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  • Question 1 - A 38-year old lady presented to the hospital with abnormal passing of blood...

    Incorrect

    • A 38-year old lady presented to the hospital with abnormal passing of blood per vagina. On examination, she was found to have an endocervical polypoidal mass. On enquiry, she gave history of oral contraceptive usage for 3 years. What finding is expected on the histopathology report of biopsy of the mass?

      Your Answer:

      Correct Answer: Microglandular hyperplasia

      Explanation:

      Endocervical polyps or microglandular hyperplasia are benign growths occurring in the endocervical canal, in about 2-5% women and occur secondary to use of oral contraceptives. They are usually < 1cm in size, friable and reddish-pink. Usually asymptomatic, they can cause bleeding or become infected, leading to leucorrhoea (purulent vaginal discharge). They are usually benign but need to be differentiated from adenocarcinomas by histology.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 2 - A 77-year-old woman's renal function is tested. The following results were obtained during...

    Incorrect

    • A 77-year-old woman's renal function is tested. The following results were obtained during a 24-h period: Urine flow rate: 2. 0 ml/min, Urine inulin: 0.5 mg/ml, Plasma inulin: 0.02 mg/ml, Urine urea: 220 mmol/l, Plasma urea: 5 mmol/l. What is the urea clearance?

      Your Answer:

      Correct Answer: 88 ml/min

      Explanation:

      Urea is reabsorbed in the inner medullary collecting ducts of the nephrons. The clearance (C) of any substance can be calculated as follows: C = (U × V)/P, where U and P are the urine and plasma concentrations of the substance, respectively and V is the urine flow rate. So, glomerular filtration rate = (0.220 × 2. 0)/0.005 = 88 ml/min.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 3 - A 40-year-old male pedestrian is brought to the A&E department after being hit...

    Incorrect

    • A 40-year-old male pedestrian is brought to the A&E department after being hit by a car. On examination, he is found to be dyspnoeic and hypoxic despite administration of high flow oxygen therapy. Moreover, his pulse is 115bpm and blood pressure is 110/70 mmHg. The right side of his chest is hyper-resonant on percussion and has decreased breath sounds. His trachea is deviated to the left. What is the most likely underlying diagnosis?

      Your Answer:

      Correct Answer: Tension pneumothorax

      Explanation:

      This patient has developed a tension pneumothorax following a blunt trauma.

      Tension pneumothorax is a life-threatening condition that develops when air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function. Blunt or penetrating chest trauma that creates a flap-type defect on the surface of the lung can result in this life-threatening condition.

      Signs and symptoms of tension pneumothorax include:
      1. Chest pain that usually has a sudden onset, is sharp, and may lead to feeling of tightness in the chest
      2. Dyspnoea and progressive hypoxia
      3. Tachycardia
      4. Hyperventilation
      5. Cough
      6. Fatigue

      On examination, hyper-resonant percussion note and tracheal deviation are typically found. Treatment is immediate without waiting for the CXR result and includes needle decompression and chest tube insertion.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
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  • Question 4 - 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
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  • Question 5 - A 6 year old girl falls during dance class and fractures the growth...

    Incorrect

    • A 6 year old girl falls during dance class and fractures the growth plate of her left wrist. Which system can be used to classify the injury?

      Your Answer:

      Correct Answer: Salter - Harris system

      Explanation:

      A Salter–Harris fracture is a fracture that involves the epiphyseal plate or growth plate of a bone, specifically the zone of provisional calcification. It is a common injury found in children, occurring in 15% of childhood long bone fractures.
      There are nine types of Salter–Harris fractures; types I to V as described by Robert B Salter and W Robert Harris in 1963, and the rarer types VI to IX which have been added subsequently:
      Type I – transverse fracture through the growth plate (also referred to as the physis): 6% incidence
      Type II – A fracture through the growth plate and the metaphysis, sparing the epiphysis: 75% incidence, takes approximately 12-90 weeks or more in the spine to heal.
      Type III – A fracture through growth plate and epiphysis, sparing the metaphysis: 8% incidence
      Type IV – A fracture through all three elements of the bone, the growth plate, metaphysis, and epiphysis: 10% incidence
      Type V – A compression fracture of the growth plate (resulting in a decrease in the perceived space between the epiphysis and metaphysis on x-ray): 1% incidence
      Type VI – Injury to the peripheral portion of the physis and a resultant bony bridge formation which may produce an angular deformity (added in 1969 by Mercer Rang)
      Type VII – Isolated injury of the epiphyseal plate (VII–IX added in 1982 by JA Ogden)
      Type VIII – Isolated injury of the metaphysis with possible impairment of endochondral ossification
      Type IX – Injury of the periosteum which may impair intramembranous ossification

      The mnemonic SALTER can be used to help remember the first five types.
      N.B.: This mnemonic requires the reader to imagine the bones as long bones, with the epiphyses at the base.

      I – S = Slip (separated or straight across). Fracture of the cartilage of the physis (growth plate)
      II – A = Above. The fracture lies above the physis, or Away from the joint.
      III – L = Lower. The fracture is below the physis in the epiphysis.
      IV – TE = Through Everything. The fracture is through the metaphysis, physis, and epiphysis.
      V – R = Rammed (crushed). The physis has been crushed.
      Alternatively, SALTER can be used for the first 6 types, as above but adding Type V — ‘E’ for ‘Everything’ or ‘Epiphysis’ and Type VI — ‘R’ for ‘Ring’.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
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  • Question 6 - Glucose is the most important source of energy for cellular respiration. The transport...

    Incorrect

    • Glucose is the most important source of energy for cellular respiration. The transport of glucose in the renal tubular cells occurs via:

      Your Answer:

      Correct Answer: Secondary active transport with sodium

      Explanation:

      In 1960, Robert K. Crane presented for the first time his discovery of the sodium-glucose cotransport as the mechanism for glucose absorption. Glucose transport through biological membranes requires specific transport proteins. Transport of glucose through the apical membrane of renal tubular as well as intestinal epithelial cells depends on the presence of secondary active Na+–glucose symporters, SGLT-1 and SGLT-2, which concentrate glucose inside the cells, using the energy provided by co-transport of Na+ ions down their electrochemical gradient.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 7 - Epstein-Barr virus (EBV) is known to be a carcinogen for: ...

    Incorrect

    • Epstein-Barr virus (EBV) is known to be a carcinogen for:

      Your Answer:

      Correct Answer: B-cell lymphoma

      Explanation:

      EBV is known to be carcinogenic for B-cell lymphoma, nasopharyngel carcinoma and Hodgkin’s lymphoma.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 8 - A 44 year old actor presents with an attack of mild acute pancreatitis....

    Incorrect

    • A 44 year old actor presents with an attack of mild acute pancreatitis. Imaging identifies gallstones but a normal calibre bile duct, and a peripancreatic fluid collection. Which management option would be the most appropriate?

      Your Answer:

      Correct Answer: Cholecystectomy once the attack has settled

      Explanation:

      Pancreatitis is inflammation of the pancreas with variable involvement of regional tissues or remote organ systems. Acute pancreatitis (AP) is characterized by severe pain in the upper abdomen and elevation of pancreatic enzymes in the blood. In the majority of patients,
      Biliary pancreatitis should always be treated eventually with a cholecystectomy after the process has subsided.
      Feeding should be introduced enterally as the patient’s anorexia and pain resolves.
      The use of nasogastric aspiration offers no clear advantage in patients with mild AP, but is beneficial in patients with profound pain, severe disease, paralytic ileus, and intractable vomiting.
      AP is a mild, self-limiting disease that resolves spontaneously without complications. Patients can be initiated on a low-fat diet initially and need not invariably start their dietary advancement using a clear liquid diet. Systematic reviews and meta-analyses have shown that administration of enteral nutrition may reduce mortality and infectious complications compared with parenteral nutrition. Although the ideal timing to initiate enteral feeding remains undetermined, administration within 48 hours appears to be safe and tolerated.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Hepatobiliary And Pancreatic Surgery
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  • Question 9 - You are asked to help a junior medical student studying anatomy to identify...

    Incorrect

    • You are asked to help a junior medical student studying anatomy to identify the left lung. Which of the following features found only in the left lung will you use the identify it?

      Your Answer:

      Correct Answer: Cardiac notch

      Explanation:

      Oblique fissure: is found on both the left and the right lungs. It separates the upper from the lower lobes in both lungs and the middle lobe from the lower lobe in the right lung(which has three lobes.)
      The superior lobar bronchus is found in both lungs.
      Cardiac notch: found only on the left lung.
      Horizontal fissure: a deep groove separating the middle lobe from the upper lobe of the right lung is absent on the left lung.
      Diaphragmatic surface: refers to the part of the lung, both the left and the right, that is in contact with the diaphragm.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 10 - The posterior cord contains nerve fibres from which of the following levels of...

    Incorrect

    • The posterior cord contains nerve fibres from which of the following levels of the spinal cord?

      Your Answer:

      Correct Answer: C5, C6, C7, C8 and T1

      Explanation:

      THE correct answer is A. The posterior cord derives its fibres from the spinal nerves C5,C6,C7,C8,T1. This cord is formed from the fusion of the posterior divisions of the upper, lower, and middle trunks.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 11 - Which of the following muscles attaches to the pterygomandibular raphe? ...

    Incorrect

    • Which of the following muscles attaches to the pterygomandibular raphe?

      Your Answer:

      Correct Answer: Superior pharyngeal constrictor muscle

      Explanation:

      The pterygomandibular raphé (pterygomandibular ligament) provides attachment on its posterior border to the superior pharyngeal constrictor and on its anterior border to the buccinator muscle.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 12 - A chest x ray of a patient reveals loculated fluid in the right...

    Incorrect

    • A chest x ray of a patient reveals loculated fluid in the right chest, which can be easily aspirated if the needle is inserted through the body wall just above the 9th rib in the midaxillary line. Where is this fluid located?

      Your Answer:

      Correct Answer: Costodiaphragmatic recess

      Explanation:

      The costodiaphragmatic recess is the lowest point of the pleural sac where the costal pleura becomes the diaphragmatic pleura. At the midclavicular line, this is found between ribs 6 and 8; at the paravertebral lines, between ribs 10 and 12 and between ribs 8 and 10 at the midaxillary line.
      The cardiac notch: is an indentation of the heart on the left lung, located on the anterior surface of the lung.
      Cupola: part of the parietal pleura that extends above the first rib.
      Oblique pericardial sinus: part of the pericardial sac located posterior to the heart behind the left atrium.
      Costomediastinal recess: a reflection of the pleura from the costal surface to the mediastinal surface, is on the anterior surface of the chest.
      The inferior mediastinum: is the space in the chest occupied by the heart.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 13 - A 28-year-old electrician is brought to the A&E department after a high-voltage full-thickness...

    Incorrect

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

      Your Answer:

      Correct Answer: Rhabdomyolysis

      Explanation:

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

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

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

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

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

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

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

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

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
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  • Question 14 - Which of the following malignancies is associated with the development of Lambert-Eaton myasthenic...

    Incorrect

    • Which of the following malignancies is associated with the development of Lambert-Eaton myasthenic syndrome?

      Your Answer:

      Correct Answer: Lung cancer

      Explanation:

      Lambert–Eaton myasthenic syndrome is a rare disorder of the neuromuscular junction. It can occur as a solitary diagnosis but it can also occur as a paraneoplastic syndrome associated with lung cancer, particularly small-cell histology. It can also be associated with other cancers such as lymphoma, non-Hodgkin’s lymphoma, T-cell leukaemia, non-small-cell lung cancer, prostate cancer and thymoma.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 15 - What is the pH of freshly formed saliva at ultimate stimulation? ...

    Incorrect

    • What is the pH of freshly formed saliva at ultimate stimulation?

      Your Answer:

      Correct Answer: 8

      Explanation:

      Saliva has four major components: mucus (lubricant), α-amylase (enzyme that initiates digestion of starch), lingual lipase (enzyme that begins fat digestion), and a slightly alkaline electrolyte solution for moistening food. As the secretion rate of saliva increases, its osmolality increases. Moreover, the pH changes from slightly acidic (at rest) to basic (pH 8) at ultimate stimulation. This occurs due to increase of HCO3-. Amylase and mucus also increase in concentration after stimulation.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 16 - Which of the following foramina provides a passage through which the vestibulocochlear nerve,...

    Incorrect

    • Which of the following foramina provides a passage through which the vestibulocochlear nerve, passes?

      Your Answer:

      Correct Answer: Internal acoustic meatus

      Explanation:

      The internal auditory meatus is a canal within the petrous part of the temporal bone of the skull between the posterior cranial fossa and the inner ear. It provides a passage through which the vestibulocochlear nerve, the facial nerve, and the labyrinthine artery (an internal auditory branch of the basilar artery) can pass from inside the skull to structures of the inner ear and face.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 17 - A new-born was found to have an undeveloped spiral septum in the heart....

    Incorrect

    • A new-born was found to have an undeveloped spiral septum in the heart. This is characteristic of which of the following?

      Your Answer:

      Correct Answer: Persistent truncus arteriosus

      Explanation:

      Persistent truncus arteriosus is a congenital heart disease that occurs when the primitive truncus does not divide into the pulmonary artery and aorta, resulting in a single arterial trunk. The spiral septum is created by fusion of a truncal septum and the aorticopulmonary spiral septum. Incomplete development of these septa results in incomplete separation of the common tube of the truncus arteriosus and the aorticopulmonary trunk.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 18 - Congenital anomalies of genitourinary tract are more common than any other system. Which...

    Incorrect

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

      Your Answer:

      Correct Answer: Bladder exstrophy

      Explanation:

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

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 19 - After finding elevated PSA levels, a 69-year-old man undergoes a needle biopsy and...

    Incorrect

    • After finding elevated PSA levels, a 69-year-old man undergoes a needle biopsy and is diagnosed with prostatic cancer. What is the stage of this primary tumour?

      Your Answer:

      Correct Answer: T1c

      Explanation:

      The AJCC uses a TNM system to stage prostatic cancer, with categories for the primary tumour, regional lymph nodes and distant metastases:
      TX: cannot evaluate the primary tumour T0: no evidence of tumour
      T1: tumour present, but not detectable clinically or with imaging T1a: tumour was incidentally found in less than 5% of prostate tissue resected (for other reasons)
      T1b: tumour was incidentally found in more than 5% of prostate tissue resected
      T1c: tumour was found in a needle biopsy performed due to an elevated serum prostate-specific antigen
      T2: the tumour can be felt (palpated) on examination, but has not spread outside the prostate
      T2a: the tumour is in half or less than half of one of the prostate gland’s two lobes
      T2b: the tumour is in more than half of one lobe, but not both
      T2c: the tumour is in both lobes
      T3: the tumour has spread through the prostatic capsule (if it is only part-way through, it is still T2)
      T3a: the tumour has spread through the capsule on one or both sides
      T3b: the tumour has invaded one or both seminal vesicles
      T4: the tumour has invaded other nearby structures.
      In this case, the tumour has a T1c stage.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 20 - Which of the following is a true statement regarding the pupil? ...

    Incorrect

    • Which of the following is a true statement regarding the pupil?

      Your Answer:

      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.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 21 - A 64 year old woman arrives at the emergency department with acute bowel...

    Incorrect

    • A 64 year old woman arrives at the emergency department with acute bowel obstruction. She complains of vomiting up to 15 times per day and is currently taking erythromycin. She is now complaining of dizziness that is sudden in onset. ECG shows torsades de pointes. Which of the following is the most appropriate step in her management?

      Your Answer:

      Correct Answer: IV Magnesium sulphate

      Explanation:

      Torsade de pointes is an uncommon and distinctive form of polymorphic ventricular tachycardia (VT) characterized by a gradual change in the amplitude and twisting of the QRS complexes around the isoelectric line. Torsade de pointes, often referred to as torsade, is associated with a prolonged QT interval, which may be congenital or acquired. Torsade usually terminates spontaneously but frequently recurs and may degenerate into ventricular fibrillation. This woman is likely to have hypokalaemia and hypomagnesaemia as a result of vomiting. In addition to this, the erythromycin will predispose her to torsades de pointes. The patient should be given Magnesium 2g over 10 minutes. Knowledge of the management of this peri arrest diagnosis is hence important in surgical practice.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
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  • Question 22 - Which of the following muscles is solely contained in the anterior triangle of...

    Incorrect

    • Which of the following muscles is solely contained in the anterior triangle of the neck and divides the anterior triangle into three smaller triangles?

      Your Answer:

      Correct Answer: Digastric

      Explanation:

      The digastric muscle is a small muscle located under the jaw. It lies below the body of the mandible, and extends, in a curved form, from the mastoid process to the symphysis menti. The digastric divides the anterior triangle of the neck into three smaller triangles:
      – The submaxillary triangle, bounded above by the lower border of the body of the mandible and a line drawn from its angle to the sternocleidomastoid, below by the posterior belly of the digastric and the stylohyoid and in front by the anterior belly of the digastric
      – The carotid triangle, bounded above by the posterior belly of the digastric and stylohyoid, behind by the sternocleidomastoid and below by the omohyoid
      – The suprahyoid or submental triangle, bounded laterally by the anterior belly of the digastric, medially by the midline of the neck from the hyoid bone to the symphysis menti and inferiorly by the body of the hyoid bone.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 23 - Which of the following is involved in vitamin B12 absorption? ...

    Incorrect

    • Which of the following is involved in vitamin B12 absorption?

      Your Answer:

      Correct Answer: Intrinsic factor

      Explanation:

      Absorption of vitamin B12 is by an active transport process and occurs in the ileum. Most cobalamins are bound to proteins and are released in the stomach due to low pH and pepsin. The cobalamins then bind to R proteins, i.e. haptocorrin (HC) secreted from salivary glands and gastric juice. Another cobalamin binding protein is Intrinsic factor (IF) secreted from the gastric parietal cells. The cobalamin-HC complex is digested by pancreatic proteases in the intestinal lumen, and the free cobalamin then binds to IF. The complex then reaches a transmembrane receptor in the ileum and undergoes endocytosis. Cobalamin is then released intracellularly and binds to transcobalamin II (TC II). The newly formed complex then exits the ileal cell and enters the blood circulation.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 24 - The following structures DO NOT lie between the layers of the mesosalpinx except...

    Incorrect

    • The following structures DO NOT lie between the layers of the mesosalpinx except for the?

      Your Answer:

      Correct Answer: Fallopian tube

      Explanation:

      Mesosalpinx is the portion of the broad ligament that stretches from the fallopian tube to the ovary and contains the uterine tubes between it’s layers.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 25 - A 32 year old presents with symptoms of an anal fistula. The clinician...

    Incorrect

    • A 32 year old presents with symptoms of an anal fistula. The clinician examines him in the lithotomy position and the external opening of the fistula is identified in the 7 o'clock position. At which of the following locations is the internal opening most likely to be found?

      Your Answer:

      Correct Answer: 6 o'clock

      Explanation:

      Goodsall’s rule can be used to clinically predict the course of an anorectal fistula tract. Imagine a line that bisects the anus in the coronal plane (transverse anal line). Any fistula that originates anterior to the line will course anteriorly in a direct route. Fistulae that originate posterior to the line will have a curved path. An exception to the rule are anterior fistulas lying more than 3 cm from the anus, which may open into the anterior midline of the anal canal.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
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  • Question 26 - A 49 year old carpenter is rushed to the hospital after falling from...

    Incorrect

    • A 49 year old carpenter is rushed to the hospital after falling from the roof of a house. He has an open fracture of his tibia with a 14 cm wound and he is neurovascularly intact. What is the most appropriate course of action?

      Your Answer:

      Correct Answer: Intravenous antibiotics, photography and application of saline soaked gauze with impermeable dressing

      Explanation:

      The administration of antibiotics is best considered therapeutic, rather than prophylactic, because of the high risk of infection in the absence of antibiotics.

      Although debate still surrounds some aspects of antibiotic administration for open fractures, the following generalizations can be made:

      – All patients with open fractures should receive cefazolin or equivalent gram-positive coverage; this may be sufficient
      – Type II or type III injuries likely benefit from the addition of adequate gram-negative coverage, typically with an aminoglycoside
      – Injuries at risk for anaerobic infections (e.g., farm injuries, severe tissue necrosis) probably benefit from the addition of penicillin or clindamycin.

      Digital photos are helpful for documenting the initial appearance of the extremity and can be a valuable addition to the medical record. Digital imaging allows other members of the treatment team to see the wound preoperatively without repeated manipulations of the wound.
      Gauze swabs soaked in normal saline are frequently used as dressing on open wounds.

      The Oxford Handbook for Medical school recommends that open fractures should be sealed with saline-soaked gauze and impermeable dressing after removal of gross contaminants.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Orthopaedics
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  • Question 27 - Driving pressure is considered to be a strong predictor of mortality in patients...

    Incorrect

    • Driving pressure is considered to be a strong predictor of mortality in patients with ARDS. What is the normal mean intravascular driving pressure for the respiratory circulation?

      Your Answer:

      Correct Answer: 10 mmHg

      Explanation:

      Driving pressure is the difference between inflow and outflow pressure. For the pulmonary circulation, this is the difference between pulmonary arterial (pa) and left atrial pressure (pLA). Normally, mean driving pressure is about 10 mmHg, computed by subtracting pLA (5 mmHg) from pA (15 mmHg). This is in contrast to a mean driving pressure of nearly 100 mmHg in the systemic circulation.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 28 - Which of the following substances is most likely to cause pulmonary vasodilatation? ...

    Incorrect

    • Which of the following substances is most likely to cause pulmonary vasodilatation?

      Your Answer:

      Correct Answer: Nitric oxide

      Explanation:

      In the body, nitric oxide is synthesised from arginine and oxygen by various nitric oxide synthase (NOS) enzymes and by sequential reduction of inorganic nitrate. The endothelium of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, so dilating the artery and increasing blood flow. Nitric oxide/oxygen blends are used in critical care to promote capillary and pulmonary dilation to treat primary pulmonary hypertension in neonatal patients post-meconium aspiration and related to birth defects.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 29 - A 52-year-old male who is a known case of leukaemia visits the day...

    Incorrect

    • A 52-year-old male who is a known case of leukaemia visits the day unit for a blood transfusion. Five days later, he presents to the emergency department with a temperature of 38.5°C, and erythematous cutaneous eruptions.What is the most likely explanation?

      Your Answer:

      Correct Answer: Graft-versus-host disease

      Explanation:

      This is transfusion-associated graft-versus-host disease (GvHD) occurring in an immunosuppressed patient. It can occur 4–30 days after a transfusion and follows a subacute pathway. Patients may also have diarrhoea and abnormal liver function tests. Management involves steroid therapy.

      Acute transfusion reactions present during or within 24 hours of a blood transfusion. The most frequent clinical features are fever, chills, pruritus, or urticaria, which typically resolve promptly without specific treatment or complications. Other signs occurring in temporal relationship with a blood transfusion such as severe dyspnoea, pyrexia, or loss of consciousness may be the first indication of a more severe, potentially fatal reaction.

      Transfusion reactions may be immune-mediated and non-immune-mediated. GvHD is a condition that might occur after an allogeneic transplant. The donated blood cells view the recipient’s body as foreign and attacks it. Immunosuppressed patients who receive white blood cells from another person are at increased risk of developing GvHD.

      There are two forms of the disease:
      1. Acute graft-versus-host disease (aGvHD): usually presents with skin and/or liver and/or gut involvement.
      2. Chronic graft-versus-host disease (cGvHD).

      The diagnosis is clinical and usually one of exclusion; however, biopsy of affected tissues may be helpful in unclear cases.

    • This question is part of the following fields:

      • Post-operative Management And Critical Care
      • Principles Of Surgery-in-General
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  • Question 30 - What is the correct order of structures a needle must pass before it...

    Incorrect

    • What is the correct order of structures a needle must pass before it enters the pleural cavity?

      Your Answer:

      Correct Answer: External intercostals – internal intercostals – innermost intercostals – parietal pleura

      Explanation:

      The correct order of structures from superficial to deep are: the skin and subcutaneous tissue, the external intercostals followed by internal intercostals, innermost intercostals and finally parietal pleura.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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