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  • Question 1 - A 56 year old mechanic undergoes a live related renal transplant. He had...

    Incorrect

    • A 56 year old mechanic undergoes a live related renal transplant. He had a good urine output and the graft appeared well perfused at the end of the operation. However, on the ward he suddenly becomes anuric. Which of the following is the most likely cause?

      Your Answer: Renal artery stenosis

      Correct Answer: Renal artery thrombosis

      Explanation:

      Acute renal artery thrombosis is a devastating complication of renal transplantation that can result in graft loss if not detected early. Surgical and technical errors are the major cause of renal artery thrombosis. Renal artery thrombosis usually presents with sudden onset oliguria or anuria accompanied by pain and tenderness over the graft site. Patients may develop thrombocytopenia due to platelet aggregation at the thrombosis site. The imaging modality of choice for diagnosis of renal artery thrombosis is colour Doppler sonography. Conventional, computed tomography (CT) and magnetic resonance (MR) angiography may also be used to confirm the presence of renal artery thrombosis. Although there are reports of successful resolution of post-transplant acute renal artery thrombosis with endovascular and surgical modalities such as percutaneous thrombus aspiration, intra-arterial injection of fibrinolytic agents and surgical thrombectomy, renal artery thrombosis usually results in ischemic necrosis and graft loss.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Organ Transplantation
      17
      Seconds
  • Question 2 - A 65 year old man is brought to the emergency department after he...

    Incorrect

    • A 65 year old man is brought to the emergency department after he collapsed at the bus station. Clinical examination is significant for a ruptured abdominal aortic aneurysm. On arrival he is hypotensive and moribund. Which of the following is most likely to be his ASA?

      Your Answer: 4

      Correct Answer: 5

      Explanation:

      ASA-V: A moribund patient who is not expected to survive without the operation. Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction

      ASA Grading
      1 – No organic physiological, biochemical or psychiatric disturbance. The surgical pathology is localised and has not invoked systemic disturbance
      2 – Mild or moderate systemic disruption caused either by the surgical disease process or though underlying pre-existing disease
      3 – Severe systemic disruption caused either by the surgical pathology or pre-existing disease
      4 – Patient has severe systemic disease that is a constant threat to life
      5 – A patient who is moribund and will not survive without surgery

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      41
      Seconds
  • Question 3 - A 46 year old man had an upper gastrointestinal endoscopy and biopsies done...

    Incorrect

    • A 46 year old man had an upper gastrointestinal endoscopy and biopsies done which were reported by two gastrointestinal pathologists as being ‘indefinite for dysplasia.’ Repeat endoscopy and biopsies were repeated 6 months after completing treatment with proton pump inhibitors. The results revealed no definite evidence of dysplasia. What is the most appropriate management?

      Your Answer: Repeat endoscopy and biopsies

      Correct Answer: Routine surveillance every 2–3 years

      Explanation:

      This patient had endoscopy and biopsy done by different doctors and proton pump inhibitor therapy followed by repeat endoscopy and biopsy six months later which had no definite evidence of dysplasia.

      British Society of Gastroenterology (BSG) guidelines state that for patients with Barrett’s oesophagus (BO) but without dysplasia, the recommended surveillance protocols are two yearly, four quadrant biopsies every 2 cm, but jumbo biopsies are not required.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Upper Gastrointestinal Surgery
      25.4
      Seconds
  • Question 4 - During a car accident, the side mirror shattered and a broken piece of...

    Incorrect

    • During a car accident, the side mirror shattered and a broken piece of glass severed the posterolateral aspect of the driver's neck. A physical examination reveals that the driver is unable to elevate the tip of his shoulder on the side that was injured. Which nerve was injured?

      Your Answer: Thoracodorsal

      Correct Answer: Accessory

      Explanation:

      The tip of the shoulder is formed by the acromion of the scapula. This part is moved by the trapezius muscle which is innervated by the accessory nerve. Damage to this nerve therefore will prevent the patient from lifting the tip of the shoulder.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      27.9
      Seconds
  • Question 5 - A 6 week old baby who is developing well starts having profuse and...

    Correct

    • A 6 week old baby who is developing well starts having profuse and projectile vomiting after feeding. She has been losing weight and the vomit is non-bilious. Which of the following is the most likely cause?

      Your Answer: Hypertrophy of the pyloric sphincter

      Explanation:

      Pyloric stenosis is a narrowing of the opening from the stomach to the first part of the small intestine (the pylorus). Symptoms include projectile vomiting without the presence of bile. This most often occurs after the baby is fed. The typical age that symptoms become obvious is two to twelve weeks old.

      The cause of pyloric stenosis is unclear. Risk factors in babies include birth by caesarean section, preterm birth, bottle feeding, and being first born. The diagnosis may be made by feeling an olive-shaped mass in the baby’s abdomen. This is often confirmed with ultrasound. It is four times more likely to occur in males, and is also more common in the first born. Rarely, infantile pyloric stenosis can occur as an autosomal dominant condition.

      It is uncertain whether it is a congenital anatomic narrowing or a functional hypertrophy of the pyloric sphincter muscle.
      Babies with this condition usually present any time in the first weeks to months of life with progressively worsening vomiting. The vomiting is often described as non-bile stained (non bilious) and projectile vomiting, because it is more forceful than the usual spitting up (gastroesophageal reflux) seen at this age. Some infants present with poor feeding and weight loss but others demonstrate normal weight gain. Dehydration may occur which causes a baby to cry without having tears and to produce less wet or dirty diapers due to not urinating for hours or for a few days. Symptoms usually begin between 3 to 12 weeks of age. Findings include epigastric fullness with visible peristalsis in the upper abdomen from the person’s left to right. Constant hunger, belching, and colic are other possible signs that the baby is unable to eat properly.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Paediatric Surgery
      16.9
      Seconds
  • Question 6 - A 36-year-old female was advised to undergo genetic testing of BRCA1 and BRCA2....

    Correct

    • A 36-year-old female was advised to undergo genetic testing of BRCA1 and BRCA2. BRCA1 and BRCA2 are tumour markers specifically for which organ?

      Your Answer: Breast

      Explanation:

      Women with harmful mutations in either BRCA1 or BRCA2 have a risk of breast cancer that is about five times the normal risk.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      5.8
      Seconds
  • Question 7 - A 30 year old male has a painless and transilluminant swelling at the...

    Correct

    • A 30 year old male has a painless and transilluminant swelling at the upper pole of his left testi. There is a negative cough test. Which of the following is the likely diagnosis?

      Your Answer: Spermatocoele

      Explanation:

      Spermatocele, also known as a spermatic cyst is a cystic mass usually occurring at the upper pole of the testis. Differential diagnosis included hydrocele as both are cystic, painless and transilluminant. Ultrasound is a useful modality. If symptomatic or large, surgical excision can be done.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      8.6
      Seconds
  • Question 8 - A 31 year old woman arrives at the clinic due to a tender...

    Correct

    • A 31 year old woman arrives at the clinic due to a tender breast lump. On examination, there is a fluctuant and tender mass. She has a 2 month old child. Which of the following most likely caused her breast lump?

      Your Answer: Breast abscess

      Explanation:

      A breast abscess is a localised collection of pus in the breast tissue. It is usually caused by a bacterial infection. Breast infections, including mastitis and breast abscesses, are most often seen in women aged 15 to 45 years. Mastitis can occur as a result of breastfeeding and if left untreated it can progress to an abscess. The bacteria most commonly associated with this is staphylococcus aureus.

    • This question is part of the following fields:

      • Breast And Endocrine Surgery
      • Generic Surgical Topics
      9.5
      Seconds
  • Question 9 - A young man is brought to the doctor and a lesion is seen...

    Correct

    • A young man is brought to the doctor and a lesion is seen on the dorsal surface of his right hand. It is examined and it is found to be a soft fluctuant swelling which is more pronounced when he is making a fist. What is the possible nature of the lesion?

      Your Answer: Ganglion

      Explanation:

      Answer: Ganglion

      A ganglion cyst is a fluid-filled swelling that usually develops near a joint or tendon. The cyst can range from the size of a pea to the size of a golf ball. Ganglion cysts look and feel like a smooth lump under the skin.

      They’re made up of a thick, jelly-like fluid called synovial fluid, which surrounds joints and tendons to lubricate and cushion them during movement.

      Ganglions can occur alongside any joint in the body, but are most common on the wrists (particularly the back of the wrist), hands and fingers.

      Ganglions are harmless, but can sometimes be painful. If they do not cause any pain or discomfort, they can be left alone and may disappear without treatment, although this can take a number of years.

      It’s not clear why ganglions form. They seem to happen when the synovial fluid that surrounds a joint or tendon leaks out and collects in a sac.
      They are most common in younger people between the ages of 15 and 40 years, and women are more likely to be affected than men. These cysts are also common among gymnasts, who repeatedly apply stress to the wrist.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
      28.2
      Seconds
  • Question 10 - A 40 year old man suffered severe trauma following a MVA. His BP...

    Correct

    • A 40 year old man suffered severe trauma following a MVA. His BP is 72/30 mmhg, heart rate of 142 beats/mins and very feeble pulse. He was transfused 3 units of blood and his BP returned to 100/70 and his heart rate slowed to 90 beats/min. What decreased after transfusion?

      Your Answer: Total peripheral resistance

      Explanation:

      The patient is in hypovolemic shock, he is transfused with blood, this fluid resuscitation will result in a decreased sympathetic discharge and adequate ventricular filling which will result in the decreases TPR with an increased CO and cardiac filling pressures

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      18.6
      Seconds
  • Question 11 - What causes a reduction in pulmonary functional residual capacity? ...

    Correct

    • What causes a reduction in pulmonary functional residual capacity?

      Your Answer: Pulmonary fibrosis

      Explanation:

      Pulmonary functional residual capacity (FRC) is = volume of air present in the lungs at the end of passive expiration.
      Obstructive diseases (e.g. emphysema, chronic bronchitis, asthma) = an increase in FRC due to an increase in lung compliance and air trapping.
      Restrictive diseases (e.g. pulmonary fibrosis) result in stiffer, less compliant lungs and a reduction in FRC.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      26.6
      Seconds
  • Question 12 - Regarding innervation to the peroneus brevis muscle: ...

    Incorrect

    • Regarding innervation to the peroneus brevis muscle:

      Your Answer: Is by the same distal nerve that innervates the peroneus tertius muscle

      Correct Answer: Could be damaged by a fracture of the neck of the fibula

      Explanation:

      The peroneus brevis is supplied by the fourth and fifth lumbar and first sacral nerves through the superficial peroneal nerve which is one of the two terminal branches of the common peroneal nerve. The common peroneal nerve winds around the neck of the fibula and can be injured in cases of fractured neck of fibula.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      11
      Seconds
  • Question 13 - What is the basic chemical reaction that takes place in the breakdown of...

    Correct

    • What is the basic chemical reaction that takes place in the breakdown of complex foodstuffs?

      Your Answer: Hydrolysis

      Explanation:

      Breakdown of complex food into simpler compounds is achieved by hydrolysis, with the help of different enzymes specific for different compounds.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      27.2
      Seconds
  • Question 14 - 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: Acute otitis media

      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
      27.6
      Seconds
  • Question 15 - During an exploratory laparotomy a herniation of bowel is identified between the lateral...

    Incorrect

    • During an exploratory laparotomy a herniation of bowel is identified between the lateral edge of the rectus abdominis, the inguinal ligament and the inferior epigastric vessels. These boundaries define the hernia as being a:

      Your Answer: Umbilical hernia

      Correct Answer: Direct inguinal hernia

      Explanation:

      The boundaries given define the inguinal triangle which is the site for direct inguinal hernias. Indirect inguinal hernias occur lateral to the inferior epigastric vessels.
      Femoral hernias protrude through the femoral ring, into the femoral canal.
      Umbilical hernias protrude through a defect in the umbilical area.
      Obturator hernias, occur through the obturator foramen. These are very rare.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      36.9
      Seconds
  • Question 16 - A 58 year old man presents to the clinic complaining of lower backache...

    Incorrect

    • A 58 year old man presents to the clinic complaining of lower backache refractory to medicine. He is a known case of metastatic prostate carcinoma, with spinal involvement. However, up until recently, he has had no problems with pain control. He takes 1g qds paracetamol daily. Neurological examination is unremarkable. Which of the following is the most appropriate next step in management?

      Your Answer:

      Correct Answer: Add non steroidal anti inflammatory drug

      Explanation:

      Acetaminophen, NSAIDs, and opiates are recommended in the basic approach to cancer pain associated with bone metastases. They should provide patients with adequate analgesia when used appropriately. NSAIDs including COX2 inhibitors are especially useful for patients with bone pain. Acetaminophen is an effective analgesic but is a weak anti-inflammatory agent. Ketorolac tromethamine is a potent NSAID capable of relieving moderate to severe acute bone pain.

    • This question is part of the following fields:

      • Oncology
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 17 - A 56 year old female is placed on Tamoxifen for the treatment of...

    Incorrect

    • A 56 year old female is placed on Tamoxifen for the treatment of ER-positive breast cancer. Which malignancy is associated with Tamoxifen use?

      Your Answer:

      Correct Answer: Endometrial cancer

      Explanation:

      A meta-analysis found that there was a twofold increase in the risk of endometrial cancer following extended versus standard adjuvant tamoxifen therapy in patients with breast cancer.
      The systematic review of four randomized controlled trials showed that the absolute risk of endometrial cancer in patients receiving adjuvant tamoxifen for 10 years was 3.2% compared with 1.5% in patients receiving 5-year standard therapy (cumulative risk ratio [RR] 2.29, 1.60 to 3.28, P<0.001).
      The breast cancer treatment tamoxifen (sometimes called by its brand name, Nolvadex) increases the risk of developing endometrial cancer, but not nearly enough to outweigh its benefits against breast cancer in most women. This risk occurs because of the way tamoxifen works: Even as it acts against the growth-promoting effects of the female hormone oestrogen in breast tissue, it acts like an oestrogen in other tissues, such as the bones and the uterus. This can be good news for the bones because oestrogen helps preserve bone density, but it may slightly increase the risk of cancer in the uterus. According to the American Cancer Society, the risk of developing endometrial cancer from tamoxifen is about 1 in 500 — a small risk, but higher than that for women in the general population. Tamoxifen also slightly increases the risk of uterine sarcoma, a cancer that begins in the muscle of the uterine wall.

      Tamoxifen belongs to a class of medications known as selective oestrogen response modifiers (SERMs). Another SERM called Fareston (chemical name: toremifene) has been found to increase the risk of endometrial hyperplasia, or the overgrowth of cells lining the uterus. Hyperplasia itself is not cancer but can sometimes develop into cancer. Evista (chemical name: raloxifene), another SERM used to lower the risk of breast cancer in high-risk women, does not have oestrogen-like effects on the uterus and does not increase endometrial cancer risk.

    • This question is part of the following fields:

      • Breast And Endocrine Surgery
      • Generic Surgical Topics
      0
      Seconds
  • Question 18 - A 27-year-old woman, who had been taking a combined oral contraceptive for 6...

    Incorrect

    • A 27-year-old woman, who had been taking a combined oral contraceptive for 6 months, presented with inguinal pain and oedema of the left leg. Which of the following investigations would you recommend to help confirm the diagnosis?

      Your Answer:

      Correct Answer: Duplex scan

      Explanation:

      Oral combined contraceptive pill (OCCP) is a drug used for birth control and treating a number of other conditions. Women who take the OCP have a higher risk of developing deep vein thrombosis (DVT), usually in the legs. Duplex ultrasonography is a safe and non-invasive technique which is used for diagnosing the presence of lower extremity thrombi.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds
  • Question 19 - 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 20 - A 40-year-old man has a tissue defect measuring 3 x 1 cm, following...

    Incorrect

    • A 40-year-old man has a tissue defect measuring 3 x 1 cm, following the excision of a lipoma from the scapula. What should be the best option for managing the wound?

      Your Answer:

      Correct Answer: Direct primary closure

      Explanation:

      This wound should be managed by primary closure as there is minimal associated tissue loss and the surgery is minor and uncontaminated.

      Primary wound closure is the fastest type of closures, and is also known as healing by primary intention. Wounds that heal by primary closure have a small, clean defect that minimizes the risk of infection and requires new blood vessels and keratinocytes to migrate only a small distance. Standard methods of suturing are usually sufficient for primary wound closure.

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Surgical Technique And Technology
      0
      Seconds
  • Question 21 - The occipital artery is accompanied by which nerve as it arises from the...

    Incorrect

    • The occipital artery is accompanied by which nerve as it arises from the external carotid artery?

      Your Answer:

      Correct Answer: Hypoglossal nerve (CN XII)

      Explanation:

      Three main types of variations in the relations of the occipital artery and the hypoglossal nerve are found according to the level at which the nerve crosses the external carotid artery and the point of origin of the occipital artery. In Type I, the hypoglossal nerve crosses the external carotid artery inferior to the origin of the occipital artery; in Type II, the nerve crosses the external carotid artery at the level of origin of the occipital artery; and in Type III, it crosses superior to that level. In Type III the occipital artery makes a loop around the hypoglossal nerve and is in a position to pull and exert pressure on the nerve. This possibility should be taken into consideration in the diagnosis of peripheral paresis or paralysis of the tongue and during surgery in this area.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 22 - A 58 year old man presents with complaints of recurrent episodes of diarrhoea...

    Incorrect

    • A 58 year old man presents with complaints of recurrent episodes of diarrhoea over the past week that has resulted in marked exhaustion and fatigue. He underwent a successful cadaveric renal transplant last year and was able to return to his job as a swimming instructor. Stool microscopy is carried out and it shows evidence of cysts. Which of the following is the most likely source of infection?

      Your Answer:

      Correct Answer: Cryptosporidium

      Explanation:

      Cryptosporidium infection occurs through the faecal-oral route of transmission. It usually lasts for 5–7 days. In immunocompetent patients it is self-limiting (nitazoxanide may be used to shorten the duration). In immunocompromised patients: Antiretroviral therapy to elevate the CD4 cell count/restore the immune system is essential prior to eradication with antiparasitic drugs. Diarrhoea is the main disease. The cysts are typically identified on stool microscopy.

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
      0
      Seconds
  • Question 23 - A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds
  • Question 24 - A football player sustained an injury to his ankle. The wound went through...

    Incorrect

    • A football player sustained an injury to his ankle. The wound went through the skin, subcutaneous tissue and flexor retinaculum. Which other structure passing under the retinaculum may be injured?

      Your Answer:

      Correct Answer: Tibial nerve

      Explanation:

      The flexor retinaculum is immediately posterior to the medial malleolus. The structures that pass under the flexor retinaculum from anterior to posterior are: tendon of the tibialis posterior, flexor digitorum longus, posterior tibial artery (and vein), tibial nerve and tendon of flexor hallucis longus. The tibial nerve is the only one which lies behind the flexor retinaculum.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 25 - A patient is diagnosed with a tumour of the parotid gland. During surgical...

    Incorrect

    • A patient is diagnosed with a tumour of the parotid gland. During surgical removal of the gland, which artery is vulnerable to injury?

      Your Answer:

      Correct Answer: External carotid artery

      Explanation:

      The external carotid artery is a major artery of the head and neck. It arises from the common carotid artery when it splits into the external and internal carotid artery. It supplies blood to the face and neck. The external carotid artery begins opposite the upper border of the thyroid cartilage and, taking a slightly curved course, passes upward and forward and then inclines backward to the space behind the neck of the mandible, where it divides into the superficial temporal and internal maxillary arteries. It rapidly diminishes in size in its course up the neck, owing to the number and large size of the branches given off from it. At its origin, this artery is more superficial and placed nearer the midline than the internal carotid and is contained within the carotid triangle. The external carotid artery is covered by the skin, superficial fascia, platysma, deep fascia and anterior margin of the sternocleidomastoid. It is crossed by the hypoglossal nerve, by the lingual, ranine, common facial and superior thyroid veins; and by the digastric and stylohyoid; higher up it passes deeply into the substance of the parotid gland, where it lies deep to the facial nerve and the junction of the temporal and internal maxillary veins. It is here that it is in danger during surgery of the parotid gland.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 26 - A 11 month old baby develops periumbilical abdominal discomfort and diarrhoea after having...

    Incorrect

    • A 11 month old baby develops periumbilical abdominal discomfort and diarrhoea after having a sore throat and fever for a few days. He presents to the A&E department and an ultrasound is done which shows a 'target sign' on the right side of the abdomen. What is the best initial course of action?

      Your Answer:

      Correct Answer: Obtain intravenous access, administer fluids and antibiotics

      Explanation:

      Answer: Obtain intravenous access, administer fluids and antibiotics.

      Intussusception is a condition in which one segment of intestine telescopes inside of another, causing an intestinal obstruction (blockage). Although intussusception can occur anywhere in the gastrointestinal tract, it usually occurs at the junction of the small and large intestines. The obstruction can cause swelling and inflammation that can lead to intestinal injury. The patient with intussusception is usually an infant, often one who has had an upper respiratory infection, who presents with the following symptoms:

      Vomiting: Initially, vomiting is nonbilious and reflexive, but when the intestinal obstruction occurs, vomiting becomes bilious

      Abdominal pain: Pain in intussusception is colicky, severe, and intermittent

      Passage of blood and mucus: Parents report the passage of stools, by affected children, that look like currant jelly; this is a mixture of mucus, sloughed mucosa, and shed blood; diarrhoea can also be an early sign of intussusception

      Lethargy: This can be the sole presenting symptom of intussusception, which makes the condition’s diagnosis challenging

      Palpable abdominal mass

      Diagnosis:
      Ultrasonography: Hallmarks of ultrasonography include the target and pseudo kidney signs.

      For all children, start intravenous fluid resuscitation and nasogastric decompression as soon as possible.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Paediatric Surgery
      0
      Seconds
  • Question 27 - The sciatic nerve does NOT supply which of the following muscles? ...

    Incorrect

    • The sciatic nerve does NOT supply which of the following muscles?

      Your Answer:

      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.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 28 - A patient under went repair of a lingual artery aneurysm in the floor...

    Incorrect

    • A patient under went repair of a lingual artery aneurysm in the floor of the mouth. During surgical dissection from the inside of the mouth which muscle would you have to pass through to reach the main portion of the lingual artery?

      Your Answer:

      Correct Answer: Hyoglossus

      Explanation:

      The lingual artery first runs obliquely upward and medialward to the greater horns of the hyoid bone. It then curves downward and forward, forming a loop which is crossed by the hypoglossal nerve, and passing beneath the digastric muscle and stylohyoid muscle it runs horizontally forward, beneath the hyoglossus, and finally, ascending almost perpendicularly to the tongue, turns forward on its lower surface as far as the tip, to become the deep lingual artery.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 29 - A 30-year old lady was admitted to the general surgical ward after a...

    Incorrect

    • A 30-year old lady was admitted to the general surgical ward after a diagnosis of perforation of the first part of the duodenum that resulted from a long standing ulcer. If this perforation led to the expulsion of the gastric content that resulted to the erosion of an artery found in this part of the duodenum (the posterior of the first part of the duodenum). Which of the following arteries is this most likely to be?

      Your Answer:

      Correct Answer: Gastroduodenal

      Explanation:

      The proximal part of the duodenum is supplied by the gastroduodenal artery. This artery is found descending behind the first part of the duodenum after branching from the hepatic artery. If gastric content was to be expelled in the posterior portion of the first part of the duodenum, then this artery would be most likely to be damaged. The common hepatic artery and the left gastric artery are branches of the coeliac trunk that are found superior to the duodenum. The proper hepatic artery is a branch of the common hepatic artery also found superior to the duodenum. The superior mesenteric artery is found behind the pancreas as a branch of the aorta that is at the bottom of the L1 level. The right gastric artery arises above the pylorus from the proper hepatic artery and supplies the lesser curvature of the stomach. The intestinal arteries supply the ileum and the jejunum.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 30 - A 46-year-old female is admitted with crampy abdominal pain and diarrhoea. She has...

    Incorrect

    • A 46-year-old female is admitted with crampy abdominal pain and diarrhoea. She has been unwell for the past 12 hours. In her history she complains that her milk bottles have been pecked repeatedly by birds, she otherwise has had no dietary changes. Which of the following is the most likely causative organism?

      Your Answer:

      Correct Answer: Campylobacter jejuni

      Explanation:

      Birds, with their broad geographic ranges and close association with humans, have historically played an important role as carriers of human disease and as reservoirs for drug-resistant bacteria.
      The highest diversity of bacteria were found on birds in natural habitats. The most frequently reported bacteria were Escherichia coli, Salmonella enterica, and Campylobacter jejuni. Of the bacteria species reported, 54% have shown pathogenicity toward humans. Percentage-wise, more pathogens were found in tropical (vs. temperate) habitats and natural (vs. suburban, urban, or agricultural) habitats.

      Campylobacter jejuni is usually the most common cause of community-acquired inflammatory enteritis.

      The symptoms and severity of the gastroenteritis produced can vary.
      Patients may have a history of ingestion of inadequately cooked poultry, unpasteurized milk, or untreated water. The incubation period is 1-7 days and is probably related to the dose of organisms ingested.
      A brief prodrome of fever, headache, and myalgias lasting up to 24 hours is followed by crampy abdominal pain, fever as high as 40°C, and as many as 10 watery, frequently bloody, bowel movements per day. Fever, which develops in more than 90% of patients, maybe low or high grade and can persist for a week.
      Patients with C jejuni infection who report vomiting, bloody diarrhoea, or both tend to have a long illness and require hospital admission.
      Abdominal pain and tenderness may be localized. Pain in the right lower quadrant may mimic acute appendicitis (pseudo appendicitis).
      Tenesmus occurs in approximately 25% of patients.

    • This question is part of the following fields:

      • Clinical Microbiology
      • Principles Of Surgery-in-General
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