Mcq Salad 015

Front 1

45. Which of the following is true concerning the calot'striangle?A.It is bounded inferiorly by the cystic arteryB.The common bile duct forms the medial borderC.it contains the Mascagni's lymph nodeD.All of the abovented_pt�٭��T

Back 1

C is correctCalot's triangle is bounded medially by the common hepaticduct not the common bile duct.inferiorly by the cystic duct and superiorly bythe inferior surface of the liver. The contents include cystic artery and the Mascagni's lymphnode a.k.a Lund nodes.

Front 2

46.Causes of vitaminB12 deficiency include the following excepta.post-gastrectomyb.blind loop syndromec.diet deficient in fresh fruit and vegetablesd.post ileal resection

Back 2

C is correct

Front 3

47.Platelet count isusually abnormal ina.patients receiving warfarin therapyb.patients receiving heparin therapyc.patients with severe hepatic failured.Voon Willebrand's disease

Back 3

C is correctSevere hepatic failure causes decreased platelet countHeparin causes thrombocytopenia but rare.Under normal circumstances, theeffect is normalVWB impairs platelet adhesion not productionml>

Front 4

48.Recognised causes of thrombocytopenia:a.alcoholismb.uraemiac.infectiond.vitamin k deficiency8<&-ضT

Back 4

D is correctIt is the only odd one outAll others cause thrombocytopeniaoNor7����T

Front 5

49.Concerning Sickle cell anaemia,which of the following isfalse?A.The underlying genetic defect is a point mutation of theB-globin geneB.causes a reduced red cell life spanC.increases susceptibility to infectionD.is treated by life long folic acidE.opiods are contraindicated during sicle cell crisis

Back 5

E is correctOpiods are the analgesics of choice in yhe management ofsickle cell crisisgene

Front 6

50. A 68 year old man had left hemicolectomy done onaccount of adenocarcinoma of the sigmoid colon.A 3x3cm mass was seen in therectum at colonoscopy 6 months post op.This was histologically confirmed asadenocarcinoma.What kind of tumour is this?a.recurrent tumourb.metachronous tumourc.synchronous tumourd.satellite lesion�

Back 6

B is correctSynnchronous tumours can be defined as 2 or more tumoursdetected either pre/intra operatively or in a 6 month period postoperatively.They should be distinctly seperate by at least 4cm distance andthey should not consist of submucosal spread or a satelite lesion of eachother.Metachronous tumours can be defined as tumours diagnosed 6months after the operation for the primary lesion and located in a differentpart of the large intestine so as notrepresent a recurrence.Because the 2nd tumour is in a different part of the largebowel,it is rather metachronous and not recurrent!

Front 7

51. A 27 year old male came with complaints of Jaundice fora duration of 2 months which was insidious in onset, gradually deepening incolor, not intermittent and not associated with pain. He says his stool arelighter in colour than normal. He also had gradually distending abdomen frompast 1 month and pedal edema -10 days. He now complaints of fever from past 2days not associated with chills and rigors. He is a known chronic alcoholic butdoes not reports of any other medical illnesses.He is febrile on examination. Gall bladder or any lump isnot palpable. Abdomen is moderately distended and mildly tender.His bilirubin total is 7.5 and direct is 3.8. Bile salts andpigments are postive in urine. SAP was found to elevated more than 3 times thenormal value and mildly elevated ALT/AST . Usg Abdomen shows Ascites and chestX ray shows bilateral pleural effusion.Q.1: What is the lowest level of bilirubin to detectjaundice in the sclera?Q.2: What can be the cause of this presentation.1. Liver cirrhosis with spontaneous bacterial peritonitis2. Carcinoma of periampullary region with spontaneousbacterial peritonitis3. Acute Fulminant Viral Hepatitis4. Carcinoma Stomach with liver metastasis and peritonealseeding

Back 7

Answer: Q1.At a total serum bilirubin of 42.8 mmol/l (2.5 mg/dl) and 53.0 mmol/l (3.1 mg/dl), 58% (95% confidence interval [CI] 33-80%) and 68% (95% CI 46-85%) of examiners detected the presence of scleral icterus, respectively Answer: Q2. Carcinoma of periampullary region with spontaneous bacterial peritonitis Points in favour of Periampullary Ca Painless progressive jaundice with clay colored stoolsSAP was found to elevated more than 3 times the normal value and mildly elevated ALT/ASTHe does not report any fever at the onset of jaundice. The onset of jaundice was Insidious. History of 2 days of fever can be attributed to SBP. He is a young individual, though he is an alcoholic, but alcoholic liver disease and liver cirrhosis would take quite a long time of exposure to heavy drinking to present.Obstructive jaundice due to metastasis will be seen in advanced stages and usually jaundice will not be the first presenting symptom To confirm our diagnosis we would do a CECT of the abdomen. t

Front 8

52.What is the commonest cause of cancer death worldwide?

Back 8

I know lung ca is the commonest ca in both men and women but i think hepatocellular ca is the commonest cause of death due to cancer world wide. ���F���

Front 9

53.What is the most common benign tumour of the oesophagus?

Back 9

Leiomyoma

Front 10

54.Which of the following is not a metastatic infection?A.pyogenic liver abscess from portal pyemiaB.ostelmyelitis of the femur without traumaC.infected prosthetic heart valveD.Brain abscess secondary to a furuncle

Back 10

All of the above are examples of metastatic infection.

Front 11

55.Preservation of normothermia in surgical patients isimportant and has become one of the goals of the surgical care improvementproject (SCIP).All of the following are negative outcomes that have beendirectly associated with perioperative hypothermia except:A.CoagulopathyB.wound infectionC.Nosocomial pneumoniaD.Myocardial ischaemiaE.Delayed wound healing

Back 11

C is correct

Hypothermia causes peripheral vasoconstriction which leads to decreased subcutaneous oxygen tension and antibiotic delivery. Neutrophil activity and leucocyte chemotaxis are also impaired hence,the incidence of wound infection will be high. The enzymes feel cold to act leading to coagulopathy Hypothermia affects collagen cross linking leading to poor wound healing Patients with background coronary artery dx will have ischaemia if exposed to cold (??the vasoconstrictive effect) We are left with nosocomial pneumonia. No one has found any relationship btw nosocomial pneumonia and hypothermia

Front 12

56. Which one of the following may suggest an acute adrenalcrisis?A.Random cortisol level of 34mcg/dlB.HypothermiaC.HyperglycaemiaD.HypokalemiaE.Increase in cortisol of 5mcg/dl after stimulation withcosyntropin

Back 12

E is correct

Front 13

57.Ionizing radiation is particularly ineffective intreatment ofA.Hodgkins diseaseB.ca breastC.rectal caD.ca of uterine cervixE.cutaneous melanoma

Back 13

E is correct

Front 14

58. Which of the following is true concerning iv contrastinduced renal toxicity?A.The highest prevalence is caused by the iv contrastmaterial used for CTB.Most patients with a rise in creatinine eventually requirerenal replacement therapyC.The cause of renal injury is precipitation of iodinatedcontrast material within the tubulesD.use of contrast agents with a lower osmolarity cansignificantly reduce the risk for renal injuryE.N-Acetylcysteine has been shown to be highly effective inpreventing renal failure.

Back 14

D is correct

Front 15

59. A liver transplant candidate has worseningencephalopathy and decreased urine output.Laboratory and physiologicabnormalities that are present in patients with hepatorenal syndrome (HRS)include all of the following except:A.High urinary sodiumB.High urinary osmolalityC.azotemiaD.vasodilationE.oliguria

Back 15

B is correct Contracted intravascular volume, kidney will try to concentrate urine... O�ٗ��n

Front 16

60. Stress related hyperglycaemia is thought to be due toincreased release of all of the following exceptA.GlucocorticoidsB.Growth hormoneC.Thyroid stimulating hormone (TSH)D.GlucagonE.Epinephrine

Back 16

C is correct

Front 17

61.Which of the following breast lesions are noninvasivemalignancies?A.intradictal carcinoma of the comedo typeB.Tubular carcinoma and mucnous carcinomaC.Infilterating ductal carcomoma and lobular carcinomaD.Medullary carcinoma,including atypical medullary lesions

Back 17

A is correct o

Front 18

62. A 63 year old man had sigmoidectomy o/a of clononicca.He developed painful right leg swelling and tachycardia on the 4th post-opday.He has noprevious history of hemoptysis,DVT or PE.Vital signs T-38,PR-104,Bp-100/60.What is the probability that he has developed PE?A.50%B.19%C.2%D.4%

Back 18

A is correct

Well's criteria for predicting probability of PE: DVT symptoms -3pts Diagnosis most likely PE-3pts Tarchycardia>100 - 1.5pts >3 days of immobilization-1.5pts Thromboembolism in the past (dvt or pe)-1.5pts Hemoptysis-1pt Cancer-1pt Score>6 (50%) Score 2-6 (19%) Score <2 (2%) The man has a score of 10 hence probabilty is 50% Mnemonic to remember Well's criteria: Well's criteria for predicting probability of PE: Don't - DVT symptoms -3pts Die - Diagnosis most likely PE-3pts Tell - Tarchycardia>100 - 1.5pts The Team- >3 days of immobilization or surg.in d past 30days -1.5pts To - Thromboembolism in the past (dvt or pe)-1.5pts Calculate- cough blood(Hemoptysis)-1pt Criteria- Cancer-1pt Score>6 (50%) Score 2-6 (19%) Score <2 (2%) Don't Die.Tell The Team To Calculate Criteria😀 i

Front 19

63.A pre-menopausal woman three years after mastectomy forbreast cancer presents with pulmonary metastases.Which of the followingstatement(s) is false concerning hermanagement?A.if the patient has received adjuvant therapy,her responseis likely to be betterB.if the patient isER positive,hormonal therapy should be the first line of treatmentC.The response to chemotherapy will likely be dose dependentD.combination chemotherapy will likely work better in thispatient than a woman who is postmenopausal

Back 19

A is correct

Mets post adjuvant therapy usually exhibit some resistance ... And appearance of met despite treatment is a sign of aggressive disease, and patient rarely do better r

Front 20

64.The following are false concerning venousthrombo-embolism except:A.Fibrin degradation products are a sensitive markerB.a diagnosis of calf vein thrombosis is reasonably excludedby duplex ultrasoundC.Forced foot dorsiflexion to test for resistance and painshould be performed in a patient with suspected DVTD.Warfarin is continued for 6 weeks in cases of spontaneousDVT with no identified risk factor.E.none of the above

Back 20

E is correct

Ultrasound they said is not good for exclusion of thrombosis below the knee.Don't know why? How we arrived at the answer: D is false, warfarin is continued for 3 months...not 6 weeks C is false because dorsiflexion shouldn't be done The stem says false 'exept'. So remaining A and B . A: sensitive test have less false negative results which is the case here since the absence of FDP , usually exclude DVT. Since it's not commonly used post surgery, I chose B....but Ultrasound they said is not good for exclusion of thrombosis below the knee Hence E is correct

Front 21

65.A 34 year old big breasted lady presented to you with a7x7cm left breast mass at the left upper outer quadrant with histologicalfeatures of malignant cystosarcoma phyllodes.She has no previous history ofbreast surgery.What treatment will you offer her?A.Wide local excision and level 2 axillary lymph nodeclearanceB.Total mastectomy with adjuvant chemotherapy C. Total mastectomy ,radiotherapy and autologous tissuereconstruction.D.Wide local excision with a margin of normal breast tissuewithout axillary lymph node dissection.

Back 21

D is correct Concern:Malignant cystosarcoma phyllodes has hematogenous spread.... No chemotherapy?????

Front 22

66.Poor prognostic indicators in acute pancreatitis includeA.an arterial oxygen partial pressure of 7kpaB.a high amylaseC.hypercalcemiaD.a blood glucose of 8mmol/l

Back 22

A is correct ҡ�W�َͶ�

Front 23

67. HaemorrhoidsA.are classified as first degree if they prolapse throughthe anusB.are a cause of melenaC.are a cause of pruritis aniD.can be felt as a boggy swelling within the anusE.reduction in dietary fibre helps ease the symptom

Back 23

C is correct L�ٗ��

Front 24

68.Hypertrophic scar is:A. Another term for keloidsB. More likely to occur on the faceC. Genetic in originD. PreventableE. Worsened with glucocorticoids

Back 24

D is correct

4 differences between keloid and hypertrophic scar please Keloid: .Genetic .Outgrows the edges .Continues to grow after 6months .Mainly trunk upper neck upper arm Hypertrophic scar: .not genetic , no familial .within the limit of the scar .anywhere in the body .Rarely grows after 6months 4 more differences please: Race: kel(more in black) hypertr(all races) Response to treatment: poor in kel , good resp to steroid in hypertrophic scar Recurrence: high in keloid, less in hypertrophic scar Pathology: keloid much more collagen and thick, immature fibroblasts hypervascular, itchy Hypertrophic scar : less fine collagen. Not vascular, no itching Sex: female >male for keloid and equal for hypertrophic scar

Front 25

69.Congenital anomalies that may present as ACUTEEmergencies in the new born include the following except:A. Diaphragmatic herniaB.Hypertrophic pyloric stenosisC. Micrognathia D. Aganglionic megacolon

Back 25

B is correct -common in infants (4wks-8wks of age) Concern: OK but how will micrognathia present as acute? Answer:May interfere with the child's breathing i guess For example ,Micrognathia or retrognathia may be accompanied by Cleft palate (usually U-shaped but sometimes V-shaped) and Glossoptosis in Pierre Robin sequence (PRS). Glossoptosis is often accompanied by airway obstruction - The tongue is not actually larger than normal, but because of the small mandible, the tongue is large for the airway and therefore causes obstruction; rarely, the tongue is smaller than norma tr���nf��

Front 26

70.Investigations of a 43-year-old woman with pluriglandularsyndrome were scheduled to determine if a gastrinoma (ZES) was present. Theserum gastrin level was slightly elevated. Further assessment to establish thediagnosis can be made by repeating the serum gastrin level after stimulationwith which of the following?(A) Phosphate(B) Potassium (C) Calcium (D) Chloride(E) Magnesium

Back 26

C is correct rger t���T���

Front 27

71. A 30-year-old woman complains of suprasternal dysphagiaonly for solids. She also has a long-standing untreated menorrhagia leading toiron deficiency anaemia. What is the most probable cause for her dysphagia ?A) Pharyngeal pouchB) Carcinoma oesophagusC) Dysphagia lusoriaD) Patterson-Kelly syndrome

Back 27

D is correct MsoNF�ٝ���

Front 28

72.A 63-year-old man has an upper gastrointestinal (UGI)study as part of his workup for abdominal pain. The only abnormal finding wasin the antrum, where the mucosa prolapsed into the duodenum. There were noabnormal findings on endoscopy. What should he do?(A) Sleep with his head elevated. (B) Be placed on an H2 antagonist.(C) Undergo surgical resection of the antrum. (D) Be observed and treated for pain accordingly. (E) Have laser treatment of the antral mucosa.

Back 28

D is correct One shouldnt do anything about it unless there are obstructive symptoms

Front 29

73.A patient is diagnosed to have a Stage T3a carcinoma ofthe prostate. Clinically, this implies ?A) Involvement of both the lobes but the disease is limitedto within the prostatic capsuleB) Involvement of both the lobes but the disease hasextended through the prostatic capsuleC) Involvement of the seminal vesiclesD) Involvement of the pelvic wall

Back 29

B is correct TNM Prostate Cancer Staging TUMORTx: primary tumor cannot be assessed T0: no evidence of a primary tumor Tis-carcinoma in situ(PIN) T1: clinically in apparent tumor neither palpable not visible by imaging T1a: incidental histology – <5% of resected tissue T1b: incidental histology – >5% of resected tissue T1c: increased PSA and subsequent identification by needle biopsy T2: tumor confined within prostate T2a: one lobe involved on truss T2b: both lobes involved on truss T3: tumor extends through capsule T3a: extracapsular extravasion T3b: tumor invades seminal vesicles T4: tumor is fixed or invades adjacent structures other than the seminal vesicles (external sphincter, rectum, bladder, lavator muscles, and/or pelvic wall NODE Nx: regional lymph nodes not assessedN0: no lymph node metastasis N1: metastasis in regional node(s)METASTASIS M0: no distant metastasis M1a: non-regional lymph node(s) M1b: bone(s) M1c: other sites with or without bone diseaseWhen more than 1 site of metastasis is present give advanced stage (M1c) is given Ok.so the summary of the T staging: T1-clinically inapparent T2-organ confined a.one side b.two sides T3-extracapsular extension a - sv b+sv T4-extension to surrounding structures

Front 30

74.The following statements regarding small boweltuberculosis are correct except ?A) There are two types: ulcerative and hyperplasticB) The strictures are common in the ulcerative typeC) In the ulcerative type, the bowel serosa is studded withtuberclesD) The ulcerative type occurs when the virulence of theorganism is greater than the host defence

Back 30

C is correct 0

Front 31

75.Which one of the following statements regarding seminomatestis is correct ?A) It is the most common type of testicular cancerB) It frequently metastasizes to the liver and bonesC) It does not respond to radiationD) Its five-year survival rates approach 50 percent

Back 31

A is correct l

Front 32

76.Obese patients have an increased risk for deep venousthrombosis for but which of the following reasons?A. Increased abdominal weight and venous stasisB.polycythemiaC. Infrequent ambulationD. Increased incidence of ischaemic heart diseaseE. Lengthy operations because of difficult exposure

Back 32

D is the answer.

Front 33

77.Use of succinylcholine should be avoided for which of thefollowing patients?A. Patients with burns to 40% of their body surface area inneed of emergency incubation 5 days aterinjuryB. Children younger than 2yearsC. Patients with burns to 40% of their body surface area inneed of emergency incubation 2 hours after injuryD. Patients arriving at the emergency room immediately aftersustaining an acute spinal cord injury (complete T4 injury)E. Patient s with end-stage renal disease and normal serumelectrolyte levels

Back 33

A is correct

Rationale: I thought of conditions that can cause hyperkalemia.Burns.If patient comes very bad 2hrs post injury,i dont have enough time to be choosy. arguement: It is actually the opposite... It s better after immediate trauma... Rather than the catabolic phase(5days later) Affirmation: That's what im saying.I will give at 2hrs post injury but if 5days post injury,i wont.I would rather spend time correcting hyperkalemia b4 i do.

Front 34

78.Which of the following statements regarding midazolam is true?A. It is ten times as potent as diazepamB. The respiratory depression caused by midazolam is usuallyminor but can be greatly exacerbated by the concomitant use of other sedativesor opioids.C. It has no active metabolites, which makes it ideal foruse in outpatients.D. Midazolam is really metabolised.E. Midazolam is a highly lipid-soluble agent that typicallycauses pain on injection.

Back 34

B is correct My facts about midazolam: 2-4 times as potent as diazepam Water soluble Mild cvs and Rs effects Used for conscious sedation during surgical and diagnostic procedures Dose:0.07-0.1mg/kg im 1hr b4 surgery Or iv 0.1-0.15mg/kg in divided doses Oral still underinvestigation ���h/��

Front 35

79.After administration of epidural anesthesia to the T3dermatome of a patient with severe lung disease who is undergoing opencholecystectomy, which of the following is least likely to occur?A. Decreased alveolar ventilationB. Increased heart rateC. Decreased venous returnD. Systemic hypotensionE. All of the above

Back 35

B is correct a

Front 36

80.Which of the following is not a trigger of visceral pain?A. IschemiaB. TractionC. DistensionD. HeatE. Inflammation

Back 36

D is correct

Visceral pain is a response to injury to the visceral peritoneum. Distension, traction, stretch, compression, torsion, ischemia, and inflammation trigger visceral pain. Abdominal organs are insensate to heat, cutting, and electrical stimulation f

Front 37

81.An 18 yr old man has a 12hour history of vague ,periumbilical abdominal pain, anorexia, and non bisous vomiting. The pain hasnow localised to the right lower quadrant. On examination he is found to havetenderness over the McBurney point along with involuntary muscle rigidity.Which of the following best explain the localisation of pain?A. Inflammation of the visceral peritoneum produceslocalising pain.B. Pain over the McBurney point is caused by distension ofappendiceal lumen.C. Unmyelinated fibers carry pain signals with the thoracicand lumbar spinal nerves.D. Movement of the inflamed Parietal peritoneum induces reboud tenderness.E. The somatic fibers course through spinal nerve root L3-5

Back 37

look for the answer

Front 38

82.Mr Ndolu is an alcoholic for 5 years. He has beenreferred to see you on account of two episodes of haematemesis. In the initialassessment of this patient:A. A history of darkstools makes the diagnosis certain.B. If on clinical examination there are distended veins onthe anterior abdominal wall then this is a case of bleeding gastric varies.C. The age of mr ndolu may contribute to an accuratediagnosis D. A history of NSAIDS abuse may be significant

Back 38

D is correct n

Front 39

83.The following list of differential diagnosis may beconsidered for Mr Ndolu :A. Bleeding gastritis B. Carcinoma of the stomach C. Angiodisplasia of stomachD. Dieulafoy lesionE. Curling ulcer

Back 39

E is correct

The only odd one out

Front 40

84. In investigating Mr Ndolu the following methods may beconsidered:A. An upper GI seriesB. Fiber optic endoscopy C. Flexible endoscopy D. Histology of duodenal biopsiesE. Barium meal performed by an experienced radiologist

Back 40

A is correct The only odd one out

Front 41

85. One hour after prolonged TURP, a 70yr old man with mildcoronary artery disease, cirrhosis, and hypertension experiences bradycardia,hypertension, confusion, nausea, and headache. Finding on preoperativelaboratory tests were normal, and his home medications included lactulose,atenolol, and alendronate. Over the last few hours he was given a 2liters bolusof 0.9% normal saline for hypitension. The patient is transferred to ICU, whereon examination he is found to be sluggish and slurring his voice. He isafebrile with an HR of 93bpm, BP of 140/73mmHg, and RR of 14cpm. He continuesto be confused and lethargic and does not follow commands. What is the bestexplanation for this conditionA. Hypotonic irrigating solutionB. HyperkalemiaC.isotonic saline solutionD. AtenololE. Hepatic encephalopathy

Back 41

D is correct

Front 42

86.Which of the following statements about the diagnosis ofacute calculous cholecystitis is true?A. Pain is so frequent that its absence almost precludes thediagnosis.B. Jaundice is present in a majority of patients.C. Ultrasonography is the definitive diagnostic test.D. Cholescintigraphy is contraindicated

Back 42

A is correct

Front 43

87.Match thefollowing conditions with the appropriate signsthat aid their diagnosis.a.coarctation of the aorta b.aortic stenosis c.bacteriaendocarditis d.fallots tetralogy e.atrial septal defect1.beading of the ribs oon xray 2. elevated erythrocytesedimentation rate 3.decreased carotid pulse 4.increased oxygen saturationgradient between the SVC and right ventricle 5.decreased vascularity of thelung fields on xrayA.a1 b2 c3 d4 e5B.a2 b1 c4 d5 e3C.a1 b3 c2 d5 e4D.a3 b1 c5 d4 e5E.a1 b3 c2 d4 e5

Back 43

C is correct

Tetralogy of fallot is a cyanotic congenital heart disease that is characterised by : 1.overriding aorta 2.pulmonary/infundibular stenosis 3.right ventricular hypertrophy 4.VSD Because of the right ventricular outlet obstruction (the infundibular stenosis),blood hardly flows to the lungs and that's seen on the xray as decreased vascularity of the lung fields.

Front 44

88.A 70 year old man was brought to the ER by his 30 yearold daughter in a confused state.The nursing staff had difficulties keeping himin bed.His daughter reported that he had been incontinent of urine,unable towalk properly and very forgetful in the past 2 weeks.There was no history of headache,nauseaor vomiting.No previous trauma or surgery.The most likely diagnosis will beconfirmed by a:A.cranial CT scan B.urodynamic studiesC.TRUSS biopsy of the prostateD.blood urea ,electrolytes and creatinineE.cystoscopy

Back 44

A is correct reast-|�٧���

Front 45

89.You have been called to review the patient in question88.What treatment option will you offer him.A.ventriculoperitoneal shuntB.clean intermittent urethral catheterization combined withoxybutyninC.channel transrectal urethtral resection of the prostateD.Augmentation cystoplastyE.Radical prostatectomy

Back 45

A is correct Opinions:Frontal lobe syndrome is a possibility in this patient but they dont usually have marked memory impairment.It is said that they typically lack insight and judgement but dont have marked cognitive abnormalities or memory impairment. But the index patient we are reviewing we were told has been very forgetful.Hence,frontal lobe syndrome may not be the most likely diagnosis. Electrolytes disturbances cuz its going on for at least 2 weeks, Like which electrolyte in particular? Chronic retention of urine , overflow incontinence with renal impairment I agree boss but will the electrolyte imbalance also explain the severe memory loss (very forgetful!!)? By the way which electrolyte are we thinking of here? Hyperkalemia , raised serum urea, Ureamic encephalopathy may be Final answer:A is correct What the patient has is Adam's syndrome. Characterised by : D- Dementia I- incontinence of urine G- Gait apraxia Mnemonic: Adam FORGOT the creator's instruction and ate the apple.He suddenly became INCONTINENT of urine and ran LIMPING to the wash room to hide.😄 Adam's syndrome is a normal pressure hydrocephalous in which the ICP is initially high causing expansion of the lateral ventricles putting tension on the corticospinal tract motor fibres which are descending to the lumbosacral spinal cord.This is why gait disturbance is the ezrliest symptom in these patients.The tension also involves the frontal lobe causing Dementia.Incontinence of urine is the last symptom to develop. This patient would need a CT scan to confirm ventriculomegaly and will benefit from a ventriculoperitoneal shunt to relieve the pressure.This improves the gait disturbance almost immediately. 88 A 89 A are correct The ICP which is initially high however later drops until it becomes normal hence the patient does not present with features of raised ICP like headache or vomiting.

Front 46

90.A 55 year old man was referred from a GP with 2 monthshistory of recurrent epigastric pain,postprandial vomiting and early satiety.Hehad also been having occasional passage of melena stool and had lost about 10kgof his usual weight.No palpable abdominal mass.Paraclinic labs revealed Serumalbumin=20g/l and hypochromic microcytic anemia.Endoscopic evaluation wasinconclusive because of excessive mucous secretion and bleeding hence bariummeal was done which revealed enlarged gastric folds and varying sizes ofmultiple filling defects in the body and fundus of the stomach.Histologicalfindings:foveolar cell hyperplasia,cystic gland changes and penetration of themuscularis mucosa.No evidence of malignancy found in multiple histologicalsections.Which of the following is true of the most likely diagnosisA.Aetiology is traceable to TNF-alphaB.it is associated with gastric hypersecretionC.first line therapy is proton pump inhibitorsD.it results from point mutation of the p53 tumour supressorgeneE.it is antrum sparing.

Back 46

E is correct Diagnosis is menetrier's dx pre-malignant condition of the stomach,characterized by massive gastric folds,excessive mucous production,resultant protein loss,gastric hyposecretion, antral sparing,idiopathic but thought to be caused by TGF - alpha,associated with gastric hyposecretion,first line therapy is cetuximab.

Front 47

91.The following statements are false concerning expression of Her-2 neu receptor in breast cancerexcept A.immunohistochemistry is a measure of gene amplificationB.The acronym FISH means Flouresecence immunohistochemicalstate of hybridizationC.immunohistochemistry result of 2+ is her-2 neu positiveD.FISH is a measure of receptor overexpressionE.none of the above

Back 47

E is correct immunohistochemistry is a Measure of receptor overexpression while FISH is a measure of gene amplification 2+ is equivocal and is an indication for FISH or CISH or DISH FISH=Flourescence in situ hybridization CISH=Chromogenic in situ hybridization DISH=Dual in situ hybridization

Front 48

92.A 40 year old woman presented with clinical andradiological features of T2N2M0 left breast tumour.The Ajcc staging is:A.Stage IIaB.Stage IIIaC.stage IIbD.Stage IIIc

Back 48

B is correct

An easy way to remember it is: I. T1 alone ÌIa T2 alone b T3 alone IIIa any T and N2 b T4, any N apart from N3 c.any T and N3 IV m1 anyT,any N The Venn diagram above may help if u study it closely comparing it with the simple staging described: Additional observations to note on the venn diagram are these Stage 2a can be T2 alone(i.e T2,N0,M0) or T1,N1 Stage 2b can be T3 alone (T3,N0,Mo) or T2,N1 Stage 3a can be any T (the intersect on the diagram + N2) or T3,N1 Hope I have not confused us more😄 (0.2 x size of tumour in cm) + N + G Where N= no of positive nodes G= Grade of tumour (0.2 x 2 ) +2 + 1=3.4 This goes with 85% 5 year survival rate Score greater than 2.4 but less than 2.4 93% Greater than or equal to 2.4 but less than or equal to 3.4 85% Greater than 3.4 but less than 5.4 70% Greater than 5.4 50% Clarification UICC/AJCC:Not really sure but i have always thought that the UICC and AJCC are a unified system. Full meaning of UICC:Union for international cancer control Full meaning of AJCC: American Joint Committee on Cancer s

Front 49

93.The above patient had metastatic work up which revealednormal findings globally.She subsequently had simple mastectomy ,level 2axillary lymph node dissection.Intraop findings were a 2x2cm mass,hard withirregular margins in the left upper outer quadrant of an otherwise healthylooking breast.Histology revealed grade 1 medullary carcinoma. Postoperative events were uneventful and shetolerated adjuvant chemotherapy.What is the probability of survival of thispatient?A.93%B.85%C.70%D.50%E.30%

Back 49

B is correct The Nottingham index is used to determine the prognosis of breast cancer Note:Possible question on breast ca long case: What are the prognostic factors for breast cancer? y

Front 50

94. A patient with grade V blunt liver injury is dischargedhome on hospital day 7 without operative intervention. She returns to theclinic 2 months after discharge with persistantdull continuous right upperquadrant pain. She denies any fever or chills,and all laboratory investigions, including hepatic function, are within normal limits.CT of the abdomen and pelvis is performed and reveals a localised homogenousfluid collection directly adjacent to the liver. What is the correct diagnosisant treatment?A. Hemobilia; angiography with embolizationB. Biloma; CT- or USD-guided percutaneous drainageC. Biloma; exploratory lap with external drainageD. Hepatic necrosis; CT- or USD-guided percutaneous drainageE. Hepatic necrosis; exploré lap with wide debridement anddrainage

Back 50

B is correct