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Question 1
Incorrect
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A 53 year old woman is admitted to the hospital with a femoral shaft fracture that occurred suddenly whilst running outside. On examination, there is no neurovascular deficit distal to the fracture site. However, there is a large firm nodule in the left lobe of the thyroid, with no associated lymphadenopathy. Which of the following is the most likely underlying cause?
Your Answer: Medullary thyroid cancer
Correct Answer: Follicular thyroid cancer
Explanation:Follicular thyroid cancer accounts for 15% of thyroid cancer and occurs more commonly in women over 50 years of age. Thyroglobulin (Tg) can be used as a tumour marker for well-differentiated follicular thyroid cancer. Follicular cells are the thyroid cells responsible for the production and secretion of thyroid hormones.
It is impossible to distinguish between follicular adenoma and carcinoma on cytological grounds. If fine needle aspiration cytology (FNAC) suggests follicular neoplasm, thyroid lobectomy should be performed to establish the histopathological diagnosis. Features for the diagnosis of follicular carcinoma are capsular invasion and vascular invasion by tumour cells. Capsular invasion should be carefully evaluated and discriminated from the capsular rupture due to FNA penetration resulting in WHAFFT (worrisome histologic alterations following FNA of thyroid).
– Follicular carcinoma tends to metastasize to lung and bone via the bloodstream.
– Papillary thyroid carcinoma commonly metastasizes to cervical lymph nodes.
– HMGA2 has been proposed as a marker to identify malignant tumours. -
This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 2
Incorrect
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Which muscle extends to form the cremasteric muscle?
Your Answer: External abdominal oblique muscle
Correct Answer: Internal abdominal oblique muscle
Explanation:The cremasteric muscle is a thin layer of muscle composed of several fasciculi that originate from the middle of the inguinal ligament. At its point of origin the fibres are continuous with the fibres of internal oblique and sometimes with the transversus abdominis. It then passes along the lateral side of the spermatic cord and descends with it through the superficial inguinal ring on the front and sides of the cord.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 3
Correct
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An 18 year old man is admitted to the intensive care unit with severe meningococcal sepsis. He is on maximal inotropic support and a CT scan of his chest and abdomen is performed. The adrenal glands show evidence of diffuse haemorrhage. Which of the following is the best explanation?
Your Answer: Waterhouse- Friderichsen syndrome
Explanation:Answer: Waterhouse- Friderichsen syndrome
Waterhouse-Friderichsen syndrome is a condition characterized by the abrupt onset of fever, petechiae, arthralgia, weakness, and myalgias, followed by acute haemorrhagic necrosis of the adrenal glands and severe cardiovascular dysfunction. The syndrome is most often associated with meningococcal septicaemia but may occur as a complication of sepsis caused by other organisms, including certain streptococcal species. This disorder may be associated with a history of splenectomy.
Fulminant infection from meningococcal bacteria in the bloodstream is a medical emergency and requires emergent treatment with vasopressors, fluid resuscitation, and appropriate antibiotics. Benzylpenicillin was once the drug of choice with chloramphenicol as a good alternative in allergic patients. Ceftriaxone is an antibiotic commonly employed today. Hydrocortisone can sometimes reverse the adrenal insufficiency. Amputations, reconstructive surgery, and tissue grafting are sometimes needed as a result of tissue necrosis (typically of the extremities) caused by the infection.
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This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 4
Correct
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A 27-year-old woman, who had been taking a combined oral contraceptive for 6 months, presented with inguinal pain and oedema of the left leg. Which of the following investigations would you recommend to help confirm the diagnosis?
Your Answer: Duplex scan
Explanation:Oral combined contraceptive pill (OCCP) is a drug used for birth control and treating a number of other conditions. Women who take the OCP have a higher risk of developing deep vein thrombosis (DVT), usually in the legs. Duplex ultrasonography is a safe and non-invasive technique which is used for diagnosing the presence of lower extremity thrombi.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 5
Incorrect
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Multiple, non-tender lymphadenopathy with biopsy showing several crowded follicles of small, monomorphic lymphocytes and the absence of Reed-Sternberg cells is seen in which of the following?
Your Answer: Hodgkin’s disease, lymphocyte predominance type
Correct Answer: Poorly differentiated lymphocytic lymphoma
Explanation:Malignant lymphoma usually causes non-tender lymphadenopathy, unlike the tender lymphadenopathy caused by infections (including infectious mononucleosis caused by Epstein-Barr virus). Also, the lymphoid hyperplasia seen in infectious mononucleosis is benign and polyclonal.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 6
Incorrect
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A 17-year-old female was given an antibiotic for a urinary tract infection. After taking the medication the patient developed Steven-Johnson syndrome. Which particular antibiotic usually causes Steven-Johnson syndrome?
Your Answer: Erythromycin
Correct Answer: Sulphonamides
Explanation:Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulphonamide antibiotics, and nevirapine.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 7
Incorrect
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The tensor villi palatini muscle is a broad thin, ribbon-like muscle in the head that tenses the soft palate. Which of the following structures is associated with the tensor villi palatini muscle?
Your Answer: The middle pharyngeal constrictor
Correct Answer: The hamulus of the medial pterygoid plate
Explanation:The pterygoid hamulus is a hook-like process at the lower extremity of the medial pterygoid plate of the sphenoid bone around which the tendon of the tensor veli palatini passes.
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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 cerebellar tremor can be differentiated from a Parkinsonian tremor in that:
Your Answer: It only occurs during voluntary movements
Explanation:Cerebellar disease leads to intention tremors, which is absent at rest and appears at the onset of voluntary movements. In comparison, Parkinson’s tremor is present at rest. Frequency of tremor is a less reliable means to differentiate between the two as the oscillation amplitude of the tremor is not constant throughout a voluntary action.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 9
Correct
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Which organs would cause pain in a patient who complains of dull pain in her pelvis, along the midline starting from the pubic bone in the front to the sacrum at the back?
Your Answer: Urinary bladder, uterus/cervix/vagina, rectum
Explanation:The pain could have been caused by the urinary bladder, uterus/cervix/vagina or rectum as it involves the pelvic viscera.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 10
Incorrect
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During cardiac catheterisation, if the blood sample from the catheter shows an oxygen saturation of 70%, and the pressure ranging from 12 to 24 mm Hg, it implies that the catheter tip is located in the:
Your Answer: Aorta
Correct Answer: Pulmonary artery
Explanation:Normal values for various parameters are as follows:
Systolic arterial blood pressure (SBP): 90–140 mmHg.
Diastolic arterial blood pressure: 60–90 mmHg.
Mean arterial blood pressure (MAP): SBP + (2 × DBP)/3 (normal range: 70-105 mmHg).
Right atrial pressure (RAP): 2–6 mmHg.
Systolic right ventricular pressure (RVSP): 15–25 mmHg.
Diastolic right ventricular pressure (RVDP): 0–8 mmHg.
Pulmonary artery pressure (PAP): Systolic (PASP) is 15-25 mmHg and Diastolic (PADP) is 8–15 mmHg.
Pulmonary artery wedge pressure (PAWP): 6–12 mmHg.
Left atrial pressure (LAP): 6–12 mmHg.
Thus, the given value indicates that the position of catheter tip is likely to be in the pulmonary artery. -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 11
Correct
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A 33 year old mechanic presents to the A&E department with epigastric pain. An endoscopy is done which shows that he has a punched out ulcer on the anterior wall of the stomach which is shallow and measures 0.8cm in diameter. What is the most likely diagnosis?
Your Answer: Acute peptic ulcer
Explanation:Peptic ulcer disease can involve the stomach or duodenum. Gastric and duodenal ulcers usually cannot be differentiated based on history alone, although some findings may be suggestive. Epigastric pain is the most common symptom of both gastric and duodenal ulcers, characterized by a gnawing or burning sensation and that occurs after meals—classically, shortly after meals with gastric ulcers and 2-3 hours afterward with duodenal ulcers.
Upper gastrointestinal (GI) endoscopy is the preferred diagnostic test in the evaluation of patients with suspected peptic ulcer disease. At endoscopy, gastric ulcers appear as discrete mucosal lesions with a punched-out smooth ulcer base, which often is filled with whitish fibrinoid exudate. Ulcers tend to be solitary and well circumscribed and usually are 0.5-2.5 cm in diameter.
Treatment of peptic ulcers varies depending on the aetiology and clinical presentation. The initial management of a stable patient with dyspepsia differs from the management of an unstable patient with upper gastrointestinal (GI) haemorrhage. In the latter scenario, failure of medical management not uncommonly leads to surgical intervention.Treatment options include empiric antisecretory therapy, empiric triple therapy for H pylori infection, endoscopy followed by appropriate therapy based on findings, and H pylori serology followed by triple therapy for patients who are infected. Breath testing for active H pylori infection may be used.
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This question is part of the following fields:
- Generic Surgical Topics
- Upper Gastrointestinal Surgery
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Question 12
Incorrect
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The circle of Willis is an arterial anastomosis in the base of the brain and is one of the cerebrovascular safeguards in the brain. Where is the circle of Willis contained?
Your Answer: Cisterna magna
Correct Answer: Cisterna basalis
Explanation:Cisterns refers to a system of intercommunicating pools formed by the subarachnoid space at the base of the brain and around the brainstem. Cisterna basalis/basal cistern (interpeduncular cistern) is found at the base of the brain between the two temporal lobes and it contains the arterial circle of Willis. The lumbar cistern is contained in the spinal canal while the foramen magna refers to the opening at the base of the skull though which the spinal cord enters into the skull.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 13
Incorrect
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Driving pressure is considered to be a strong predictor of mortality in patients with ARDS. What is the normal mean intravascular driving pressure for the respiratory circulation?
Your Answer: 50 mmHg
Correct Answer: 10 mmHg
Explanation:Driving pressure is the difference between inflow and outflow pressure. For the pulmonary circulation, this is the difference between pulmonary arterial (pa) and left atrial pressure (pLA). Normally, mean driving pressure is about 10 mmHg, computed by subtracting pLA (5 mmHg) from pA (15 mmHg). This is in contrast to a mean driving pressure of nearly 100 mmHg in the systemic circulation.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 14
Incorrect
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A 25-year old man presented to the clinic with swelling of the penis. His uncircumcised penis was erythematous and oedematous. The foreskin could not be retracted over the glans. Which of the following agents is the likely cause of his condition?
Your Answer: Human papillomavirus
Correct Answer: Staphylococcus aureus
Explanation:Inflammation of the glans penis is known as balanitis. Associated involvement of the foreskin is then known as balanoposthitis. More likely to occur in men who have a tight foreskin that is difficult to pull back, or poor hygiene.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 15
Correct
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A computer tomography guided needle biopsy is done on a patient with a cystic swelling in the left chest. The radiologist inserted the biopsy needle into the 9th intercostal space along the mid axillary line to aspirate the swelling and obtain tissue for histological diagnosis. In which space is the swelling most likely to be?
Your Answer: Costodiaphragmatic recess
Explanation:The costodiaphragmatic recess is the lowest point of the pleural sac where the costal pleura becomes the diaphragmatic pleura. At the midclavicular line, this is found between ribs 6 and 8; at the paravertebral lines, between ribs 10 and 12 and between ribs 8 and 10 at the midaxillary line.
The cardiac notch: is an indentation of the heart on the left lung, located on the anterior surface of the lung.
Cupola: part of the parietal pleura that extends above the first rib.
Oblique pericardial sinus: part of the pericardial sac located posterior to the heart behind the left atrium.
Costomediastinal recess: a reflection of the pleura from the costal surface to the mediastinal surface, is on the anterior surface of the chest.
The inferior mediastinum: is the space in the chest occupied by the heart. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 16
Correct
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Severe abdominal pain radiating to the back, along with increased serum amylase levels, is seen in which of the following conditions?
Your Answer: Pancreatitis
Explanation:The primary test for diagnosis and monitoring of pancreatitis is amylase. Increased plasma levels of amylase can be found in: salivary trauma (including anaesthetic intubation), mumps, pancreatitis and renal failure. However, a rise in the total amylase levels over 10 times the upper limit of normal (ULN) is suggestive of pancreatitis; 5–10 times the ULN may indicate ileus or duodenal disease or renal failure. Lower levels are commonly found in salivary gland disease.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 17
Incorrect
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A 15-day old male baby was brought to the emergency department with sweating and his lips turning blue while feeding. He was born full term. On examination, his temperature was 37.9°C, blood pressure 75/45 mmHg, pulse was 175/min, and respiratory rate was 42/min. A harsh systolic ejection murmur could be heard at the left upper sternal border. X-ray chest showed small, boot-shaped heart with decreased pulmonary vascular markings. He most likely has:
Your Answer: Atrial septal defect
Correct Answer: Tetralogy of Fallot
Explanation:The most common congenital cyanotic heart disease and the most common cause of blue baby syndrome, Tetralogy of Fallot shows four cardiac malformations occurring together. These are ventricular septal defect (VSD), pulmonary stenosis (right ventricular outflow obstruction), overriding aorta (degree of which is variable), and right ventricular hypertrophy. The primary determinant of severity of disease is the degree of pulmonary stenosis. Tetralogy of Fallot is seen in 3-6 per 10,000 births and is responsible for 5-7% congenital heart defects, with slightly higher incidence in males. It has also been associated with chromosome 22 deletions and DiGeorge syndrome. It gives rise to right-to-left shunt leading to poor oxygenation of blood. Primary symptom is low oxygen saturation in the blood with or without cyanosis at birth of within first year of life. Affected children ay develop acute severe cyanosis or ‘tet spells’ (sudden, marked increase in cyanosis, with syncope, and may result in hypoxic brain injury and death). Other symptoms include heart murmur, failure to gain weight, poor development, clubbing, dyspnoea on exertion and polycythaemia. Chest X-ray reveals characteristic coeur-en-sabot (boot-shaped) appearance of the heart. Treatment consists of immediate care for cyanotic spells and Blalock–Taussig shunt (BT shunt) followed by corrective surgery.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 18
Correct
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A textbook of cardiac surgery explains that while doing a left pneumonectomy, a surgeon must be careful to avoid injury to a vital structure that leaves an impression on the mediastinal surface of the left lung. Which structure is it referring to?
Your Answer: Aortic arch
Explanation:Structures that leave an impression on the mediastinal surface of the left lung include: the oesophagus, subclavian artery, brachiocephalic vein, first rib, thymus, the heart, the diaphragm, descending aorta and arch of the aorta. The other structures form an impression on the mediastinal aspect of the right lung.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 19
Incorrect
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A 4 year old boy is rushed to the A&E department and admitted with lethargy and abdominal pain. On examination, he is febrile, temperature 38.2oC, pulse rate is 121 and blood pressure is 101/62. His abdomen is soft but there is some right sided peritonism. His WCC is 14 and urinalysis is positive for leucocytes but is otherwise normal. Which of the following is the best course of action?
Your Answer: Undertake ultrasound scan
Correct Answer: Take to theatre for appendicectomy within 6 hours
Explanation:The definitive treatment for appendicitis is appendectomy. An appendectomy, also spelled appendicectomy, is a surgical operation in which the vermiform appendix is removed. Appendectomy is normally performed as an urgent or emergency procedure to treat acute appendicitis.
Appendectomy may be performed laparoscopically (as minimally invasive surgery) or as an open operation. Laparoscopy is often used if the diagnosis is in doubt, or in order to leave a less visible surgical scar.
The classic history of anorexia and vague periumbilical pain, followed by migration of pain to the right lower quadrant (RLQ) and onset of fever and vomiting, is observed in fewer than 60% of patients. Children with appendicitis do not localize in the same way as adults and often the diagnosis is difficult and all too often made late. If the appendix perforates, an interval of pain relief is followed by development of generalized abdominal pain and peritonitis.Laboratory findings may increase suspicion of appendicitis but are not diagnostic. The minimum laboratory workup for a patient with possible appendicitis includes a white blood cell (WBC) count with differential and urinalysis. Liver function tests and amylase and lipase assessments are helpful when the aetiology is unclear. Baseline blood urea nitrogen and creatinine are needed prior to intravenous contrast CT scanning. The WBC count becomes elevated in approximately 70-90% of patients with acute appendicitis.
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This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 20
Correct
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A 60 year old alcoholic man is seen in the A&E department. When asked his reason for being there, he says he is looking for a place to sleep for the night. He is examined by one of the doctors and has no evidence of trauma, a skull x-ray fails to show any evidence of fracture. He is placed on observation and ten hours later, he develops a sudden onset headache, falls into a coma and then dies. What is the most likely cause?
Your Answer: Sub arachnoid haemorrhage
Explanation:The classic symptom of subarachnoid haemorrhage is thunderclap headache (a headache described as like being kicked in the head, or the worst ever, developing over seconds to minutes). This headache often pulsates towards the occiput (the back of the head). About one-third of people have no symptoms apart from the characteristic headache, and about one in ten people who seek medical care with this symptom are later diagnosed with a subarachnoid haemorrhage. Vomiting may be present, and 1 in 14 have seizures. Confusion, decreased level of consciousness or coma may be present, as may neck stiffness and other signs of meningism.
In 85 percent of spontaneous cases the cause is a cerebral aneurysm—a weakness in the wall of one of the arteries in the brain that becomes enlarged. They tend to be located in the circle of Willis and its branches. While most cases are due to bleeding from small aneurysms, larger aneurysms (which are less common) are more likely to rupture. Aspirin also appears to increase the risk.
In 15–20 percent of cases of spontaneous SAH, no aneurysm is detected on the first angiogram. About half of these are attributed to non-aneurysmal perimesencephalic haemorrhage, in which the blood is limited to the subarachnoid spaces around the midbrain (i.e. mesencephalon). In these, the origin of the blood is uncertain. The remainder are due to other disorders affecting the blood vessels (such as cerebral arteriovenous malformations), disorders of the blood vessels in the spinal cord, and bleeding into various tumours.
Genetics may play a role in a person’s disposition to SAH; risk is increased three- to fivefold in first-degree relatives of people having had a subarachnoid haemorrhage. But lifestyle factors are more important in determining overall risk. These risk factors are smoking, hypertension (high blood pressure), and excessive alcohol consumption.
The absence of trauma and skull fracture rules out the other types of haemorrhages and haematomas. -
This question is part of the following fields:
- Generic Surgical Topics
- Surgical Disorders Of The Brain
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Question 21
Correct
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A sexually active 21 year old man presents with the history of dysuria for the past 3 days. Urine culture confirmed Neisseria gonorrhoeae and smear showed abundant neutrophils. Which of the following mediators is responsible for causing diapedesis of the neutrophils to reach the site of infection?
Your Answer: Complement C5a
Explanation:C5a is part of the complement cascade and is released frim the complement C5. It acts as a chemotactic factor for neutrophils. Other chemotactic mediators are TNF, leukotrienes and bacterial products.
Bradykinin is associated with the production of pain and vasodilation.
Hageman factor is a clotting factor.
Histamine causes vasodilation.
C3B causes opsonisation.
IL-6 and IL-12 are inflammatory mediators causing B cell maturation and mediating inflammation and prostaglandins are involved with pain, increasing cell permeability and vasodilation. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 22
Correct
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A 30-year-old male is playing tennis when he suddenly collapses and has a GCS of 4 when examined. What is the most likely cause?
Your Answer: Subarachnoid haemorrhage
Explanation:The term subarachnoid haemorrhage (SAH) refers to extravasation of blood into the subarachnoid space between the pial and arachnoid membranes. SAH constitutes half of all spontaneous atraumatic intracranial haemorrhages; the other half consists of bleeding that occurs within the brain parenchyma.
Intracranial saccular aneurysms (“berry aneurysms”) represent the most common aetiology of nontraumatic SAH; about 80% of cases of SAH result from ruptured aneurysms. -
This question is part of the following fields:
- Generic Surgical Topics
- Surgical Disorders Of The Brain
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Question 23
Incorrect
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Which of the following organs is an ectoderm derivative?
Your Answer: Mesothelium
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 24
Incorrect
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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 bronchial artery – left apical segmental artery
Correct 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.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 25
Incorrect
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Anthrax is an infection caused by the bacterium Bacillus anthracis. Anthrax spores have been used as a biological warfare weapon. What is the drug of choice in treating anthrax infection?
Your Answer: Ceftazidime
Correct Answer: Ciprofloxacin
Explanation:Early antibiotic treatment of anthrax is essential. A delay may significantly lessen the chances for survival of the patient. Treatment for anthrax infection include large doses of intravenous and oral antibiotics, such as fluoroquinolones (ciprofloxacin), doxycycline, erythromycin, vancomycin, or penicillin.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 26
Incorrect
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Passing through the lesser sciatic foramen are the:
Your Answer: Posterior cutaneous nerve of the thigh
Correct Answer: Pudendal nerve
Explanation:Structures that pass through the lesser sciatic foramen include:
– the pudendal nerve
– the nerve to obturator internus
– internal pudendal artery
– the tendon of obturator internus -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 27
Correct
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A 56-year-old male is admitted for an elective hip replacement. Three days postoperatively you suspect he has had a pulmonary embolism. He has no past medical history of note. Blood pressure is 120/80 mmHg with a pulse of 90/min. The chest x-ray is normal. Following treatment with low-molecular-weight heparin, what is the most appropriate initial lung imaging investigation to perform?
Your Answer: Computed tomographic pulmonary angiography
Explanation:According to the ECS Guidelines 2019, Multidetector Computed tomographic pulmonary angiography (CTPA) is the method of choice for imaging the pulmonary vasculature in patients with suspected PE. It allows adequate visualization of the pulmonary arteries down to the subsegmental level.112–114 The Prospective Investigation On Pulmonary Embolism Diagnosis (PIOPED) II study observed a sensitivity of 83% and a specificity of 96% for (mainly four-detector) CTPA in PE diagnosis.
D-dimer levels are elevated in plasma in the presence of acute thrombosis because of simultaneous activation of coagulation and fibrinolysis. The negative predictive value of D-dimer testing is high, and a normal D-dimer level renders acute PE or DVT unlikely. On the other hand, the positive predictive value of elevated D-dimer levels is low and D-dimer testing is not useful for confirmation of PE.
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This question is part of the following fields:
- Post-operative Management And Critical Care
- Principles Of Surgery-in-General
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Question 28
Incorrect
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A 15 month old boy has a history of repeated bacterial pneumonia, failure to thrive and a sputum culture positive for H.influenzea and S.pneumoniae. There is no history of congenital anomalies. He is most likely suffering from?
Your Answer: Selective IgA deficiency
Correct Answer: X-linked agammaglobulinemia
Explanation:Recurrent bacterial infections may be due to lack of B-cell function, consequently resulting in a lack of gamma globulins production. Once the maternal antibodies have depleted, the disease manifests with greater severity and is called x-linked agammaglobulinemia also known as ‘X-linked hypogammaglobulinemia’, ‘XLA’ or ‘Bruton-type agammaglobulinemia. it is a rare x linked genetic disorder that compromises the bodies ability to fight infections.
Acute leukaemia causes immunodeficiency but not so specific.
DiGeorge syndrome is due to lack of T cell function.
Aplastic anaemia and EBV infection does not cause immunodeficiency. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 29
Correct
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A 43 year old detective undergoes a vasectomy at the local hospital. He is reviewed at the request of his general practitioner. On examination, he has a small rounded nodule adjacent to the vas. Which of the following is the most likely underlying diagnosis?
Your Answer: Sperm granuloma
Explanation:A sperm granuloma is a lump of extravasated sperm that appears along the vasa deferentia or epididymides in vasectomized men.
Sperm granulomas are rounded or irregular in shape, one millimetre to one centimetre or more, with a central mass of degenerating sperm surrounded by tissue containing blood vessels and immune system cells. Sperm granulomas can be either asymptomatic or symptomatic (i.e., either not painful or painful, respectively). If it is painful, it can be treated using over-the-counter anti-inflammatory /pain medication. If it causes unbearable discomfort, it may need to be surgically removed. However, they generally heal by themselves. Statistics suggest that between 15-40% of men may develop a granuloma post-vasectomy. -
This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 30
Incorrect
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The renal cortex and medulla, if seen under the microscope, is lacking one of the following:
Your Answer: Fenestrated endothelium
Correct 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.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
