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Question 1
Incorrect
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An 8 month old baby girl presents with a spiral fracture of her left humerus. Her father states that he grabbed her arm because she was falling off the park slide. He noticed that something was wrong and he rushed to the hospital with her. Which of the following is the most likely issue?
Your Answer: Non accidental injury
Correct Answer: Accidental fracture
Explanation:In this case, there is no delay in treatment and the mechanism by which the fracture occurred fits accidental fracture.
A statement from the parent or guardian and any witnesses regarding how the child sustained the injury will help determine whether the injury is accidental or abusive. A statement from the parent or guardian explaining why he or she delayed in seeking medical treatment is important to the investigation because caretakers often postpone medical treatment or fail to provide treatment for an injured child to hide physical abuse. The abusing parent or caregiver may also put a child in oversized clothing or keep the child inside a residence for extended periods of time in an attempt to conceal the child’s injuries.
Parents who inflict fractures on their children tend to minimize the severity of the accident purported to cause the fracture, whereas many parents of children with accidental fractures will relate a history of high-energy events.
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This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 2
Incorrect
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Which one of the following groups of lymph nodes is most likely to be inflamed due to paronychia involving the big toe?
Your Answer: Medial group of superficial inguinal lymph nodes
Correct Answer: Vertical group of superficial inguinal lymph nodes
Explanation:Paronychia affecting the big toe will result in inflammation of the superficial inguinal lymph nodes as it drains lymph from the big toe.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 3
Incorrect
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Which of the deep fasciae located in the anterolateral abdominal wall form the inguinal ligament?
Your Answer: Transversalis fascia
Correct Answer: External abdominal oblique aponeurosis
Explanation:The inguinal ligament is the inferior border of the aponeurosis of the external oblique abdominis and extends from the anterior superior iliac spine to the pubic tubercle from whence it is reflected backward and laterally to attach to the pectineal line and form the lacunar ligament.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 4
Correct
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Which of the following is likely to result in hematocolpos in a 12-year old girl?
Your Answer: Imperforate hymen
Explanation:Hematocolpos means accumulation of blood in vagina and hematometra is accumulation of blood in the uterus. These are most likely seen with an imperforate hymen; which is seen I 1 in 2000 females. If spontaneous resolution does not occur, treatment involves making a hole in the hymen to allow discharge of menstrual blood.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 5
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 6
Incorrect
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Which statement is true regarding the diaphragmatic openings:
Your Answer: The aorta passes through the opening at T10
Correct Answer: The thoracic duct passes through the opening at T12
Explanation:The diaphragmatic openings are:
T8 – opening for the inferior vena cavaand the right phrenic nerve
T10 – opening for the oesophagusand the left gastric artery and vein
T12 – opening for the aorta, the thoracic duct and azygos vein. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 7
Incorrect
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Which of the following is a true statement regarding the pupil?
Your Answer: General increase in sympathetic tone during emotional excitement results in pupil constriction
Correct Answer: Phentolamine causes pupil constriction
Explanation:A balance between the sympathetic tone to the radial fibres of the iris and parasympathetic tone to the pupillary sphincter muscle determines the pupil size. Phentolamine (α-adrenergic receptor blocker) causes pupillary constriction. Dilatation of the pupil occurs with increased sympathetic activity, decreased parasympathetic activity during darkness or block of muscarinic receptors by atropine.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 8
Incorrect
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Below which level of the spinal cord will the inferior gluteal nerve be unaffected?
Your Answer: S1
Correct Answer: S3
Explanation:The inferior gluteal nerve arises from the dorsal divisions of the fifth lumbar and first and second sacral nerves. According to this fact any lesion at or below the S3 will not affect the inferior gluteal nerve.
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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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Point of entry of the vagal trunk into the abdomen:
Your Answer: Inferior vena cava hiatus
Correct 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 10
Correct
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Which antibiotic acts by inhibiting protein synthesis?
Your 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
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Question 11
Correct
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Laboratory findings in a patient with dark urine and yellowish skin revealed a prolonged prothrombin time. Which of the following is the most likely cause of this finding?
Your Answer: Liver damage
Explanation:Various conditions may prolong the prothrombin time (PT), including: warfarin use, vitamin K deficiency, liver disease, disseminated intravascular coagulopathy, hypofibrinogenemia, heparin infusion, massive blood transfusion and hypothermia. Liver disease causes prolonging of PT due to diminished synthesis of clotting factors. Dark urine colour and jaundice are indicators of the presence of a liver disease in this patient.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 12
Incorrect
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A 42-year-old woman is admitted with sepsis and right flank pain. Twenty-four hours ago, she was started on trimethoprim, by the GP, for a urinary tract infection (UTI).Which of the following organisms is the most likely causative agent?
Your Answer: Clostridium difficile
Correct Answer: E. coli
Explanation:Ascending infection of the urinary tract is most commonly caused by Escherichia coli (E.coli). Other organisms may be accountable. However, these are less common.
E. coli are gram-negative rods. They have a wide range of subtypes and some are normal gut commensals. Most varieties of E. coli are harmless or cause relatively brief diarrhoea. But a few nasty strains, such as E. coli O157:H7, can cause severe abdominal cramps, bloody diarrhoea, and vomiting. Some strains of E. coli are also resistant to a large number of antibiotics used to treat gram-negative infections.
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This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 13
Incorrect
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Which organ is responsible for the secretion of enzymes that aid in digestion of complex starches?
Your Answer: Salivary glands
Correct Answer: Pancreas
Explanation:α-amylase is secreted by the pancreas, which is responsible for hydrolysis of starch, glycogen and other carbohydrates into simpler compounds.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 14
Correct
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A 22 year old male sustains a distal radius fracture during a rugby match. Imaging shows a comminuted fracture with involvement of the articular surface. What is the most appropriate management?
Your Answer: Open reduction and internal fixation
Explanation:Fractures of the distal radius account for up to 20% of all fractures treated in the emergency department. Initial assessment includes a history of the mechanism of injury, associated injury and appropriate radiological evaluation
Most of the fractures are caused by a fall on the outstretched hand with the wrist in dorsiflexion. The form and severity of fracture of distal radius as well as the concomitant injury of disco-ligamentary structures of the wrist also depend on the position of the wrist at the moment of hitting the ground. The width of this angle influences the localization of the fracture. Pronation, supination and abduction determine the direction of the force and the compression of the carpus and different appearances of ligament injuries.
The basic principle of fracture treatment is to obtain accurate fracture reduction and then to use a method of immobilization that will maintain and hold that reduction. While the goal of treatment in fracture distal end of the radius is the restoration of normal function, the precise methods to achieve that desired outcome are controversial. Intra-articular fractures of the distal end of the radius can be difficult to treat, at times, with a traditional conservative method. A number of options for treatment are available to prevent the loss of reduction in an unstable fracture of the distal end of the radius.
One of the recent advances in the treatment of distal radius fractures is the more frequent application of open reduction and internal fixation, especially for intra-articular fractures. There are two groups of fractures for which open reduction and internal fixation is advisable.
The first group includes the two-part shear fracture (Barton fracture), which actually is a radio-carpal fracture-dislocation. Although the anatomical reduction is possible by closed means in some cases, these fractures are very unstable and difficult to control in plaster. The second group includes complex intra-articular fractures in which the articular fragments are displaced, rotated or impacted and are not amenable to reduction through limited operative exposure. -
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 15
Incorrect
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Which Statement is true of the brachial plexus?
Your Answer: The lateral cord continues as the axillary nerve
Correct Answer: The posterior cord continues as the axillary nerve
Explanation:The lateral cord continues as the musculocutaeous nerve.
The medial cord continues as the ulnar nerve.
The posterior cord continues as the radial nerve and the axillary nerve.
The nerve to subclavius muscle is a branch of the C6 root.
The suprascapular nerve is a branch from the upper trunk. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 16
Correct
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A 23-year-old male presents with a persistent and unwanted erection that has been present for the previous 7 hours. On examination, the penis is rigid and tender. Aspiration of blood from the corpus cavernosa shows dark blood. Which of the following is the most appropriate initial management?
Your Answer: Aspirate further blood from the corpus cavernosa in an attempt to decompress
Explanation:Priapism is defined as a prolonged penile erection lasting for >4 h in the absence of sexual stimulation and remains despite orgasm.
The classification of priapism is conventionally divided into three main groups. The commonest classification is into non‐ischaemic (high flow), ischaemic (low flow), and stuttering (recurrent) subtypes.
The EAU guidelines refer to the subtypes as ischaemic (low flow, veno‐occlusive) and arterial (high flow, non‐ischaemic). Of these, ischaemic priapism is the commonest, with refractory cases at risk of smooth muscle necrosis in the corpus cavernosum leading to sequelae of corporal fibrosis and erectile dysfunction (ED).
One of the key considerations in the management of priapism is the duration of the erection at presentation.
The EAU guidelines do differentiate the periods such that the intervention varies accordingly, which is particularly important for prolonged episodes that are refractory to pharmacological interventions and allow a step‐wise intervention.Ischaemic priapism is a medical emergency as the progressive ischaemia within the cavernosal tissue is associated with time‐dependent changes in the corporal metabolic environment, which eventually leads to smooth muscle necrosis. As the duration of the penile erection becomes pathologically prolonged, as in the case of low‐flow priapism, the partial pressure of oxygen (pO2) progressively falls as the closed compartment prevents replenishment of stagnant blood with freshly oxygenated arterial blood.
Investigations using corporal blood aspiration, that in itself can be a therapeutic intervention leading to partial or complete penile detumescence, helps to differentiate ischaemic from non‐ischaemic priapism subtypes based on the pO2, pCO2 and pH levels. The AUA guidelines state that typically the blood gas analysis would give a pO2 of <30 mmHg and pCO2 of >60 mmHg and a pH of <7.25 in ischaemic priapism, whereas non‐ischaemic blood gas analysis would show values similar to venous blood. Once the diagnosis of priapism has been made, the initial management involves corporal blood aspiration followed by instillation of α‐agonists directly into the corpus cavernosum.
The EAU guidelines recommend several possible agents for intracavernosal injection, as well as oral terbutaline after intracavernosal injection.
Phenylephrine – 200 μg every 3–5 min to a maximum of 1 mg within 1 h.
Etilephrine – 2.5 mg diluted in 1–2 mL saline.
Adrenaline – 2 mL of 1/100 000 solution given up to 5 times in a 20‐min period.
Methylene blue – 50–100 mg intracavernosal injection followed by aspiration and compression.Shunt surgery allows diversion of blood from the corpus cavernosum into another area such as the corpus spongiosum (glans or urethra) or the venous system (saphenous vein). Both the EAU and AUA guidelines recommend surgical intervention using firstly distal shunts and then proximal shunts in cases where aspiration and instillation of pharmacological agents fails to achieve penile detumescence. The EAU guidelines recommend that distal shunts should be attempted before proximal shunts, although the specific technique is left to the individual surgeon’s preference. The EAU guidelines also define a time point (36 h) when shunt surgery is likely to be ineffective in maintaining long‐term erectile function and may serve to reduce pain only. This is an important consideration when contemplating early penile prosthesis placement.
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This question is part of the following fields:
- Generic Surgical Topics
- Urology
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Question 17
Incorrect
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Calculate the cardiac output of a patient with the following measurements: oxygen uptake 200 ml/min, oxygen concentration in the peripheral vein 7 vol%, oxygen concentration in the pulmonary artery 10 vol% and oxygen concentration in the aorta 15 vol%.
Your Answer: 1333 ml/min
Correct Answer: 4000 ml/min
Explanation:The Fick’s principle states that the uptake of a substance by an organ equals the arteriovenous difference of the substance multiplied by the blood flowing through the organ. We can thus calculate the pulmonary blood flow with pulmonary arterial (i.e., mixed venous) oxygen content, aortic oxygen content and oxygen uptake. The pulmonary blood flow, systemic blood flow and cardiac output can be considered the same assuming there are no intracardiac shunts. Thus, we can calculate the cardiac output. Cardiac output = oxygen uptake/(aortic − mixed venous oxygen content) = 200 ml/min/(15 ml O2/100 ml − 10 ml O2/100 ml) = 200 ml/min/(5 ml O2/100 ml) = 200 ml/min/0.05 = 4000 ml/min.
It is crucial to remember to use pulmonary arterial oxygen content and not peripheral vein oxygen content, when calculating the cardiac output by Fick’s method. -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 18
Incorrect
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A 7-year old child from a rural setting complains of recurrent abdominal pain. The child is found to have a heavy parasitic infestation and anaemia. Which type of anaemia is most likely seen in this patient?
Your Answer: Anaemia of chronic disease
Correct Answer: Iron deficiency anaemia
Explanation:The most common cause of iron deficiency anaemia in children in developing countries is parasitic infection (hookworm, amoebiasis, schistosomiasis and whipworm).
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 19
Correct
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Severe abdominal pain radiating to the back, along with increased serum amylase levels, is seen in which of the following conditions?
Your Answer: Pancreatitis
Explanation:The primary test for diagnosis and monitoring of pancreatitis is amylase. Increased plasma levels of amylase can be found in: salivary trauma (including anaesthetic intubation), mumps, pancreatitis and renal failure. However, a rise in the total amylase levels over 10 times the upper limit of normal (ULN) is suggestive of pancreatitis; 5–10 times the ULN may indicate ileus or duodenal disease or renal failure. Lower levels are commonly found in salivary gland disease.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 20
Incorrect
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A 21 year old female presents to the clinic with axillary lymphadenopathy and symptoms suggestive of Hodgkin's lymphoma. Which of the following tests should be done?
Your Answer: Axillary node clearance
Correct Answer: Excision biopsy of a lymph node
Explanation:Answer: Excision biopsy of a lymph node
Hodgkin lymphoma is an uncommon cancer that develops in the lymphatic system, which is a network of vessels and glands spread throughout your body. In Hodgkin lymphoma, B-lymphocytes (a particular type of lymphocyte) start to multiply in an abnormal way and begin to collect in certain parts of the lymphatic system, such as the lymph nodes (glands). The affected lymphocytes lose their infection-fighting properties, making you more vulnerable to infection. The most common symptom of Hodgkin lymphoma is a painless swelling in a lymph node, usually in the neck, armpit or groin.
A histologic diagnosis of Hodgkin lymphoma is always required. An excisional lymph node biopsy is recommended because the lymph node architecture is important for histologic classification.Features of Hodgkin lymphoma include the following:
Asymptomatic lymphadenopathy may be present (above the diaphragm in 80% of patients)
Constitutional symptoms (unexplained weight loss [>10% of total body weight] within the past 6 months, unexplained fever >38º C, or drenching night sweats) are present in 40% of patients; collectively, these are known as B symptoms
Intermittent fever is observed in approximately 35% of cases; infrequently, the classic Pel-Ebstein fever is observed (high fever for 1-2 week, followed by an afebrile period of 1-2 week)
Chest pain, cough, shortness of breath, or a combination of those may be present due to a large mediastinal mass or lung involvement; rarely, haemoptysis occurs
Pruritus may be present
Pain at sites of nodal disease, precipitated by drinking alcohol, occurs in fewer than 10% of patients but is specific for Hodgkin lymphoma
Back or bone pain may rarely occur
A family history is also helpful; in particular, nodular sclerosis Hodgkin lymphoma (NSHL) has a strong genetic component and has often previously been diagnosed in the family.
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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 21
Incorrect
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A 70 year old women, died suddenly. She had a history of hypertension and aortic stenosis. On autopsy her heart weighed 550g. What is the most likely cause of this pathology?
Your Answer: Hyperplasia
Correct Answer: Hypertrophy
Explanation:Due to increased pressure on the heart as a result of hypertension and aortic stenosis, the myocardial fibres hypertrophied to adapt to the increased pressure and to effectively circulate blood around the body. Hyperplasia could not occur, as myocardial fibres are stable cells and cannot divide further.
Fat does not deposit in the heart due to volume overload.
Myocardial oedema is not characteristic of a myocardial injury.
Metaplasia is a change in the type of epithelium.
Atrophy would result in a decreased heart size and inability to function. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 22
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: Paired T 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 23
Correct
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The oesophagus is an important part of the alimentary canal. It receives blood from various arteries in the body. Which one of the following is an artery that will lead to some level of ischaemia to the oesophagus when ligated?
Your Answer: Left inferior phrenic
Explanation:The oesophagus receives its blood supply from the following arteries: the inferior thyroid branch of the thyrocervical trunk, the descending thoracic aorta, the left gastric branch of the coeliac artery and the from the left inferior phrenic artery of the abdominal aorta. Hence ligation of the left inferior phrenic will lead to ischemia to some portions of the oesophagus.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 24
Correct
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A 76 year old man who presented with lower back pain is diagnosed with prostatic carcinoma that has metastasized to his lumber spine. Which of the following markers is characteristically elevated?
Your Answer: PSA
Explanation:Spread of prostatic carcinoma is common to the lumbar spine and pelvis. This results in osteoblastic metastases that will present as lower back pain with increased alkaline phosphatase, prostatic acid phosphates and PSA. PSA is more specific and a PSA > 10 ng/ml for any age is worrisome.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 25
Incorrect
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A 63 year old man presents with recurrent colicky abdominal pain. A CT scan demonstrates a hernia lateral to the rectus muscle at the level of the arcuate line. What type of hernia would this be classified as?
Your Answer: Incisional
Correct Answer: Spigelian
Explanation:A Spigelian hernia (or lateral ventral hernia) is a hernia through the Spigelian fascia, which is the aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally. These are generally interparietal hernias, meaning that they do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall; therefore, there is often no notable swelling.
Spigelian hernias are usually small and therefore risk of strangulation is high. Most occur on the right side. (4th–7th decade of life.) Compared to other types of hernias they are rare.
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This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 26
Correct
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Which of the following is the cause of flattened (notched) T waves on electrocardiogram (ECG)?
Your Answer: Hypokalaemia
Explanation:The T-wave is formed due to ventricular repolarisation. Normally, it is seen as a positive wave. It can be normally inverted (negative) in V1 (occasionally in V2-3 in African-Americans/Afro-Caribbeans). Hyperacute T-waves are the earliest ECG change of acute myocardial infarction. ECG findings of hyperkalaemia include high, tent-shaped T-waves, a small P-wave and a wide QRS complex. Hypokalaemia results in flattened (notched) T-waves, U-waves, ST-segment depression and prolonged QT interval.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 27
Correct
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A 30 year old mother presents with a tender indurated mass in her left breast which developed 6 days after giving birth and breastfeeding the baby. Which organism is most likely to have caused this infection?
Your Answer: Staphylococcus aureus
Explanation:Answer: Staphylococcus aureus
Mastitis is defined as inflammation of the breast. Although it can occur spontaneously or during lactation, this discussion is limited to mastitis in breastfeeding women, with mastitis defined clinically as localized, painful inflammation of the breast occurring in conjunction with flu-like symptoms (e.g., fever, malaise). Mastitis is especially problematic because it may lead to the discontinuation of breast-feeding, which provides optimal infant nutrition. Mastitis occurs in approximately 10 percent of U.S. mothers who are breastfeeding, and it can lead to the cessation of breastfeeding. The risk of mastitis can be reduced by frequent, complete emptying of the breast and by optimizing breastfeeding technique. Sore nipples can precipitate mastitis. The differential diagnosis of sore nipples includes mechanical irritation from a poor latch or infant mouth anomalies, such as cleft palate or bacterial or yeast infection. The diagnosis of mastitis is usually clinical, with patients presenting with focal tenderness in one breast accompanied by fever and malaise. Treatment includes changing breastfeeding technique, often with the assistance of a lactation consultant. When antibiotics are needed, those effective against Staphylococcus aureus (e.g., dicloxacillin, cephalexin) are preferred. As methicillin-resistant S. aureus becomes more common, it is likely to be a more common cause of mastitis, and antibiotics that are effective against this organism may become preferred. Continued breastfeeding should be encouraged in the presence of mastitis and generally does not pose a risk to the infant. Breast abscess is the most common complication of mastitis. It can be prevented by early treatment of mastitis and continued breastfeeding. Once an abscess occurs, surgical drainage or needle aspiration is needed. Breastfeeding can usually continue in the presence of a treated abscess.
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This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 28
Incorrect
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A 39-year-old man, after radiological evaluation and thoracentesis, was found to have chylothorax. What is the most probable cause of this diagnose?
Your Answer: Systemic lupus erythematosus
Correct Answer: Mediastinal malignant lymphoma
Explanation:Chylothorax is a potentially lethal condition characterized by fluid (chyle) accumulation in the pleural cavity, resulting from disruption of lymphatic drainage in the thoracic duct. Chyle is a fluid rich in triglycerides and chylomicrons and can originate from the thorax, the abdomen or both. Malignant tumours, especially lymphoma, are the most common causes of nontraumatic chylothorax. Bronchogenic carcinoma and trauma are the most common causes after lymphomas. Other rare causes of chylothorax are; granulomatous diseases, tuberculosis, congenital malformations, nephrotic syndrome, hypothyroidism, cirrhosis, decompensated heart failure and idiopathic chylothorax.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 29
Incorrect
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A patient who has used NSAIDS for many years presents to the A&E with symptoms of acute haemorrhagic shock. An emergency endoscopy is done that shows that a duodenal ulcer has perforated the posterior wall of the first part of the duodenum. Which artery is most likely to be the cause of the haemorrhage?
Your Answer: Superior mesenteric
Correct Answer: Gastroduodenal
Explanation:The gastroduodenal artery is a branch of the hepatic artery and descends near the pylorus between the first part of the duodenum and the neck of the pancreas to divide at the lower border of the duodenum into the right gastroepiploic and pancreaticoduodenal arteries. Before it divides, it gives off a few branches to the pyloric end of the stomach and to the pancreas. The artery that is most likely involved in this situation is the gastroduodenal artery since it is posterior to the first part of the duodenum.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 30
Incorrect
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What Is the mechanism behind rhesus incompatibility in a new born baby?
Your Answer: Type IV hypersensitivity
Correct Answer: Type II hypersensitivity
Explanation:In type II hypersensitivity the antibodies that are produced by the immune response bind to the patients own cell surface antigens. These antigens can be intrinsic or extrinsic. Destruction occurs due to antibody dependent cell mediated antibodies. Antibodies bind to the cell and opsonise the cell, activating phagocytes to destroy that cell e.g. autoimmune haemolytic anaemia, Goodpasture syndrome, erythroblastosis fetalis, pernicious anaemia, Graves’ disease, Myasthenia gravis and haemolytic disease of the new-born.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
