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Question 1
Incorrect
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The mechanism of action of streptokinase involves:
Your Answer: Direct lysis of the clot
Correct Answer: Direct conversion of plasminogen to plasmin
Explanation:Streptokinase is an enzyme that is produced by group A beta haemolytic streptococcus and is an effective and cost efficient method for the dissolution of a clot used in cases of MI and pulmonary embolism. It works by directly converting plasminogen to plasmin which breaks down the blood components in the clot and fibrin, dissolving the clot. Streptokinase is a bacterial product and thus the body will develop immunity against it.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 2
Incorrect
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Which of the following is true regarding factor XI?
Your Answer: Is a cytokine
Correct Answer: Deficiency causes haemophilia C
Explanation:Factor XI is also known as plasma thromboplastin and is one of the enzymes of the coagulation cascade. It is produced in the liver and is a serine protease. It is activated by factor XIIa, thrombin and by itself. Deficiency of factor XI causes the rare type of haemophilia C. Low levels of factor XI also occur in other disease states, including Noonan syndrome. High levels of factor XI have been seen in thrombosis.
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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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What occurs during cellular atrophy?
Your Answer: Cell size decreases
Explanation:Atrophy is the decrease in the size of cells, tissues, or organs. There are several causes including inadequate nutrition, poor circulation, loss of hormonal support or nerve supply, disuse, lack of exercise, or disease. An increase in cell size is termed hypertrophy which is distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 4
Incorrect
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A 63 year old woman reports colicky abdominal pain and foul smelling diarrhoea on the 4th day following a cholecystectomy for acute cholecystitis. Her surgery was complicated as the gallbladder spilled stones intraoperatively. She has been on ciprofloxacin therapy ever since her surgery. Which of the following organisms is most likely responsible for her symptoms?
Your Answer: Clostridium perfringens
Correct Answer: Clostridium difficile
Explanation:Clostridioides difficile (C. difficile; formerly known as Clostridium difficile) is a gram-positive rod-shaped bacillus that is commonly involved in antibiotic-associated diarrhoea. As the bacterial spores are difficult to eradicate and easily transmitted (via faecal-oral transmission), the C. difficile infection rate is particularly high among hospitalized patients and residents in long-term care facilities.
Colonization with C. difficile occurs following antibiotic treatment of other diseases, as the bacteria is particularly resistant to antibiotics. The resulting damage to the intestinal flora promotes infection, which may be accompanied by high fever, abdominal pain, and characteristically foul-smelling diarrhoea. The most severe form of C. difficile infection is pseudomembranous colitis, which may lead to ileus, sepsis, and toxic megacolon. In most cases, however, colonization results in asymptomatic carriage rather than symptomatic infection.
Diagnosis is usually made via detection of the C. difficile toxin and/or corresponding genes in stool samples. C. difficile infections are treated with oral vancomycin or oral fidaxomicin. Following diagnosis, strict adherence to hygiene measures and patient isolation is essential, especially in hospitals and other healthcare settings. -
This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 5
Correct
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A 35 year-old woman is undergoing thyroidectomy. The external laryngeal nerve may be injured whilst ligating this artery during the procedure due to its close relationship?
Your Answer: Superior thyroid artery
Explanation:The superior thyroid artery arises from the external carotid artery just below the level of the greater cornu of the hyoid bone and ends in the thyroid gland. This artery must be ligated at the thyroid when conducting a thyroidectomy. If the artery is severed, but not ligated, it will bleed profusely. In order to gain control of the bleeding, the surgeon may need to extend the original incision laterally to ligate the artery at its origin at the external carotid artery. The external laryngeal branch of the superior laryngeal nerve courses in close proximity to the superior thyroid artery, making it at risk for injury during surgery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 6
Incorrect
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A 55 year old man presented with a 4 day history of cough and fever. His sputum culture showed the presence of Strep pneumoniae. Which of the following substances produced by the inflammatory cells will result in effective clearance of this organism from the lung parenchyma?
Your Answer: Prostaglandins
Correct Answer: Hydrogen peroxide
Explanation:Hydrogen peroxide is produced by myeloperoxidase to form a potent oxidant that eliminates bacteria, but is not effective in chronic granulomatous diseases.
Platelet activating factor will lead to the activation, adhesion and aggregation of platelets but will not directly kill bacteria.
Prostaglandins cause vasodilation but do not activate neutrophils.
Kallikrein promotes formation of bradykinin that leads to vasodilation.
Leukreines increase vascular permeability.
Cytokines are communicating molecules between immune cells but directly will not kill bacteria.
Interleukins will regulate the immune response. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 7
Correct
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A young man is referred by his family doctor to the urologist after having recurrent episodes of left flank pain. He was diagnosed with left sided PUJ obstruction as a little boy but he was lost to follow up. A CT scan is done and it shows considerable renal scarring. Which investigation should be done?
Your Answer: MAG 3 renogram
Explanation:Answer: MAG 3 renogram
This is the agent of choice due to a high extraction rate, which may be necessary for an obstructed system. Diuretic (furosemide) renogram is performed to evaluate between obstructive vs. nonobstructive hydronephrosis. The non-obstructive hydronephrosis will demonstrate excretion (downward slope on renogram) after administration of diuretic from the collecting system. Whereas mechanical obstructive hydronephrosis will show no downward slope on renogram, with retained tracer in the collecting system.
Pelviureteric junction (PUJ) obstruction/stenosis can be one of the causes of an obstructive uropathy. It can be congenital or acquired with a congenital PUJ obstruction being one of the most common causes of antenatal hydronephrosis. This is defined as an obstruction of the flow of urine from the renal pelvis to the proximal ureter.
Many cases are asymptomatic and identified incidentally when the renal tract is imaged for other reasons. When symptomatic, symptoms include recurrent urinary tract infections, stone formation and even a palpable flank mass. They are also at high risk of renal injury even by minor trauma.Symptom: Classically intermittent pain after drinking large volumes of fluid or fluids with a diuretic effect is described, due to the reduced outflow from the renal pelvis into the ureter.
Tc-99m DMSA (dimercaptosuccinic acid) is a technetium radiopharmaceutical used in renal imaging to evaluate renal structure and morphology, particularly in paediatric imaging for detection of scarring and pyelonephritis. DMSA is an ideal agent for the assessment of renal cortex as it binds to the sulfhydryl groups in proximal tubules at the renal cortex with longer retention than other agents. This results in higher concentration and hence much higher resolution with pinhole SPECT imaging. Also, it allows better assessment of differential renal function. It is a static scan as opposed to dynamic DTPA or MAG3 scans.
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This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 8
Incorrect
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A 55- year old male patient with cancer of the head of the pancreas was to undergo whipple's operation to have the tumour removed. During the surgery, the surgeon had to ligate the inferior pancreaticoduodenal artery to stop blood supply to the head of the pancreas. Which of the following arteries does the inferior pancreaticoduodenal artery branch from?
Your Answer: Gastroduodenal artery
Correct Answer: Superior mesenteric artery
Explanation:The inferior pancreaticoduodenal artery is a branch of the superior mesenteric artery or from the first intestinal branch of the superior mesenteric artery. Once given off, it runs to the right between the pancreatic head and the duodenum and then ascends to form an anastomosis with the superior pancreaticoduodenal artery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 9
Incorrect
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The pleural cavity is the space between the two pulmonary pleurae which cover the lungs. What is the normal amount of pleural fluid?
Your Answer: 35 ml
Correct Answer: 10 ml
Explanation:Pleural fluid is a serous fluid produced by the serous membrane covering normal pleurae. Most fluid is produced by the parietal circulation (intercostal arteries) via bulk flow and reabsorbed by the lymphatic system. The total volume of fluid present in the intrapleural space is estimated to be only 2–10 ml. A small amount of protein is present in intrapleural fluid. Normally, the rate of reabsorption increases as a physiological response to accumulating fluid.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 10
Incorrect
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A 25-year-old male is found to have a 5cm carcinoid tumour of the appendix. Imaging and diagnostic workup show no distant diseases. What is the best course of action?
Your Answer: Appendicectomy
Correct Answer: Right hemicolectomy
Explanation:Carcinoid tumours are of neuroendocrine origin and derived from primitive stem cells in the gut wall, especially the appendix.
Signs and symptoms of carcinoid tumours vary greatly. Carcinoid tumours can be non-functioning presenting as a tumour mass or functioning. The sign and symptoms of a non-functioning tumour depend on the tumour location and size as well as on the presence of metastases. Therefore, findings range from no tumour-related symptoms (most carcinoid tumours) to full symptoms of carcinoid syndrome (primarily in adults).
– Periodic abdominal pain: Most common presentation for a small intestinal carcinoid; often associated with malignant carcinoid syndrome
– Cutaneous flushing: Early and frequent (94%) symptom
– Diarrhoea and malabsorption (84%)
– Cardiac manifestations (60%): Valvular heart lesions, fibrosis of the endocardium; may lead to heart failure with tachycardia and hypertension
– Wheezing or asthma-like syndrome (25%)
– Pellagra
– Carcinoid crisis can be the most serious symptom of carcinoid tumours and can be life-threatening. It can occur suddenly, after stress, or following chemotherapy and anaesthesia.Two surgical procedures can be applied to treat appendiceal Neuroendocrine Neoplasm (NEN): simple appendicectomy and oncological right-sided hemicolectomy.
– For T1 (ENETS) or T1a (UICC/AJCC) NEN (i.e. <1 cm), generally simple appendicectomy is curative and sufficient.
– For NEN >2 cm with a T3 stage (ENETS) or higher and T2 (UICC/AJCC) or higher respectively, a right-sided hemicolectomy is advised due to the increased risk of lymph node metastasis and long-term tumour recurrence and/or distant metastasis. The right-sided hemico- lectomy should be performed either as the initial surgical intervention should the problem be overt at that time, or during a second intervention. -
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 11
Correct
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A 65-year old patient with altered bowl movement experienced the worsening of shortness of breath and exertional chest pains over the course of 8 weeks. Examination shows pallor and jugular venous distension. Furthermore, a test of the stool for occult blood is positive. Laboratory studies show: Haemoglobin 7.4 g/dl, Mean corpuscular volume 70 fl, Leukocyte count 5400/mm3, Platelet count 580 000/mm3, Erythrocyte sedimentation 33 mm/h.A blood smear shows hypochromic, microcytic RBCs with moderate poikilocytosis. Which of the following is the most likely diagnosis?
Your Answer: Iron deficiency anaemia
Explanation:Iron deficiency anaemia is the most common type of anaemia. It can occur due to deficiency of iron due to decreased intake or due to faulty absorption. An MCV less than 80 will indicated iron deficiency anaemia. On the smear the RBC will be microcytic hypochromic and will also show piokilocytosis. iron profiles tests are important to make a diagnosis. Clinically the patient will be pale and lethargic.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 12
Correct
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The primary somatosensory cortex is located in the:
Your Answer: Postcentral gyrus
Explanation:The primary somatic sensory cortex is located in the postcentral gyrus and is the largest cortical receiving area for information from somatosensory receptors. Through corticocortical fibres, it then sends the information to other areas of the neocortex and further analysis takes place in the posterior parietal association cortex.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 13
Correct
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Which of the following structure contains the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle?
Your Answer: Edinger–Westphal nucleus
Explanation:The Edinger–Westphal nucleus (accessory oculomotor nucleus) is the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 14
Incorrect
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Endometrial hyperplasia is most likely to be associated with which of the following conditions?
Your Answer: Choriocarcinoma
Correct Answer: Fibrothecoma
Explanation:A benign tumour arising from the ovarian stroma, fibrothecoma are bilateral in 10% cases. The thecoma component of the tumour can produce oestrogen leading to endometrial hyperplasia. The thecoma is rich in lipid content and is responsible for the yellowish appearance of the tumour. Meig’s syndrome is the presence of fibrothecoma with a right-sided hydrothorax.
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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 32-year-old woman is vomiting persistently following a laparoscopic appendicectomy for a perforated gangrenous appendicitis. Imaging shows some dilated small bowel loops. What should be the most appropriate course of action?
Your Answer: Insertion of wide bore nasogastric tube
Explanation:This patient is likely to have paralytic ileus and the administration of antiemetic drugs, in this situation, will have no effect. It is, therefore, important to decompress the stomach with a wide bore nasogastric tube.
Paralytic ileus is the obstruction of the intestine due to paralysis of the intestinal muscles. It commonly occurs after an abdominal surgery. Irrespective of the cause, paralytic ileus causes constipation, abdominal distention, nausea, and vomiting. It is a severe condition because if left untreated, an ileus can cut off blood supply to the intestines and cause tissue death.
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This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 16
Incorrect
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A 29-year-old woman is due to undergo a laparoscopic cholecystectomy. Which of the following intra-abdominal pressures should typically be set on the gas insufflation system?
Your Answer: 20 mmHg
Correct Answer: 10 mmHg
Explanation:A pressure of 10 mmHg should be set on the gas insufflation system.
Laparoscopic surgery may be performed in a number of body cavities. In some areas, irrigation solutions are preferred. In the abdomen, however, insufflation with carbon dioxide gas is commonly used. The amount of gas delivered is adjusted to maintain a constant intra-abdominal pressure of 12–15 mmHg. Excessive intra-abdominal pressure may reduce venous return and lead to hypotension. Too little insufflation will risk obscuring the surgical view.
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This question is part of the following fields:
- Principles Of Surgery-in-General
- Surgical Technique And Technology
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Question 17
Incorrect
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What is the primary function of the Kupffer cells found in the liver?
Your Answer: Synthesis of intrinsic factor
Correct Answer: Recycling of old red blood cells
Explanation:Kupffer cells found in the liver are part of the monocyte-reticular system. They are specialised macrophages and primarily function to recycle old and damaged RBCs. The RBCs are phagocytosed and the haemoglobin is broken down into haem and globin. The haem is further broken down into iron that is recycled and bilirubin that is conjugated with glucuronic acid and excreted in the bile.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 18
Correct
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A 21 year old lady notices a non-tender, mobile breast lump while doing her breast self-examination. The lump is smooth and not tethered to her skin. What is the diagnosis?
Your Answer: Fibroadenoma
Explanation:Answer: Fibroadenoma
A fibroadenoma is a painless, unilateral, benign (non-cancerous) breast tumour that is a solid, not fluid-filled, lump. It occurs most commonly in women between the age of 14 to 35 years but can be found at any age. Fibroadenomas shrink after menopause, and therefore, are less common in post-menopausal women. Fibroadenomas are often referred to as a breast mouse due to their high mobility. Fibroadenomas are a marble-like mass comprising both epithelial and stromal tissues located under the skin of the breast. These firm, rubbery masses with regular borders are often variable in size.
Fibroadenoma tends to occur in early age. It is most commonly found in adolescents and less commonly found in postmenopausal women. The incidence of fibroadenoma decreases with increasing age and generally found before 30 years of age in females in the general population. It is estimated that 10% of the world’s female population suffers from fibroadenoma once in a lifetime.
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This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 19
Correct
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Point of entry of the vagal trunk into the abdomen:
Your Answer: Oesophageal hiatus
Explanation:The oesophageal hiatus is located in the muscular part of the diaphragm a T10 and is above, in front and a little to the left of the aortic hiatus. It transmits the oesophagus, the vagus nerves and some small oesophageal arteries.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 20
Correct
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A patient is brought to the accident and emergency department. He is said to have been involved in a mall explosion. Chest imaging reveals metal fragments in his thoracic cavity. He also has a pericardial effusion suggestive of a pericardial tear. An emergency thoracotomy is done which revealed a tear of the pericardium inferiorly. The surgeon began to explore for fragments in the pericardial sac with his hand from below the apex. He slips his fingers upward and to the right within the sac until they were stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart. His finger tips were now in the:
Your Answer: Oblique pericardial sinus
Explanation:Transverse sinus: part of pericardial cavity that is behind the aorta and pulmonary trunk and in front of the superior vena cava separating the outflow vessels from the inflow vessels.
Oblique pericardial sinus: is behind the left atrium where the visceral pericardium reflects onto the pulmonary veins and the inferior vena cava. Sliding a finger under the heart will take you to this sinus.
Coronary sinus: large vein that drains the heart into the right atrium. Located on the surface of the heart.
Coronary sulcus: groove on the heart demarcating the atria from the ventricles.
Costomediastinal recess: part of the pleural sac where the costal pleura transitions to become the mediastinal pleura.
Sulcus terminalis: a groove between the right atrium and the vena cava. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 21
Correct
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A 45-year-old male is involved in a road traffic accident. He suffers significant injuries to his thorax, he has bilateral haemopneumothoraces and a suspected haemopericardium. He is to undergo surgery, what is the best method of accessing these injuries?
Your Answer: Clam shell thoracotomy
Explanation:Thoracic trauma accounts for > 25% of all traumatic injuries and is a leading cause of death in all age groups. The majority of thoracic trauma patients require only conservative management (e.g. analgesia, simple chest drainage). However, a subset of these patients will show signs of deterioration in the emergency department, especially with penetrating injuries. Such patients may require an emergency thoracotomy for rapid access to the thoracic cavity so that pericardial tamponade can be released and haemorrhage controlled. Furthermore, in severe thoracic trauma cases, specific injuries are difficult to confidently rule out or identify, even if they can be anticipated. Therefore, it is recommended to use an approach that provides the most rapid access to all vital chest organs for assessment and control.
Clamshell thoracotomy (also known as bilateral anterolateral thoracotomy) or hemi-clamshell (longitudinal sternotomy and anterolateral thoracotomy) are techniques used to provide complete exposure of the thoracic cavity (heart, mediastinum and lungs). Studies have demonstrated that it is easier to control the cardiac wound using this approach compared to the standard left anterolateral thoracotomy, as it gives wider exposure for all injuries, which are then easier to control surgically through the larger incision.
Contraindications:
Absolute:
– Traumatic cardiac arrest where the underlying pathology is so severe as to render the procedure futile (e.g. severe traumatic brain injury)
Relative:
Blunt cardiac injury with no signs of life or organised cardiac rhythm -
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 22
Incorrect
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A 34 year old man arrives at the clinic due to a painless lump in his left teste. His blood tests and US point towards a teratoma. Which of the following is the most appropriate next step in the management of this patient?
Your Answer: Orchidectomy via a scrotal approach
Correct Answer: Orchidectomy via an inguinal approach
Explanation:Unlike other cancers for which a biopsy is performed, when testicular cancer is suspected the entire testicle is removed in a procedure called an orchiectomy through an incision in the groin and pulling the testicle up from the scrotum. A biopsy through the scrotum for testicular cancer runs the risk of spreading the cancer, and can complicate future treatment options. Removing the entire testicle out of the scrotum is the only safe way to diagnose for testicular cancer. Only the cancer-containing testicle is removed, and it is important to do so promptly.
If there is any uncertainty, the urologists can examine the testicle by pulling the testicle out of the scrotum; if a condition other than testis cancer is found, the testicle is placed back into the scrotum.Testicular cancer is the most common malignancy in men aged 20-30 years. Around 95% of cases of testicular cancer are germ-cell tumours.
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This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 23
Correct
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Which of these conditions causes haematuria, hypertension and proteinuria in children, usually after a streptococcal infection?
Your Answer: Acute nephritic syndrome
Explanation:Nephritic syndrome (or acute nephritic syndrome) is a syndrome comprising of signs of nephritis. Children between 2 and 12 are most commonly affected, but it may occur at any age. Predisposing factors/causes include:
Infections with group A streptococcal bacteria (acute post-streptococcal glomerulonephritis).
Primary renal diseases: immunoglobulin A nephropathy, membranoproliferative glomerulonephritis, idiopathic rapidly progressive crescentic glomerulonephritis.
Secondary renal diseases: subacute bacterial endocarditis, infected ventriculo–peritoneal shunt, glomerulonephritis with visceral abscess, glomerulonephritis with bacterial, viral or parasitic infections.
Multisystem diseases.
By contrast, nephrotic syndrome is characterized by only proteins moving into the urine. -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 24
Incorrect
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A 59-year old gentleman admitted for elective cholecystectomy was found to have a haemoglobin 12.5 g/dl, haematocrit 37%, mean corpuscular volume 90 fl, platelet count 185 × 109/l, and white blood cell count 32 × 109/l; along with multiple, small mature lymphocytes on peripheral smear. The likely diagnosis is:
Your Answer: Acute lymphocytic leukaemia
Correct Answer: Chronic lymphocytic leukaemia
Explanation:CLL or chronic lymphocytic leukaemia is the most common leukaemia seen in the Western world. Twice more common in men than women, the incidence of CLL increases with age. About 75% cases are seen in patients aged more than 60 years. The blood, marrow, spleen and lymph nodes all undergo infiltration, eventually leading to haematopoiesis (anaemia, neutropenia, thrombocytopenia), hepatomegaly, splenomegaly and decreased production of immunoglobulin. In 98% cases, CD+5 B cells undergo malignant transformation.
Often diagnosed on blood tests while being evaluated for lymphadenopathy, CLL causes symptoms like fatigue, anorexia, weight loss, pallor, dyspnoea on exertion, abdominal fullness or distension. Findings include multiple lymphadenopathy with minimal-to- moderate hepatomegaly and splenomegaly. Increased susceptibility to infections is seen. Herpes Zoster is common. Diffuse or maculopapular skin infiltration can also be seen in T-cell CLL.
Diagnosis is by examination of peripheral blood smear and marrow: hallmark being a sustained, absolute leucocytosis (>5 ×109/l) and increased lymphocytes in the marrow (>30%). Other findings can include hypogammaglobulinemia (<15% of cases) and, rarely, raised lactate dehydrogenase (LDH). Only 10% cases demonstrate moderate anaemia and/or thrombocytopenia. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 25
Correct
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A 37 year old woman has recently undergone a mastectomy along with axillary node clearance for an invasive ductal carcinoma. Histological analysis show a completely excised grade III lesion measuring 3.5cm. Two of the axillary nodes are significant for metastatic spread. The tumour is found to be oestrogen receptor negative. Which of the following would be the next best step in the management of this patient?
Your Answer: Administration of cytotoxic chemotherapy
Explanation:Chemotherapy is offered to patients to help downstage advanced lesions to facilitate breast conserving surgery i.e. in grade 3 tumours with axillary node metastasis.
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This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 26
Incorrect
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A 76-year-old woman is diagnosed with diabetes mellitus after a urine test revealed she has glucosuria. Glucosuria may occur due to inadequate glucose reabsorption at:
Your Answer: Distal convoluted tubule
Correct Answer: Proximal convoluted tubule
Explanation:Glucose is reabsorbed almost 100% via sodium–glucose transport proteins (apical) and GLUT (basolateral) in the proximal convoluted tubule. Glycosuria or glucosuria is a condition of osmotic diuresis typical in those suffering from diabetes mellitus. Due to a lack of insulin, plasma glucose levels are above normal. This leads to saturation of receptors in the kidneys and glycosuria usually at plasma glucose levels above 11 mmol/l. Rarely, glycosuria is due to an intrinsic problem with glucose reabsorption within the kidneys (such as Fanconi syndrome), producing a condition termed renal glycosuria.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 27
Incorrect
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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: 20 ml
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.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 28
Incorrect
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A group of surgeons in the colorectal unit wish to identify if there is a significant difference in their individual leak rates for anterior resection of the rectum. Which investigation would be appropriate?
Your Answer: Chi squared test
Correct Answer: Kruskall Wallis test
Explanation:Answer: Kruskall Wallis test
Kruskall Wallis test is a non-parametric method for testing whether samples originate from the same distribution. It is used for comparing two or more independent samples of equal or different sample sizes. It extends the Mann–Whitney U test, which is used for comparing only two groups. The parametric equivalent of the Kruskal–Wallis test is the one-way analysis of variance (ANOVA).
T-tests are useful for comparing the means of two samples. There are two types: paired and unpaired.Paired means that both samples consist of the same test subjects. A paired t-test is equivalent to a one-sample t-test.
Unpaired means that both samples consist of distinct test subjects. An unpaired t-test is equivalent to a two-sample t-test.
A chi-squared test, also written as χ2 test, is any statistical hypothesis test where the sampling distribution of the test statistic is a chi-squared distribution when the null hypothesis is true. The chi-squared test is used to determine whether there is a significant difference between the expected frequencies and the observed frequencies in one or more categories.Fisher’s exact test is a statistical test used to determine if there are non-random associations between two categorical variables.
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This question is part of the following fields:
- Management And Legal Issues In Surgery
- Principles Of Surgery-in-General
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Question 29
Correct
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Loperamide is a drug used to treat diarrhoea. What is the mechanism of action of loperamide?
Your Answer: Opiate agonist
Explanation:Loperamide is an opioid-receptor agonist and acts on the mu opioid receptors in the myenteric plexus of large intestine. It works by decreasing the motility of the circular and longitudinal smooth muscles of the intestinal wall. It is often used for this purpose in gastroenteritis, inflammatory bowel disease, and short bowel syndrome.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 30
Incorrect
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A 49 year old carpenter is rushed to the hospital after falling from the roof of a house. He has an open fracture of his tibia with a 14 cm wound and he is neurovascularly intact. What is the most appropriate course of action?
Your Answer: Thorough wound debridement in the emergency department
Correct Answer: Intravenous antibiotics, photography and application of saline soaked gauze with impermeable dressing
Explanation:The administration of antibiotics is best considered therapeutic, rather than prophylactic, because of the high risk of infection in the absence of antibiotics.
Although debate still surrounds some aspects of antibiotic administration for open fractures, the following generalizations can be made:
– All patients with open fractures should receive cefazolin or equivalent gram-positive coverage; this may be sufficient
– Type II or type III injuries likely benefit from the addition of adequate gram-negative coverage, typically with an aminoglycoside
– Injuries at risk for anaerobic infections (e.g., farm injuries, severe tissue necrosis) probably benefit from the addition of penicillin or clindamycin.Digital photos are helpful for documenting the initial appearance of the extremity and can be a valuable addition to the medical record. Digital imaging allows other members of the treatment team to see the wound preoperatively without repeated manipulations of the wound.
Gauze swabs soaked in normal saline are frequently used as dressing on open wounds.The Oxford Handbook for Medical school recommends that open fractures should be sealed with saline-soaked gauze and impermeable dressing after removal of gross contaminants.
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This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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SESSION STATS - PERFORMANCE PER SPECIALTY
