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Question 1
Correct
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Which of the following factors will not affect the wound healing process in a young women who suffered serious burns to her chest and hands?
Your Answer: Vitamin A deficiency
Explanation:Healing can be sped-up or slowed down due to various reasons: 1. blood supply, 2. infection, 3. denervation, 4. collection of blood/hematoma, 5. mechanical stress, 6. foreign body, 7. techniques used during surgery and 8. dressing of the wound. Other systemic factors include 1. nutrition e.g. deficiency of zinc, vitamin C, protein deficiency, 2. metabolic status, 3. circulatory status and 4. hormonal influence
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 2
Incorrect
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The sciatic nerve does NOT supply which of the following muscles?
Your Answer: Quadratus femoris
Correct Answer: Obturator externus
Explanation:The sciatic nerve supplies both gemellae, quadratus femoris, semitendinosus, semimembranosus, both heads of the biceps femoris, the hamstring half of abductor magnus and obturator internus. Obturator externus is supplied by the obturator nerve.
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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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A 40-year old gentleman underwent a computed tomographic scan for the abdomen to rule out blunt abdominal trauma, after a vehicular accident. The scan revealed no abnormal finding except for a 1 cm-sized cortical mass in the left adrenal gland. The doctor-on-call decided to not intervene for this mass because it was likely to be a:
Your Answer: Non-functioning adrenal adenoma
Explanation:Adrenal adenomas are common, benign lesions which are asymptomatic and seen in 10% of population. Usually detected incidentally on Computed tomography (‘incidentaloma’), only around 1 in 10,000 are malignant (adenocarcinoma). Adrenal adenomas rarely need to be investigated, especially if they are homogenous and less than 3 cm in diameter. Follow-up imaging can be done after an interval of 3-6 months to assess any change in size. Some adenomas can secrete cortisol (leading to Cushing syndrome), or aldosterone (leads to Conn syndrome) or androgens (leading to hyperandrogenism).
Haematomas and simple cysts are not usually seen in adrenal gland. Infection due to Histoplasma capsulatum is usually bilateral and leads to multiple granulomas. Adrenal metastasis will usually demonstrate a lung primary and the adrenal lesions will be often multiple and larger than 1 cm. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 4
Incorrect
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Which of the following muscles attach to the hyoid bone?
Your Answer: Sternothyroid
Correct Answer: Middle pharyngeal constrictor
Explanation:The hyoid bone is a horseshoe-shaped bone situated in the anterior midline of the neck between the chin and the thyroid cartilage. A large number of muscles attach to the hyoid: Superiorly – the middle pharyngeal constrictor muscle, hyoglossus muscle, genioglossus, intrinsic muscles of the tongue and suprahyoid muscles. Inferiorly – the thyrohyoid muscle, omohyoid muscle and sternohyoid muscle.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 5
Correct
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Which of the following is found to be elevated in a case of hepatocellular carcinoma?
Your Answer: AFP
Explanation:Alpha-fetoprotein (AFP) is a glycoprotein that is normally produced by the yolk sac of the embryo, and then the fetal liver. It is elevated in the new-born and thus, also in the pregnant women. Eventually, it decreases in the first year of life to reach the adult normal value of < 20 ng/ml by 1 year of age. Markedly elevated levels (>500 ng/ml) in a high-risk patient is considered diagnostic for primary hepatocellular carcinoma (HCC). Moreover, due to smaller tumours secreting less quantities of AFP, rising levels can be a better indication. However, not all hepatocellular carcinomas produce AFP. Also, the level of AFP is not a prognostic factor. Populations where hepatitis B and HCC are common (e.g.: sub-Saharan Africans, ethnic Chinese) can see AFP levels as high as 100,000 ng/ml, whereas levels are low (about 3000 ng/ml) in regions with lesser incidences of HCC.
AFP can also be elevated up to 500 ng/ml in conditions like embryonic teratocarcinomas, hepatoblastomas, fulminant hepatitis, hepatic metastases from gastrointestinal tract cancers, some cholangiocarcinomas). Lesser values are seen in acute and chronic hepatitis.
Overall, the sensitivity of AFP value ≥20 ng/ml is 39-64% and the specificity is 76%–91%. Value of 500 ng/ml is considered as the diagnostic cut-off level for HCC. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 6
Correct
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Cancer of the testis most likely metastases to which set of lymph nodes?
Your Answer: Aortic
Explanation:The lymphatic drainage of an organ is related to its blood supply. The lymphatic drainage of the testis drains along the testicular artery to reach the lymph nodes along the aorta.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 7
Correct
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A 5 year old boy is rushed to the A&E department after accidentally inhaling a Brazil nut. He is seen to be extremely distressed and cyanotic and imaging shows that it is lodged in the left main bronchus. Which of the following is the best course of action?
Your Answer: Arrange immediate transfer to theatre for bronchoscopy
Explanation:A small number of foreign body aspirations are incidentally found after chest radiography or bronchoscopic inspection. Patients may be asymptomatic or may be undergoing testing for other diagnoses. If present, physical findings may include stridor, fixed wheeze, localized wheeze, or diminished breath sounds. If obstruction is severe, cyanosis may occur. Signs of consolidation can accompany post obstructive pneumonia.
Bronchoscopy can be used diagnostically and therapeutically. Most aspirated foreign bodies are radiolucent. Radiologic procedures do not have extreme diagnostic accuracy, and aspiration events are not always detected. Rigid bronchoscopy usually requires heavy intravenous sedation or general anaesthesia. The rigid bronchoscope has important advantages over the flexible bronchoscope. The larger diameter of the rigid bronchoscope facilitates the passage of various grasping devices, including a flexible bronchoscope. A better chance of quick, successful extraction and better capabilities of suctioning clotted blood and thick secretions are offered by the rigid bronchoscope. The paediatric flexible bronchoscope lacks a hollow working channel through which instruments may be inserted or blood and secretions may be aspirated.
Unlike the flexible bronchoscope, the patient can be ventilated through the rigid scope; therefore, ventilation of the patient can be maintained. Rigid bronchoscopy is the procedure of choice for removing foreign bodies in children and in most adults. Success rates for extracting foreign bodies are reportedly more than 98%. Large solid and semisolid objects are best managed emergently in the operating room with a rigid bronchoscope and appropriate grasping instruments. -
This question is part of the following fields:
- Generic Surgical Topics
- Paediatric Surgery
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Question 8
Correct
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A 59 year old man presents with septicaemia 48 hours after undergoing a difficult colonoscopy to assess the extent of a caecal carcinoma. His abdomen is soft and non tender. Blood cultures grow gram positive cocci. Which of the following organisms is likely responsible for this condition?
Your Answer: Streptococcus bovis
Explanation:Streptococcus bovis (S. bovis) bacteria are associated with colorectal cancer and adenoma. S. bovis is currently named S. gallolyticus. 25-80% of patients with S. bovis/gallolyticus bacteraemia have concomitant colorectal tumours. Colonic neoplasia may arise years after the presentation of bacteraemia or infectious endocarditis of S. bovis/gallolyticus. The presence of S. bovis/gallolyticus bacteraemia and/or endocarditis is also related to the presence of villous or tubular-villous adenomas in the large intestine.
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This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 9
Correct
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A man was stabbed in the thigh following a bar brawl. A superficial vein was injured which terminates in the femoral vein. This superficial vein is?
Your Answer: Great saphenous
Explanation:The great saphenous vein is considered the longest vein in the body. It terminates in the femoral vein nearly 3cm below the inguinal ligament. It begins at the dorsum of the foot in the medial marginal vein and ascends at the medial side of the leg in relation with the saphenous nerve.
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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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Which of these structures does NOT pass posterior to the medial malleolus?
Your Answer: Flexor hallucis longus tendon
Correct Answer: Saphenous vein
Explanation:The saphenous vein passes anterior to the medial malleolus. The structures passing posterior, from nearest to furthest include: tibial, posterior tendon, flexor digitorum longus tendon, posterior tibial artery, posterior tibial vein, posterior tibial nerve and the flexor hallucis longus tendon.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 11
Correct
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A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and oliguria. She is diagnosed with chronic renal failure. Dipstick testing shows no protein, glucose, nitrite or ketones but a semi-quantitative sulphosalicylic acid test for urine protein is positive. Which of the following is the most probable cause of chronic renal failure in this patient.
Your Answer: Multiple myeloma
Explanation:Dipstick results are negative because the proteins found in the urine of this patient are not albumin but Bence Jones proteins. A Bence Jones protein is a monoclonal globulin protein commonly detected in patients affected by multiple myeloma. Multiple myeloma is a malignancy of plasma cells characterised by the production of monoclonal immunoglobulin. Symptoms include bone pain, bone fractures, bleeding, neurologic symptoms, fatigue, frequent infections and weight loss.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 12
Correct
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A 30 year old waiter is stabbed in the right upper quadrant during a fight at the restaurant and is haemodynamically unstable. He is rushed to the hospital where a laparotomy is performed and the liver has some extensive superficial lacerations and is bleeding profusely. He becomes progressively more haemodynamically unstable. What is the best management option?
Your Answer: Pack the liver and close the abdomen
Explanation:Perihepatic packing is a surgical procedure used in connection with surgery to the liver. In this procedure the liver is packed to stop non arterial bleeding, most often caused by liver injury.
During this surgery laparotomy pads are placed around the site of the bleeding. The main purpose of hepatic packing is to prevent the person from succumbing to the trauma triad of death. Under- or over-packing of the liver can cause adverse outcomes, and if the bleeding cannot be controlled through this surgical method, the Pringle manoeuvre is an alternate technique that can be utilized.
Rebleeding, constant decline of haemoglobin and increased transfusion requirement, as well as the failure of angioembolization of actively bleeding vessels are a few factors which indicate the need for laparotomy.
The operative approach has also evolved over the last two decades. Direct suture ligation of the parenchymal bleeding vessel, perihepatic packing, repair of venous injury under total vascular isolation and damage control surgery with utilization of preoperative and/or postoperative angioembolization are the preferred methods, compared to anatomical resection of the liver and use of the atriocaval shunt.
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This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 13
Correct
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Injury to this nerve may result in loss of sensation of the mandibular teeth and bone:
Your Answer: Inferior alveolar nerve
Explanation:The inferior alveolar nerve (sometimes called the inferior dental nerve) is a branch of the mandibular nerve, which is itself the third branch of the trigeminal nerve. The inferior alveolar nerves supply sensation to the lower teeth of the mandible.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 14
Correct
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A space defined by the teres major muscle, the teres minor muscle, long head of the triceps brachii muscle and surgical neck of the humerus contains the axillary nerve and the?
Your Answer: Posterior circumflex humeral artery
Explanation:This quadrangular space transmits the posterior circumflex humeral vessels and the axillary nerve.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 15
Correct
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A 40-year-old man is brought to the A&E department in an unconscious state, following a car collision. He was driving at a high speed of 140 km/hr, wearing a seat belt, when his car collided with a brick wall. CT scan of the brain appears to be normal. However, he remains in a persistent vegetative state. What is the most likely underlying cause?
Your Answer: Diffuse axonal injury
Explanation:This is a case of diffuse axonal injury (DAI) which occurs when the head is rapidly accelerated or decelerated.
DAI is a form of traumatic brain injury which occurs when the brain rapidly shifts inside the skull as an injury is occurring. The long connecting fibres in the brain called axons are sheared as the brain rapidly accelerates and decelerates inside the hard bone of the skull. There are two components of DAI:
1. Multiple haemorrhages
2. Diffuse axonal damage in the white matterUp to two-thirds of the changes occurs at the junction of the grey and white matter due to the different densities of the tissue. These are mainly histological and axonal damage is secondary to biochemical cascades. Often, there are no signs of a fracture or contusion. DAI typically causes widespread injury to the brain leading to loss of consciousness. The changes in the brain are often very tiny and can be difficult to detect using CT or MRI scans.
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This question is part of the following fields:
- Generic Surgical Topics
- Surgical Disorders Of The Brain
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Question 16
Incorrect
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A 55-year old gentleman presented to the doctor with worsening dysphagia for both solids and liquids over 6 months. This was associated with regurgitation of undigested food and occasional chest pain. Barium swallow revealed distal oesophageal dilatation with lack of peristalsis in the distal two-third oesophagus. The likely diagnosis is:
Your Answer: Diffuse oesophageal spasm
Correct Answer: Achalasia
Explanation:Achalasia is an oesophageal motility disorder where inappropriate contractions in the oesophagus lead to reduced peristalsis and failure of the lower oesophageal sphincter to relax properly in response to swallowing. Classical triad of symptoms include dysphagia to fluids followed by solids, chest pain and regurgitation of undigested food. Other symptoms include belching, hiccups, weight loss and cough. Diagnosis is by:
– X-ray with a barium swallow or oesophagography : narrowing at the gastroesophageal junction (‘bird/parrot beak’ or ‘rat tail’ appearance) and various degrees of mega-oesophagus (oesophageal dilatation) as the oesophagus is gradually stretched by retained food. Effectiveness of treatment can be measured with a 5-minute timed barium swallow.
– Manometry – probe measures the pressure waves in different parts of oesophagus and stomach while swallowing.
– Endoscopy
– CT scan to exclude other causes like malignancy
– Pathological examination showing defect in the nerves which control oesophageal motility (myenteric plexus).
In Chagas disease, there is destruction of ganglion cells by Trypanosoma cruzi. -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 17
Incorrect
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A 30-year-old female was alarmed when she started to experience hair loss and balding, however, she also noted increased hair on her face and body and developed an acne breakout. Deepening of her voice also became prominent. She was referred to an oncologist and was diagnosed with a hormone-producing tumour. What is the most likely diagnosis ?
Your Answer: Seminoma
Correct Answer: Arrhenoblastoma
Explanation:Arrhenoblastoma, known as ‘Sertoli–Leydig tumour’ is a rare ovarian stromal neoplasm that secretes testosterone. It is mostly seen in women in the reproductive years. The key clinical features of this tumour is due to excessive production of testosterone which leads to progressive masculinisation in a woman who was typical normal beforehand. The lesion tends to grow slowly and rarely metastasises. Treatment is surgical removal of the tumour and the prognosis is generally good.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 18
Correct
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A 45-year old male, who was a chronic smoker presented to the clinic with backache and dry, incessant cough. On examination, he was found to have raised blood pressure, purplish striae on his abdomen, truncal obesity and tenderness over the lower thoracic spine. These findings are suggestive of which condition?
Your Answer: Small-cell anaplastic (oat cell) carcinoma
Explanation:The symptoms suggest Cushing syndrome due to increased glucocorticoid levels. One cause of Cushing syndrome is ectopic production of adrenocorticotrophic hormone from oat cell carcinoma. As oat cell carcinoma is known to be highly metastatic, the tenderness in lower back could represent metastatic involvement.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 19
Incorrect
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Which of the following structures is affected or damaged when the 'anterior drawer test' is positive?
Your Answer: Posterior cruciate ligament
Correct Answer: Anterior cruciate ligament
Explanation:The anterior drawer test is an important orthopaedic test that is used to test weakness of the anterior cruciate ligament. The test is done by having the patient sit in a supine position with his/her knees flexed at 90 degrees. An examiner stabilises the patients feet and softly pulls or pushes on the proximal tibia. The test is positive if there is translational movement of the tibia in relation to the femur, indicating a weakened anterior cruciate ligament. The anterior cruciate ligament prevents the tibia from sliding out in front of the femur.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 20
Incorrect
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A 64 year old diabetic man presents with a deep laceration of his lateral thigh which measures 3cm in depth by 7cm in length, that penetrates to the bone. There are no signs of fracture. His diabetes is diet controlled and is on low dose prednisolone therapy for polymyalgia rheumatica. Which of the following options should be employed most safely for the wound management of this patient?
Your Answer: Primary closure in layers
Correct Answer: Delayed primary closure
Explanation:Delayed primary closure is often intentionally applied to lacerations that are not considered clean enough for immediate primary closure. The wound is left open for 5-10 days; then, it is sutured closed to decrease the risk of wound infection. Improved blood flow at the wound edges, which develops increasingly over the first few days, is another benefit of this style of wound healing and can be associated with progressive increases in resistance to infections. The combination of diabetes and steroids makes wound complications more likely. Despite his high risk, a primary skin graft or flap is unlikely to be a safer option.
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This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 21
Correct
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A 68-year-old man underwent sigmoid resection with diverting colostomy for a ruptured sigmoid diverticulum 10 days ago. He received gentamicin and ampicillin post-op. 2 days after he was discharged from the hospital, he was readmitted because of high grade fever and chills. His blood culture grew Gram-negative bacilli. Which organism is most likely responsible for the patient's infection?
Your Answer: Bacteroides fragilis
Explanation:Bacteroides fragilis is an anaerobic, Gram-negative, rod-shaped bacterium. It is part of the normal flora of the human colon and is generally a commensal, but can cause infection if displaced into the bloodstream or surrounding tissue following surgery, disease, or trauma.
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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 woman is diagnosed with Hodgkin's lymphoma. Which of the following chemotherapy regimens would be used in this case?
Your Answer: ABVD
Explanation:ABVD is a chemotherapy regimen used in the first-line treatment of Hodgkin’s lymphoma. It consists of concurrent treatment with the chemotherapy drugs, adriamycin, bleomycin, vinblastine and dacarbazine. It supplanted the older MOPP protocol.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 23
Correct
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A 51-year-old man is brought to the A&E department following a road traffic accident. He complains of lower abdominal pain. On examination, fracture of the pelvis along with distended, tender bladder is observed. What is the most likely diagnosis?
Your Answer: Urethral injury
Explanation:Pelvic fractures may cause laceration of the urethra. Urinary retention, blood at the urethral meatus, and a high-riding prostate on digital rectal examination are the typical features of urethral injury.
Up to 10% of male pelvic fractures are associated with urethral or bladder injuries. Urethral injury occurs mainly in males. It has two types.
1.Bulbar rupture:
a. most common
b. mostly associated with straddle-type injury, e.g. from bicycles
c. presentation with a triad of urinary retention, perineal haematoma, and blood at the meatus2. Membranous rupture:
a. can be extra- or intraperitoneal
b. occurs commonly due to pelvic fracture
c. symptomology may include penile or perineal oedema/haematoma
d. prostate displaced upwards (high-riding prostate)Ascending urethrogram is carried out in patients of suspected urethral injury. Suprapubic catheter is surgically placed and is indicated in:
1. External genitalia injuries (i.e. the penis and the scrotum)
2. Injury to the urethra caused by penetration, blunt trauma, continence- or sexual pleasure–enhancing devices, and mutilation. -
This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 24
Incorrect
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A 55-year-old woman died 3 years after a cardiac transplant due to worsening congestive heart failure. Autopsy revealed diffuse hyperplasia of the vascular intima involving the entire length of the coronary arteries. The most probable cause of deterioration of the cardiac function is:
Your Answer: Amyloidosis
Correct Answer: Coronary atherosclerosis
Explanation:Allograft coronary artery disease (CAD) can begin right after the transplant and is the major cause of later death in cardiac transplant recipients. This form of atherosclerosis progresses quickly resulting in allograft failure. Due to lack of premonitory symptoms CAD may lead to sudden death.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 25
Correct
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A 32 year old man has a perianal abscess at 6 o'clock position. Which of the following is the most appropriate step in the management of this patient?
Your Answer: Examination under anaesthetic and drainage of sepsis
Explanation:Optimal physical assessment of an anorectal abscess may require anaesthesia to alleviate patient discomfort that would otherwise limit the extent of the examination.
Drainage should be carried out promptly to prevent the sepsis worsening. Perianal incisions to allow drainage of pus should be circumanal, thus reducing the likelihood of damage to the sphincters and thereby preventing faecal incontinence. -
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 26
Incorrect
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A 27-year-old woman presents with abdominal pain. On investigation, her serum calcium is found to be 3.5 mmol/L. What should be the most appropriate initial management?
Your Answer: Oral bisphosphonates
Correct Answer: Intravenous 0.9% sodium chloride
Explanation:The immediate treatment of hypercalcaemia involves intravenous fluid resuscitation. This may be complemented with the use of bisphosphonates and sometimes, diuretics. However, fluids are administered first. Normal saline is usually preferred for this over other solutions.
Urgent management in hypercalcaemia is indicated if:
1. Serum calcium level >3.5 mmol/L
2. Reduced consciousness
3. Severe abdominal pain
4. Pre-renal failureManagement options include:
1. Intravenous fluid resuscitation with 3–6 litres of 0.9% normal saline in 24 hours
2. Concurrent administration of calcitonin to help lower calcium levels
3. Medical therapy (usually if corrected calcium >3.0mmol/L) -
This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
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Question 27
Correct
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The thoracic duct :
Your Answer: varies in length from 38 to 45 cm
Explanation:The thoracic duct is the main drainage of lymph in the body. It varies in length from 38 to 45 cm and extends from the second lumbar vertebra to the root of the neck.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 28
Incorrect
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A 27-year-old cyclist is hit by a bus travelling at 30mph. He was not wearing a helmet. He arrives with a GCS of 3/15 and is intubated. A CT scan shows evidence of cerebral contusion but no localising clinical signs are present. What is the most appropriate course of action?
Your Answer: Administration of intravenous mannitol
Correct Answer: Insertion of intra cranial pressure monitoring device
Explanation:This patient may well develop raised ICP over the next few days and intracranial pressure monitoring will help with the
management.Summary of guidelines:
For adults who have sustained a head injury and have any of the following risk factors, perform a CT head scan within 1 hour of the risk factor being identified:
– GCS less than 13 on initial assessment in the emergency department.
– GCS less than 15 at 2 hours after the injury on assessment in the emergency department.
– Suspected open or depressed skull fracture.
– Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
– Post-traumatic seizure.
– Focal neurological deficit.
– More than 1 episode of vomiting.
A provisional written radiology report should be made available within 1 hour of the scan being performedFor adults with any of the following risk factors who have experienced some loss of consciousness or amnesia since the injury, perform a CT head scan within 8 hours of the head injury:
– Age 65 years or older.
– Any history of bleeding or clotting disorders.
– Dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs).
– More than 30 minutes’ retrograde amnesia of events immediately before the head injury.
A provisional written radiology report should be made available within 1 hour of the scan being performed.– Intubate and ventilate all patients with GCS 8 or less requiring transfer to a neuroscience unit.
Intubate and ventilate the patient immediately in the following circumstances:
– Coma – not obeying commands, not speaking, not eye opening (that is, GCS 8 or less).
– Loss of protective laryngeal reflexes.
– Ventilatory insufficiency as judged by blood gases: hypoxaemia (PaO2 < 13 kPa on oxygen) or hypercarbia (PaCO2 > 6 kPa).
– Spontaneous hyperventilation causing PaCO2 < 4 kPa.
– Irregular respirations.Use the criteria below for admitting patients to hospital following a head injury:
– Patients with new, clinically significant abnormalities on imaging.
– Patients whose GCS has not returned to 15 after imaging, regardless of the imaging results.
– When a patient has indications for CT scanning but this cannot be done within the appropriate period, either because CT is not available or because the patient is not sufficiently cooperative to allow scanning.
– Continuing worrying signs (for example, persistent vomiting, severe headaches) of concern to the clinician.
– Other sources of concern to the clinician (for example, drug or alcohol intoxication, other injuries, shock, suspected non-accidental injury, meningism, cerebrospinal fluid leak).
– Perform and record observations on a half-hourly basis until GCS equal to 15 has been achieved.
– Do not discharge patients presenting with head injury until they have achieved GCS equal to 15 -
This question is part of the following fields:
- Generic Surgical Topics
- Surgical Disorders Of The Brain
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Question 29
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 30
Correct
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Depression of the normal coagulation system and excessive bleeding after surgery can occur in which of the following medical conditions?
Your Answer: Liver disease
Explanation:As most of the coagulation factors are synthesized in the liver, liver diseases like hepatitis or cirrhosis will depress the coagulation system. Vitamin K deficiency can also decrease the production of vitamin K dependent coagulation factors VII, XI, X and prothrombin.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
