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  • Question 1 - A 75-year-old woman comes in with a femoral hernia. What structure makes up...

    Incorrect

    • A 75-year-old woman comes in with a femoral hernia. What structure makes up the lateral boundary of the femoral canal?

      Your Answer: Pubic tubercle

      Correct Answer: Femoral vein

      Explanation:

      The purpose of the canal is to facilitate the natural expansion of the femoral vein located on its side.

      Understanding the Femoral Canal

      The femoral canal is a fascial tunnel located at the medial aspect of the femoral sheath. It contains both the femoral artery and femoral vein, with the canal lying medial to the vein. The borders of the femoral canal include the femoral vein laterally, the lacunar ligament medially, the inguinal ligament anteriorly, and the pectineal ligament posteriorly.

      The femoral canal plays a significant role in allowing the femoral vein to expand, which facilitates increased venous return to the lower limbs. However, it can also be a site of femoral hernias, which occur when abdominal contents protrude through the femoral canal. The relatively tight neck of the femoral canal places these hernias at high risk of strangulation, making it important to understand the anatomy and function of this structure. Overall, understanding the femoral canal is crucial for medical professionals in diagnosing and treating potential issues related to this area.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 2 - Which of the following is not an extraintestinal manifestation of Crohn's disease? ...

    Incorrect

    • Which of the following is not an extraintestinal manifestation of Crohn's disease?

      Your Answer: Clubbing

      Correct Answer: Erythema multiforme

      Explanation:

      Understanding Crohn’s Disease

      Crohn’s disease is a type of inflammatory bowel disease that can affect any part of the digestive tract, from the mouth to the anus. The exact cause of Crohn’s disease is unknown, but there is a strong genetic component. Inflammation occurs in all layers of the affected area, which can lead to complications such as strictures, fistulas, and adhesions.

      Symptoms of Crohn’s disease typically appear in late adolescence or early adulthood and can include non-specific symptoms such as weight loss and lethargy, as well as more specific symptoms like diarrhea, abdominal pain, and perianal disease. Extra-intestinal features, such as arthritis, erythema nodosum, and osteoporosis, are also common in patients with Crohn’s disease.

      To diagnose Crohn’s disease, doctors may look for raised inflammatory markers, increased faecal calprotectin, anemia, and low levels of vitamin B12 and vitamin D. It’s important to note that Crohn’s disease shares some features with ulcerative colitis, another type of inflammatory bowel disease, but there are also important differences between the two conditions. Understanding the symptoms and diagnostic criteria for Crohn’s disease can help patients and healthcare providers manage this chronic condition more effectively.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 3 - A 52-year-old woman visits her primary care physician after her spouse noticed a...

    Correct

    • A 52-year-old woman visits her primary care physician after her spouse noticed a gradual yellowing of her eyes over the past three days. The patient reports experiencing fatigue and excessive sleepiness for several years, along with occasional bouts of intense itching. She has no significant medical history. Lab tests reveal elevated levels of alkaline phosphatase, IgM antibodies, and anti-mitochondrial antibodies. What is the underlying pathology of this patient's condition?

      Your Answer: Interlobular bile duct granulomatous destruction with dense lymphocytic infiltrate

      Explanation:

      The patient’s symptoms and laboratory findings suggest a cholestatic disease, specifically primary biliary cholangitis, which is an autoimmune condition of the biliary tract. This disease is more common in middle-aged women and can present with symptoms such as fatigue and pruritus. Non-alcoholic steatohepatitis is a metabolic syndrome-related condition characterized by triglyceride accumulation and myofibroblast proliferation, while primary sclerosing cholangitis is characterized by bile duct inflammation and sclerosis. Alcoholic hepatitis is caused by long-term alcohol misuse and is characterized by macrovesicular fatty change, spotty necrosis, and fibrosis.

      Primary biliary cholangitis is a chronic liver disorder that affects middle-aged women. It is thought to be an autoimmune condition that damages interlobular bile ducts, causing progressive cholestasis and potentially leading to cirrhosis. The classic presentation is itching in a middle-aged woman. It is associated with Sjogren’s syndrome, rheumatoid arthritis, systemic sclerosis, and thyroid disease. Diagnosis involves immunology and imaging tests. Management includes ursodeoxycholic acid, cholestyramine for pruritus, and liver transplantation in severe cases. Complications include cirrhosis, osteomalacia and osteoporosis, and an increased risk of hepatocellular carcinoma.

    • This question is part of the following fields:

      • Gastrointestinal System
      36.9
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  • Question 4 - A 25-year-old male with Gilbert's syndrome (GS) visits his doctor worried about a...

    Correct

    • A 25-year-old male with Gilbert's syndrome (GS) visits his doctor worried about a recent change in skin tone. During the examination, his skin appears to be normal, but he insists that it was yellow earlier today.

      What is true about Gilbert's syndrome?

      Your Answer: Transient jaundice after physiological stress such as exercise and fasting is seen in Gilbert’s syndrome

      Explanation:

      Gilbert’s syndrome is a harmless liver condition that is characterized by increased levels of bilirubin in the blood. While some individuals may not experience any symptoms, others may develop temporary jaundice following physical stressors such as fasting or exercise. Treatment and regular monitoring are not necessary for this condition. It is important to reassure patients that Gilbert’s syndrome does not progress to chronic liver disease. The condition is caused by a mutation in the UGT1A1 gene, which leads to reduced activity of the UGT1A1 enzyme. Gilbert’s syndrome is more prevalent in males.

      Gilbert’s syndrome is a genetic disorder that affects the way bilirubin is processed in the body. It is caused by a deficiency of UDP glucuronosyltransferase, which leads to unconjugated hyperbilirubinemia. This means that bilirubin is not properly broken down and eliminated from the body, resulting in jaundice. However, jaundice may only be visible during certain conditions such as fasting, exercise, or illness. The prevalence of Gilbert’s syndrome is around 1-2% in the general population.

      To diagnose Gilbert’s syndrome, doctors may look for a rise in bilirubin levels after prolonged fasting or the administration of IV nicotinic acid. However, treatment is not necessary for this condition. While the exact mode of inheritance is still debated, it is known to be an autosomal recessive disorder.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 5 - A 65-year-old man presents to the clinic with a complaint of losing 1...

    Incorrect

    • A 65-year-old man presents to the clinic with a complaint of losing 1 stone in weight over the past three months. Apart from this, he has no significant medical history. During the physical examination, his abdomen is soft, and no palpable masses are detected. A normal PR examination is also observed. The patient's blood tests reveal a haemoglobin level of 80 g/L (120-160) and an MCV of 70 fL (80-96). What is the most appropriate initial investigation for this patient?

      Your Answer:

      Correct Answer: Upper GI endoscopy and colonoscopy

      Explanation:

      Possible GI Malignancy in a Man with Weight Loss and Microcytic Anaemia

      This man is experiencing weight loss and has an unexplained microcytic anaemia. The most probable cause of his blood loss is from the gastrointestinal (GI) tract, as there is no other apparent explanation. This could be due to an occult GI malignancy, which is why the recommended initial investigations are upper and lower GI endoscopy. These tests will help to identify any potential sources of bleeding in the GI tract and determine if there is an underlying malignancy. It is important to diagnose and treat any potential malignancy as early as possible to improve the patient’s prognosis. Therefore, prompt investigation and management are crucial in this case.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 6 - A 30-year-old man is about to undergo a surgical procedure and is being...

    Incorrect

    • A 30-year-old man is about to undergo a surgical procedure and is being catheterised. What changes will occur as the catheter enters his prostatic urethra?

      Your Answer:

      Correct Answer: Resistance will decrease

      Explanation:

      The membranous urethra is narrower than the prostatic urethra, resulting in increased resistance. The prostatic urethra is angled vertically.

      Anatomy of the Prostate Gland

      The prostate gland is a small, walnut-shaped gland located below the bladder and separated from the rectum by Denonvilliers fascia. It receives its blood supply from the internal iliac vessels, specifically the inferior vesical artery. The gland has an internal sphincter at its apex, which can be damaged during surgery and result in retrograde ejaculation.

      The prostate gland has four lobes: the posterior lobe, median lobe, and two lateral lobes. It also has an isthmus and three zones: the peripheral zone, central zone, and transition zone. The peripheral zone, which is the subcapsular portion of the posterior prostate, is where most prostate cancers occur.

      The gland is surrounded by various structures, including the pubic symphysis, prostatic venous plexus, Denonvilliers fascia, rectum, ejaculatory ducts, lateral venous plexus, and levator ani. Its lymphatic drainage is to the internal iliac nodes, and its innervation comes from the inferior hypogastric plexus.

      In summary, the prostate gland is a small but important gland in the male reproductive system. Its anatomy includes lobes, zones, and various surrounding structures, and it plays a crucial role in ejaculation and prostate health.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 7 - A somatostatinoma patient with constantly elevated somatostatin levels experiences a significant decrease in...

    Incorrect

    • A somatostatinoma patient with constantly elevated somatostatin levels experiences a significant decrease in the secretion of many endocrine hormones. Which hormone responsible for stimulating the pancreas and hepatic duct cells to secrete bicarbonate-rich fluid is affected when S cells are not stimulated?

      Your Answer:

      Correct Answer: Secretin

      Explanation:

      Secretin is the correct answer as it is produced by S cells in the upper small intestine and stimulates the pancreas and hepatic duct cells to secrete bicarbonate-rich fluid. It also reduces gastric acid secretion and promotes the growth of pancreatic acinar cells. However, if there is a somatostatinoma present, there will be an excess of somatostatin which inhibits the production of secretin by S cells.

      Cholecystokinin (CCK) is an incorrect answer as it is released by I-cells in the upper small intestine in response to fats and proteins. CCK stimulates the gallbladder and pancreas to contract and secrete bile enzymes into the duodenum.

      Gastrin is an incorrect answer as it is produced by G cells in the stomach and stimulates the release of hydrochloric acid into the stomach.

      Ghrelin is an incorrect answer as it is released to stimulate hunger, particularly before meals.

      Overview of Gastrointestinal Hormones

      Gastrointestinal hormones play a crucial role in the digestion and absorption of food. These hormones are secreted by various cells in the stomach and small intestine in response to different stimuli such as the presence of food, pH changes, and neural signals.

      One of the major hormones involved in food digestion is gastrin, which is secreted by G cells in the antrum of the stomach. Gastrin increases acid secretion by gastric parietal cells, stimulates the secretion of pepsinogen and intrinsic factor, and increases gastric motility. Another hormone, cholecystokinin (CCK), is secreted by I cells in the upper small intestine in response to partially digested proteins and triglycerides. CCK increases the secretion of enzyme-rich fluid from the pancreas, contraction of the gallbladder, and relaxation of the sphincter of Oddi. It also decreases gastric emptying and induces satiety.

      Secretin is another hormone secreted by S cells in the upper small intestine in response to acidic chyme and fatty acids. Secretin increases the secretion of bicarbonate-rich fluid from the pancreas and hepatic duct cells, decreases gastric acid secretion, and has a trophic effect on pancreatic acinar cells. Vasoactive intestinal peptide (VIP) is a neural hormone that stimulates secretion by the pancreas and intestines and inhibits acid secretion.

      Finally, somatostatin is secreted by D cells in the pancreas and stomach in response to fat, bile salts, and glucose in the intestinal lumen. Somatostatin decreases acid and pepsin secretion, decreases gastrin secretion, decreases pancreatic enzyme secretion, and decreases insulin and glucagon secretion. It also inhibits the trophic effects of gastrin and stimulates gastric mucous production.

      In summary, gastrointestinal hormones play a crucial role in regulating the digestive process and maintaining homeostasis in the gastrointestinal tract.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 8 - A 65-year-old male is undergoing a Whipples procedure for adenocarcinoma of the pancreas....

    Incorrect

    • A 65-year-old male is undergoing a Whipples procedure for adenocarcinoma of the pancreas. During the mobilisation of the pancreatic head, the surgeons come across a large vessel passing over the anterior aspect of the uncinate process. What is the probable identity of this vessel?

      Your Answer:

      Correct Answer: Superior mesenteric artery

      Explanation:

      The origin of the superior mesenteric artery is the aorta, and it travels in front of the lower section of the pancreas. If this area is invaded, it is not recommended to undergo resectional surgery.

      Anatomy of the Pancreas

      The pancreas is located behind the stomach and is a retroperitoneal organ. It can be accessed surgically by dividing the peritoneal reflection that connects the greater omentum to the transverse colon. The pancreatic head is situated in the curvature of the duodenum, while its tail is close to the hilum of the spleen. The pancreas has various relations with other organs, such as the inferior vena cava, common bile duct, renal veins, superior mesenteric vein and artery, crus of diaphragm, psoas muscle, adrenal gland, kidney, aorta, pylorus, gastroduodenal artery, and splenic hilum.

      The arterial supply of the pancreas is through the pancreaticoduodenal artery for the head and the splenic artery for the rest of the organ. The venous drainage for the head is through the superior mesenteric vein, while the body and tail are drained by the splenic vein. The ampulla of Vater is an important landmark that marks the transition from foregut to midgut and is located halfway along the second part of the duodenum. Overall, understanding the anatomy of the pancreas is crucial for surgical procedures and diagnosing pancreatic diseases.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 9 - A 57-year-old woman comes to the doctor complaining of colicky pain in her...

    Incorrect

    • A 57-year-old woman comes to the doctor complaining of colicky pain in her right upper quadrant that has been occurring periodically for the past 4 months. She had her worst episode last night after eating takeout, which caused her to vomit due to the severity of the pain.

      During the examination, her temperature was found to be 37.7ÂșC, respiratory rate 14/min, blood pressure 118/75mmHg, and oxygen saturation was 98%. Her abdomen was soft and non-tender, and Murphy's sign was negative.

      What is the hormone responsible for her symptoms?

      Your Answer:

      Correct Answer: Cholecystokinin (CCK)

      Explanation:

      The correct answer is Cholecystokinin (CCK) as the woman is experiencing classic symptoms of biliary colic. CCK is released in response to fatty foods in the duodenum, causing increased gallbladder contraction and resulting in biliary colic.

      Gastrin stimulates the secretion of gastric acid in response to stomach distension after a meal.

      Prostaglandin causes uterine muscles to contract, leading to the expulsion of the uterine lining during menstruation. However, the patient’s symptoms are more indicative of biliary colic than dysmenorrhea.

      Secretin decreases gastric acid secretion and increases pancreatic secretion, but it does not stimulate the gallbladder.

      Overview of Gastrointestinal Hormones

      Gastrointestinal hormones play a crucial role in the digestion and absorption of food. These hormones are secreted by various cells in the stomach and small intestine in response to different stimuli such as the presence of food, pH changes, and neural signals.

      One of the major hormones involved in food digestion is gastrin, which is secreted by G cells in the antrum of the stomach. Gastrin increases acid secretion by gastric parietal cells, stimulates the secretion of pepsinogen and intrinsic factor, and increases gastric motility. Another hormone, cholecystokinin (CCK), is secreted by I cells in the upper small intestine in response to partially digested proteins and triglycerides. CCK increases the secretion of enzyme-rich fluid from the pancreas, contraction of the gallbladder, and relaxation of the sphincter of Oddi. It also decreases gastric emptying and induces satiety.

      Secretin is another hormone secreted by S cells in the upper small intestine in response to acidic chyme and fatty acids. Secretin increases the secretion of bicarbonate-rich fluid from the pancreas and hepatic duct cells, decreases gastric acid secretion, and has a trophic effect on pancreatic acinar cells. Vasoactive intestinal peptide (VIP) is a neural hormone that stimulates secretion by the pancreas and intestines and inhibits acid secretion.

      Finally, somatostatin is secreted by D cells in the pancreas and stomach in response to fat, bile salts, and glucose in the intestinal lumen. Somatostatin decreases acid and pepsin secretion, decreases gastrin secretion, decreases pancreatic enzyme secretion, and decreases insulin and glucagon secretion. It also inhibits the trophic effects of gastrin and stimulates gastric mucous production.

      In summary, gastrointestinal hormones play a crucial role in regulating the digestive process and maintaining homeostasis in the gastrointestinal tract.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 10 - A 50-year-old obese woman presents with right upper quadrant abdominal pain, nausea and...

    Incorrect

    • A 50-year-old obese woman presents with right upper quadrant abdominal pain, nausea and vomiting. She has a family history of gallstone disease. Upon physical examination, a positive Murphy's sign is observed. An abdominal ultrasound reveals gallstones in the thickened gallbladder. The surgeon opts for a laparoscopic cholecystectomy to remove the gallbladder. During the procedure, the surgeon identifies and dissects the hepatobiliary triangle to safely ligate and divide two structures.

      What are the two structures being referred to in the above scenario?

      Your Answer:

      Correct Answer: Cystic duct and cystic artery

      Explanation:

      During laparoscopic cholecystectomy, the hepatobiliary triangle plays a crucial role in ensuring the safe ligation and division of the cystic duct and cystic artery. Surgeons must carefully dissect this area to identify these structures and avoid any potential biliary complications.

      The hepatobiliary triangle is bordered by the common hepatic duct, which is formed by the union of the common bile duct and cystic duct. The cystic artery branches off from the right hepatic artery, while Lund’s node serves as the sentinel lymph node of the gallbladder.

      The accessory duct is considered auxiliary to the biliary tree, and the left and right hepatic ducts merge into the common hepatic duct. The gastroduodenal artery arises from the common hepatic artery, and the cystic vein helps distinguish between the cystic and common hepatic ducts during surgery, but is not ligated.

      The gallbladder is a sac made of fibromuscular tissue that can hold up to 50 ml of fluid. Its lining is made up of columnar epithelium. The gallbladder is located in close proximity to various organs, including the liver, transverse colon, and the first part of the duodenum. It is covered by peritoneum and is situated between the right lobe and quadrate lobe of the liver. The gallbladder receives its arterial supply from the cystic artery, which is a branch of the right hepatic artery. Its venous drainage is directly to the liver, and its lymphatic drainage is through Lund’s node. The gallbladder is innervated by both sympathetic and parasympathetic nerves. The common bile duct originates from the confluence of the cystic and common hepatic ducts and is located in the hepatobiliary triangle, which is bordered by the common hepatic duct, cystic duct, and the inferior edge of the liver. The cystic artery is also found within this triangle.

    • This question is part of the following fields:

      • Gastrointestinal System
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Gastrointestinal System (2/4) 50%
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