-
Question 1
Correct
-
A 50 year-old man, who sustained a head injury experienced sudden onset of horizontal double vision. He is diagnosed with lateral rectus palsy. Which of the following nerves is affected in this condition?
Your Answer: Abducent
Explanation:The lateral rectus muscle is one of the 6 extra-ocular muscles that control eye movements. It is responsible for abduction and is the only muscle that is innervated by the abducens nerve (CN VI).
-
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 2
Correct
-
Which of the following is found to be elevated in a case of hepatocellular carcinoma?
Your Answer: AFP
Explanation:Alpha-fetoprotein (AFP) is a glycoprotein that is normally produced by the yolk sac of the embryo, and then the fetal liver. It is elevated in the new-born and thus, also in the pregnant women. Eventually, it decreases in the first year of life to reach the adult normal value of < 20 ng/ml by 1 year of age. Markedly elevated levels (>500 ng/ml) in a high-risk patient is considered diagnostic for primary hepatocellular carcinoma (HCC). Moreover, due to smaller tumours secreting less quantities of AFP, rising levels can be a better indication. However, not all hepatocellular carcinomas produce AFP. Also, the level of AFP is not a prognostic factor. Populations where hepatitis B and HCC are common (e.g.: sub-Saharan Africans, ethnic Chinese) can see AFP levels as high as 100,000 ng/ml, whereas levels are low (about 3000 ng/ml) in regions with lesser incidences of HCC.
AFP can also be elevated up to 500 ng/ml in conditions like embryonic teratocarcinomas, hepatoblastomas, fulminant hepatitis, hepatic metastases from gastrointestinal tract cancers, some cholangiocarcinomas). Lesser values are seen in acute and chronic hepatitis.
Overall, the sensitivity of AFP value ≥20 ng/ml is 39-64% and the specificity is 76%–91%. Value of 500 ng/ml is considered as the diagnostic cut-off level for HCC. -
This question is part of the following fields:
- Basic Sciences
- Pathology
-
-
Question 3
Correct
-
Which type of contractions are responsible for the propulsion of chyme along the small intestine?
Your Answer: Segmentation
Explanation:Two major types of intestinal contractions are segmentation and peristalsis:
Segmentation occurs most frequently and primarily involves circular muscle. It is essentially a contraction of 2- or 3-cm long intestinal segments while the muscle on either side of it relaxes. Chyme in the segment is displaced in both orad and aborad directions. As the contracted segment relaxes, the previously relaxed segments on either side may contract. This efficiently mixes the chyme with the digestive secretions and exposes the mucosal absorptive surface to the luminal contents. It also serves a propulsive function and contributes to the aborad movement of chyme.
Peristalsis is a propulsive wave of contraction that is initiated by intestinal distension. It is short lived and travels only a few centimetres before dying out. The combined effects of intestinal peristalsis and segmentation provide for both adequate mixing of the intestinal contents and slow, steady movement of chyme. -
This question is part of the following fields:
- Basic Sciences
- Physiology
-
-
Question 4
Correct
-
Which of the following foramina provides a passage through which the vestibulocochlear nerve, passes?
Your Answer: Internal acoustic meatus
Explanation:The internal auditory meatus is a canal within the petrous part of the temporal bone of the skull between the posterior cranial fossa and the inner ear. It provides a passage through which the vestibulocochlear nerve, the facial nerve, and the labyrinthine artery (an internal auditory branch of the basilar artery) can pass from inside the skull to structures of the inner ear and face.
-
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 5
Correct
-
A 70-year old man who is suspected to have a perforated colonic diverticulum is explored in theatre through a midline incision. This incision will be through the:
Your Answer: Linea alba
Explanation:The linea alba is the point where this incision was made. It is a tendinous raphe in the midline of the abdomen extending between the xiphoid process and the symphysis pubis. It is placed between the medial borders of the recti and is formed by the blending of the aponeuroses of the external and internal obliques and transversi.
The linea aspera is a vertical ridge on the posterior surface of the femur.
The arcuate line is the inferior border of the posterior rectus sheath behind the rectus abdominis muscle.
The semilunar line is the lateral margin of the rectus abdominis.
The iliopectineal line is a line on the pelvic bones formed by the arcuate line of the ilium and the pectineal line of the pubis. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 6
Incorrect
-
A 36 year old opera singer is admitted for a right thyroid lobectomy. Post operatively, he is unable to sing high notes. Which muscle is likely to demonstrate impaired function?
Your Answer: Thyroarytenoid
Correct Answer: Cricothyroid
Explanation:Thyroidectomy has been reported as the most frequent cause of external branch of superior laryngeal nerve (EBSLN) injury.
Diagnosis of EBSLN injury may be difficult because the symptoms are nonspecific in many cases. However, advanced diagnostic techniques have revealed the incidence to be relatively high, ranging from 5 to 28%. Paralysis of the EBSLN causes difficulty with high pitch phonation and decreased pitch range secondary to failure of cricothyroid muscle stimulation and lack of tension in the vocal cord. This symptom may be extremely serious for professional voice users. EBSLN injury can also cause vocal fatigue, hoarseness, breathy sounding voice, and vocal nodules. -
This question is part of the following fields:
- Generic Surgical Topics
- Head And Neck Surgery
-
-
Question 7
Correct
-
A 32 year old presents with symptoms of an anal fistula. The clinician examines him in the lithotomy position and the external opening of the fistula is identified in the 7 o'clock position. At which of the following locations is the internal opening most likely to be found?
Your Answer: 6 o'clock
Explanation:Goodsall’s rule can be used to clinically predict the course of an anorectal fistula tract. Imagine a line that bisects the anus in the coronal plane (transverse anal line). Any fistula that originates anterior to the line will course anteriorly in a direct route. Fistulae that originate posterior to the line will have a curved path. An exception to the rule are anterior fistulas lying more than 3 cm from the anus, which may open into the anterior midline of the anal canal.
-
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
-
-
Question 8
Correct
-
A 41 year old lawyer presents with diarrhoea and bleeding from the rectum which has been occurring for the past 16 days. She has also noticed that she has had incontinence at night. What is her most likely diagnosis?
Your Answer: Inflammatory bowel disease
Explanation:Answer: Inflammatory bowel disease
Inflammatory bowel disease (IBD) is an idiopathic disease caused by a dysregulated immune response to host intestinal microflora. The two major types of inflammatory bowel disease are ulcerative colitis (UC), which is limited to the colonic mucosa, and Crohn disease (CD), which can affect any segment of the gastrointestinal tract from the mouth to the anus, involves skip lesions, and is transmural. There is a genetic predisposition for IBD, and patients with this condition are more prone to the development of malignancy.
Generally, the manifestations of IBD depend on the area of the intestinal tract involved. The symptoms, however, are not specific for this disease. They are as follows:
Abdominal cramping
Irregular bowel habits, passage of mucus without blood or pus
Weight loss
Fever, sweats
Malaise, fatigue
Arthralgias
Growth retardation and delayed or failed sexual maturation in children
Extraintestinal manifestations (10-20%): Arthritis, uveitis, or liver disease
Grossly bloody stools, occasionally with tenesmus: Typical of UC, less common in CD
Perianal disease (e.g., fistulas, abscesses): Fifty percent of patients with CD
The World Gastroenterology Organization (WGO) indicates the following symptoms may be associated with inflammatory damage in the digestive tract [1] :
Diarrhoea: mucus or blood may be present in the stool; can occur at night; incontinence may occur
Constipation: this may be the primary symptom in ulcerative colitis, when the disease is limited to the rectum; obstipation may occur and may proceed to bowel obstruction
Bowel movement abnormalities: pain or rectal bleeding may be present, as well as severe urgency and tenesmus
Abdominal cramping and pain: commonly present in the right lower quadrant in Crohn disease; occur peri umbilically or in the left lower quadrant in moderate to severe ulcerative colitis
Nausea and vomiting: occurs more often in Crohn disease than in ulcerative colitis
The nocturnal diarrhoea and incontinence are important symptoms in diagnosis IBD.
-
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
-
-
Question 9
Correct
-
An infant, 5 weeks and 6 days old born with a large sub-aortic ventricular septal defect, is prepared for pulmonary artery banding through a left thoracotomy (the child is not fit for a surgical closure). The surgeon initially passes his index finger immediately behind two great arteries in the pericardial sac to mobilise the great arteries in order to pass the tape around the pulmonary artery. Into which space is the surgeon's finger inserted?
Your Answer: Transverse pericardial sinus
Explanation:Cardiac notch: is an indentation on the left lung of the heart.
Coronary sinus: a venous sinus on the surface of the heart (the posterior aspect) that receives blood from the smaller veins that drain the heart.
Coronary sulcus: a groove on the heart between the atria and ventricles.
Transverse pericardial sinus: located behind the aorta and pulmonary trunk and anterior to the superior vena cava.
Oblique pericardial sinus: located behind the left atrium. Accessed from the inferior side (or the apex) of the heart upwards.
Horizontal pericardial sinus: this is a made-up term. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 10
Correct
-
A 49-year-old woman with acute renal failure has a total plasma [Ca2+] = 2. 5 mmol/l and a glomerular filtration rate of 160 l/day. What is the estimated daily filtered load of calcium?
Your Answer: 240 mmol/day
Explanation:Calcium is the most abundant mineral in the human body. The average adult body contains in total approximately 1 kg of calcium of which 99% is in the skeleton in the form of calcium phosphate salts. The extracellular fluid (ECF) contains approximately 22 mmol, of which about 9 mmol is in the plasma. About 40% of total plasma Ca2+ is bound to proteins and not filtered at the glomerular basement membrane. Therefore, the estimated daily filtered load is 1.5 mmol/l × 160 l/day = 240 mmol/day. The exact amount of free versus total Ca2+ depends on the blood pH: free Ca2+ increases during acidosis and decreases during alkalosis.
-
This question is part of the following fields:
- Basic Sciences
- Physiology
-
-
Question 11
Correct
-
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: 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
-
-
Question 12
Incorrect
-
A young man was thrown from a vehicle in a collision. He landed on his head and shoulder tip, stretching the left side of his neck. A neurological examination revealed that the fifth and sixth cervical nerves had been torn from the spinal cord. What is the most obvious clinical manifestation of this?
Your Answer: Flexion
Correct Answer: Abduction
Explanation:In the case of injuries to the upper roots of the brachial plexus there is complete loss of abduction. The muscle performing this movement is the supraspinatus. This initiates the movement, followed by the deltoid muscle, which allows for complete abduction. Both these muscles are innervated by nerves originating from C5 and C6. The injury to these roots results in a condition named Erb-Duchenne’s palsy.
-
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 13
Incorrect
-
A 35 year old woman presents to her family physician complaining of perianal discomfort. She is diagnosed with pruritis ani. Which of the following would not be associated with this condition?
Your Answer: Anal fissure
Correct Answer: Tuberculosis
Explanation:Tuberculosis is least likely to be associated with this condition. Anal pruritus affects up to 5% of the population. It is often persistent and the constant urge to scratch the area can cause great distress. Although usually caused by a combination of irritants, particularly faecal soiling and dietary factors, it can be a symptom of serious dermatosis, skin or generalised malignancy or systemic illness.
-
This question is part of the following fields:
- Colorectal Surgery
- Generic Surgical Topics
-
-
Question 14
Correct
-
Where is the mental foramen located?
Your Answer: In the mandible
Explanation:The mental foramen is found bilaterally on the anterior surface of the mandible adjacent to the second premolar tooth. The mental nerve and terminal branches of the inferior alveolar nerve and mental artery leave the mandibular canal through it.
-
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 15
Correct
-
Which statement is correct regarding secretions from the adrenal glands?
Your Answer: Aldosterone is producd by the zona glomerulosa
Explanation:The secretions of the adrenal glands by zone are:
Zona glomerulosa – aldosterone
Zona fasciculata – cortisol and testosterone
Zona reticularis – oestradiol and progesterone
Adrenal medulia – adrenaline, noradrenaline and dopamine. -
This question is part of the following fields:
- Basic Sciences
- Physiology
-
-
Question 16
Correct
-
The tensor villi palatini muscle is a broad thin, ribbon-like muscle in the head that tenses the soft palate. Which of the following structures is associated with the tensor villi palatini muscle?
Your Answer: The hamulus of the medial pterygoid plate
Explanation:The pterygoid hamulus is a hook-like process at the lower extremity of the medial pterygoid plate of the sphenoid bone around which the tendon of the tensor veli palatini passes.
-
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 17
Correct
-
A 42 year old man slips while walking down the stairs and injures his ankle. He is rushed to the doctor's office and on examination, he has tenderness over the lateral and medial malleolus. X-rays demonstrate an undisplaced fracture of the distal fibula at the level of the syndesmosis and a congruent ankle mortise. What is the best course of management?
Your Answer: Application of below knee plaster cast
Explanation:Fractures of the distal tibia and fibula may result in loss of stability of the ankle joint. They may present as a fracture only, fracture and ligamentous injury, multiple fractures or a fracture dislocation.
Isolated fibular fractures at the level of the syndesmosis (Weber B) without associated medial injury should be placed in a short leg backslab (ankle at plantargrade) and remain NWB (non-weight bearing).
With medial malleolus fractures care should be taken to rule out any other fracture or injury around the ankle. The entire length of the fibula should be palpated and x-rayed to rule out any Maisonneuve type injuries. Any other fracture, ligament injury or talar shift indicate the fracture is likely to be unstable and should be reviewed by orthopaedics.
If medial malleolar injury is truly isolated then a short leg backslab (below knee plaster cast) should be applied and the patient is to remain NWB until orthopaedic review.
-
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
-
-
Question 18
Correct
-
Which of the following structures lying posterior to the ovary are at risk of injury in excision of a malignant tumour in the right ovary?
Your Answer: Ureter
Explanation:The ovaries are two nodular structures situated one on either side of the uterus in relation to the lateral wall of the pelvis and attached to the back of the broad ligament of the uterus, lying posteroinferiorly to the fallopian tubes. Each ovary has a lateral and medial surface. The ureter is at greater risk of iatrogenic injury at this location.
-
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 19
Incorrect
-
A patient under went repair of a lingual artery aneurysm in the floor of the mouth. During surgical dissection from the inside of the mouth which muscle would you have to pass through to reach the main portion of the lingual artery?
Your Answer: Mylohyoid
Correct Answer: Hyoglossus
Explanation:The lingual artery first runs obliquely upward and medialward to the greater horns of the hyoid bone. It then curves downward and forward, forming a loop which is crossed by the hypoglossal nerve, and passing beneath the digastric muscle and stylohyoid muscle it runs horizontally forward, beneath the hyoglossus, and finally, ascending almost perpendicularly to the tongue, turns forward on its lower surface as far as the tip, to become the deep lingual artery.
-
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 20
Correct
-
A victim of road traffic accident presented to the emergency department with a blood pressure of 120/90 mm Hg, with a drop in systolic pressure to 100 mm Hg on inhalation. This is known as:
Your Answer: Pulsus paradoxus
Explanation:Weakening of pulse with inhalation and strengthening with exhalation is known as pulsus paradoxus. This represents an exaggeration of the normal variation of the pulse in relation to respiration. It indicates conditions such as cardiac tamponade and lung disease. The paradox refers to the auscultation of extra cardiac beats on inspiration, as compared to the pulse. Due to a decrease in blood pressure, the radial pulse becomes impalpable along with an increase in jugular venous pressure height (Kussmaul sign). Normal systolic blood pressure variation (with respiration) is considered to be >10 mmHg. It is >100 mmHg in Pulsus paradoxus. It is also predictive of the severity of cardiac tamponade.
-
This question is part of the following fields:
- Basic Sciences
- Physiology
-
-
Question 21
Incorrect
-
A 45-year old male patient with a long history of alcoholism developed liver cirrhosis that has led to portal hypertension. Which of the following plexuses of veins is most likely dilated in this patient?
Your Answer:
Correct Answer: Haemorrhoidal plexus
Explanation:The haemorrhoidal plexus or also known as the rectal plexus is a venous plexus that surrounds the rectum. This venous plexus in males communicates anteriorly with the vesical plexus and uterovaginal plexus in females. This venous plexus forms a site of free communication between the portal and systemic venous systems. In the case of portal hypertension this plexus would most likely dilate due to the increased pressure.
-
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 22
Incorrect
-
Which of the following statements is true of Colles’ fracture?
Your Answer:
Correct Answer: Is a cause of carpal tunnel syndrome
Explanation:Colles’ fracture is a distal fracture of the radius that is a known cause of carpal tunnel syndrome (compression of the median nerve in the carpal tunnel). It rarely results in ulnar nerve compression. A Colles’ fracture is extra-articular and does not extend into the wrist joint, otherwise this would make it an intra-articular fracture (Barton’s fracture). The distal fragment in a Colles’ fracture is displaced dorsally, unlike in a Smith’s fracture where the distal fragment is displaced volarly (ventrally). Associated fracture of the ulnar styloid process may occur and is a common associated injury.
-
This question is part of the following fields:
- Basic Sciences
- Pathology
-
-
Question 23
Incorrect
-
Selective destruction of which of the following cells will affect antibody synthesis?
Your Answer:
Correct Answer: Plasma cells
Explanation:Plasma cell are memory cells. After the antigen Is engulfed by the B cells it is presented to the CD4+ helper cells via the MCH II receptor and this leads to their activation which in turn stimulates the B cells to form antibodies against that specific antigen. Some B cells differentiate into plasma cells also called memory cells that get activated after subsequent infection.
-
This question is part of the following fields:
- Basic Sciences
- Physiology
-
-
Question 24
Incorrect
-
An explorative laparotomy is done on a 23 year old following a gunshot abdominal injury through the right iliac fossa. It is found that the ileocolic artery is severed and the bullet had perforated the caecum. From which branch does the ileocolic artery originate?
Your Answer:
Correct Answer: Superior mesenteric artery
Explanation:Ileocolic artery branches off from the superior mesenteric artery. It then divides to give a superior and inferior branch.
-
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 25
Incorrect
-
During thymectomy the surgeon accidentally nicks a vein that lies just posterior to the thymus. Which of the following vessels is likely to be injured?
Your Answer:
Correct Answer: Left brachiocephalic vein
Explanation:The thymus is located superficially in the anterior mediastinum. The left brachiocephalic vein courses through the mediastinum to join the right brachiocephalic vein and form the superior vena cava on the right side of the thorax. The left brachiocephalic vein, being superficial, courses just deep to the thymus so that it may be susceptible to compression by an adjacent tumour. The left pulmonary vein, left bronchial vein and right pulmonary artery are deep, and enter and exit the lung at its root, thus are not near the thymus. The right superior intercostal vein drains the 2nd to the 4th intercostal spaces and drains into the arch of the azygos vein. It is not, therefore, closely related with the thymus.
-
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 26
Incorrect
-
A 50-year-old female undergoes an ERCP for jaundice. 36 hours following the procedure she develops a fever and rigours. A blood culture is taken, which of the following organisms is most likely to be cultured?
Your Answer:
Correct Answer: Escherichia coli
Explanation:One of the most serious post-ERCP complications is cholangitis leading to subsequent septicaemia. Enteric bacteria enter the biliary tree by the hematogenous route or following endoscopic or radiologic manipulation. Improperly disinfected endoscopes and accessories may also introduce infection into the biliary tree. The most common organisms responsible for infection after ERCP are the Enterobacteriaceae (especially Escherichia coli and Klebsiella species), alpha-haemolytic streptococci, Pseudomonas aeruginosa, Enterococcus, and Staphylococcus epidermidis. In most patients with acute cholangitis, a single organism is isolated from blood cultures.
Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. It is also referred to as Charcot’s Triad. Cholangitis was first described by Charcot as a serious and life-threatening illness; however, it is now recognized that the severity can range from mild to life-threatening.
Risk factors for post-ERCP infection include the use of combined percutaneous and endoscopic procedures, stent placement in malignant strictures, the presence of jaundice, low case volume, and incomplete or failed biliary drainage. Patients who are immunocompromised are more likely to experience an infectious complication.
Prevention and/or reduction of the risk of post-ERCP infectious complications can be achieved by judicious use of preprocedural antibiotics and intraprocedural steps, such as minimizing or avoiding contrast injection in patients with known biliary obstruction or cholangitis, endoscopic decompression, including the placement of a biliary stent when complete drainage cannot be achieved, and prompt percutaneous drainage if endoscopic drainage is not possible or incomplete. Prophylactic preprocedural antibiotics should be given to patients with jaundice and suspected mechanical obstruction. In addition, patients with sclerosing cholangitis, pancreatic pseudocysts, and those who are immunocompromised should also receive preprocedural antibiotics
-
This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
-
-
Question 27
Incorrect
-
The third branch of the maxillary artery lies in which fossa?
Your Answer:
Correct Answer: Pterygopalatine fossa
Explanation:The maxillary artery supplies deep structures of the face. It branches from the external carotid artery just deep to the neck of the mandible. It is divided into three portions:
– The first or mandibular portion (or bony portion) passes horizontally forward, between the neck of the mandible and the sphenomandibular ligament.
– The second or pterygoid portion (or muscular portion) runs obliquely forward and upward under cover of the ramus of the mandible, on the surface of the lateral pterygoid muscle; it then passes between the two heads of origin of this muscle and enters the fossa.
– The third portion lies in the pterygopalatine fossa in relation to the pterygopalatine ganglion. This is considered the terminal branch of the maxillary artery. Branches from the third portion includes: the sphenopalatine artery, descending palatine artery, infraorbital artery, posterior superior alveolar artery, artery of pterygoid canal, pharyngeal artery, middle superior alveolar artery and anterior superior alveolar artery. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
-
-
Question 28
Incorrect
-
A 32-year-old man presents with aching pain and discomfort in his right testicle. He has generally been feeling unwell for the past 48 hours as well. On examination, tenderness of the right testicle and an exaggerated cremasteric reflex has been found. What should be the appropriate course of action?
Your Answer:
Correct Answer: Administration of antibiotics
Explanation:This is likely a case of epididymo-orchitis which usually occurs due to infection with gonorrhoea or chlamydia in this age group (<35 years). Epididymo-orchitis is an acute inflammation of the epididymis and often involves the testis. It is usually caused by bacterial infection which spreads from the urethra or bladder. Amiodarone is a recognised non-infective cause of epididymitis, which resolves on stopping the drug. On examination, tenderness is usually confined to the epididymis, which may facilitate differentiating it from torsion where pain usually affects the entire testis.
-
This question is part of the following fields:
- Generic Surgical Topics
- Urology
-
-
Question 29
Incorrect
-
A 40-year old gentleman, who is a known with ulcerative colitis, complains of recent-onset of itching and fatigue. On examination, his serum alkaline phosphatase level was found to be high. Barium radiography of the biliary tract showed a 'beaded' appearance. What is the likely diagnosis?
Your Answer:
Correct Answer: Sclerosing cholangitis
Explanation:Primary sclerosing cholangitis is characterised by patchy inflammation, fibrosis and strictures in intra- and extra-hepatic bile ducts. It is a chronic cholestatic condition with 80% patients having associated inflammatory bowel disease (likely to be ulcerative colitis). Symptoms include pruritus and fatigue. ERCP (endoscopic retrograde cholangiopancreatography) or MRCP (magnetic resonance cholangiopancreatography) are diagnostic. Disease can lead to complete obliteration of ducts, which can result in liver failure. Cholangiocarcinoma is also a recognised complication..
-
This question is part of the following fields:
- Basic Sciences
- Pathology
-
-
Question 30
Incorrect
-
A 54-year-old male presents with central chest pain and vomiting. He has drunk a bottle of vodka. On examination, there is some mild crepitus in the epigastric region. What is the likely diagnosis?
Your Answer:
Correct Answer: Oesophageal perforation
Explanation:Boerhaave syndrome classically presents as the Mackler triad of chest pain, vomiting, and subcutaneous emphysema due to oesophageal rupture, although these symptoms are not always present.
The classic clinical presentation of Boerhaave syndrome usually consists of repeated episodes of retching and vomiting, typically in a middle-aged man with recent excessive dietary and alcohol intake.
These repeated episodes of retching and vomiting are followed by a sudden onset of severe chest pain in the lower thorax and the upper abdomen. The pain may radiate to the back or to the left shoulder. Swallowing often aggravates the pain.
Typically, hematemesis is not seen after oesophageal rupture, which helps to distinguish it from the more common Mallory-Weiss tear.
Swallowing may precipitate coughing because of the communication between the oesophagus and the pleural cavity. -
This question is part of the following fields:
- Emergency Medicine And Management Of Trauma
- Principles Of Surgery-in-General
-
SESSION STATS - PERFORMANCE PER SPECIALTY
