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  • Question 1 - A 40-year old gentleman, known with past peptic ulcer disease, was brought to...

    Correct

    • A 40-year old gentleman, known with past peptic ulcer disease, was brought to the clinic in a dehydrated state with persistent vomiting. His blood investigations revealed sodium = 142 mmol/l, potassium = 2.6 mmol/l, chloride = 85 mmol/l, pH = 7.55, p(CO2) = 50 mmHg, p(O2) = 107 mmHg and standard bicarbonate = 40 mmol/l. This patient had:

      Your Answer: Metabolic alkalosis

      Explanation:

      High pH with high standard bicarbonate indicates metabolic alkalosis. The pa(CO2) was appropriately low in compensation. This is hypokalaemia hypochloraemic metabolic acidosis due to prolonged vomiting. Treatment includes treating the cause and intravenous sodium chloride with potassium.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      56.4
      Seconds

  • Question 2 - A 34 year old woman underwent a wide local excision for her breast...

    Incorrect

    • A 34 year old woman underwent a wide local excision for her breast carcinoma. Histology reveals an invasive lobular carcinoma present at three of the resection margins. Cavity shavings that were taken at the original operation are also involved. The sentinel lymph node biopsy was reported to be negative. Which of the following management plans would be the most appropriate for this patient?

      Your Answer: Arrange for completion mastectomy and axillary node clearance

      Correct Answer: Arrange for completion mastectomy alone

      Explanation:

      Mastectomy should ideally be done in this patient. This patient has extensive spread of disease and tumour margins are unclear which makes radiotherapy the less likely option. Mastectomy is the safest option in this scenario. Patients who have undergone mastectomy may be offered a reconstructive procedure either in conjunction with their primary resection or as a staged procedure at a later date.

    • This question is part of the following fields:

      • Breast And Endocrine Surgery
      • Generic Surgical Topics
      80.8
      Seconds

  • Question 3 - A surgeon performing a Whipple's procedure, that involves mobilizing the head of the...

    Correct

    • A surgeon performing a Whipple's procedure, that involves mobilizing the head of the pancreases, accidentally injured a structure immediately posterior to the neck of the pancreases which bled out. Which structure is most likely to have been injured?

      Your Answer: Superior mesenteric artery

      Explanation:

      The splenic vein runs behind the pancreas, receives the inferior mesenteric vein and joins the superior mesenteric vein to form the portal vein behind the pancreatic neck.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      14
      Seconds

  • Question 4 - A cancer patient was found to have a radio resistant tumour. Which tumour...

    Incorrect

    • A cancer patient was found to have a radio resistant tumour. Which tumour does the patient most likely have?

      Your Answer: Lymphoma

      Correct Answer: Liposarcoma

      Explanation:

      Liposarcoma is a cancer that arises in fat cells in deep soft tissue. Commonly it occurs inside the thigh or retroperitoneum. It usually affects middle-aged and older adults, over 40 years. Liposarcoma is the most common soft-tissue sarcoma. It is very radio resistant. Five-year survival rates vary from 100% to 56% based on histological subtype.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      12.6
      Seconds

  • Question 5 - Which tumour site is more commonly involved in adults than in children? ...

    Incorrect

    • Which tumour site is more commonly involved in adults than in children?

      Your Answer: Soft tissue

      Correct Answer: Lung

      Explanation:

      In adults, the most common primary site of tumour is in the lungs, compared to children wherein the most common primary site is the blood.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      12.6
      Seconds

  • Question 6 - A 52 year old man presents to the emergency department with a stab...

    Incorrect

    • A 52 year old man presents to the emergency department with a stab wound to his left iliac fossa. He is hemodynamically unstable and is taken immediately to the OT for emergency laparotomy. During surgery, colonic mesentery is found to be injured that has resulted in the blood loss. The left colon is also injured with signs of local perforation and contamination. Which of the following is the most important aspect of management?

      Your Answer: Undertake a repair of the descending colon and place drains

      Correct Answer: Resect the left colon and construct a left iliac fossa end colostomy

      Explanation:

      Colonic injuries that are managed with resection are associated with a high complication rate regardless of whether an anastomosis or colostomy is performed. Colonic resection and anastomosis can be performed safely in the majority of patients with severe colonic injury, including injuries to the left colon. For injuries of the right colon, an ileocolostomy has a lower incidence of leakage than a colocolonic anastomosis. For injuries to the left colon, there remains a role for colostomy specifically in the subgroups of patients with a high ATI or hypotension, because these patients are at greater risk for an anastomotic leak. The role of resection and primary anastomosis versus colostomy in colonic trauma requires further investigation.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      36.1
      Seconds

  • Question 7 - Congenital anomalies of genitourinary tract are more common than any other system. Which...

    Incorrect

    • Congenital anomalies of genitourinary tract are more common than any other system. Which of the following anomalies carries the greatest risk of morbidity?

      Your Answer:

      Correct Answer: Bladder exstrophy

      Explanation:

      Bladder exstrophy is the condition where the urinary bladder opens from the anterior aspect suprapubically. The mucosa of the bladder is continuous with the abdominal skin and there is separation of the pubic bones. The function of the upper urinary tract remains normal usually. Treatment consists of surgical reconstruction of the bladder and returning it to the pelvis. There can be a need for continent urinary diversion along with reconstruction of the genitals.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 8 - A 65-year-old man with no history of smoking complains of shortness of breath...

    Incorrect

    • A 65-year-old man with no history of smoking complains of shortness of breath and persistent cough over the past 8 months. He reveals that in the 1960s he worked for several years as a boiler operator. Chest X-ray shows diffuse lung infiltrates. Which of the following is the most probable cause of these findings?

      Your Answer:

      Correct Answer: Asbestosis

      Explanation:

      Asbestosis is a chronic lung disease which leads to long-term respiratory complications and is caused by the inhalation of asbestos fibres. Symptoms due to long exposure to asbestos usually appear 10 to 40 years after initial exposure and include shortness of breath, cough, weight loss, clubbing of the fingers and chest pain. Typical chest X-ray findings include diffuse lung infiltrates that cause the appearance of shaggy heart borders.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 9 - A 33 year old woman complains of a persistent offensive discharge from the...

    Incorrect

    • A 33 year old woman complains of a persistent offensive discharge from the left ear. On examination, the hearing of left ear is found to be reduced to 40 decibels compared to the right side. Which of the following is the most likely cause of this presentation?

      Your Answer:

      Correct Answer: Cholesteatoma

      Explanation:

      Cholesteatoma is a special form of chronic otitis media in which keratinizing squamous epithelium grows from the tympanic membrane or the auditory canal into the middle ear mucosa or mastoid. The presence of abnormal epithelium in an abnormal location triggers an inflammatory response that can destroy surrounding structures such as the ossicles. Cholesteatomas may be congenital or acquired later in life. Acquired cholesteatomas are usually associated with chronic middle ear infection. Cardinal symptoms are painless otorrhea and progressive hearing loss. Important diagnostic procedures include mastoid process x-rays, temporal bone CT scans, and audiometric tests. Left untreated, erosion of the surrounding bone by a cholesteatoma can lead to facial nerve palsy, extradural abscess, and/or sigmoid sinus thrombosis. Therefore, even if a cholesteatoma is asymptomatic, surgery is always indicated. Surgical treatment involves tympanomastoidectomy to excise the cholesteatoma, followed by repair of the damaged middle ear structures.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Head And Neck Surgery
      0
      Seconds

  • Question 10 - A 55-year-old alcoholic male presents with acute pancreatitis. He is clinically dehydrated. His...

    Incorrect

    • A 55-year-old alcoholic male presents with acute pancreatitis. He is clinically dehydrated. His blood results show normal renal function and electrolytes. Which of the intravenous fluids below should be prescribed?

      Your Answer:

      Correct Answer: Hartmann's solution

      Explanation:

      Management of Acute Pancreatitis revolves around supportive care, adequate nutrition, and intravenous hydration. The rationale for hydration is based on the need to resolve the hypovolemia that occurs secondary to vomiting, reduced oral intake, third space extravasation, respiratory losses and diaphoresis. Besides, early hydration provides macrocirculatory and microcirculatory support to prevent the cascade of events leading to pancreatic necrosis.
      There is a lack of high level evidence to guide the choice of fluid in AP. Crystalloids are recommended by the American Gastroenterological Association, and colloids (packed red blood cells) are considered in cases of low haematocrit (< 25%) and low serum albumin (< 2 g/dL). Among the crystalloids, Ringer's lactate solution is preferred over Normal saline. However, there is an urgent need of studies on this issue.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      0
      Seconds

  • Question 11 - The mandibular nerve, which is the largest of the 3 divisions of the...

    Incorrect

    • The mandibular nerve, which is the largest of the 3 divisions of the trigeminal nerve, exits the cranial cavity through which foramen?

      Your Answer:

      Correct Answer: Foramen ovale

      Explanation:

      At the base of the skull the foramen ovale is one of the larger of the several holes that transmit nerves through the skull. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery, lesser petrosal nerve, a branch of the glossopharyngeal nerve, emissary vein connecting the cavernous sinus with the pterygoid plexus of veins and occasionally the anterior trunk of the middle meningeal vein.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 12 - A 34-year-old Asian male presents with cervical lymphadenopathy. The patient is suspected to...

    Incorrect

    • A 34-year-old Asian male presents with cervical lymphadenopathy. The patient is suspected to have tuberculous lymphadenopathy. Excision biopsy of one of the nodes showed granulomatous inflammation. Which histopathologic feature is most likely consistent with the diagnosis of tuberculosis?

      Your Answer:

      Correct Answer: Caseation necrosis

      Explanation:

      The granulomas of tuberculosis tend to contain necrosis (caseating tubercles), but non-necrotizing granulomas may also be present. Multinucleated giant cells with nuclei arranged like a horseshoe (Langhans giant cells) and foreign body giant cells are often present, but are not specific for tuberculosis. A definitive diagnosis of tuberculosis requires identification of the causative organism by microbiological cultures.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 13 - Myoglobin is released as a result of rhabdomyolysis from damaged skeletal muscles. What...

    Incorrect

    • Myoglobin is released as a result of rhabdomyolysis from damaged skeletal muscles. What function do they perform in the muscle?

      Your Answer:

      Correct Answer: Acts like haemoglobin and binds with O2

      Explanation:

      Myoglobin is a pigmented globular protein made up of 153 amino acids with a prosthetic group containing haem around which the apoprotein folds. It is the primary oxygen carrying protein of the muscles. The binding of oxygen to myoglobin is unaffected by the oxygen pressure as it has an instant tendency to bind given its hyperbolic oxygen curve. It releases oxygen at very low pO2 levels.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 14 - A 1 year old baby is taken to the A&E with colicky abdominal...

    Incorrect

    • A 1 year old baby is taken to the A&E with colicky abdominal pain and an ileo-ileal intussusception is found on investigation. What is the most appropriate course of action?

      Your Answer:

      Correct Answer: Undertake a laparotomy

      Explanation:

      Answer: Undertake a laparotomy

      Intussusception, which is defined as the telescoping or invagination of a proximal portion of intestine (intussusceptum) into a more distal portion (intussuscipiens), is one of the most common causes of bowel obstruction in infants and toddlers.
      Intussusception may be ileoileal, colocolic, ileoileocolic, or ileocolic (the most common type).
      Most infants with intussusception have a history of intermittent severe cramping
      or colicky abdominal pain, occurring every 5-30 minutes. During these attacks, the infant screams and flexes at the waist, draws the legs up to the abdomen, and may appear pale. These episodes may last for only a few seconds and are separated by periods of calm normal appearance and activity. However, some infants become quite lethargic and somnolent between attacks.
      Infants with intussusception require surgical correction. Prompt laparotomy following diagnosis is crucial for achieving better outcomes. Primary anastomosis can be performed successfully, and stomas can be created in the critically ill patients or those with late detection and septicaemia.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Paediatric Surgery
      0
      Seconds

  • Question 15 - A 64 year old man who has undergone a total hip replacement is...

    Incorrect

    • A 64 year old man who has undergone a total hip replacement is given an infusion of packed red cells. Which of the following adverse effects is most likely to occur as a result of this treatment?

      Your Answer:

      Correct Answer: Pyrexia

      Explanation:

      Acute transfusion reactions present as adverse signs or symptoms during or within 24 hours of a blood transfusion. The most frequent reactions are fever, chills, pruritus, or urticaria, which typically resolve promptly without specific treatment or complications.

    • This question is part of the following fields:

      • Post-operative Management And Critical Care
      • Principles Of Surgery-in-General
      0
      Seconds

  • Question 16 - A 49-year-old male patient is recovering from a right hemicolectomy for Crohn's disease....

    Incorrect

    • A 49-year-old male patient is recovering from a right hemicolectomy for Crohn's disease. He is oliguric and dehydrated owing to a high output ileostomy. His electrolytes are normal. Out of the following, which intravenous fluid should be administered?

      Your Answer:

      Correct Answer: Hartmann's solution

      Explanation:

      Hartmann’s solution is the preferred fluid among the listed options.

      In UK, Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP) and The National Institute for Health and Care Excellence (NICE) guidelines were devised to try and develop a consensus on how to administer intravenous fluids (IV) postoperatively. A decade ago, it was a commonly held belief that little harm would occur as a result of excessive administration of normal saline, and many oliguric postoperative patients received enormous quantities of IV fluids. As a result, they developed hyperchloraemic acidosis. With greater understanding of this potential complication, the use of electrolyte-balanced solutions (Hartmann’s or Ringer Lactate solution) is now favoured over normal saline.

      The guidelines further include:
      1. Fluids given should be documented clearly.
      2. Assess the patient’s fluid status when they leave the theatre.
      3. If the patient is haemodynamically stable and euvolaemic, aim to restart oral fluid intake as soon as possible.
      4. If the patient is oedematous, hypovolaemia if present should be treated first. This should then be followed by a negative balance of sodium and water, monitored closely.
      5. Solutions such as Dextran 70 should be cautiously used in patients with sepsis as there is a risk of developing acute renal injury.

    • This question is part of the following fields:

      • Post-operative Management And Critical Care
      • Principles Of Surgery-in-General
      0
      Seconds

  • Question 17 - A 46-year old lady presents with chief complaints of a large mass in...

    Incorrect

    • A 46-year old lady presents with chief complaints of a large mass in the left breast. Histopathology of the mass revealed a stromal component with an epithelial component. What is the likely lesion?

      Your Answer:

      Correct Answer: Phyllodes tumour

      Explanation:

      Phyllodes tumours are large, quickly growing tumours which arise from the periductal stroma of the breast. These are fibroepithelial tumours and account for less than 1% of breast cancers. These tumours can be benign, borderline or malignant based on the histology. The tumour usually affects adult women, mostly between the age of 40 to 50 years. It can be confused with fibroadenoma, which however affects much younger patients.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 18 - A 26 year old man is admitted for severe anorexia nervosa and he...

    Incorrect

    • A 26 year old man is admitted for severe anorexia nervosa and he is given nasogastric feeding which is initially tolerated well. Four days later, he becomes acutely agitated and confused. On examination, his heart rate is 121/min with regular rhythm and a blood pressure of 97/86 mmHg. despite all this, he appears adequately hydrated and has no fever. Which investigation would be the best one for this patient?

      Your Answer:

      Correct Answer: Serum phosphate

      Explanation:

      Answer: Serum phosphate

      Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally. These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.
      During refeeding, glycaemia leads to increased insulin and decreased secretion of glucagon. Insulin stimulates glycogen, fat, and protein synthesis. This process requires minerals such as phosphate and magnesium and cofactors such as thiamine. Insulin stimulates the absorption of potassium into the cells through the sodium-potassium ATPase symporter, which also transports glucose into the cells. Magnesium and phosphate are also taken up into the cells. Water follows by osmosis. These processes result in a decrease in the serum levels of phosphate, potassium, and magnesium, all of which are already depleted. The clinical features of the refeeding syndrome occur as a result of the functional deficits of these electrolytes and the rapid change in basal metabolic rate.

      Symptoms of hypophosphatemia include:

      confusion or hesitation
      seizures
      muscle breakdown
      neuromuscular problems
      acute heart failure

      Deficiency in thiamine can lead to Korsakoff’s syndrome (retrograde and anterograde amnesia, confabulation) and Wernicke’s encephalopathy (ocular abnormalities, ataxia, confusional state, hypothermia, coma). These symptoms are not present in the patient so Thiamine deficiency can be ruled out and there is no need to do tests for Serum vitamin B.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      0
      Seconds

  • Question 19 - Calculate the cardiac output in an adult male with the following parameters: Heart...

    Incorrect

    • Calculate the cardiac output in an adult male with the following parameters: Heart rate 70 beats/min, Arterial [O2] 0.24 ml O2/min, Venous [O2] 0.16 ml O2/min, Whole body O2 consumption 500 ml/min, Pulmonary diastolic pressure 15 mmHg, Pulmonary systolic pressure 25 mmHg, Wedge pressure 5 mmHg.

      Your Answer:

      Correct Answer: 6.25 l/min

      Explanation:

      As per Fick’s principle, VO2 = (CO × CAO2) – (CO × CVO2) where VO2 = oxygen consumption, CO = cardiac output, CAO2 = oxygen concentration of arterial blood and CVO2 = oxygen concentration of venous blood. Thus, CO = VO2/CAO2– CVO2, CO = 500/0.24 – 0.16, CO = 500/0.8, CO = 6.25 l/min.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 20 - The nasolacrimal duct is a membranous canal. It extends from the lower part...

    Incorrect

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

      Your Answer:

      Correct Answer: Inferior meatus

      Explanation:

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

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 21 - A 34-year old gentleman presented with acute pancreatitis to the emergency department. On...

    Incorrect

    • A 34-year old gentleman presented with acute pancreatitis to the emergency department. On enquiry, there was found to be a history of recurrent pancreatitis, eruptive xanthomas and raised plasma triglyceride levels associated with chylomicrons. Which of the following will be found deficient in this patient?

      Your Answer:

      Correct Answer: Lipoprotein lipase

      Explanation:

      The clinical features mentioned here suggest the diagnosis of hypertriglyceridemia due to lipoprotein lipase (LPL) deficiency. LPL aids in hydrolysing the lipids in lipoproteins into free fatty acids and glycerol. Apo-CII acts as a co-factor. Deficiency of this enzyme leads to hypertriglyceridemia.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 22 - Which of the following veins is prostate cancer most likely to metastasize through?...

    Incorrect

    • Which of the following veins is prostate cancer most likely to metastasize through?

      Your Answer:

      Correct Answer: Internal vertebral venous plexus

      Explanation:

      The internal vertebral veins are the most likely route of metastasis as they are valveless. They serve an important clinical role as they are the route of free travel for cancerous cells to other body structures. The other veins on the list have valves and would be the least likely routes for metastasis.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 23 - Which antibiotic acts by inhibiting protein synthesis? ...

    Incorrect

    • Which antibiotic acts by inhibiting protein synthesis?

      Your Answer:

      Correct Answer: Erythromycin

      Explanation:

      Penicillins and cephalosporins (e.g. cefuroxime, cefotaxime, ceftriaxone) inhibit bacterial cell wall synthesis through the inhibition of peptidoglycan cross-linking.
      Macrolides (e.g. erythromycin), tetracyclines, aminoglycosides and chloramphenicol act by interfering with bacterial protein synthesis.
      Sulphonamides (e.g. trimethoprim, co-trimoxazole) work by inhibiting the synthesis of nucleic acid

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 24 - Infection to all of the following will lead to enlargement of the superficial...

    Incorrect

    • Infection to all of the following will lead to enlargement of the superficial inguinal lymph nodes, except for:

      Your Answer:

      Correct Answer: Ampulla of the rectum

      Explanation:

      The superficial inguinal lymph nodes form a chain immediately below the inguinal ligament. They receive lymphatic supply from the skin of the penis, scrotum, perineum, buttock and abdominal wall below the level of the umbilicus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 25 - A biopsy is performed on a 67-year-old-man with testicular seminoma; it reveals that...

    Incorrect

    • A biopsy is performed on a 67-year-old-man with testicular seminoma; it reveals that the tumour affects the tunica vaginalis. The tumour stage in this case is:

      Your Answer:

      Correct Answer: T2

      Explanation:

      The primary tumour staging for testicular seminoma is as follows, according to AJCC guidelines:
      Tis: intratubular germ cell neoplasia (carcinoma in situ)
      T1: tumour limited to testis/epididymis without vascular or lymphatic invasion; the tumour can invade into the tunica albuginea but not the tunica vaginalis
      T2: tumour limited to testis/epididymis with vascular or lymphatic invasion or tumour extending through the tunica albuginea with involvement of the tunica vaginalis
      T3: tumour invading the spermatic cord, with or without vascular/lymphatic invasion
      T4: tumour invading the scrotum, with or without vascular/lymphatic invasion.
      According to these guidelines, the tumour in this case has a T2 stage.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 26 - A 23-year-old man presents to the hospital with complaints of pain in the...

    Incorrect

    • A 23-year-old man presents to the hospital with complaints of pain in the lower limbs after walking for five minutes, which improves after three minutes of stopping. On examination, he is found to have reduced hair growth on the lower limbs, and his calf muscles appear atrophied. There is a weak popliteal pulse and it remains intact when the knee is fully extended. What could be the most likely diagnosis?

      Your Answer:

      Correct Answer: Adductor canal compression syndrome

      Explanation:

      Adductor canal compression syndrome most commonly presents in young males, and it is important to differentiate it from acute limb ischaemia on exertion. Of the listed options, popliteal fossa entrapment is the main differential diagnosis. However, the popliteal pulse disappears when the knee is fully extended in popliteal fossa entrapment.

      Adductor canal compression syndrome is caused by compression of the femoral artery by the musculotendinous band of adductor magnus muscle. The treatment consists of division of the abnormal band and restoration of the arterial circulation.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Vascular
      0
      Seconds

  • Question 27 - A 28-year-old electrician is brought to the A&E department after a high-voltage full-thickness...

    Incorrect

    • A 28-year-old electrician is brought to the A&E department after a high-voltage full-thickness burn to his left leg. His urinalysis shows haematuria 1+ and his blood reports show mild hyperkalaemia and serum CK level of 3000 U/L. What is the most likely explanation?

      Your Answer:

      Correct Answer: Rhabdomyolysis

      Explanation:

      High-voltage electrical burns are associated with rhabdomyolysis. Acute tubular necrosis may also occur.

      Electrical burns occur following exposure to electrical current. Full-thickness burns are third-degree burns. With these types of burns, the epidermal and dermal layers of skin are destroyed, and the damage may even penetrate the layer of fat beneath the skin.

      Following the burn, there is a local response with progressive tissue loss and release of inflammatory cytokines. Systemically, there are cardiovascular effects resulting from fluid loss and sequestration of fluid into the third space. There is a marked catabolic response as well. Immunosuppression is common with large burns, and bacterial translocation from the gut lumen is a recognised event. Sepsis is a common cause of death following major burns.

      After the initial management and depth assessment of the burn, the patient is transferred to burn centre if:
      1. Needs burn shock resuscitation
      2. Face/hands/genitals affected
      3. Deep partial-thickness or full-thickness burns
      4. Significant electrical/chemical burns

      Management options include:
      1. The initial aim is to stop the burning process and resuscitate the patient. Adults with burns greater than 15% of total body surface area require burn fluid resuscitation. Fluids administration is calculated using the Parkland formula. Half of the fluid is administered in the first eight hours. A urinary catheter should be inserted and analgesics should be started.

      2. Conservative management is appropriate for superficial burns and mixed superficial burns that will heal in two weeks. More complex burns may require excision and skin grafting. Excision and primary closure is not generally practised as there is a high risk of infection.

      3. Circumferential full-thickness burns affecting a limb or severe torso burns impeding respiration may require escharotomy to divide the burnt tissue.

      4. There is no evidence to support the use of antimicrobial prophylaxis or topical antibiotics in burn patients.

    • This question is part of the following fields:

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

  • Question 28 - What is the mostly likely cause of prolonged activated partial thromboplastin time (aPPT)...

    Incorrect

    • What is the mostly likely cause of prolonged activated partial thromboplastin time (aPPT) ?

      Your Answer:

      Correct Answer: Heparin therapy

      Explanation:

      The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT) is an indicator for measuring the efficacy of both the intrinsic and common coagulation pathway. Prolonged aPTT may indicate: use of heparin, antiphospholipid antibody and coagulation factor deficiency (e.g., haemophilia). Deficiencies of factors VIII, IX, XI and XII and rarely von Willebrand factor (if causing a low factor VIII level) may lead to a prolonged aPTT correcting on mixing studies.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 29 - A 56-year-old woman weighs 75 kg. In this patient, total body water, intracellular...

    Incorrect

    • A 56-year-old woman weighs 75 kg. In this patient, total body water, intracellular fluid and extracellular fluid are respectively:

      Your Answer:

      Correct Answer: 45 l, 30 l, 15 l

      Explanation:

      The percentages of body water contained in various fluid compartments add up to total body water (TBW). This water makes up a significant fraction of the human body, both by weight and by volume. The total body water (TBW) content of humans is approximately 60% of body weight. Two-thirds is located in the intracellular and one-third in the extracellular compartment. So, in a 75-kg individual, TBW = 60 × 75/100 = 45 l. Intracellular content = 2/3 × 45 = 30 l and extracellular content = 1/3 × 45 = 15 l.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 30 - A 54 year old man, underwent an Ivor Lewis esophagectomy for oesophageal carcinoma....

    Incorrect

    • A 54 year old man, underwent an Ivor Lewis esophagectomy for oesophageal carcinoma. How should he be fed post operatively?

      Your Answer:

      Correct Answer: Surgically inserted jejunostomy feeding tube

      Explanation:

      Jejunostomy feeding (enteral feeding) is now the standard of care in most feeding protocols after esophagectomy. The feeding regimen consists of a gradually increasing volume of feeds in the first five to seven days. Patients should resume oral intake as soon as possible after surgery. In hospital, all forms of enteral access appear to be safe. Out of hospital, the ability to provide home feeding by feeding jejunostomy is likely where meaningful nutritional improvements can be made. Improving nutrition and related quality of life in the early months might improve the long-term outcome

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
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Physiology (1/1) 100%
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Generic Surgical Topics (0/1) 0%
Anatomy (1/1) 100%
Pathology (1/3) 33%
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