lateral rotators of the arm, the infraspinatus and the teres minor muscles. The infraspinatus muscle receives nerve supply from C5 and C6 via the suprascapular nerve, whilst the teres minor is supplied by C5 via the axillary nerve.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 21
Incorrect
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A football player sustained an injury to his ankle. The wound went through the skin, subcutaneous tissue and flexor retinaculum. Which other structure passing under the retinaculum may be injured?
Your Answer: Anterior tibial artery
Correct Answer: Tibial nerve
Explanation:The flexor retinaculum is immediately posterior to the medial malleolus. The structures that pass under the flexor retinaculum from anterior to posterior are: tendon of the tibialis posterior, flexor digitorum longus, posterior tibial artery (and vein), tibial nerve and tendon of flexor hallucis longus. The tibial nerve is the only one which lies behind the flexor retinaculum.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 22
Incorrect
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Which of the following organs is an ectoderm derivative?
Your Answer: Kidney
Correct Answer: Adrenal medulla
Explanation:Ectoderm derivatives include the adrenal medulla, posterior pituitary, the epidermis of the skin, nails, hair, sweat glands, mammary glands, sebaceous glands, the central nervous system, the peripheral nervous system, the retina and lens of eye, the pupillary muscle of the iris, melanocytes, Schwann cells and odontoblasts.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 23
Correct
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A premenopausal woman has an ovarian tumour. Which is the most common benign germ-cell tumour that could occur in a premenopausal woman?
Your Answer: Dermoid cyst
Explanation:A dermoid cyst is a teratoma of a cystic nature that contains an array of developmentally mature and solid tissues. Dermoid cysts grow slowly and this type of cystic teratoma is nearly always benign.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 24
Incorrect
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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: Bed rest, splinting and traction
Correct 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.
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This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 25
Correct
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A 23 year old woman is Rh -ve and she delivered a baby with a Rh+ blood group. What measure can be performed to prevent Rh incompatibility in the next pregnancy?
Your Answer: Immunoglobulin D
Explanation:Rh disease is also known as erythroblastosis fetalis and is a disease of the new-born. In mild states it can cause anaemia with reticulocytosis and in severe forms causes severe anaemia, morbus hemolytcus new-born and hydrops fetalis. RBCs of the Rh+ baby can cross the placenta and enter into the maternal blood. As she is Rh- her body will form antibodies against the D antigen which will pass through the placenta in subsequent pregnancies.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 26
Correct
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A 17 year old girl is taken to the hospital with a 10 hour history of pelvic pain. Her last normal menstrual cycle was 14 days ago and she is otherwise well. Her abdomen was soft with mild suprapubic pain on examination. What is the underlying cause?
Your Answer: Mittelschmerz
Explanation:Answer: Mittelschmerz
Mittelschmerz is midcycle abdominal pain due to leakage of prostaglandin-containing follicular fluid at the time of ovulation. It is self-limited, and a theoretical concern is treatment of pain with prostaglandin synthetase inhibitors, which could prevent ovulation. The pain of mittelschmerz usually occurs in the lower abdomen and pelvis, either in the middle or to one side. The pain can range from a mild twinge to severe discomfort and usually lasts from minutes to hours. In some cases, a small amount of vaginal bleeding or discharge might occur. Some women have nausea, especially if the pain is very strong.
Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, ovarian torsion) must be considered.
Many women never have pain at ovulation. Some women, however, have mid-cycle pain every month, and can tell by the pain that they are ovulating.
As an egg develops in the ovary, it is surrounded by follicular fluid. During ovulation, the egg and the fluid, as well as some blood, are released from the ovary. While the exact cause of mittelschmerz is not known, it is believed to be caused by the normal enlargement of the egg in the ovary just before ovulation. Also, the pain could be caused by the normal bleeding that comes with ovulation.
Pelvic inflammatory disease can be ruled out if the patient is not sexually active. -
This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 27
Correct
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A 45-year old gentleman presented to the emergency department at 5.00 AM with pain in his left flank. The pain began suddenly and presented in waves throughout the night. Urine examination was normal except for presence of blood and few white blood cells. The pH and specific gravity of the urine were also found to be within normal range. What is the likely diagnosis?
Your Answer: Ureteric calculus
Explanation:A calculus in the ureter, if less than 5mm in diameter is likely to pass spontaneously. However, a larger calculus irritates the ureter and may become lodged, leading to hydroureter and/or hydronephrosis. Likely sites where the calculus might get lodged, include pelviureteric junction, distal ureter at the level of iliac vessels and the vesicoureteric junction. An obstruction can result in reduced glomerular filtration. There can be deterioration in renal function due to hydronephrosis and a raised glomerular pressure, leading to poor renal blood flow. Permanent renal dysfunction usually takes about 4 weeks to occur. Secondary infection can also occur in chronic obstruction.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 28
Incorrect
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The wound healing process is documented in patients undergoing laparoscopic procedures. The port incisions are sutured closed and the wounds observed every few weeks for re-epithelialisation and tensile strength. Which substance is mostly likely to be found at a cellular level involved in wound healing?
Your Answer: Collagen
Correct Answer: Tyrosine kinase
Explanation:Cell surface growth factor receptors require intercellular proteins such as tyrosine kinase which are necessary to initiate a series of events that eventually lead to cell division and growth. Tyrosine kinase is an enzyme that transfers a phosphate group to the tyrosine residue in a protein. This phosphorylation will lead to an up regulation of the enzyme activity.
Fibronectin acts in the extracellular matrix to bind macromolecules (such as proteoglycans) via integrin receptors to aid attachment and migration of cells.
Laminin is an extracellular matrix component that is abundant in basement membranes.
Hyaluronic acid is one of the proteoglycans in the extracellular matrix.
Collagen fibres are part of the extracellular matrix that gives strength and stability to connective tissues. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 29
Correct
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A 55-year-old male presents with an ulcerated mass at the anal verge. A biopsy is taken and the histology demonstrates as squamous cell carcinoma. Which of the following viral infection is most likely to have contributed to the development of the condition?
Your Answer: Human papillomavirus 16
Explanation:Anal squamous cell cancer is believed to be directly linked to the presence of a complex inflammatory process most commonly caused by HPV infection (particularly with serotypes 16 and 18) in the histologically unique area of the anal squamocolumnar epithelium. In one Scandinavian study, serotype 16 HPV DNA was detected in 73% of anal cancer specimens, and serotype 16, 18, or both were detected in 84% of specimens. In contrast, no rectal cancer specimens contained HPV DNA.
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This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 30
Incorrect
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A 29-year-old man with gunshot to the abdomen is transferred to the operating theatre, following his arrival in the A&E department. He is unstable and his FAST scan is positive. During the operation, extensive laceration to the right lobe of the liver and involvement of the IVC are found, along with massive haemorrhage. What should be the most appropriate approach to blood component therapy?
Your Answer: Use Factor VIII concentrates early
Correct Answer:
Explanation:There is strong evidence to support haemostatic resuscitation in the setting of massive haemorrhage due to trauma. This advocates the use of 1:1:1 ratio.
Uncontrolled haemorrhage accounts for up to 39% of all trauma-related deaths. In the UK, approximately 2% of all trauma patients need massive transfusion. Massive transfusion is defined as the replacement of a patient’s total blood volume in less than 24 hours or the acute administration of more than half the patient’s estimated blood volume per hour. During acute bleeding, the practice of haemostatic resuscitation has been shown to reduce mortality rates. It is based on the principle of transfusion of blood components in fixed ratios. For example, packed red cells, FFP, and platelets are administered in a ratio of 1:1:1.
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This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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SESSION STATS - PERFORMANCE PER SPECIALTY
