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Question 1
Correct
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A 30-year-old man who is a known case of von Willebrand disease has started bleeding following the excision of a sebaceous cyst.Administration of which of the following agents is most likely to be beneficial?
Your Answer: Desmopressin
Explanation:Desmopressin is useful in managing mild to moderate episodes of bleeding in von Willebrand disease (vWD).
vWD is the most common hereditary coagulopathy resulting from the deficiency or abnormal function of von Willebrand factor (vWF). vWF promotes platelet adhesion to damaged endothelium and other platelets and is also involved in the transport and stabilization of factor VIII.
There are seven subtypes of vWD. Type 1 vWD (autosomal dominant) is the most common and accounts for 80% of the cases. Type 2 vWD (autosomal dominant or recessive) accounts for 15% of the cases. There is a significant spectrum of severity ranging from spontaneous bleeding and epistaxis through to troublesome excessive bleeding following minor procedures.
Bleeding time is mostly used as a diagnostic test for vWD. Treatment options include administration of tranexamic acid for minor cases undergoing minor procedures. More significant bleeding or procedures respond well to desmopressin (DDAVP). It is most effective in type 1 vWD, less effective in type 2 and contraindicated in type 2B. Individuals who cannot have desmopressin or in whom it is contraindicated usually receive factor VIII concentrates containing vWF.
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This question is part of the following fields:
- Post-operative Management And Critical Care
- Principles Of Surgery-in-General
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Question 2
Incorrect
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Which of the following muscles is innervated by the inferior branch of the right recurrent laryngeal nerve?
Your Answer: Cricothyroid
Correct Answer: Posterior cricoarytenoid
Explanation:The posterior cricoarytenoid muscle, which is the sole abductor of the vocal folds, receives its innervation from the inferior laryngeal nerve which is a continuation of the recurrent laryngeal nerve.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 3
Incorrect
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In multiple myeloma, which of these cell types confirms the diagnosis when found in a smear of bone marrow aspirate?
Your Answer: Giant cells
Correct Answer: Plasma cells
Explanation:A bone marrow aspiration is the diagnostic test for multiple myeloma, which is a malignant bone tumour that usually affects older adults. The smear reveals clusters of plasma cells, while X-rays tend to show circumscribed lytic lesions or diffuse demineralisation.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 4
Incorrect
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A patient is diagnosed with a tumour of the parotid gland. During surgical removal of the gland, which artery is vulnerable to injury?
Your Answer: Internal Carotid artery
Correct Answer: External carotid artery
Explanation:The external carotid artery is a major artery of the head and neck. It arises from the common carotid artery when it splits into the external and internal carotid artery. It supplies blood to the face and neck. The external carotid artery begins opposite the upper border of the thyroid cartilage and, taking a slightly curved course, passes upward and forward and then inclines backward to the space behind the neck of the mandible, where it divides into the superficial temporal and internal maxillary arteries. It rapidly diminishes in size in its course up the neck, owing to the number and large size of the branches given off from it. At its origin, this artery is more superficial and placed nearer the midline than the internal carotid and is contained within the carotid triangle. The external carotid artery is covered by the skin, superficial fascia, platysma, deep fascia and anterior margin of the sternocleidomastoid. It is crossed by the hypoglossal nerve, by the lingual, ranine, common facial and superior thyroid veins; and by the digastric and stylohyoid; higher up it passes deeply into the substance of the parotid gland, where it lies deep to the facial nerve and the junction of the temporal and internal maxillary veins. It is here that it is in danger during surgery of the parotid gland.
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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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A 17-year-old boy, who had developed shortness of breath and a loss of appetite over the last month, was referred to a haematologist because he presented with easy bruising and petechiae. His prothrombin time, platelet count, partial thromboplastin and bleeding time were all normal. Which of the following would explain the presence of the petechiae and easy bruising tendency?
Your Answer: Scurvy
Explanation:Scurvy is a condition caused by a dietary deficiency of vitamin C, also known as ascorbic acid. Humans are unable to synthesize vitamin C, therefore the quantity of it that the body needs has to come from the diet. The presence of an adequate quantity of vitamin C is required for normal collagen synthesis. In scurvy bleeding tendency is due to capillary fragility and not coagulation defects, therefore blood tests are normal.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 6
Correct
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A 5 year old boy presents with an abnormal gait. On examination, his WCC was found to be 12 and ESR was 31. Past medical history shows a recent viral illness. Which of the following is the cause of these symptoms?
Your Answer: Transient synovitis
Explanation:Transient synovitis (TS) is the most common cause of acute hip pain in children aged 3-10 years. The disease causes arthralgia and arthritis secondary to a transient inflammation of the synovium of the hip. Biopsy reveals only nonspecific inflammation and hypertrophy of the synovial membrane. Ultrasonography demonstrates an effusion that causes bulging of the anterior joint capsule. Synovial fluid has increased proteoglycans.
Unilateral hip or groin pain is the most common symptom reported; however, some patients with transient synovitis (TS) may report medial thigh or knee pain. Transient synovitis has the highest incidence rate among causes of nontraumatic hip pain in children. Guidelines for chronic hip pain have been established.Causes
No definitive cause of transient synovitis is known, although the following have been suggested:
– Patients with transient synovitis often have histories of trauma, which may be a cause or predisposing factor.
– One study found an increase in viral antibody titres in 67 of 80 patients with transient synovitis.
– Postvaccine or drug-mediated reactions and an allergic disposition have been cited as possible causes.The following studies may be indicated in transient synovitis (TS):
– CBC count: The white blood cell (WBC) count may be slightly elevated.
– Erythrocyte sedimentation rate (ESR) may be slightly elevated. One study found that the combination of an ESR greater than 20 mm/h and/or a temperature greater than 37.5°C identified 97% of individuals with septic hip. -
This question is part of the following fields:
- Generic Surgical Topics
- Orthopaedics
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Question 7
Incorrect
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A TRUE statement regarding abolition of the cephalic phase of pancreatic secretion is that it:
Your Answer: Will mainly affect HCO3 – secretion
Correct Answer: Will result after vagotomy
Explanation:Recognition and integration of the sight, smell and taste of food triggers the cephalic phase of pancreatic secretion, causing an increase in pancreatic HCO3- and enzyme secretion. The degree of enzyme secretion in this phase is about 50% of the maximal response seen with exogenous CCK and secretin. The vagus nerve regulates the secretion through the cholinergic fibres innervating the acinar cells of the pancreas, and through peptidergic nerve fibres, which innervate ductal cells.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 8
Incorrect
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Fine-needle aspiration is a type of biopsy procedure. When performing a fine-needle aspiration of the lungs, which is the most common complication of the procedure?
Your Answer: Chronic pain after the procedure
Correct Answer: Pneumothorax
Explanation:Pneumothorax is the most common complication of a fine-needle aspiration procedure. Various factors, such as lesion size, have been associated with increased risk of pneumothorax .
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 9
Correct
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A patient presented with continuous bleeding several hours after dental extraction. Which of the following findings is most often associated with clinical bleeding?
Your Answer: Factor IX deficiency
Explanation:Factor IX deficiency, also called Haemophilia B or Christmas disease, is a disorder caused by missing or defective clotting factor IX. Deficiency of the factor IX causes irregular bleeding that can happen spontaneously or after mild trauma, surgery and dental extractions.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 10
Incorrect
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An excision of a mass in the right parietal area of the head will be performed. In which layer of the scalp are the nerves and blood vessels located?
Your Answer: Pericranium
Correct Answer: Connective tissue
Explanation:The scalp is the anatomical area bordered by the face at the front, and by the neck at the sides and back. The scalp is usually described as having five layers:
1. The skin which contains numerous sebaceous glands and hair follicles.
2. The connective tissue, a dense subcutaneous layer of fat and fibrous tissue that lies beneath the skin, containing the nerves and vessels of the scalp.
3. The aponeurosis or galea aponeurotica, a tough layer of dense fibrous tissue which runs from the frontalis muscle anteriorly to the occipitalis posteriorly.
4. The loose areolar connective tissue layer provides an easy plane of separation between the upper three layers and the pericranium.
5. The pericranium is the periosteum of the skull bones and provides nutrition to the bone and the capacity for repair. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 11
Incorrect
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A football player sustained an injury to his ankle. The wound went through the skin, subcutaneous tissue and flexor retinaculum. Which other structure passing under the retinaculum may be injured?
Your Answer:
Correct Answer: Tibial nerve
Explanation:The flexor retinaculum is immediately posterior to the medial malleolus. The structures that pass under the flexor retinaculum from anterior to posterior are: tendon of the tibialis posterior, flexor digitorum longus, posterior tibial artery (and vein), tibial nerve and tendon of flexor hallucis longus. The tibial nerve is the only one which lies behind the flexor retinaculum.
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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 25 year old man is admitted with a splenic rupture despite not being involved in any trauma. Which of the following infections can cause spontaneous splenic rupture?
Your Answer:
Correct Answer: Epstein-Barr virus
Explanation:Answer: Epstein-Barr virus
The Epstein–Barr virus is one of eight known human herpesvirus types in the herpes family, and is one of the most common viruses in humans. Infection with Epstein-Barr virus (EBV) is common and usually occurs in childhood or early adulthood.
EBV is the cause of infectious mononucleosis, an illness associated with symptoms and signs like:
fever,
fatigue,
swollen tonsils,
headache, and
sweats,
sore throat,
swollen lymph nodes in the neck, and
sometimes an enlarged spleen.Although EBV can cause mononucleosis, not everyone infected with the virus will get mononucleosis. White blood cells called B cells are the primary targets of EBV infection.
Petechiae on the palate are characteristic of streptococcal pharyngitis but also can be seen in Epstein–Barr virus infection, Arcanobacterium haemolyticum pharyngitis, rubella, roseola, viral haemorrhagic fevers, thrombocytopenia, and palatal trauma.
Despite the fact that infectious mononucleosis is a self-limiting disease, it may cause serious and lethal complications. The mechanism of splenic rupture secondary to infectious mononucleosis has been controversial. It is commonly believed that it is caused by an increase in intra-abdominal pressure or contraction of the diaphragm with vigorous cough, vomiting and defecation, leading to a compression of the spleen. However, Patel et al. argue that it is primarily the result of an expanding subcapsular haematoma which subsequently tears the capsule and leads to hemoperitoneum. Traditionally, rupture of spleen is treated by splenectomy. The rationale is to prevent the chance of sudden death as an early complication of splenic rupture and the risk from blood transfusion. -
This question is part of the following fields:
- Clinical Microbiology
- Principles Of Surgery-in-General
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Question 13
Incorrect
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A 3 year old boy is awaiting surgery for a ruptured appendix and the nurse wants to give him an infusion of intravenous fluid whilst waiting for theatre. Given that his electrolytes are normal, which of the following infusion fluid would be appropriate?
Your Answer:
Correct Answer: 0.9% Saline solution
Explanation:Indications for IV fluids include:
– Resuscitation and circulatory support
– Replacing on-going fluid losses
– Maintenance fluids for children for whom oral fluids are not appropriate
– Correction of electrolyte disturbancesAccording to the NICE guidelines, if children and young people need IV fluid resuscitation, use glucose‑free crystalloids that contain sodium in the range 131–154 mmol/litre, with a bolus of 20 ml/kg over less than 10 minutes. Take into account pre‑existing conditions (for example, cardiac disease or kidney disease), as smaller fluid volumes may be needed.
All the others are contraindicated according to the guidelines as they are either made of glucose or are colloids.
Gelofusine is a 4% w/v solution of succinylated gelatine (also known as modified fluid gelatine) used as an intravenous colloid, and behaves much like blood filled with albumins.
Dextrose solution is a mixture of dextrose (glucose) and water. It is used to treat low blood sugar or water loss without electrolyte loss. Intravenous sugar solutions are in the crystalloid family of medications. They come in a number of strengths including 5%, 10%, and 50% dextrose.
0.45% saline/ 5% glucose solution also contains glucose hence it is contraindicated. -
This question is part of the following fields:
- Generic Surgical Topics
- Paediatric Surgery
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Question 14
Incorrect
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Destruction of the ventromedial nucleus of the hypothalamus will result in:
Your Answer:
Correct Answer: Loss of satiety
Explanation:The ventromedial nucleus of the hypothalamus is divided into an anterior and a superior part. The anterior part controls the female sexual drive, whereas the superior part is responsible for satiety. Destruction of the superior part of the nucleus will result in overeating, as no signal tells the body that it is satisfied.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 15
Incorrect
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Which of the following is the most likely cause of prolonged thrombin clotting time?
Your Answer:
Correct Answer: Hypofibrinogenemia
Explanation:Thrombin clotting time, also called thrombin time (TT), is test used for the investigation of possible bleeding or clotting disorders. TT reflects the conversion of fibrinogen to fibrin and it’s also very sensitive to the presence of the anticoagulant heparin. A prolonged thrombin time may indicate the presence of hypofibrinogenemia (decreased fibrinogen level ), dysfibrinogenaemia, disseminated intravascular coagulation (DIC), end stage liver disease or malnutrition.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 16
Incorrect
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If a patient takes long-term corticosteroid therapy, which of the following diseases is most likely to develop?
Your Answer:
Correct Answer: Osteoporosis
Explanation:One of the complications of long-term intake of corticosteroids is osteoporosis. Some guidelines recommend prophylactic calcium and vitamin D supplementation in patients who take more than 30 mg hydrocortisone or 7.5 mg of prednisolone daily.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 17
Incorrect
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A 35 year-old woman is undergoing thyroidectomy. The external laryngeal nerve may be injured whilst ligating this artery during the procedure due to its close relationship?
Your Answer:
Correct Answer: Superior thyroid artery
Explanation:The superior thyroid artery arises from the external carotid artery just below the level of the greater cornu of the hyoid bone and ends in the thyroid gland. This artery must be ligated at the thyroid when conducting a thyroidectomy. If the artery is severed, but not ligated, it will bleed profusely. In order to gain control of the bleeding, the surgeon may need to extend the original incision laterally to ligate the artery at its origin at the external carotid artery. The external laryngeal branch of the superior laryngeal nerve courses in close proximity to the superior thyroid artery, making it at risk for injury during surgery.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 18
Incorrect
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Which of the following statements regarding the arteries in the neck are TRUE?
Your Answer:
Correct Answer: The thyrocervical trunk typically gives rise to the inferior thyroid artery, transverse cervical artery and suprascapular artery
Explanation:The thyrocervical trunk is one of the three branches of the first part of the subclavian artery and gives numerous branches which supply viscera of the neck, the brachial plexus, neck muscles and scapular anastomoses. The vertebral arteries are major arteries of the neck. They arise as branches from the subclavian arteries and merge to form the single midline basilar artery. The carotid sinus is a dilated area at the base of the internal carotid artery just superior to the bifurcation of the internal carotid and external carotid at the level of the superior border of thyroid cartilage.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 19
Incorrect
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A 27-year-old man presents to the A&E department with a headache and odd behaviour after being hit on the side of his head by a bat. Whilst waiting for a CT scan, he becomes drowsy and unresponsive. What is the most likely underlying injury?
Your Answer:
Correct Answer: Extradural haematoma
Explanation:Extradural haematoma is the most likely cause of this patient’s symptomology. The middle meningeal artery is prone to damage when the temporal side of the head is hit.
Patients who suffer head injuries should be managed according to ATLS principles and extracranial injuries should be managed alongside cranial trauma. Inadequate cardiac output compromises the CNS perfusion, irrespective of the nature of cranial injury.
An extradural haematoma is a collection of blood in the space between the skull and the dura mater. It often results from acceleration-deceleration trauma or a blow to the side of the head. The majority of extradural haematomas occur in the temporal region where skull fractures cause a rupture of the middle meningeal artery. There is often loss of consciousness following a head injury, a brief regaining of consciousness, and then loss of consciousness again—lucid interval. Other symptoms may include headache, confusion, vomiting, and an inability to move parts of the body. Diagnosis is typically by a CT scan or MRI, and treatment is generally by urgent surgery in the form of a craniotomy or burr hole.
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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 20
Incorrect
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Following a lacerating injury along the anterior border of the trapezius muscle in the neck, a man has the point of his shoulder (scapula) sagging and he has difficulty with full abduction of his arm. Which nerve is most likely injured?
Your Answer:
Correct Answer: Accessory (cranial nerve XI)
Explanation:Injury to the accessory nerve denervates the trapezius muscle so that the person will no longer be able to raise the acromion of the shoulder. The dorsal scapular nerve supplies the rhomboids i.e. major and minor and the levator scapulae so that injury to this nerve weakens retraction of the scapula. The greater occipital nerve is responsible for sensation of the posterior scalp. The axillary nerve innervates the deltoid muscle which is responsible for abduction of the arm and the suprascapular nerve is responsible for rotating the humerus laterally. Cutaneous nerves supply the skin.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 21
Incorrect
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A 30-year-old man is admitted to the hospital with an embolus in the brachial artery. A cervical rib is suspected as being the underlying cause. From which of the following vertebral levels does the cervical rib arise?
Your Answer:
Correct Answer: C7
Explanation:A cervical rib in humans is an extra rib which arises from the C7 vertebra. Its presence is a congenital abnormality located above the normal first rib, and it consists of an anomalous fibrous band that often originates from C7 and may arc towards but rarely reaches the sternum. It is estimated to occur in 0.2% to 0.5% of the population. People may have a cervical rib on the right, left, or both sides.
Most cases of cervical ribs are not clinically relevant and do not have symptoms; cervical ribs are generally discovered incidentally. However, they vary widely in size and shape, and in rare cases, they may cause problems such as contributing to thoracic outlet syndrome due to compression of the lower trunk of the brachial plexus or subclavian artery.
Compression of the brachial plexus may be identified by weakness of the muscles near the base of the thumb. Compression of the subclavian artery is often diagnosed by finding a positive Adson’s sign on examination, where the radial pulse in the arm is lost during abduction and external rotation of the shoulder.
Treatment is most commonly undertaken when there is evidence of neurovascular compromise. A transaxillary approach is the traditional operative method for excision of the cervical rib.
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This question is part of the following fields:
- Generic Surgical Topics
- Vascular
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Question 22
Incorrect
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A 63 year old man presents with recurrent colicky abdominal pain. A CT scan demonstrates a hernia lateral to the rectus muscle at the level of the arcuate line. What type of hernia would this be classified as?
Your Answer:
Correct Answer: Spigelian
Explanation:A Spigelian hernia (or lateral ventral hernia) is a hernia through the Spigelian fascia, which is the aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally. These are generally interparietal hernias, meaning that they do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall; therefore, there is often no notable swelling.
Spigelian hernias are usually small and therefore risk of strangulation is high. Most occur on the right side. (4th–7th decade of life.) Compared to other types of hernias they are rare.
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This question is part of the following fields:
- Generic Surgical Topics
- The Abdomen
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Question 23
Incorrect
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During a clinical rotation in the ENT clinic, you observe a flexible bronchoscopy. As the scope is passed down the trachea, you see a cartilaginous structure that resembles a ship's keel and separates the right and the left main stem bronchi. This structure is the:
Your Answer:
Correct Answer: Carina
Explanation:The carina (a keel-like cartilage) is found at the bifurcation of the trachea separating the right from the left main stem bronchi. It is a little more to the left than to the right.
The cricoid cartilage is the inferior and posterior cartilage of the larynx.
The costal cartilage on the other hand elongates the ribs anteriorly and contribute to the elasticity of the thoracic cage.
The pulmonary ligament is a fold of pleura located below the root of the lung.
Tracheal rings are rings of cartilage that support the trachea.
Peritracheal fascia is a layer of connective tissue that invests the trachea from the outside and is not visible on bronchoscopy. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 24
Incorrect
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The ostium of the maxillary sinus opens into which of the following structures?
Your Answer:
Correct Answer: Middle meatus
Explanation:The maxillary sinuses usually develop symmetrically. The maxillary sinus ostium drains into the infundibulum which joins the hiatus semilunaris and drains into the middle meatus.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 25
Incorrect
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The surgical registrar is doing an exploratory laparotomy on a 35 year old lady of African descent with tuberculous of the abdomen and suspected perforation. The small bowel is matted due to adhesions and it is difficult to differentiate the ileum from the jejunum. Which of the following features is typical of the jejunum?
Your Answer:
Correct Answer: It has sparse aggregated lymph nodules
Explanation:The jejunum has a wider diameter, is thicker and more vascularized, hence of a deeper colour compared to the ileum. The valvulae conniventes (circular folds) of its mucous membranes are large and thick and its villi are larger than those in the ileum. The jejunum also has sparse aggregates of lymph nodules and most of its part occupies the umbilical and left iliac regions whilst the ileum is mostly in the umbilical, hypogastric, right iliac and pelvic regions.
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This question is part of the following fields:
- Anatomy
- Basic Sciences
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Question 26
Incorrect
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A 45-year-old female is receiving chemotherapy for the treatment of metastatic breast cancer. You are called because it has become apparent that her doxorubicin infusion has extravasated. What is the most appropriate course of action?
Your Answer:
Correct Answer: Stop the infusion and apply a cold compress to the site
Explanation:Extravasation is the process by which any liquid (fluid or drug) accidentally leaks into the surrounding tissue. In terms of cancer therapy, extravasation refers to the inadvertent infiltration of chemotherapy into the subcutaneous or subdermal tissues surrounding the intravenous or intra-arterial administration site.
Extravasated drugs are classified according to their potential for causing damage as ‘vesicant’, ‘irritant’ and ‘non-vesicant’.
Doxorubicin is one of the vesicant drugs.
Regardless of the chemotherapy drug, early initiation of treatment is considered mandatory. In this context, patient education is crucial for prompt identification of the extravasation.
Step 1: Stop the infusion and leave the needle in place
Step 2: Identify the extravasated agent
Step 3: Leave the cannula in place, gently aspirate the agent and avoid manual compression, then remove the cannula
Step 4: Use a pen to outline the extravasated area
Step 5: Start Specific measures
Step 5A: For Anthracyclines (Doxorubicin), Apply cold compressions for 20 minutes, 4 times daily for 1-2 days.
Step 5B: Using Specific Antidotes as Topical Dimethyl sulfoxide (DMSO) or Dexrazoxane -
This question is part of the following fields:
- Oncology
- Principles Of Surgery-in-General
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Question 27
Incorrect
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A 30-year-old male cuts the corner of his lip whilst shaving. Over the next few days, a large purplish lesion appears at the site which bleeds on contact. What is the most likely diagnosis?
Your Answer:
Correct Answer: Pyogenic granuloma
Explanation:Pyogenic granuloma (lobular capillary haemangioma) is a relatively common benign vascular lesion of the skin and mucosa whose exact cause is unknown
The name pyogenic granuloma is a misnomer since the condition is not associated with pus and does not represent a granuloma histologically. Pyogenic granuloma of the oral cavity is known to involve the gingiva commonly. Extragingivally, it can occur on the lips, tongue, buccal mucosa, palate, and the like. A history of trauma is common in such sites. The aetiology of the lesion is not known, though it was originally believed to be a botryomycotic infection. It is theorized that pyogenic granuloma possibly originates as a response of tissues to minor trauma and/or chronic irritation, thus opening a pathway for the invasion of nonspecific microorganisms, although microorganisms are seldom demonstrated within the lesion. Pathogenesis of pyogenic granuloma is still debatable.
Patients with pyogenic granuloma may report a painless glistening red lesion that bleeds spontaneously or after irritation. -
This question is part of the following fields:
- Generic Surgical Topics
- Skin Lesions
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Question 28
Incorrect
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A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect:
Your Answer:
Correct Answer: Regulation of circadian rhythm
Explanation:The suprachiasmatic nucleus (SCN) in the hypothalamus is responsible for controlling endogenous circadian rhythms and destruction of the SCN leads to a loss of circadian rhythm.
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This question is part of the following fields:
- Basic Sciences
- Physiology
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Question 29
Incorrect
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A 44-year old gentleman presented to the hospital in congestive cardiac failure. On further investigation, he was found to have a right-sided retroperitoneal mass. On enquiry, he gave a history of intermittent hypertensive attacks. 24-hour urine specimen revealed raised metanephrine and vanillylmandelic acid levels. What is the likely diagnosis?
Your Answer:
Correct Answer: Pheochromocytoma
Explanation:A neuroendocrine tumour of the chromaffin cells in adrenal medulla, pheochromocytoma secretes excessive catecholamines – adrenaline (epinephrine) and noradrenaline (norepinephrine). Pheochromocytomas are also known as the ‘10% tumour’. This is because 10% of them are bilateral, 10% are malignant, and 10% are extra-adrenal. Extra-adrenal paragangliomas (also known as extra-adrenal pheochromocytomas) are less common than pheochromocytomas and arise in the ganglia of sympathetic nervous system. Around 25% of pheochromocytomas are familial. Symptoms are described as feeling of ‘impending doom’, and include tachycardia, hypertension, palpitations, anxiety, headaches and pallor. Orthostatic hypertension is typically seen where there is a more than 100 mmHg fall in systolic pressure when the patient stands up. Pheochromocytomas can also lead to malignant hypertension. Diagnosis is by measurement of catecholamines and metanephrines in blood or in 24-hour urine, after exclusion of other possible causes such as stress, hypoglycaemia and drugs (methyldopa, dopamine agonists, ganglion-blocking antihypertensive). Imaging is also needed to localize the tumour. Localization of the tumour can also be done by Iodine-131 meta-iodobenzylguanidine (I131-MIBG) imaging.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 30
Incorrect
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The operating surgeon notices a structure lying alongside a herniated mass whilst repairing an indirect inguinal hernia in a female patient. Which structure could this be?
Your Answer:
Correct Answer: Round ligament of the uterus
Explanation:The main structure traversing the inguinal canal in women is the round ligament. In men, it is the spermatic cord.
The iliohypogastric nerve innervates the abdominal wall and runs between the transversus abdominis and internal oblique muscles before piercing the internal oblique at the anterior superior iliac spine to run between the internal and external obliques.
The inferior epigastric artery is between the peritoneum and the transversus abdominis creating the lateral umbilical fold.
The ovarian artery and the ovarian vein are branches from the descending aorta and inferior vena cava that supply the ovary in the pelvic cavity.
The pectineal ligament is a thick fascial layer over the pectineal line of the pubis. It doesn’t traverse the canal.
The broad ligament if found on the lateral sides of the uterus. -
This question is part of the following fields:
- Anatomy
- Basic Sciences
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SESSION STATS - PERFORMANCE PER SPECIALTY
