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Question 1
Incorrect
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Diuretics that act on the ascending limb of the loop of Henle produce:
Your Answer: Reduced passive transport of chloride
Correct Answer: Reduced active transport of sodium
Explanation:The loop of Henlé leads from the proximal convoluted tubule to the distal convoluted tubule. Its primary function uses a counter current multiplier mechanism in the medulla to reabsorb water and ions from the urine. It can be divided into four parts:
1. Descending limb of loop of Henl̩ Рlow permeability to ions and urea, while being highly permeable to water 2. Thin ascending limb of loop of Henl̩ Рnot permeable to water, but it is permeable to ions
3. Medullary thick ascending limb of loop of Henlé – sodium (Na+), potassium (K+) and chloride (Cl–) ions are reabsorbed by active transport. K+ is passively transported along its concentration gradient through a K+ channel in the basolateral aspect of the cells, back into the lumen of the ascending limb.
4. The cortical thick ascending limb – the site of action where loop diuretics such as furosemide block the K+/Na+/2Cl− co-transporters = reduced active transport. -
This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 2
Incorrect
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A 32 year old man has had a total pancreatectomy done. He has severe necrotizing pancreatitis that is unresponsive to conservative therapy. Which statement regarding the physiological effects of a total pancreatectomy on this patient is false?
Your Answer: The patient is at a higher risk of developing iron deficient anaemia
Correct Answer: Loss of fat emulsification will result in the malabsorption of vitamins A, C, D, and K
Explanation:Answer: Loss of fat emulsification will result in the malabsorption of vitamins A, C, D, and K
Vitamins are classified as either fat soluble (vitamins A, D, E and K) or water soluble (vitamins B and C). This difference between the two groups is very important. It determines how each vitamin acts within the body. The fat soluble vitamins are soluble in lipids (fats). These vitamins are usually absorbed in fat globules (called chylomicrons) that travel through the lymphatic system of the small intestines and into the general blood circulation within the body. These fat soluble vitamins, especially vitamins A and E, are then stored in body tissues.
Vitamin C is a water soluble vitamin which makes the statement false.
Primary pancreatic maldigestion of carbohydrate, protein, and fat is caused by decreased activity of amylase, trypsin, and lipase. Pancreatic lipase is an enzyme secreted from the pancreas. As the primary lipase enzyme that hydrolyses dietary fat molecules in the human digestive system, it is one of the main digestive enzymes, converting triglyceride substrates found in ingested oils to monoglycerides and free fatty acids.
The duodenum plays a key role in absorption of vitamins and minerals, and is removed in PD resections. This, in combination with malabsorption and increased metabolic demand, results in increased risk of micronutrient deficiencies. Routine supplementation of fat soluble vitamin and trace elements are recommended following resection. -
This question is part of the following fields:
- Peri-operative Care
- Principles Of Surgery-in-General
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Question 3
Incorrect
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A 40-year old woman with portal hypertension has impaired venous drainage of the anal canal above the pectinate line. Thus, there might be an increase in blood flow downward to the systemic venous system via anastomoses with the inferior rectal vein. This is a tributary of?
Your Answer: Inferior mesenteric vein
Correct Answer: Internal pudendal vein
Explanation:The inferior rectal vein drains into the internal pudendal vein. In addition the external iliac vein is one of the two branches of the common iliac vein however the internal iliac vein and it’s tributaries (including the pudendal vein) are much more important in draining the pelvic structures.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 4
Correct
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The following organs would be expected to lie within the right lower quadrant of the abdomen, assuming that the gastrointestinal tract is rotated normally:
Your Answer: Distal jejunum, caecum, vermiform appendix
Explanation:The abdomen is divided by theoretical anatomic lines into four quadrants. The median plane follows the linea alba and extends from the xiphoid process to the pubic symphysis and splits the abdomen in half. The transumbilical plane is a horizontal line that runs at the level of the umbilicus. This forms the upper right and left quadrants and the lower right and left quadrants. Structures in the right lower quadrant include: caecum, appendix, part of the small intestine, ascending colon, the right half of the female reproductive system, right ureter. Pain in this region is most commonly associated with appendicitis.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 5
Correct
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When at rest, which of the following will be higher in a marathon runner compared to an untrained individual?
Your Answer: Cardiac stroke volume
Explanation:Cardiac muscle hypertrophy is seen in trained athletes as compared to the normal population. This hypertrophy results in higher stroke volume at rest and increased cardiac reserve (maximum cardiac output during exercise). However, the cardiac output at rest is almost the same in both trained and untrained people. This is because in trained athletes, the heart rate is slower, even up to 40-50 beats/min. There is minimal affect of athletic training on oxygen consumption and respiratory rate.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 6
Correct
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A blood sample from a patient with polycythaemia vera will show which of the following abnormalities?
Your Answer: High platelet count
Explanation:Polycythaemia is a condition that results in an increase in the total number of red blood cells (RBCs) in the blood. It can be due to a myeloproliferative syndrome, chronically low oxygen levels or rarely malignancy. In primary polycythaemia/ polycythaemia vera the increase is due to an abnormality in the bone marrow, resulting in increased RBCs, white blood cells (WBCs) and platelets. In secondary polycythaemia the increase occurs due to high levels of erythropoietin either artificially or naturally. The increase is about 6-8 million/cm3 of blood. A type of secondary polycythaemia is physiological polycythaemia where people living in high altitudes who are exposed to hypoxic conditions produce more erythropoietin as a compensatory mechanism for thin oxygen and low oxygen partial pressure.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 7
Incorrect
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Inside the palatoglossal arch is a muscle. Which nerve innervates this muscle?
Your Answer: IX
Correct Answer: X
Explanation:The palatoglossal arch contains the palatoglossal muscle which is innervated by the vagus nerve which is the tenth cranial nerve. So the correct answer is X
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 8
Correct
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A mechanic sustained a deep laceration to his right cubital fossa which resulted in him unable to move the proximal radioulnar joint of his right arm. Which muscles was affected?
Your Answer: Pronator teres
Explanation:The correct answer is the pronator teres muscle. This muscle arises from 2 heads of origin: the humerus and ulnar. Between the 2 heads is the site of entrance of median nerve to the forearm. This muscle acts on the proximal radio-ulnar joint to rotate the radius on the ulna, otherwise known as pronation. It also assists in forearm flexion if the radius is fixed.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 9
Correct
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A 6 year old boy is brought to the ER after being hit by a car. He is hemodynamically unstable with bilateral femoral shaft fractures and a suspicion of splenic rupture. Despite having thoroughly explained the risks, the parents have refused blood transfusions and any invasive measures on account of religious beliefs. What would be the most appropriate response by the physician?
Your Answer: Proceed with treatment
Explanation:In an emergency, where consent cannot be obtained, doctors should provide medical treatment that is in the patient’s best interests and is immediately necessary to save a life or avoid significant deterioration in the patient’s health. There is clearly insufficient time here to apply to a court. The GMC and common law advises that emergency life saving treatment can be given to a child irrespective of the parents views.
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This question is part of the following fields:
- Management And Legal Issues In Surgery
- Principles Of Surgery-in-General
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Question 10
Incorrect
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A terrorist running away from the police was shot in the back. The bullet hit his left lung halfway between its apex and the diaphragmatic surface. Which part of the lung was most likely to be injured?
Your Answer: Lingula
Correct Answer: Inferior lobe
Explanation:The oblique fissure of the left lung is so sharp that the posterior surface of the left lung is mostly composed of the inferior lobe so that the point halfway between the apex and the diaphragmatic surface of the lung would result in injury to the inferior lobe.
The hilum is the point on the medial surface of the lung where the structures that form the root of the lung enter and leave the lung.
The lingual on the other hand is part of the superior lobe of the left lung and it is part of the anterior and superior sides of the lung.
The middle lobe is only found on the right lung. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 11
Correct
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All the following arteries contribute to the blood supply of the hip joint except:
Your Answer: Pudendal
Explanation:The blood supply to the hip joint is from two main arteries, the medial circumflex femoral and lateral circumflex femoral arteries. These are branches of the deep artery of the thigh, which itself is a branch of the femoral artery. There is contribution of blood supply from the inferior gluteals, foveal and obturator arteries.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 12
Incorrect
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A 6 year-old boy is brought to you coughing. He is suspected to have aspirated a Lego piece which he was seen playing with. Where would you expect the piece to be?
Your Answer: Terminal bronchiole of the right lung, lower lobe
Correct Answer: Right main bronchus
Explanation:Inhaled objects are more likely to enter the right lung for several reasons. First the right bronchus is shorter, wider and more vertical than the left bronchus. Also, the carina (a ridge-like structure at the point of tracheal bifurcation) is set a little towards the left. The terminal bronchiole is a very small space and impossible for the seed to lodge here.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 13
Incorrect
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A 34-year-old woman with severe burns, presented to casualty with a blood pressure of 75/40 mmHg and pulse of 172/minute. Obviously the patient is in shock. Which type of shock is it more likely to be?
Your Answer: Septic shock
Correct Answer: Hypovolaemic shock
Explanation:Shock is a life-threatening condition that occurs when the organs and tissues of the body are not receiving a sufficient flow of blood. Lack of blood flow, oxygen and nutrients results in the inability to function properly and damage to many organs. Shock requires immediate treatment because, if left untreated the impaired tissue perfusion and cellular hypoxia can cause irreversible tissue injury, collapse, coma or even death. There are various types of physiological shock, including: cardiogenic (due to heart damage), hypovolaemic (due to low total volume of blood or plasma), neurogenic (due to nervous system damage), septic (due to infections) and anaphylactic shock (due to allergic reactions). Hypovolaemic shock can be caused by blood loss due to trauma, internal bleeding or other fluid loss due to severe burns, prolonged diarrhoea, vomiting and sweating.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 14
Incorrect
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Which cells are most commonly seen in a granulomatous lesion that suggests an underlying chronic inflammation?
Your Answer: Mast cells
Correct Answer: Lymphocytes
Explanation:Lymphocytes and monocytes are commonly and characteristically recognised in a case of chronic inflammation.
Eosinophils and neutrophils are seen with acute inflammation.
Mast cells release histamine in early inflammation.
Basophils are seen with allergies.
Plasma cells are seen with viral infection.
Platelets are not characteristic of any type of inflammation. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 15
Incorrect
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A 20 year old lady is involved in a motor vehicle accident in which her car crashes head on into a truck. She complains of severe chest pain and a chest x-ray performed as part of a trauma series shows widening of the mediastinum. Which of the following is the most likely injury that she has sustained?
Your Answer: Rupture of the aorta proximal to the left subclavian artery
Correct Answer: Rupture of the aorta distal to the left subclavian artery
Explanation:Answer: Rupture of the aorta distal to the left subclavian artery
Aortic rupture is typically the result of a blunt aortic injury in the context of rapid deceleration. After traumatic brain injury, blunt aortic rupture is the second leading cause of death following blunt trauma. Thus, this condition is commonly fatal as blood in the aorta is under great pressure and can quickly escape the vessel through a tear, resulting in rapid haemorrhagic shock, exsanguination, and death.
Traumatic aortic transection or rupture is associated with a sudden and rapid deceleration of the heart and the aorta within the thoracic cavity. Anatomically, the heart and great vessels (superior vena cava, inferior vena cava, pulmonary arteries, pulmonary veins, and aorta) are mobile within the thoracic cavity and not fixed to the chest wall, unlike the descending abdominal aorta. Injury to the aorta during a sudden deceleration commonly originates near the terminal section of the aortic arch, also known as the isthmus. This portion lies just distal to the take-off of the left subclavian artery at the intersection of the mobile and fixed portions of the aorta. -
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 16
Correct
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A 14-year old girl presented with a 2cm, mobile, cystic mass in the midline of her neck. Fine needle aspiration of the mass revealed clear fluid. This is most likely a case of:
Your Answer: Thyroglossal duct cyst
Explanation:Thyroglossal cyst is the most common congenital thyroid anomaly which is clinically significant and affects women more than men. It is a vestigial remnant of developing thyroid. Although the thyroglossal cyst can develop anywhere along the thyroglossal duct, the most common site is in the midline between the isthmus of thyroid and hyoid bone, or just above the hyoid. Thyroglossal cysts are also associated with ectopic thyroid tissue. Clinically, the cyst moves upward with protrusion of the tongue. Rarely, the persistent duct can become malignant (thyroglossal duct carcinoma) where the cancerous cells arise in the ectopic thyroid tissue that are deposited along the duct. Exposure to radiation is a predisposing factor.
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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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A 26-year-old man is playing football when he slips during a tackle. His left knee becomes painful immediately after. Several hours later, he notices that the knee has become swollen. Following a course of NSAIDs and rest, the situation improves. However, he presents to the clinic with recurrent pain. On examination, it is impossible to fully extend the knee, although the patient is able to do so when asked. What is the most likely injury?
Your Answer: Torn meniscus
Explanation:Twisting or rotational injuries to the knee in sports, followed by delayed onset of knee swelling and locking are strongly suggestive of a meniscal tear. Arthroscopic meniscectomy is the usual treatment.
Meniscal tear is one of the most common knee injuries, characterized by:
1. A popping sensation
2. Delayed swelling or stiffness of the affected knee
3. Pain, especially when twisting or rotating the knee
4. Difficulty straightening the knee fully
5. Locking of knee in place (patient may be able to unlock the knee)In older adults, degenerative changes of the knee can also contribute to a torn meniscus with little or no trauma.
A torn meniscus may lead to knee instability, inability to move the knee normally, or persistent/recurrent knee pain. There is a strong likelihood of developing osteoarthritis in the injured knee.
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This question is part of the following fields:
- Oncology
- Principles Of Surgery-in-General
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Question 18
Correct
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A 22 year old male sustains a distal radius fracture during a rugby match. Imaging shows a comminuted fracture with involvement of the articular surface. What is the most appropriate management?
Your Answer: Open reduction and internal fixation
Explanation:Fractures of the distal radius account for up to 20% of all fractures treated in the emergency department. Initial assessment includes a history of the mechanism of injury, associated injury and appropriate radiological evaluation
Most of the fractures are caused by a fall on the outstretched hand with the wrist in dorsiflexion. The form and severity of fracture of distal radius as well as the concomitant injury of disco-ligamentary structures of the wrist also depend on the position of the wrist at the moment of hitting the ground. The width of this angle influences the localization of the fracture. Pronation, supination and abduction determine the direction of the force and the compression of the carpus and different appearances of ligament injuries.
The basic principle of fracture treatment is to obtain accurate fracture reduction and then to use a method of immobilization that will maintain and hold that reduction. While the goal of treatment in fracture distal end of the radius is the restoration of normal function, the precise methods to achieve that desired outcome are controversial. Intra-articular fractures of the distal end of the radius can be difficult to treat, at times, with a traditional conservative method. A number of options for treatment are available to prevent the loss of reduction in an unstable fracture of the distal end of the radius.
One of the recent advances in the treatment of distal radius fractures is the more frequent application of open reduction and internal fixation, especially for intra-articular fractures. There are two groups of fractures for which open reduction and internal fixation is advisable.
The first group includes the two-part shear fracture (Barton fracture), which actually is a radio-carpal fracture-dislocation. Although the anatomical reduction is possible by closed means in some cases, these fractures are very unstable and difficult to control in plaster. The second group includes complex intra-articular fractures in which the articular fragments are displaced, rotated or impacted and are not amenable to reduction through limited operative exposure. -
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 19
Correct
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The likely cause of a tender and swollen breast in a lactating mother is:
Your Answer: Acute mastitis
Explanation:Acute mastitis results due to bacterial infection of the breast and results in signs of inflammation. It commonly occurs 2-3 weeks postpartum and common causative microorganisms are Staphylococcus aureus, Streptococcus species, and Escherichia coli. Complications like an abscess can be avoided by prompt treatment, which includes antibiotics and rest along with continued lactation.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 20
Correct
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A 29-year-old woman is brought to the A&E department with chest pain after being involved in a road traffic accident. Clinical examination is essentially unremarkable and she is discharged. However, she is subsequently found dead at home. What could have been the most likely underlying injury?
Your Answer: Traumatic aortic disruption
Explanation:Aortic injuries not resulting in immediate death may be due to a contained haematoma. Clinical signs are subtle, and diagnosis may not be apparent on clinical examination. Without prompt treatment, the haematoma usually bursts and the patient dies.
Traumatic aortic disruption, or aortic transection, is typically the result of a blunt aortic injury in the context of rapid deceleration. This condition is commonly fatal as blood in the aorta is under great pressure and can quickly escape the vessel through a tear, resulting in rapid haemorrhagic shock and death. A temporary haematoma may prevent the immediate death. Injury to the aorta during a sudden deceleration commonly originates near the terminal section of the aortic arch, also known as the isthmus. This portion lies just distal to the take-off of the left subclavian artery at the intersection of the mobile and fixed portions of the aorta. As many as 80% of the patients with aortic transection die at the scene before reaching a trauma centre for treatment.
A widened mediastinum may be seen on the X-ray of a person with aortic rupture. Other findings on CXR may include:
1. Deviation of trachea/oesophagus to the right
2. Depression of left main stem bronchus
3. Widened paratracheal stripe/paraspinal interfaces
4. Obliteration of space between aorta and pulmonary artery
5. Rib fracture/left haemothoraxDiagnosis can be made by angiography, usually CT aortogram.
Treatment options include repair or replacement. The patient should, ideally, undergo endovascular repair.
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This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 21
Incorrect
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Perforin are present in the granules of which cell?
Your Answer: Kupffer cell
Correct Answer: Natural killer cell
Explanation:Perforins are characteristically found In the granules of CD8+ T cells and natural killer cells. They are cytolytic proteins that insert into the target plasma membrane forming a hole and resulting in lysis. They along with granzyme B induce apoptosis in the target cell.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 22
Correct
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A 26-year-old Indian woman who is 18 weeks pregnant presented with increasing shortness of breath, chest pain, and was coughing clear sputum. On examination, she was afebrile with a blood pressure of 140/80 mmHg, heart rate of 130 bpm and saturation of 94% on 15L oxygen. Furthermore, there was a mid-diastolic murmur, bibasilar crepitations, and mild pedal oedema. Her urgent CXR was requested. Suddenly, she deteriorated and had a respiratory arrest. Her CXR showed bilateral complete whiteout of her lungs. What could be the most likely explanation?
Your Answer: Mitral valve stenosis
Explanation:Mitral valve stenosis is the most common cause of cardiac abnormality occurring in pregnant women. It is becoming less common in the UK population; however, it should be considered in women from countries where there is a higher incidence of rheumatic heart disease. Physiological changes in pregnancy may cause an otherwise asymptomatic patient to suddenly deteriorate.
Mitral stenosis causes a mid-diastolic murmur which may be difficult to auscultate unless the patient is placed in the left lateral position. These patients are at risk of atrial fibrillation (up to 40%) which can also contribute to rapid decompensation such as pulmonary oedema (hence, whiteout of lungs seen on CXR). Balloon valvuloplasty is the treatment of choice in patients with mitral valve stenosis.
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This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
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Question 23
Correct
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The nasolacrimal duct is a membranous canal. It extends from the lower part of the lacrimal sac and drains into which structure?
Your Answer: Inferior meatus
Explanation:The nasolacrimal duct carries tears from the lacrimal sac of the eye into the nasal cavity. The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. The opening of the nasolacrimal duct into the inferior nasal meatus of the nasal cavity is partially covered by a mucosal fold (valve of Hasner or plica lacrimalis). Excess tears flow through the nasolacrimal duct which drains into the inferior nasal meatus.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 24
Correct
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A 43-year-old diabetic man complains of headaches, palpitations, anxiety, abdominal pain and weakness. He is administered sodium bicarbonate used to treat:
Your Answer: Metabolic acidosis
Explanation:Sodium bicarbonate is indicated in the management of metabolic acidosis, which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis. Bicarbonate is given at 50-100 mmol at a time under scrupulous monitoring of the arterial blood gas readings. This intervention, however, has some serious complications including lactic acidosis, and in those cases, should be used with great care.
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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 53 year old woman is admitted to the hospital with a femoral shaft fracture that occurred suddenly whilst running outside. On examination, there is no neurovascular deficit distal to the fracture site. However, there is a large firm nodule in the left lobe of the thyroid, with no associated lymphadenopathy. Which of the following is the most likely underlying cause?
Your Answer: Follicular thyroid cancer
Explanation:Follicular thyroid cancer accounts for 15% of thyroid cancer and occurs more commonly in women over 50 years of age. Thyroglobulin (Tg) can be used as a tumour marker for well-differentiated follicular thyroid cancer. Follicular cells are the thyroid cells responsible for the production and secretion of thyroid hormones.
It is impossible to distinguish between follicular adenoma and carcinoma on cytological grounds. If fine needle aspiration cytology (FNAC) suggests follicular neoplasm, thyroid lobectomy should be performed to establish the histopathological diagnosis. Features for the diagnosis of follicular carcinoma are capsular invasion and vascular invasion by tumour cells. Capsular invasion should be carefully evaluated and discriminated from the capsular rupture due to FNA penetration resulting in WHAFFT (worrisome histologic alterations following FNA of thyroid).
– Follicular carcinoma tends to metastasize to lung and bone via the bloodstream.
– Papillary thyroid carcinoma commonly metastasizes to cervical lymph nodes.
– HMGA2 has been proposed as a marker to identify malignant tumours. -
This question is part of the following fields:
- Breast And Endocrine Surgery
- Generic Surgical Topics
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Question 26
Correct
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Which of the following two cerebral veins join up to form the great cerebral vein, otherwise also known as the great vein of Galen?
Your Answer: Internal cerebral veins
Explanation:The great vein of Galen or great cerebral vein, is formed by the union of the internal cerebral veins and the basal veins of Rosenthal. This vein curves upwards and backwards along the border of the splenium of the corpus callosum and eventually drains into the inferior sagittal sinus and straight sinus at its anterior extremity.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 27
Incorrect
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Leukotrienes normally function during an asthma attack and work to sustain inflammation. Which of the following enzymes would inhibit their synthesis?
Your Answer: Cyclooxygenase-2
Correct Answer: 5-lipoxygenase
Explanation:Leukotrienes are produced from arachidonic acid with the help of the enzyme 5-lipoxygenase. This takes place in the eosinophils, mast cells, neutrophils, monocytes and basophils. They are eicosanoid lipid mediators and take part in allergic and asthmatic attacks. They are both autocrine as well as paracrine signalling molecules to regulate the body’s response and include: LTA4, LTB4, LTC4, LTD4, LTE4 and LTF4.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 28
Correct
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A 30-year-old male patient is undergoing an open appendicectomy. The surgeons extend the incision medially and suddenly encounter troublesome bleeding. What should be the best course of action?
Your Answer: Ligate the bleeding vessel
Explanation:Medial extension of an appendicectomy incision carries a risk of injury to the inferior epigastric artery which can bleed briskly. It is best managed by ligation.
Bleeding is a complication encountered in all branches of surgery. The decision as to how best to manage the bleed, depends upon its site, vessel, and circumstances.
1. Superficial dermal bleeding:
This will usually cease spontaneously. If not, then direct use of a monopolar or a bipolar cautery device will usually control the situation. Scalp wounds are a notable exception and bleeding from them may be brisk. In this situation, use of a mattress suture as a wound closure method will usually address the problem.2. Superficial arterial bleeding:
If the vessel can be safely identified in superficial arterial bleeding, then the easiest method is to apply a haemostatic clip and ligate the vessel.3. Major arterial bleeding:
If the vessel can be clearly identified and is accessible, then it may be possible to apply a clip and ligate the vessel. If the vessel is located in a pool of blood, then blind application of haemostatic clips is highly dangerous and may result in collateral injury. In this situation, evacuating the clot and packing the area is often safer. The pack can then be carefully removed when the required instruments are available. Some vessels may retract and bleeding may then be controlled by dissection of surrounding structures or underrunning the bleeding point.4. Major venous bleeding:
The safest initial course of action is to apply digital pressure to the bleeding point. To control the bleeding, thereafter, the surgeon will need a working suction device. Divided veins may require ligation.5. Bleeding from raw surfaces:
This may be mixed bleeding and can be troublesome. Spray diathermy and argon plasma coagulation are both useful agents. Certain topical haemostatic agents, such as surgicel, are useful in encouraging clot formation and may be used in conjunction with, or instead of, the above agents. -
This question is part of the following fields:
- Principles Of Surgery-in-General
- Surgical Technique And Technology
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Question 29
Correct
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A 36 year old man with severe treatment refractory ulcerative colitis arrives at the clinic in a state of hypotension and tachycardia with peritonitis. Which of the following is the most appropriate treatment strategy for this patient?
Your Answer: Emergency subtotal colectomy and ileostomy
Explanation:Subtotal colectomy with ileostomy remains a safe and effective treatment for patients requiring urgent surgery for severe inflammatory bowel disease. As the patient is not hemodynamically stable, any anastomosis like ileorectal or ileoanal should not be done. The patient should be fully resuscitated and given antibiotics and thromboprophylaxis preoperatively.
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This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
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Question 30
Correct
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Cancer of the testis most likely metastases to which set of lymph nodes?
Your Answer: Aortic
Explanation:The lymphatic drainage of an organ is related to its blood supply. The lymphatic drainage of the testis drains along the testicular artery to reach the lymph nodes along the aorta.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
