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  • Question 1 - A 30-year-old woman undergoes a laparotomy for a perforated duodenal ulcer and broad-spectrum...

    Correct

    • A 30-year-old woman undergoes a laparotomy for a perforated duodenal ulcer and broad-spectrum antibiotics are administered. However, she develops hearing impairment postoperatively.Which of the following agents is responsible for this adverse effect?

      Your Answer: Gentamicin

      Explanation:

      Ototoxicity is a recognised adverse reaction with the aminoglycoside antibiotics.

      Gentamicin belongs to a class of drugs known as aminoglycoside antibiotics. It is a broad-spectrum antibiotic that is most affective against aerobic gram-negative rods. Gentamicin acts by inhibiting bacterial protein synthesis. This creates a pool of inactive bacterial ribosomes that can no longer re-initiate and translate new proteins.

      The hearing loss produced by gentamicin is known as gentamycin-induced ototoxicity. The antibiotic itself is not dangerous. It becomes toxic when it binds to iron in the blood and produces destructive chemical agents known as free radicals.

    • This question is part of the following fields:

      • Peri-operative Care
      • Principles Of Surgery-in-General
      4.8
      Seconds

  • Question 2 - What is the percentage of bone calcium that is freely exchangeable with the...

    Incorrect

    • What is the percentage of bone calcium that is freely exchangeable with the extracellular fluid that is available for buffering changes in the calcium ion balance?

      Your Answer: 20%

      Correct Answer: 1%

      Explanation:

      Around 1% of calcium in the body is available for buffering changes in calcium ion balance. These are mainly derived from the bone that are freely exchangeable with extracellular fluid.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      8.1
      Seconds

  • Question 3 - A 70 year old women, died suddenly. She had a history of hypertension...

    Correct

    • A 70 year old women, died suddenly. She had a history of hypertension and aortic stenosis. On autopsy her heart weighed 550g. What is the most likely cause of this pathology?

      Your Answer: Hypertrophy

      Explanation:

      Due to increased pressure on the heart as a result of hypertension and aortic stenosis, the myocardial fibres hypertrophied to adapt to the increased pressure and to effectively circulate blood around the body. Hyperplasia could not occur, as myocardial fibres are stable cells and cannot divide further.
      Fat does not deposit in the heart due to volume overload.
      Myocardial oedema is not characteristic of a myocardial injury.
      Metaplasia is a change in the type of epithelium.
      Atrophy would result in a decreased heart size and inability to function.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      8.9
      Seconds

  • Question 4 - A 46 year old woman is taken to the A&E department with a...

    Correct

    • A 46 year old woman is taken to the A&E department with a full thickness burn on her chest which is well circumscribed. Her saturation was reduced to 92% on 15L of Oxygen, blood pressure of 104/63 mmHg and HR 106 bpm. What is the best management step?

      Your Answer: Escharotomy

      Explanation:

      Answer: Escharotomy

      Escharotomy is the surgical division of the nonviable eschar, which allows the cutaneous envelope to become more compliant. Hence, the underlying tissues have an increased available volume to expand into, preventing further tissue injury or functional compromise.

      Full-thickness circumferential and near-circumferential skin burns result in the formation of a tough, inelastic mass of burnt tissue (eschar). The eschar, by virtue of this inelasticity, results in the burn-induced compartment syndrome. This is caused by the accumulation of extracellular and extravascular fluid within confined anatomic spaces of the extremities or digits. The excessive fluid causes the intracompartmental pressures to increase, resulting in collapse of the contained vascular and lymphatic structures and, hence, loss of tissue viability. The capillary closure pressure of 30 mm Hg, also measured as the compartment pressure, is accepted as that which requires intervention to prevent tissue death.

      The circumferential eschar over the torso can lead to significant compromise of chest wall excursions and can hinder ventilation. Abdominal compartment syndrome with visceral hypoperfusion is associated with severe burns of the abdomen and torso. (A literature review by Strang et al found the prevalence of abdominal compartment syndrome in severely burned patients to be 4.1-16.6%, with the mean mortality rate for this condition in these patients to be 74.8%). Similarly, airway patency and venous return may be compromised by circumferential burns involving the neck.

      Performing an escharotomy will therefore improve ventilation.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      25.4
      Seconds

  • Question 5 - Evaluation of a 60-year old gentleman, who has been a coal miner all...

    Incorrect

    • Evaluation of a 60-year old gentleman, who has been a coal miner all his life and is suspected to have pulmonary fibrosis reveals the following: FEV1 of 75% (normal > 65%), arterial oxygen saturation 92%, alveolar ventilation 6000 ml/min at a tidal volume of 600 ml and a breathing rate of 12 breaths/min. There are also pathological changes in lung compliance and residual volume. Calculate his anatomical dead space.

      Your Answer: 120 ml

      Correct Answer: 100 ml

      Explanation:

      Dead space refers to inhaled air that does not take part in gas exchange. Because of this dead space, taking deep breaths slowly is more effective for gas exchange than taking quick, shallow breaths where a large proportion is dead space. Use of a snorkel by a diver increases the dead space marginally. Anatomical dead space refers to the gas in conducting areas such as mouth and trachea, and is roughly 150 ml (2.2 ml/kg body weight). This corresponds to a third of the tidal volume (400-500 ml). It can be measured by Fowler’s method, a nitrogen wash-out technique. It is posture-dependent and increases with increase in tidal volume. Physiological dead space is equal to the anatomical dead space plus the alveolar dead space, where alveolar dead space is the area in the alveoli where no effective exchange takes place due to poor blood flow in capillaries. This physiological dead space is very small normally (< 5 ml) but can increase in lung diseases. Physiological dead space can be measured by Bohr’s method. Total ventilation per minute (minute ventilation) is given by the product of tidal volume and the breathing rate. Here, the total ventilation is 600 ml times 12 breaths/min = 7200 ml/min. The problem mentions alveolar ventilation to be 6000 ml/min. Thus, the difference between the alveolar ventilation and total ventilation is 7200 – 6000 ml/min = 1200 ml/min, or 100 ml per breath at 12 breaths per min. This 100 ml is the dead space volume.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      91.9
      Seconds

  • Question 6 - A 50-year-old man presents with bright red rectal bleeding that occurs post defecation...

    Correct

    • A 50-year-old man presents with bright red rectal bleeding that occurs post defecation and is noted on the toilet paper. It is also associated with severe pain. On external anal examination, a skin tag is identified at 6 o'clock position.Which of the following treatment options is most likely to be helpful?

      Your Answer: Topical GTN

      Explanation:

      Since the most likely diagnosis is anal fissure, the correct treatment is topical nitrates.

      Anal fissures are a common cause of painful, bright red rectal bleeding. Most fissures are idiopathic and present as a painful mucocutaneous defect in the posterior midline (90% cases). Fissures are more likely to be anteriorly located in females, particularly if they are multiparous. Diseases associated with fissure-in-ano include:
      1. Crohn’s disease
      2. Tuberculosis
      3. Internal rectal prolapse

      Diagnostic options are as follows:
      In most cases, the defect can be visualised as a posterior midline epithelial defect. Where symptoms are highly suggestive of the condition and examination findings are unclear, an examination under anaesthesia may be helpful. Atypical disease presentation should be investigated by colonoscopy and EUA, with biopsies of the area.

      For management of anal fissure:
      1. Stool softeners are important as hard stools may tear the epithelium and result in recurrent symptoms. The most effective first-line agents are topically applied GTN (0.2%) or Diltiazem (2%) paste.
      2. Resistant cases may benefit from injection of botulinum toxin or lateral internal sphincterotomy. Advancement flaps may be used to treat resistant cases.

    • This question is part of the following fields:

      • Colorectal Surgery
      • Generic Surgical Topics
      14.5
      Seconds

  • Question 7 - Two boys were playing when one of them brought the forearm of the...

    Correct

    • Two boys were playing when one of them brought the forearm of the other behind his back. This resulted in a stretching of the lateral rotator of the arm. Which of the following muscles was most likely to have been involved?

      Your Answer: Infraspinatus

      Explanation:

      There are two lateral rotators of the arm, the infraspinatus and the teres minor muscles. The infraspinatus muscle receives nerve supply from C5 and C6 via the suprascapular nerve, whilst the teres minor is supplied by C5 via the axillary nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      21.2
      Seconds

  • Question 8 - During an inguinal hernia repair, an incision is made parallel to and 5cm...

    Incorrect

    • During an inguinal hernia repair, an incision is made parallel to and 5cm above the inguinal ligament. The registrar is warned to look out for the inferior epigastric vessels to avoid damage. Between which layers of the abdominal wall is the registrar likely to find these vessels?

      Your Answer: Transversalis fascia and peritoneum

      Correct Answer: Transversus abdominis muscle and peritoneum

      Explanation:

      The inferior epigastric vessels lie on the inner surface of the transversus abdominis muscle covered by the parietal peritoneum. This layer of peritoneum lies over the inferior epigastric vessels to make the lateral umbilical fold. Camper’s and Scarpa’s fascia are two layers of the superficial fascia, the fatty layer and the membranous layer respectively.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      33.6
      Seconds

  • Question 9 - A 56 year old man, on his 8th day following a left hemicolectomy,...

    Incorrect

    • A 56 year old man, on his 8th day following a left hemicolectomy, complains of swinging pyrexia over the past 48 hours. Clinical examination is significant for an ileus. Which of the following investigations would be the most appropriate?

      Your Answer: Erect chest x-ray

      Correct Answer: Abdominal CT scan with IV contrast

      Explanation:

      Abdominal CT with IV contrast would be carried out in this case and this presentation has most likely resulted due to an anastomotic leak with abscess formation which is a common complication following surgery. This can occur in any of the branches and anticipating the likely complication and appropriate avoidance will minimize their occurrence. Detailed imaging is required to allow accurate diagnosis and further planning.

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Surgical Technique And Technology
      93.2
      Seconds

  • Question 10 - A victim of assault in a domestic violence is stabbed in the left...

    Incorrect

    • A victim of assault in a domestic violence is stabbed in the left chest. The tip of the pen knife entered the pleural space just above the cardiac notch. Luckily the lung was spared as it would only occupy this space during deep inspiration. Which of these structures was pierced by the knife?

      Your Answer:

      Correct Answer: Costomediastinal recess

      Explanation:

      The costomediastinal recess is located immediately next to the cardiac notch. The medial aspect of the superior lobe of the left lung, when fully inflated expands to this place. The lung wouldn’t enter the anterior or the posterior mediastinum which are found between the two pleural cavities.
      The costodiaphragmatic recess is the lowest extent of the pleural cavity where the inferior lobes of the lungs would expand into in deep inhalation.
      The cupola, is the part of the pleural cavity that extends above the first rib into the root of the neck. The superior most part of the superior lobe of the lung might extend into this part.
      Pulmonary ligament: pleural fold that is located below the root of the lung where the visceral pleura and the mediastinal pleura are in continuity.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 11 - A 27-year-old woman, who had been taking a combined oral contraceptive for 6...

    Incorrect

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

      Your Answer:

      Correct Answer: Duplex scan

      Explanation:

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

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 12 - A 38-year old woman presents to the clinic with a 2 cm eczema-like...

    Incorrect

    • A 38-year old woman presents to the clinic with a 2 cm eczema-like lesion on the areolar region of her left breast, for 5 months. Biopsy of the lesion showed large cells at the dermal-epidermal junction with positive staining for mucin. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Paget’s disease of the breast

      Explanation:

      Paget’s disease of the breast or nipple resembles eczema in appearance with an underlying carcinoma typically. The disease is usually unilateral and presents with inflammation, oozing and crusting along with a non-healing ulcer. Treatment is often delayed due to the innocuous appearance but can be fatal. It results due to spread of neoplastic cells from the ducts of the mammary gland to the epithelium.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 13 - A 30 year old gym coach presented to the surgical out patient clinic...

    Incorrect

    • A 30 year old gym coach presented to the surgical out patient clinic with a lump in the inguinal region. He was booked for surgery, during which, the surgeon opened the inguinal region and found a hernial sac with a small segment of intestine projecting through the abdominal wall. It was located just above the inguinal ligament and lateral to the inferior epigastric vessels. What type of hernia was this?

      Your Answer:

      Correct Answer: An indirect inguinal hernia

      Explanation:

      An indirect inguinal hernia exits the abdominal cavity lateral to the inferior epigastric vessels and enters the inguinal canal through the deep inguinal ring. These are the most common types of hernias often caused by heavy weigh lifting. Direct inguinal hernias exit the abdominal cavity medial to the inferior epigastric vessels through weak fascia.
      Congenital inguinal hernias are indirect hernias that occur due to persistence of the processus vaginalis.
      Femoral hernias occur when abdominal viscera push through the femoral ring in the femoral canal.
      Incisional hernia occurs after surgery when the omentum or organ protrudes through a previous site of incision.
      Obturator hernia are a very rare type of hernia where the pelvic or abdominal contents protrude through the obturator foramen.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 14 - When the pitch of a sound increases, what is the physiological response seen...

    Incorrect

    • When the pitch of a sound increases, what is the physiological response seen in the listener?

      Your Answer:

      Correct Answer: The location of maximal basilar membrane displacement moves toward the base of the cochlea

      Explanation:

      An increase in the frequency of sound waves results in a change in the position of maximal displacement of the basilar membrane in the cochlea. Low pitch sound produces maximal displacement towards the cochlear apex and greatest activation of hair cells there. With an increasing pitch, the site of greatest displacement moves towards the cochlear base. However, increased amplitude of displacement, increase in the number of activated hair cells, increased frequency of discharge of units in the auditory nerve and increase in the range of frequencies to which such units respond, are all seen in increases in the intensity or a sound stimulus.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 15 - Which of the given options best describes the metabolic changes which occur following...

    Incorrect

    • Which of the given options best describes the metabolic changes which occur following a severe soft tissue injury sustained after a PVA?

      Your Answer:

      Correct Answer: Mobilisation of fat stores

      Explanation:

      The following metabolic responses occur following trauma as part of a coping mechanism for the additional stress. These include acid base changes (metabolic acidosis or alkalosis), decrease urine output and osmolality, reduced basal metabolic rate (BMR), gluconeogenesis with amino acid breakdown and shunting, hyponatraemia as a result of impaired functioning of sodium pumps, hypoxic injury, coagulopathies, decreased immunity, increase extracellular fluid and hypovolemic shock, increase permeability leading to oedema, break down and mobilization of fat reserves, pyrexia and reduced circulating levels of albumin.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 16 - Renal function is an indication of the state of the kidney, measured by glomerular...

    Incorrect

    • Renal function is an indication of the state of the kidney, measured by glomerular filtration rate (GFR). In a healthy person, GFR would be greatly increased by: 

      Your Answer:

      Correct Answer: Substantial increases in renal blood flow

      Explanation:

      An increase in the rate of renal blood flow (RBF) greatly increases the glomerular filtration rate (GFR). The more plasma available (from increased RBF), the more filtrate is formed. Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. Central to the physiologic maintenance of GFR is the differential basal tone of the afferent and efferent arterioles.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 17 - The mandibular nerve, which is the largest of the 3 divisions of the...

    Incorrect

    • The mandibular nerve, which is the largest of the 3 divisions of the trigeminal nerve, exits the cranial cavity through which foramen?

      Your Answer:

      Correct Answer: Foramen ovale

      Explanation:

      At the base of the skull the foramen ovale is one of the larger of the several holes that transmit nerves through the skull. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery, lesser petrosal nerve, a branch of the glossopharyngeal nerve, emissary vein connecting the cavernous sinus with the pterygoid plexus of veins and occasionally the anterior trunk of the middle meningeal vein.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 18 - A victim of mob justice was brought to the A & E with...

    Incorrect

    • A victim of mob justice was brought to the A & E with a stab wound in the anterior chest 2 cm lateral to the left sternal border. He underwent an emergency thoracotomy that revealed clots in the pericardium, with a puncture wound in the right ventricle. To evacuate the clots from the pericardial cavity the surgeon slipped his hand behind the heart at its apex. He extended his finger upwards until its tip was stopped by a line of pericardial reflection which forms the:

      Your Answer:

      Correct Answer: Oblique pericardial sinus

      Explanation:

      Transverse sinus: part of pericardial cavity that is behind the aorta and pulmonary trunk and in front of the superior vena cava separating the outflow vessels from the inflow vessels.
      Oblique pericardial sinus: is behind the left atrium where the visceral pericardium reflects onto the pulmonary veins and the inferior vena cava. Sliding a finger under the heart will take you to this space.
      Cardiac notch: indentation of the ‘of the heart’ on the superior lobe of the left lung.
      Hilar reflection: the reflection of the pleura onto the root of the lung to continue as mediastinal pleura.
      Costomediastinal recess: part of the pleural sac where the costal pleura transitions to become the mediastinal pleura.
      Sulcus terminalis: a groove between the right atrium and the vena cava

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

  • Question 19 - Which of the following is a true statement regarding secretion of gastric acid?...

    Incorrect

    • Which of the following is a true statement regarding secretion of gastric acid?

      Your Answer:

      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.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
      Seconds

  • Question 20 - A 3 year old boy is taken to the doctor by his mother...

    Incorrect

    • A 3 year old boy is taken to the doctor by his mother who has noticed that he has been having rectal bleeding for a few months and a cherry red lesion appeared at the anal verge after defecation. Which of the following is most likely the diagnosis?

      Your Answer:

      Correct Answer: Juvenile polyp

      Explanation:

      Juvenile polyps are benign hamartomas with neoplastic potential that are the most frequent gastrointestinal polyp of childhood, with the peak incidence between 3 and 5 years of age.. The presence of multiple juvenile polyps may indicate a premalignant condition commonly named juvenile polyposis coli or juvenile polyposis syndrome (JPS). In contrast, single or solitary juvenile polyps generally are considered benign sporadic lesions that confer little to no future risk of malignancy. Most frequent presentation is painless rectal bleeding. Other features include a prolapsing rectal mass and abdominal pain.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Paediatric Surgery
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Peri-operative Care (1/1) 100%
Principles Of Surgery-in-General (2/3) 67%
Basic Sciences (2/5) 40%
Pathology (1/2) 50%
Emergency Medicine And Management Of Trauma (1/1) 100%
Physiology (0/1) 0%
Colorectal Surgery (1/1) 100%
Generic Surgical Topics (1/1) 100%
Anatomy (1/2) 50%
Surgical Technique And Technology (0/1) 0%
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