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Question 1
Incorrect
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The gradual depolarization in-between action potentials in pacemaker tissue is a result of?
Your Answer: An increase in the ‘delayed rectifier’ current due to outward movement of inward K+ (IK)
Correct Answer: A combination of gradual inactivation outward IK along with the presence of an inward ‘funny’ current (If) due to opening of channels permeable to both Na+ and K+ ions
Explanation:One of the characteristic features of the pacemaker cell is the generation of a gradual diastolic depolarization also called the pacemaker potential. In phase 0, the upstroke of the action potential caused by an increase in the Ca2+ conductance, an influx of calcium occurs and a positive membrane potential is generated. The next is phase 3 which is repolarization caused by increased K+ conductance as a result of outwards K+ current. Phase 4 is a slow depolarization which accounts for the pacemaker activity, caused by increased conductance of Na+, inwards Na+ current called IF. it is turned on by repolarization.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 2
Incorrect
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The specimen sent to the pathologist for examination was found to be benign. Which one of the following is most likely a benign tumour?
Your Answer: Haematoma
Correct Answer: Warthin’s tumour
Explanation:Warthin’s tumour is also known as papillary cystadenoma lymphomatosum. It is a benign cystic tumour of the salivary glands containing abundant lymphocytes and germinal centres. It has a slightly higher incidence in males and most likely occur in older adults aged between 60 to 70 years. This tumour is also associated with smoking. Smokers have an eight-fold greater risk in developing the tumour compared to non-smokers.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 3
Incorrect
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A 60 year old woman with Crohn's disease presents with a high output enterocutaneous fistula. She is started on total parenteral nutrition (TPN) to reduce the output of the fistula and improve her nutritional status. Which of the following statements regarding TPN is incorrect?
Your Answer: Volume overload, hyperglycaemia, and hyperchloremic acidosis are early complications of TPN
Correct Answer: It may result in metabolic complications such a refeeding syndrome, resulting in hyperkalaemia, hypermagnesemia, and hyperphosphatemia
Explanation:Answer: It may result in metabolic complications such a refeeding syndrome, resulting in hyperkalaemia, hypermagnesemia, and hyperphosphatemia.
Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally. These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.
During refeeding, glycaemia leads to increased insulin and decreased secretion of glucagon. Insulin stimulates glycogen, fat, and protein synthesis. This process requires minerals such as phosphate and magnesium and cofactors such as thiamine. Insulin stimulates the absorption of potassium into the cells through the sodium-potassium ATPase symporter, which also transports glucose into the cells. Magnesium and phosphate are also taken up into the cells. Water follows by osmosis. These processes result in a decrease in the serum levels of phosphate, potassium, and magnesium, all of which are already depleted. The clinical features of the refeeding syndrome occur as a result of the functional deficits of these electrolytes and the rapid change in basal metabolic rate. -
This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
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Question 4
Incorrect
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A 39 year old male is identified as having gallstones after presenting with colicky right upper quadrant pain. An abdominal ultrasound scan was done. Which of the following is the best course of action?
Your Answer: MRCP
Correct Answer: Liver function tests
Explanation:In patients with suspected gallstone complications, blood tests should include a complete blood cell (CBC) count with differential, liver function panel, and amylase and lipase. Up to 24% of women and 12% of men may have gallstones. Of these up to 30% may develop local infection and cholecystitis.
Acute cholecystitis is associated with polymorphonuclear leucocytosis. However, up to one third of the patients with cholecystitis may not manifest leucocytosis. In severe cases, mild elevations of liver enzymes may be caused by inflammatory injury of the adjacent liver.
Patients with cholangitis and pancreatitis have abnormal laboratory test values. Importantly, a single abnormal laboratory value does not confirm the diagnosis of choledocholithiasis, cholangitis, or pancreatitis; rather, a coherent set of laboratory studies leads to the correct diagnosis.
Choledocholithiasis with acute common bile duct (CBD) obstruction initially produces an acute increase in the level of liver transaminases (alanine and aspartate aminotransferases), followed within hours by a rising serum bilirubin level. The higher the bilirubin level, the greater the predictive value for CBD obstruction. CBD stones are present in approximately 60% of patients with serum bilirubin levels greater than 3 mg/dL.
If obstruction persists, a progressive decline in the level of transaminases with rising alkaline phosphatase and bilirubin levels may be noted over several days. Prothrombin time may be elevated in patients with prolonged CBD obstruction, secondary to depletion of vitamin K (the absorption of which is bile-dependent). Concurrent obstruction of the pancreatic duct by a stone in the ampulla of Vater may be accompanied by increases in serum lipase and amylase levels.
Repeated testing over hours to days may be useful in evaluating patients with gallstone complications. Improvement of the levels of bilirubin and liver enzymes may indicate spontaneous passage of an obstructing stone. Conversely, rising levels of bilirubin and transaminases with progression of leucocytosis in the face of antibiotic therapy may indicate ascending cholangitis with the need for urgent intervention. Blood culture results are positive in 30%-60% of patients with cholangitis.
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This question is part of the following fields:
- Generic Surgical Topics
- Hepatobiliary And Pancreatic Surgery
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Question 5
Incorrect
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Atractyloside is an inhibitor of electron transport chain. It is expected to have little or no effect on the functioning of which of the following cell types?
Your Answer: Parietal cells of the stomach
Correct Answer: Red blood cells
Explanation:Electron transport chain is a series of electron carriers that are embedded in the mitochondrial membrane. It is the place where ATP is made. Inhibiting the electron transport chain will stop production of ATP. Red blood cells are the only cell in the given option which do not contain ATP.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 6
Incorrect
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A 48-year-old woman has a mass in her right breast and has right axillary node involvement. She underwent radical mastectomy of her right breast. The histopathology report described the tumour to be 4 cm in its maximum diameter with four axillary lymph nodes with evidence of tumour. The most likely stage of cancer in this patient is:
Your Answer: IIIA
Correct Answer: IIB
Explanation:Stage IIB describes invasive breast cancer in which: the tumour is larger than 2 centimetres but no larger than 5 centimetres; small groups of breast cancer cells — larger than 0.2 millimetre but not larger than 2 millimetres — are found in the lymph nodes OR the tumour is larger than 2 centimetres but no larger than 5 centimetres; cancer has spread to 1 to 3 axillary lymph nodes or to lymph nodes near the breastbone (found during a sentinel node biopsy) OR the tumour is larger than 5 centimetres but has not spread to the axillary lymph nodes.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 7
Correct
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A 40-year-old woman undergoes a mastectomy and latissimus dorsi flap reconstruction for breast cancer. For optimal cosmetic results, a McGhan breast implant is placed under the myocutaneous flap. Three weeks postoperatively, the patient continues to suffer from recurrent wound infections resistant to multiple courses of antibiotics. Which of the following organisms is most likely to be responsible?
Your Answer: Staphylococcus epidermidis
Explanation:Staphylococcus epidermidis tends to colonise plastic devices (such as the breast implant in this scenario) and forms a biofilm which allows colonisation with other bacterial agents. It is extremely difficult to eradicate the infection once established, and the usual treatment is removal of the device.
Staphylococcus epidermidis is a gram-positive facultative anaerobic bacterium. It is part of the normal human flora, typically the skin flora, and less commonly the mucosal flora. It is also one of the most frequently detected pathogens in infections following implant surgery.
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This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 8
Incorrect
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Different substances have different renal clearance rates. Which of the following substances should have the lowest renal clearance rate in a healthy patient?
Your Answer: Sodium
Correct Answer: Glucose
Explanation:Under normal conditions the renal clearance of glucose is zero, since glucose is completely reabsorbed in the renal tubules and not excreted. Glycosuria – the excretion of glucose into the urine- is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 9
Correct
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A 30 year old man presents with a surgical wound that is erythematous, tender and discharging pus. He states that he had undergone an inguinal hernia repair eight days earlier. What is the cause of this?
Your Answer: Infection with Staphylococcus aureus
Explanation:Answer: Infection with Staphylococcus aureus
Surgical site infections (SSIs) are among the most common healthcare-associated infections, and contribute significantly to patient morbidity and healthcare costs. Staphylococcus aureus is the most common microbial cause. The epidemiology of S. aureus is changing with the dissemination of newer clones and the emergence of mupirocin resistance. Pre-operative screening, using culture- or molecular-based methods, and subsequent decolonization of patients who are positive for methicillin-susceptible S. aureus and methicillin-resistant S. aureus (MRSA) reduces SSIs and hospital stay. This applies especially to major clean surgery, such as cardiothoracic and orthopaedic, involving the insertion of implanted devices. However, it requires a multi-disciplinary approach coupled with patient education. Universal decolonization pre-operatively without screening for S. aureus may compromise the capacity to monitor for the emergence of new clones of S. aureus, contribute to mupirocin resistance, and prevent the adjustment of surgical prophylaxis for MRSA (i.e. replacement of a beta-lactam agent with a glycopeptide or alternative).
A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material.
Symptoms include:
Redness and pain around the area where you had surgery
Drainage of cloudy fluid from your surgical wound
Fever -
This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 10
Correct
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A 26-year-old woman presents with right iliac fossa pain and history of some bloodstained vaginal discharge. On examination, she has diffuse lower abdominal tenderness and is afebrile with a heart rate of 97 bpm and blood pressure of 120/70 mmHg. Considering these signs and symptoms, what should be the most appropriate course of action?
Your Answer: Abdominal and pelvic USS
Explanation:The history of bloodstained vaginal discharge and lower abdominal tenderness makes ectopic pregnancy a strong possibility. Therefore, a pregnancy test (for beta hCG) and abdominal and pelvic USS should be performed. If the beta HCG is high, that is an indication for intrauterine pregnancy. If it is not, then an ectopic pregnancy is likely, and surgery should be considered.
Generally, the differential diagnosis of right iliac fossa (RIF) pain includes:
1. Appendicitis
2. Crohn’s disease
3. Mesenteric adenitis
4. Diverticulitis
5. Meckel’s diverticulitis
6. Perforated peptic ulcer
7. Incarcerated right inguinal or femoral hernia
8. Bowel perforation secondary to caecal or colon carcinoma
9. Gynaecological causes—pelvic inflammatory disease/salpingitis/pelvic abscess/ectopic pregnancy/ovarian torsion/threatened or complete abortion
10. Urological causes—ureteric colic/urinary tract infection/Testicular torsion
11. Other causes—tuberculosis/typhoid/ infection with herpes zoster -
This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 11
Incorrect
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A 3 month old infant is taken to the hospital after she is observed to have jaundice. Tests show an elevated conjugated bilirubin level. Diagnosis is confirmed by cholangiography during surgery. Which of the following is the best course of action?
Your Answer: Choledochoduodenostomy
Correct Answer: Roux-en-Y portojejunostomy
Explanation:In most cases of atresia, dissection into the porta hepatis and creation of a Roux-en-Y anastomosis with a 35 to 40-cm retro colic jejunal segment is the procedure of choice.
In the unusual circumstance of distal patency of the common duct with acceptable proximal luminal calibre, a modified portoenterostomy may be considered in place of the traditional Kasai procedure. However, the clinician must be aware that progression of disease pathophysiology may occur.Biliary atresia is characterized by obliteration or discontinuity of the extrahepatic biliary system, resulting in obstruction to bile flow. Regardless of aetiology, the clinical presentation of neonatal cholestasis is remarkably similar in most infants.
Typical symptoms include variable degrees of jaundice, dark urine, and light stools. In the case of biliary atresia, most infants are full-term, although a higher incidence of low birthweight may be observed. In most cases, acholic stools are not noted at birth but develop over the first few weeks of life. Appetite, growth, and weight gain may be normal.
Physical findings do not identify all cases of biliary atresia. No findings are pathognomonic for the disorder. Infants with biliary atresia are typically full term and may manifest normal growth and weight gain during the first few weeks of life.
Hepatomegaly may be present early, and the liver is often firm or hard to palpation. Splenomegaly is common, and an enlarging spleen suggests progressive cirrhosis with portal hypertension.
Direct hyperbilirubinemia is always an abnormal finding and it is typically present from birth in the foetal/embryonic form. Consider biliary atresia in all neonates with direct hyperbilirubinemia.
In the more common postnatal form, physiologic jaundice frequently merges into conjugated hyperbilirubinemia. The clinician must be aware that physiologic unconjugated hyperbilirubinemia rarely persists beyond 2 weeks. Infants with prolonged physiologic jaundice must be evaluated for other causes.
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This question is part of the following fields:
- Generic Surgical Topics
- Paediatric Surgery
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Question 12
Correct
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Which of the following conditions is characterized by generalised oedema due to effusion of fluid into the extracellular space?
Your Answer: Anasarca
Explanation:Anasarca (or ‘generalised oedema’) is a condition characterised by widespread swelling of the skin due to effusion of fluid into the extracellular space. It is usually caused by liver failure (cirrhosis of the liver), renal failure/disease, right-sided heart failure, as well as severe malnutrition/protein deficiency.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 13
Incorrect
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A medical student is asked to calculate the net pressure difference in a capillary wall, considering: Interstitial fluid hydrostatic pressure = –3 mmHg, Plasma colloid osmotic pressure = 28 mmHg, Capillary hydrostatic pressure = 17 mmHg, Interstitial fluid colloid osmotic pressure = 8 mmHg, and Filtration coefficient = 1. Which is the correct answer?
Your Answer: –2 mmHg
Correct Answer: 0 mmHg
Explanation:The rate of filtration at any point along a capillary depends on a balance of forces sometimes called Starling’s forces after the physiologist who first described their operation in detail. The Starling principle of fluid exchange is key to understanding how plasma fluid (solvent) within the bloodstream (intravascular fluid) moves to the space outside the bloodstream (extravascular space). Fluid movement = k[(pc– pi)–(Πc– Πi)] where k = capillary filtration coefficient, pc = capillary hydrostatic pressure, pi= interstitial hydrostatic pressure, Πc = capillary colloid osmotic pressure, Πi = interstitial colloid osmotic pressure. Therefore: 1 × [capillary hydrostatic pressure (17) – interstitial fluid hydrostatic pressure (–3)] – [plasma colloid osmotic pressure (28) – interstitial fluid colloid osmotic pressure (8)] = 0 mmHg
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 14
Correct
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A 16-year old boy was brought in an unconscious state to the emergency department. Clinical evaluation pointed in favour of acute adrenal insufficiency. On enquiry, it was revealed that he was suffering from a high grade fever 24 hours prior. On examination, extensive purpura were noted on his skin. The likely diagnosis is:
Your Answer: Meningococcaemia
Explanation:Findings described are suggestive of Waterhouse-Friderichsen syndrome which develops secondary to meningococcaemia. The reported incidence of Addison’s disease is 4 in 100,000. It affects both sexes equally and is seen in all age groups. It tends to show clinical symptoms at the time of metabolic stress or trauma. The symptoms are precipitated by acute infections, trauma, surgery or sodium loss due to excessive perspiration.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 15
Correct
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what is the cause of a prolonged PT(prothrombin time)?
Your Answer: Liver disease
Explanation:PT measure the intrinsic pathway of coagulation. It determines the measure of the warfarin dose regime, liver disease and vit K deficiency status along with the clotting tendency of blood. PT measured factors are II,V,VII,X and fibrinogen. It is used along with aPTT which measure the intrinsic pathway.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 16
Correct
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A 7-year-old boys undergoes a testicular biopsy after a tumour is found in his right testis. Elements similar to hair and teeth are found in it. What kind of tumour is this?
Your Answer: Teratoma
Explanation:A teratoma is a tumour containing tissue elements that are similar to normal derivatives of more than one germ layer. They usually contain skin, hair, teeth and bone tissue and are more common in children, behaving as a benign tumour. After puberty, they are regarded as malignant and can metastasise.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 17
Correct
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Pain in the epigastric region occurring typically 2-3 hours after meals and causing the patient to wake up at night is characteristic of which of the following conditions?
Your Answer: Duodenal ulcer
Explanation:The description is typical for duodenal ulcers. There is no pain upon waking in the morning however it appears around mid-morning and is relieved by ingestion of food. The pain also often causes the patient to wake up at night.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 18
Incorrect
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Which of the following is a true statement regarding secretion of gastric acid?
Your Answer: Somatostatin increases gastric acid secretion
Correct Answer: Acetylcholine increases gastric acid secretion
Explanation:Gastric acid secretion is increased by acetylcholine, histamine and gastrin, with the help of cAMP as a secondary messenger. They increase H+ and Cl- secretion by increasing the number of H+/K+ ATPase molecules and Cl- channels. In contrast, gastric acid secretion is decreased by somatostatin, epidermal growth factor and prostaglandins.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 19
Incorrect
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Different portions of the renal tubule have varying degrees of water permeability. Which of the following renal sites is characterised by low water permeability under normal circumstances?
Your Answer: Proximal tubule
Correct Answer: Thick ascending limb of the loop of Henlé
Explanation:Within the nephron of the kidney, the ascending limb of the loop of Henle is a segment of the loop of Henle downstream of the descending limb, after the sharp bend of the loop. Both the thin and the thick ascending limbs of the loop of Henlé have very low permeability to water. Since there are no regulatory mechanisms to alter its permeability, it remains poorly permeable to water under all circumstances. Sodium and chloride are transported out of the luminal fluid into the surrounding interstitial spaces, where they are reabsorbed. Water must remain behind because it is not reabsorbed, so the solute concentration becomes less and less (the luminal fluid becomes more dilute). This is one of the principal mechanisms (along with diminution of ADH secretion) for the production of a dilute, hypo-osmotic urine (water diuresis).
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 20
Correct
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In a young, sexually active male, what is the most common cause of non-gonococcal urethritis?
Your Answer: Chlamydia
Explanation:Non-gonococcal urethritis is most commonly caused by Chlamydia trachomatis (50% cases). Less common organisms include Mycoplasma genitalium, Urea urealyticum and Trichomonas vaginalis. Chlamydia is also the commonest cause of non-gonococcal cervicitis in women and proctitis in both sexes.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 21
Incorrect
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Below which level of the spinal cord will the inferior gluteal nerve be unaffected?
Your Answer: S2
Correct Answer: S3
Explanation:The inferior gluteal nerve arises from the dorsal divisions of the fifth lumbar and first and second sacral nerves. According to this fact any lesion at or below the S3 will not affect the inferior gluteal nerve.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 22
Correct
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A 30-year-old male is playing tennis when he suddenly collapses and has a GCS of 4 when examined. What is the most likely cause?
Your Answer: Subarachnoid haemorrhage
Explanation:The term subarachnoid haemorrhage (SAH) refers to extravasation of blood into the subarachnoid space between the pial and arachnoid membranes. SAH constitutes half of all spontaneous atraumatic intracranial haemorrhages; the other half consists of bleeding that occurs within the brain parenchyma.
Intracranial saccular aneurysms (“berry aneurysms”) represent the most common aetiology of nontraumatic SAH; about 80% of cases of SAH result from ruptured aneurysms. -
This question is part of the following fields:
- Generic Surgical Topics
- Surgical Disorders Of The Brain
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Question 23
Correct
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After surgery, a patient developed a stitch granuloma . Which leukocyte in the peripheral blood will become an activated macrophage in this granuloma?
Your Answer: Monocyte
Explanation:Monocytes are leukocytes that protect the body against infections and move to the site of infection within 8-12 hours to deal with it. They are produced in the bone marrow and shortly after being produced are released into the blood stream where they circulate until an infection is detected. When called upon they leave the circulation and transform into macrophages within the tissue fluid and thus gain the capability to phagocytose the offending substance. Monocyte count is part of a complete blood picture. Monocytosis is the state of excess monocytes in the peripheral blood and may be indicative of various disease states. Examples of processes that can increase a monocyte count include: • chronic inflammation • stress response • hyperadrenocorticism • immune-mediated disease • pyogranulomatous disease • necrosis • red cell regeneration.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 24
Incorrect
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A recognised side-effect of prefrontal leukotomy is:
Your Answer: Global aphasia
Correct Answer: Confusion
Explanation:Used previously as a treatment for psychiatric disorders, prefrontal leucotomy severs the connection between the prefrontal cortical association area and the thalamus. This leads to functional isolation of the prefrontal and orbitofrontal association cortex. Thus, along with the desired reduction in anger and frustration, undesirable side effects included changes in mood and affect, as well as confusion.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 25
Correct
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A 5 year old boy is taken to the doctor with symptoms of dysuria and frequency in urination. Blood and nitrites are shown positive on urine dipstick. A urinary tract infection is suspected. Which follow up strategy is the most appropriate?
Your Answer: Watchful waiting
Explanation:In a child 3 months to 12 years of age who is afebrile and well-appearing, it is reasonable to consider withholding empiric treatment if urine analysis (UA) is mildly positive or equivocal e.g.: leukocyte esterase (LE0 only, low WBC count) while awaiting culture results. Conversely, if the history is very consistent with UTI and positive UA, start treatment empirically.
Positive leukocyte esterase: very sensitive, but less specific for true infection (false positives are common)
Note: if no WBC on microscopy, more likely to be a false positive
Positive nitrite: high specificity for UTI, but lower sensitivity i.e. positive nitrite means likely UTI, but negative nitrite does not rule out UTICan also see positive nitrite in contaminated specimen if left at room temperature for too long
• Positive blood and protein: not specific for UTI
• Microscopy:>10 WBC/mm3 is suggestive of UTIManagement
– A single isolated UTI (in girls) may be managed expectantly.
– > 2 UTI’s (or 1 in males) in a 6 month period should prompt further testing.
– Voiding cystourethrograms show the greatest anatomical detail and is the ideal first line test in males; isotope cystography has a lower radiation dose and is the first line test in girls.
– USS should also be performed.
– Renal cortical scintigraphy should be performed when renal scarring is suspected. -
This question is part of the following fields:
- Generic Surgical Topics
- Paediatric Surgery
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Question 26
Correct
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An 18-year-old male is admitted with a three-month history of intermittent pain in the right iliac fossa. He suffers from episodic diarrhoea and has lost two kilograms of weight. On examination, he is febrile and has right iliac fossa tenderness.What is the most likely diagnosis?
Your Answer: Inflammatory bowel disease
Explanation:A history of weight loss and intermittent diarrhoea makes inflammatory bowel disease (IBD) the most likely diagnosis. Conditions such as appendicitis and infections have a much shorter history. Although Meckel’s diverticulum can bleed and cause inflammation, it seldom causes marked weight loss. Irritable bowel syndrome (IBS) presents with alternating episodes of constipation and diarrhoea along with abdominal pain, bloating, and gas.
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This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 27
Incorrect
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When inserting a chest drain anteriorly into the second intercostal space, one must identify the second costal cartilage by palpating which landmark?
Your Answer: Sternoclavicular joint
Correct Answer: Sternal angle
Explanation:The sternal angle is the site for identification of the second rib as the second rib is attached to the sternum at this point.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 28
Incorrect
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Which of the following tumours is very radiosensitive?
Your Answer: Gastric carcinoma
Correct Answer: Seminoma
Explanation:Seminoma is the most radiosensitive tumour and responds well to radiation therapy after unilateral orchidectomy. The ipsilateral inguinal areas are routinely not treated however, depending on the stage, the mediastinum and the left supraclavicular regions may also be irradiated.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 29
Correct
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A 33 year old woman presents with a complaint of dysphagia. She has a ten year history of treatment refractory anaemia secondary to menorrhagia. Which of the following is the most likely underlying cause?
Your Answer: Plummer Vinson syndrome
Explanation:Iron deficiency anaemia (IDA) is the most common form of anaemia worldwide and can be due to inadequate intake, decreased absorption (e.g., atrophic gastritis, inflammatory bowel disease), increased demand (e.g., during pregnancy), or increased loss (e.g., gastrointestinal bleeding, menorrhagia) of iron. Prolonged deficiency depletes the iron stores in the body, resulting in decreased erythropoiesis and anaemia.
Symptoms are nonspecific and include fatigue, pallor, lethargy, hair loss, brittle nails, and pica. Diagnostic lab values include low haemoglobin, microcytic, hypochromic red blood cells on peripheral smear, and low ferritin and iron levels. Once diagnosed, the underlying cause should be determined. Patients at risk for underlying gastrointestinal malignancy should also undergo a colonoscopy.
Iron deficiency anaemia is treated with oral (most common) or parenteral iron supplementation. Severe anaemia or those with concomitant cardiac conditions may also require blood transfusions. The underlying cause of IDA should also be corrected. IDA may manifest as Plummer-Vinson syndrome (PVS): triad of postcricoid dysphagia, upper oesophageal webs, and iron deficiency anaemia -
This question is part of the following fields:
- Generic Surgical Topics
- Upper Gastrointestinal Surgery
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Question 30
Correct
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A 3-year-old boy is brought to the A&E department following a trauma. He is haemodynamically unstable. Initial attempts at intravenous access are proving unsuccessful.What should be the best course of action?
Your Answer: Insert an intraosseous infusion system
Explanation:Gaining venous access in small children is challenging most of the times especially in cases of trauma. Therefore, intraosseous infusions should be preferred in this setting. Broviac lines are long-term IV access systems with narrow lumens and, hence, would be unsuitable.
Intraosseous access is typically undertaken at the anteromedial aspect of the proximal tibia and provides access to the marrow cavity and circulatory system. Although traditionally preferred in paediatric practice, it may be used in adults as well, and a wide range of fluids can be infused using this approach.
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This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
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SESSION STATS - PERFORMANCE PER SPECIALTY
