Tjandra Mcq Adjusted

Front 1

Without the use of prophylaxis the risk of deep calf vein
thrombosis in a patient undergoing an anterior resection
for rectal cancer is likely to be at least:

Back 1

50%

Front 2

Which of the following measures is most likely to reduce
the risk of post operative wound infection with
MRSA?

Back 2

a policy of staff handwashing between patients

Front 3

Which of the following constitute the legal standard for
the information that should be passed to a patient to
meet the requirements of ‘informed consent’?

Back 3

what a patient in that position would regard as

Front 4

The best indicator of cardiorespiratory capacity and
reserve for surgery is:

Back 4

functional exercise capacity

Front 5

The commonest reason for poor outcome after
anaesthesia is:

Back 5

inadequate pre-operative assessment and
optimisation

Front 6

Absolute contraindications to performing neuraxial
(epidural or spinal) local anaesthetic blockade include

Back 6

coagulopathy
patient refusal
systemic sepsis
local infection at insertion site

But pre-existing neuro deficit not absolutely CI

Front 7

Patients with obstructive sleep apnoea are often
undiagnosed. Clinical features of obstructive sleep
apnoea include all of the following

Back 7

a snoring during sleep
b excessive daytime somnolence
c feelings of choking during sleep
d pulmonary hypertension

But not aortic stenosis

Front 8

Airway assessment should include all of the following

Back 8

a ability to open mouth
b subluxability of the temporomandibular joint
c thyro-mental distance
d cervical spine mobility and stability

don't assess size of uvula

Front 9

A 78-year-old woman develops an arrhythmia 2 days
after a laparotomy for perforated diverticular disease.
The ECG shows a bradycardia of 30 beats/min and
spiked T waves. The only biochemical abnormalities
are a potassium level of 6.3 mmol/L (normal range
3.8–5.2) and a creatinine level of 0.2 mmol/L (normal
range 0.05–0.12). Her monitored vital signs (including
ECG) are normal. What should be your first course of
action?

Back 9

give an intravenous infusion of 20 mL of calcium
gluconate

Front 10

A 40-year-old man is confused and restless the second
day after upper abdominal surgery and repair of a hiatus
hernia. The most probable cause of his condition is:

Back 10

pulmonary atalectasis

Front 11

You are asked to see a patient in your ward, 7 days
following a left hemicolectomy. The patient has a
discharging wound. The discharge oozes freely between
the sutures and is profuse, watery and blood-stained.
There are no signs of inflammation. What is the most
likely diagnosis:

Back 11

dehiscence of the wound

Front 12

You have been asked to see a 68-year-old woman
who has developed abdominal distension 5 days
after a total hip replacement. Her abdomen is
distended but soft. There is no localised tenderness,
and rectal examination is unremarkable. A few
scattered bowel sounds can be heard. The plain
abdominal film shows gas all the way to the
rectum and a dilated caecum and ascending colon. The
radiological diameter of the caecum measures 14 cm.
What will you do as immediate management of this
patient?

Back 12

arrange for decompression by colonoscopy

Front 13

A previously fit 55-year-old man has undergone an
emergency right hemicolectomy for a perforated caecal
carcinoma. Two days after the operation you note the
following on his fluid balance sheet – intravenous input
2 L, nasogastric aspirate 2 L, drain losses 700 mL, urine
output 500 mL. Biochemistry shows [Na+] 135 mmol/L,
[K+] 3.0 mmol/L, [Cl−] 100 mmol/L, [HCO−
3 ] 27
mmol/L. Which of the fluid balance regimens below
would you order for the next 24-hour period?

Back 13

3 L N saline + 2 L dextrose 5% + 100 meq KCl

Front 14

Universal precautions:

Back 14

impose a physical barrier between patients and carers

Front 15

Endoscopic surgery:

Back 15

enables cholecystectomy to be performed as day case
surgery in some patients

Front 16

Sutures:

Back 16

made of catgut lose tensile strength within 3 weeks

Front 17

Surgical drains:

Back 17

are removed when they are no longer necessary

Front 18

Nutritional markers include the following

Back 18

skin fold thickness
mid-arm muscle circumference
serum albumin
skin recall antigens

Front 19

The requirement for intravenous nutrition per day is:

Back 19

50 kcal/kg body weight

Front 20

Marasmus is characterised by the following
characteristics

Back 20

inadequate intake of an otherwise balanced diet
cachexia in the adult
decreased metabolic rate
easy correction with standard nutrition

Front 21

Treatment of critically ill patients in an intensive care unit:

Back 21

is associated with a 15% death rate overall

Front 22

Infection in critical illness is often found where

Back 22

often found in the lungs or abdomen

Front 23

The systemic inflammatory response syndrome:

Back 23

consists of at least two from a list of four categories of
physiological and haematological abnormality

Front 24

Intravenous fluid resuscitation of hypotensive,
hypovolaemic critically ill patients should be:

Back 24

rapid and complete using crystalloids or colloids or
both

Front 25

Commonly applied critical care organ support involves

Back 25

mechanical ventilation for hypercarbia
haemodiafiltration for uraemia
platelet transfusion for thrombocytopaenia
inotropic infusions for low cardiac output states

Front 26

The best prophylaxis against infection in dirty wounds is
achieved by:

Back 26

removing foreign bodies and devitalised tissues

Front 27

Opportunistic infections caused by Candida albicans and
fungi are associated with:

Back 27

cancer
diabetes
the administration of cytotoxic drugs
the use of immunosuppressant drugs after cardiac
transplantation

Front 28

What is not an example of metastatic
infection?

Back 28

colo-vesical fistula due to diverticular disease of the
colon

These are all metastatic infections:
b liver abscess after portal pyaemia
c infection in a prosthetic heart valve
d brain abscess secondary to a furuncle
e staphylococcal osteomyelitis in the absence of trauma

Front 29

Appendisectomy wounds are classified as being:

Back 29

clean-contaminated

Front 30

The concept of Universal Precautions is based on:

Back 30

the need to regard all patients as being potentially
infectious

Front 31

Immunosuppression:

Back 31

has the side effects of increased risk of infection and
malignancy

Front 32

Organ donation:

Back 32

requires that brain stem death criteria are fulfilled

Front 33

Kidney transplantation:

Back 33

has a 5-year kidney survival rate of approximately
75–85%

Front 34

Liver transplantation:

Back 34

can be life saving in cases of fulminant hepatic failure

Front 35

Pancreas transplantation:

Back 35

can be undertaken using the whole pancreas or just
the islets of Langerhan

Front 36

Ionising radiation is particularly effective in treatment
of

Back 36

a Hodgkins disease
b Carcinoma of the breast
c Cancer of the rectum
d Cancer of the uterine cervix

It is not effective for
e Cutaneous melanoma

Front 37

Screening for malignant disease is effective in the
following situations

Back 37

Where a tumour is detected at a stage where it can be
cured by treatment
There is high public acceptance of the
process
Specificity of screening is high
Sensitivity of screening is high

but it is **** when done on an individual basis

Front 38

The following statements in relation to simultaneous
regional lymph node dissection at the time of primary
tumour excision are true

Back 38

a Allows more accurate tumour staging
b Allows provision of appropriate prognosis to the
patient
d Allows appropriate adjuvant treatment to be
undertaken
e May confer a survival advantage

but there is a high morbidity

Front 39

In gastro-oesophageal reflux, the following statements
are true

Back 39

a alcohol consumption and smoking are important
aggravating factors
b is often associated with disordered oesophageal
motility
d barretts oesophagus may develop
e iron deficiency anaemia may occur as a result of
chronic blood loss

Front 40

The following statements on the management of
gastro-oesophageal reflux are correct

Back 40

b a proton pump inhibitor is an effective treatment
c laryngeal spill-over is an indication for surgery
d the most appropriate operation is a laparoscopic
fundoplication
e dysphagia may complicate anti-reflux surgery

Front 41

For patients suffering from oesophageal cancer, which
of the following symptoms indicates the WORST
prognosis?

Back 41

hoarseness of voice

Front 42

A 75-year-old man complains of progressive dysphagia
for 2 months. He has loss of 10 lb in weight and can only
tolerate a liquid diet. Oesophageal cancer is suspected.
Which of the following investigations is MOST likely to
detect evidence of distant metastases from his cancer?

Back 42

PET

Front 43

Out of the following, the MOST LIKELY risk factor for
the development of a squamous cell cancer of the
oesophagus is:

Back 43

history of cancer of the larynx

Front 44

The most common benign tumour of the oesophagus is:

Back 44

leiomyoma

Front 45

The diagnosis of chylous leak after oesophagectomy is
helped by:

Back 45

analysis of chylomicrons in the chest tube output
lymphangiogram
milk challenge
test for triglyceride in chest tube output

Front 46

With a perforation of a duodenal ulcer which occurred 6
h ago, what features are likely to
be present?

Back 46

a generalised abdominal tenderness and guarding

c percussion over the liver may demonstrate resonance
d the respiration is shallow and the abdominal muscles
are held rigid
e plain radiograph shows free gas under the diaphragm

Front 47

Which of the following factors is MOST likely to be
associated with a significant risk of rebleeding from a
duodenal ulcer?

Back 47

a visible vessel with adherent clot seen on endoscopy

Front 48

The treatment of choice for a perforated duodenal ulcer
in a 56-year-old man with a strong history of ulcer
disease and signs of peritonitis after 12 hours is

Back 48

omental patch repair and peritoneal lavage

Front 49

Following a gastric resection for a stage III gastric cancer
the patient asks whether any further therapy will
improve their prognosis. What is true of chemo?

Back 49

chemoradiotherapy may improve outcome

Front 50

A 67 year old man is found to have a submucosal 5 cm
tumour in the body of his stomach. The treating
physician considers that this may be a gastrointestinal
stromal tumour. How does it grow?

Back 50

it is difficult to predict how this tumour will behave

Front 51

Following gastric resection a patient is told that they
have a T2 N1 (stage II) cancer of the stomach. They ask
about 5-year survival, how many patients from 100 with
such a tumour would be alive at 5 years?

Back 51

60

Front 52

Endoscopic ultrasound is used in the staging of gastric
cancer. What is it good for in particular?

Back 52

EUS is better than CT in assessing T stage

Front 53

An 80-year-old woman presents with biliary pain and
stones are seen in the gall bladder on ultrasound. The
probability of the pain being due to a stone in the
common bile duct is approximately:

Back 53

30%

Front 54

A 73-year-old man presents with cholangitis. He has had
no previous abdominal operation. The definitive
treatment should be:

Back 54

ERCP, sphincterotomy with stone extraction and later
consideration of cholecystectomy

Front 55

Which of the following is the appropriate investigation in
a patient presenting with a recent episode of right upper
quadrant pain and a normal physical examination?

Back 55

upper abdominal ultrasound

Front 56

The following investigation should always be performed
when investigating obstructive jaundice:

Back 56

liver US

Front 57

When is bile duct injury during laparoscopic cholecystectomy is
more common:

Back 57

a in the presence of cholecystitis
b when the surgeon is inexperienced
c if the biliary anatomy is unusual
d when the operation is complicated by haemorrhage

Front 58

Cholangiocarcinoma is most commonly found:

Back 58

at the biliary confluence

Front 59

Primary sclerosing cholangitis is associated with:

Back 59

a inflammatory bowel disease
b carcinoma of the bile duct
c gallstones
d multifocal biliary strictures

it is not associated with hepatocellular carcinoma

Front 60

Primary hepato-cellular carcinoma may be caused by

Back 60

alcohol
haemochromatosis
hepatitis B virus
gallstones

not caused by steroids

Front 61

Liver metastases may be treated by

Back 61

arterial embolisation
cryotherapy
laparoscopic resection
regional chemotherapy

not treated with open lobectomy

Front 62

Regarding pyogenic liver abscess, what does therapy entail

Back 62

drainage of the abscess and appropriate antibiotic
therapy are the mainstay of management

Front 63

Regarding amoebic liver absesses, what are some facts about it

Back 63

a it is an uncommon disease in Australia and is endemic
in South and Southeast Asia
b intestinal amoebiasis, which leads to liver abscess, is
transmitted by the faeco-oral route
c amoebic serology is usually positive in these patients
d mainstay of treatment is antimicrobial therapy
e amoebic liver abscess can be drained by
percutaneous technique

Front 64

Regarding hydatid disease, what are some facts

Back 64

a the human is an end host, which breaks the
development cycle of the parasite
b initial infection occurs through the alimentary tract and
is asymptomatic
c the natural history of a hydatid cyst in the human is
one of slow progressive growth
d rupture of a hydatid cyst is not a common event
e most symptoms are related to pressure effects on the
liver and surrounding organs

Front 65

Tell me more about hydatid disease, I am intruiged

Back 65

a extremely small cysts may be managed conservatively
provided they are followed up to monitor growth
b medical management is unsuccessful in the majority of
cases
c medical therapy is usually used to supplement surgical
intervention
d the most common surgical technique is that of
evacuation of the content and de-roofing of the cyst
and the placement of an omental patch in the cavity
e prevention of spillage of the contents into the
peritoneal cavity is of critical importance

Front 66

The following are true of liver infestations:

Back 66

a the liver fluke Fasciola hepatica is acquired from sheep
and cattle and infests the biliary tree
b the flat worm Clonorchis sinensis is usually ingested
by eating raw fish
c Clonorchis sinensis infestation leads to recurrent
cholangitis and a high incidence of
cholangiocarcinoma
d biliary ascariasis is caused by the migration of the
common intestinal roundworm into the biliary
tree

Front 67

What are causes of pancreatitis?

Back 67

a gallstones
b alcohol
c mumps
d ampulla of Vater tumours

Front 68

The pancreas is protected from autodigestion by:

Back 68

secreting enzymes in an inactivated form

Front 69

Severity of acute pancreatitis is determined by:

Back 69

clinical scoring systems (Ranson/Imrie)

Front 70

Which features regarding antibiotic use in acute
pancreatitis which are important

Back 70

a antibiotic uptake by pancreatic necrotic tissue
b therapeutic level in serum
d broad-spectrum cover, including anaerobes

Front 71

Patients who suffer from chronic pancreatitis are totally
cured of their disease by:

Back 71

None of these cure chronic pancreatitis
a surgical removal of the pancreas
b endoscopic drainage of the pancreatic duct via a stent
c total abstinence from alcohol

Front 72

Gimme some facts about
pancreatic carcinoma:

Back 72

a most pancreatic cancers are incurable
b palliation can be achieved with a biliary stent
c palliation can be achieved by surgical bypass of the
tumour
d ampullary cancer has a worse prognosis than
carcinoma of the body of the pancreas

Front 73

Which of the following investigations are useful in
determining the curability of pancreatic carcinoma:

Back 73

a Ultrasound
b ERCP
d Serum markers
e Pancreatic biopsy

CT is apparently shithouse

Front 74

Regarding the portal circulation in the normal healthy
adult, where does the portal vein form?

Back 74

the portal vein is formed by the confluence of the
superior mesenteric vein and the splenic vein behind
the neck of the pancreas

Front 75

Which one of following physical signs are seen in a patient with portal hypertension?

Back 75

a caput medusae
b hepatomegaly
c ascites
d splenomegaly

would not expect to see lower limb varicose veins

Front 76

What are the main disease with portal HT leading to cirrhosis in the Aus popn?

Back 76

the main diseases leading to cirrhosis in the Australian
population are alcoholic liver disease and chronic viral
hepatitis

Front 77

How are oesophageal varices managed?

Back 77

intravenous infusion of drugs such as octreotide and
terlipressin which reduce splanchnic blood flow play an
important role in the prevention of early re-bleed of
oesophageal varices

Front 78

What play an important role
in the prevention of the first variceal bleed in patients
with portal hypertension?

Back 78

a surveillance upper gastrointestinal endoscopy
b prophylactic banding of visible varices
c the use of β-blockers
d prophylactic sclerotherapy

surgical porta-systemic shunt is not useful

Front 79

A 52-year-old man develops symptoms of small bowel
obstruction over a 24-h period. What
MOST SUGGESTS development of bowel strangulation?

Back 79

constant abdominal pain associated with abdominal
guarding

Front 80

In acute proximal small bowel obstruction:

Back 80

there is a tendency towards dehydration, with
hyponatraemia and hypokalaemic, hypochloraemic
metabolic alkalosis

Front 81

Spontaneous cholecystoenteric fistula:

Back 81

can be diagnosed by plain abdominal X-rays

Front 82

Common causes of small bowel obstruction
include:

Back 82

a post-surgical adhesions
b inguinal hernia
c incisional hernia
d small bowel tumour

Front 83

Investigations in a patient with acute small bowel
obstruction would include:

Back 83

a supine and erect abdominal radiographs
b blood urea and electrolyte estimation
c gastrografin small bowel follow-through
e computed tomography of the abdomen

Front 84

What are common causes of large bowel
obstruction:

Back 84

b sigmoid volvulus
c carcinoma of the colon
d diverticular disease
e carcinoma of the rectum

Front 85

Large bowel obstruction requires urgent treatment
because:

Back 85

there is a significant risk of colonic perforation

Front 86

Sigmoid volvulus:

Back 86

may lead to ischaemia and perforation of the colon

Front 87

Colonic pseudo-obstruction:

Back 87

is common in the elderly and debilitated

Front 88

Complete left-sided large bowel obstruction:

Back 88

will mostly require treatment by a three-staged
surgical procedure

Front 89

Three days after elective repair of an abdominal aortic
aneurysm, a 70-year-old man developed left iliac fossa
pain, abdominal distension, bloody diarrhoea and a fever
of 38◦C. The most helpful investigation would be:

Back 89

limited flexible sigmoidoscopy and biopsy

Front 90

Three days after a myocardial infarction with cardiogenic
shock, a 75-year-old man develops abdominal pain and
distension. The abdomen is slightly tender with reduced
bowel sounds. A plain abdominal X-ray shows distended
small bowel without fluid levels. Blood tests reveal a
metabolic acidosis. The most likely diagnosis is:

Back 90

mesenteric ischaemia

Front 91

Following massive small bowel resection for mesenteric
venous thrombosis, the following may develop

Back 91

a dehydration
b malnutrition
c lactose intolerance
d fat malabsorption

Front 92

Right iliac fossa pain and nausea in a 62-year-old woman
may be due to

Back 92

a acute appendicitis
b caecal cancer
c urinary tract infection
e sigmoid diverticulitis

Front 93

Tell me some stuff about sepsis associated with
appendicectomy for acute appendicitis

Back 93

a may present with a pelvic abscess
b may present as a wound infection
c is reduced by prophylactic peri-operative antibiotics
e is most often associated with anaerobic bacteria

Front 94

Tell me some **** about Meckel’s diverticulum:

Back 94

a may cause small bowel obstruction due to
intussusception
c may present with meal-related central abdominal
pain
d may present with melaena and a normal upper
gastrointestinal endoscopy
e may be diagnosed with a sodium technetium-99 m
scan in some cases

Front 95

Adenocarcinoma of the small bowel is most commonly
associated with:

Back 95

a familial adenomatous polyposis

Front 96

Carcinoid tumour of the appendix is associated with what features

Back 96

a most are asymptomatic
b tumours less than 2 cm in size require no further
therapy other than appendicectomy
d carcinoid syndrome arises when hepatic metastases
have occurred
e synchronous carcinoid tumour in the distal ileum may
be present

Front 97

What are appropriate managements for familial
adenomatous polyposis

Back 97

a restorative proctocolectomy and ileoanal pouch
anastomosis
b regular surveillance with flexible sigmoidoscopy
c enrolment in a familial adenomatous polyposis registry
d identification of presymptomatic carrier by molecular
genetic testing

Front 98

Tell me about FAP:

Back 98

a inheritance is in autosomal dominant fashion
c most affected individuals develop polyps by the age of
10 years
d desmoid tumour is an association
e all affected patients will develop colorectal carcinomas
with time

Front 99

The HNPCC syndrome:

Back 99

is linked to hereditary adenomatous polyposis

Front 100

Hamartomatous polyposis includes:

Back 100

Peutz–Jeghers syndrome

Front 101

The oncologic outcome of rectal cancer is:

Back 101

improved by pre-operative chemotherapy alone, if
pre-operative endorectal ultrasound indicates that it is
a T3 cancer

Front 102

A 72-year-old woman presents with left iliac fossa pain,
fever and abdominal distension. Abdominal X-ray reveals
two dilated loops of small bowel. The most likely
diagnosis is:

Back 102

acute diverticulitis

Front 103

Diverticular disease of the colon is associated with:

Back 103

increased intraluminal pressure within the colon

Front 104

Surgical management of perforated diverticular disease
with faecal peritonitis includes:

Back 104

Hartmann’s procedure and sigmoid end colostomy

Front 105

The complications of sigmoid diverticular disease include

Back 105

a sigmoid inflammatory phlegmon
b colonic bleeding
c purulent peritonitis
d colovaginal fistula

doesn't cause colon ca

Front 106

Extra-intestinal manifestations of ulcerative colitis include

Back 106

a pyoderma gangrenosum
b iritis
c sacroileitis
d sclerosing cholangitis

Front 107

What features may occur in both ulcerative
colitis and Crohn’s disease

Back 107

a proctitis
b erythema nodosum
c toxic megacolon
e response to mesalazine

Front 108

Gimme a fact about Crohn’s disease

Back 108

adenocarcinoma of the small bowel is a recognised
complication of Crohn’s disease

Front 109

Ulcerative colitis:

Back 109

toxic megacolon may be the initial manifestation

Front 110

Indications for restorative proctocolectomy in ulcerative
colitis include:

Back 110

a 2-cm villous adenoma in the hepatic flexure of the
colon

Front 111

Pathological findings in Crohn’s disease of the small
bowel include:

Back 111

a cobblestone appearance of the bowel arising
from fissuring of the mucosa and submucosal
oedema

Front 112

Radiation enteritis:

Back 112

may benefit from a high-fibre diet

Front 113

What treatments are appropriate for a
high-output enterocutaneous fistula

Back 113

b total parenteral nutrition
c intravenous fluid and electrolyte replacement
d sandostatin
e skin care by an enterostomal therapist

Front 114

An enterocutaneous fistula that occurs 5 days after a
small bowel resection for Crohn’s disease may be
associated with

Back 114

a anastomotic breakdown
b persistent intestinal obstruction distal to the fistula
c the presence of an inadequately drained abscess
adjacent to the anastomosis
d traumatic enterotomy during adhesion lysis, which has
been overlooked

Front 115

Surgery for complete rectal prolapse includes

Back 115

a abdominal rectopexy
b sigmoid colectomy and rectopexy
d perineal proctosigmoidectomy
e D´elorme’s procedure (mucosal sleeve resection)

Front 116

Full-thickness rectal prolapse is characterised by:

Back 116

faecal incontinence in approximately half the patients

Front 117

Complications of ileostomy include

Back 117

a ileostomy prolapse
b skin irritation around stoma site
c ileostomy retraction
d food bolus obstruction

Front 118

Tell me about stoma
management?

Back 118

a pre-operative stoma siting and counselling are
important
b further measurements for new stoma appliances are
performed approximately 4 weeks after surgery
c dietary restrictions are necessary
e the enterostomal therapist is an integral member of
the management team

Front 119

The preferred treatment of an ischiorectal abscess is:

Back 119

incision and drainage under general anaesthesia

Front 120

The aetiology of anal fistula includes:

Back 120

anal gland infection

Front 121

Painful perianal conditions include:

Back 121

perianal haematoma

Front 122

Complications of haemorrhoidectomy include

Back 122

a severe anal pain
b urinary retention
c anal stricture
e rectal bleeding

Front 123

Anal fissure is characterised by

Back 123

a severe anal pain during and immediately after
defecation
b bleeding on defecation
c a sentinel anal skin tag
d a relapsing history

Front 124

A 48-year-old woman presents with thick greenish nipple
discharge from both breasts. There is no palpable breast
lump, although both nipples are slightly retracted. The
patient does not take any medication. Mammogram and
ultrasound do not show any evidence of cancer. The
most likely diagnosis is:

Back 124

mammary duct ectasia

Front 125

A 42-year-old woman presents with a 2-cm breast lump,
detected 2 weeks ago. The lump is discrete but soft.
There is no past history of breast disease. The initial
management includes:

Back 125

bilateral mammogram with or without breast
ultrasound

Front 126

Mammography screening programmes:

Back 126

detect smaller cancers with a lower incidence of
axillary nodal metastases than in the unscreened
population

Front 127

A 39-year-old woman has a 5-cm, grade III breast
cancer. Twelve of 16 lymph nodes contain metastases.
The oestrogen receptor is negative, although the
progesterone receptor is positive. There is no evidence of
systemic metastases on chest X-ray and bone scan.
Following a total mastectomy and axillary clearance, the
MOST likely follow-up management would be:

Back 127

adjuvant chemotherapy

Front 128

Correct statement concerning ductal carcinoma in situ
(DCIS):

Back 128

it is associated with microcalcification on
mammography

Front 129

Thyroid follicular cells arise primarily from:

Back 129

the base of the tongue

Front 130

FNAC can reliably diagnose which types of thyroid cancer

Back 130

b papillary thyroid cancer
c anaplastic thyroid cancer
d medullary thyroid cancer
e metastases from renal cell cancer

it can't diagnose follicular thyroid ca

Front 131

The type of thyroid cancer with the worst prognosis
(5-year survival <1%) is:

Back 131

anaplastic thyroid cancer

Front 132

Thyroiditis presenting following a viral infection with an
exquisitely tender, enlarged, firm thyroid gland, and
with systemic symptoms of headache and malaise is
generally due to:

Back 132

de Quervain’s (subacute) thyroiditis

Front 133

Damage to one recurrent laryngeal nerve during
thyroidectomy generally leads to:

Back 133

a hoarse voice

Front 134

The parathyroid glands arise from:

Back 134

the third and fourth branchial pouches

Front 135

Parathyroid hormone (PTH) has a half-life of:

Back 135

5 minutes

Front 136

Primary hyperparathyroidism is due, in 90% of cases,
to:

Back 136

a single parathyroid adenoma

Front 137

The diagnosis of primary hyperparathyroidism is usually
confirmed by the following biochemical results:

Back 137

raised serum calcium, raised or normal PTH

Front 138

The most common cause of hypoparathyroidism is:

Back 138

surgical removal of the parathyroids at total
thyroidectomy

Front 139

Adrenal masses occur in:

Back 139

3–7% of the population

Front 140

Conn’s syndrome is due to a tumour of the adrenal
cortex secreting excess:

Back 140

aldosterone

Front 141

Paragangliomas arise from:

Back 141

parasympathetic tissue arising from the neural crest

Front 142

The initial test used to diagnose Cushing’s syndrome is
measurement of:

Back 142

serum cortisol and 24-hour urinary free cortisol
levels

Front 143

Adrenal “incidentalomas” should be removed when they
are:

Back 143

>3–5 cm

Front 144

The most common form of functioning tumour of the
pancreatic islet cells is:

Back 144

insulinoma

Front 145

The Zollinger–Ellison syndrome can be controlled by
administration of:

Back 145

omeprazole

Front 146

The islets of Langerhans contain all these types of cells

Back 146

a alpha cells
b beta cells
c gamma cells
e enterochromaffin cells

they dont contain delta cells

Front 147

The Snellen visual acuity in a patient is noted to be 6/60
in the right eye and 6/18 in the left eye. Tell me some **** about snellen acuity

Back 147

Snellen acuity compares a tested eye to a normally
seeing eye

Front 148

Which of the following is most likely to be found in a
patient with an orbital blow-out fracture?

Back 148

horizontal diplopia

Front 149

The preferred treatment for an intra-ocular infection is:

Back 149

intensive antibiotic drops

Front 150

Which modality of treatment is most useful for
nasopharyngeal carcinoma?

Back 150

radiotherapy

Front 151

tell me some stuff concerning
nasopharyngeal carcinoma

Back 151

a keratinising SCC is most common in developed
countries
c in 90% of patients, cervical nodes were involved
d there are known aetiological factors
e the tumour tends to infiltrate widely

Front 152

Tell me a little concerning parotid
gland tumours

Back 152

a a cystic lesion in the lower pole is likely to be benign
b a long-standing tumour that enlarges and becomes
painful suggests malignancy
c bilateral tumours in elderly men are usually benign
d facial nerve palsy suggests malignant disease
e needle aspiration of parotid tumor is not CI

Front 153

The commonest tumour of the head and neck area is:

Back 153

BCC of skin

Front 154

The most common paediatric soft tissue sarcoma in the
head and neck area is:

Back 154

rhabdomyosarcoma

Front 155

The highest propensity for lymph node metastasis occurs
in squamous cell carcinoma of the:

Back 155

upper lip

Front 156

The commonest type of hernia is:

Back 156

inguinal

Front 157

The most serious and urgent complication of a hernia is:

Back 157

strangulation

Front 158

Indirect inguinal hernias:

Back 158

can be treated by herniotomy, herniorraphy and
hernioplasty

Front 159

Femoral hernias:

Back 159

should always be repaired surgically

Front 160

A 70-year-old man presents with a 1-cm painless nodule
on the side of his nose. This has been present for
3 weeks. The centre of the lesion appears to contain a
plug of hard skin. What is the most likely diagnosis?

Back 160

keratoacanthoma

Front 161

A 45-year-old motor mechanic presents with a nodule on
the tip of his finger. This has been present for 12 months
and it bothers him now when he presses on that finger.
He seems to remember injuring that finger at work
several years earlier. On examination there is a 0.5-cm
nodule and the overlying skin is intact. What is the most
likely diagnosis?

Back 161

epidermoid cyst

Front 162

The parents of a 4-week-old boy are concerned about a
lump above the infant’s right eye. It has been present
since birth and has not changed in size. The skin over the
1-cm lump is intact and the lump appears to be attached
to the underlying tissues. What is the most likely
diagnosis?

Back 162

dermoid cyst

Front 163

A 75-year-old man has what appears to be a 1-cm basal
cell carcinoma on the side of his nose immediately below
his left eye. What would be the most appropriate
treatment?

Back 163

excision and full-thickness graft

Front 164

A 17-year-old girl presents with a painless swelling on
the anterior aspect of her right leg. This has been present
for about 6 months and does not bother her much,
except that it itches occasionally. The lump is pink and
firm, and the overlying skin is intact. What is the most
likely diagnosis?

Back 164

dermatofibroma

Front 165

Soft tissue sarcomas are commonest in:

Back 165

lower limb

Front 166

The commonest site of metastasis for soft tissue
sarcomas is:

Back 166

lung

Front 167

Which of the following is an indication for removal of a
lipoma?

Back 167

a 3-cm lipoma in the tibialis anterior

Front 168

Desmoid tumours:

Back 168

occur in the root of the mesentry in association
with the FAP syndrome

Front 169

Cellulitis:

Back 169

is treated with rest, immobilisation and high-dose
penicillin

Front 170

Fournier’s gangrene:

Back 170

occurs mainly in debilitated patients and can be
life-threatening

Front 171

Hidradenitis suppurativa:

Back 171

chronic cases are improved by excisonal surgery

Front 172

Clostridial infections:

Back 172

require urgent surgical debridement

Front 173

Which of the following predispose to ischaemic
necrosis and wound breakdown?

Back 173

a excessive tension
b foreign body
d haematoma
e irradiation

but not, application of vacuum

Front 174

Lesions such as naevi, birthmarks and skin cancers can
be:

Back 174

removed with elliptical excision

Front 175

Sutures should:

Back 175

be the least number to maintain closure

Front 176

A graft shaved at a dermal level, which includes elements
of the epidermis and dermis:

Back 176

is used where large areas of skin are required

Front 177

What are critical determinants of patient
outcome following injury

Back 177

a time from injury to definitive care
b presence of a well-organised regional system of
trauma care
c protocols and guidelines when clinical experience is
limited
e thrombosis prophylaxis

Front 178

Hypovolaemic shock can result from any of

Back 178

a pulmonary laceration
c pelvic fracture
d femur fracture
e laceration to scalp

Front 179

A restrained 32-year-old male involved in a head-on
motor vehicle collision presents with chest pain and the
following vital signs on arrival in the emergency
department: Heart rate – 120/minute; Blood pressure –
86/50; GCS score – 10; and O2 saturations of 92%.
Which of the following takes first priority?

Back 179

e elimination of tension pneumothorax as a cause of his
symptoms/signs:

Front 180

What are considered immediate
threats to life?

Back 180

b splenic injury with ongoing bleeding
c open pneumothorax
d rapidly rising intra-cranial pressures
e aspiration

not T6 injury

Front 181

The volume of fluid replacement required in the first
24 hours in a 70-kg adult with 30% burns is
approximately:

Back 181

7,500 mL

Front 182

Fluid replacement in a 70-kg adult with 30% burns
should maintain a urine flow of:

Back 182

70 mL/hour

Front 183

Mesh split skin grafts are used in burns because:

Back 183

they release haematomas

Front 184

Which of the following bacteria occur commonly in burn
wound infections?

Back 184

Pseudomonas pyocyanea

Front 185

Radiologic evidence of an acute fracture includes:

Back 185

loss of continuity in cortical bone

Front 186

In assessing the severity of an acute fracture, one must
always:

Back 186

examine the status of the neurovascular system of the
fractured part

Front 187

The cardinal feature of a compartment syndrome are:

Back 187

pain

Front 188

When a plaster cast is applied for a fractured wrist, care
must be taken to instruct the patient on symptoms of:

Back 188

compartment syndrome

Front 189

Dislocation may be missed in the following circumstance:

Back 189

posterior dislocation of the shoulder

Front 190

Degenerative arthritis is a common condition
characterised by:

Back 190

joint pain, stiffness, contracture and deformity

Front 191

The radiologic features of degenerative arthritis include:

Back 191

joint narrowing, subchondral sclerosis, osteophyte
formation, cyst formation

Front 192

Crystal arthropathy may be seen in the following
condition:

Back 192

hyperurecaemia

Front 193

Septic arthritis is associated with the following features:

Back 193

exquisite pain with attempted joint motion

Front 194

Septic arthritis should be managed urgently with:

Back 194

arthrocentesis

Front 195

In the treatment of head injury, tell me a little about GCS

Back 195

patients with a Glasgow Coma Scale score less than 8
are usually intubated and ventilated

Front 196

The best investigation for patients with severe head
injury is:

Back 196

CT scan

Front 197

Traumatic intracerebral haematomas following blunt
trauma:

Back 197

are usually associated with severe brain injury

Front 198

An acute subdural haematoma:

Back 198

shows a characteristic hyperdense extra-cerebral mass

Front 199

Which kind of brain tumors are fatal?

Back 199

high-grade cerebral gliomas are invariably fatal

Front 200

Cerebral gliomas in adults:

Back 200

best visualised with MRI

Front 201

Brain tumours in children:

Back 201

most commonly occur in the posterior fossa

Front 202

Cerebral aneurysms:

Back 202

are the most common cause of subarachnoid haemorrhage in adults

Front 203

Subarachnoid haemorrhage:

Back 203

is characterised by the onset of a sudden severe
headache

Front 204

In considering pituitary tumours, the following is true:

Back 204

ACTH-secreting tumours cause Cushing’s disease

Front 205

Carpal tunnel syndrome:

Back 205

is especially associated with pregnancy and lactation

Front 206

In considering spinal cord compression, the following is
true:

Back 206

the usual treatment for spinal cord compression due
to malignant tumours is urgent surgery or
radiotherapy

Front 207

In considering nerve injuries, the following is true:

Back 207

an Erb’s palsy is due to damage of the upper trunk of
the brachial plexus

Front 208

Considering peripheral nerve entrapments, the following
is true:

Back 208

meralgia paraesthetica is due to entrapment of the
lateral cutaneous nerve of the thigh

Front 209

Which of the following is true about a pulsatile mass in
the abdomen?

Back 209

an ultrasound would be the best initial investigation

Front 210

Which of the following suggest that acute arterial
ischaemia is due to embolus in a 70-year-old woman?

Back 210

she is in atrial fibrillation

Front 211

Which of the following is true about arterial trauma?

Back 211

bleeding is more likely with partial than with complete
arterial transection

Front 212

Which of the following is true about the diabetic foot
complications?

Back 212

the prognosis is worse with arterial disease and
ongoing smoking

Front 213

Tell me some facts about the anatomy of
extracranial arterial disease

Back 213

a the left subclavian artery arises directly from the aortic
arch
b the vertebral artery is a branch of the subclavian
carotid artery
c the vertebral arteries form the basilar artery
e there is a low-resistance flow pattern in the internal
carotid artery

Front 214

An 80-year-old woman presents with transient right
hemiparesis, lasting 15 minutes and resolving completely.
She is otherwise healthy and independent. Her carotid
duplex scan shows >80% stenosis of her left internal
carotid artery. Despite aspirin therapy, she has a
further episode. Which of the following statements is
true?

Back 214

left carotid endarterectomy is indicated

Front 215

Gimme a fact about the pathology of
extracranial arterial disease

Back 215

atherosclerosis is the commonest cause of internal
carotid stenosis

Front 216

Tell me something about carotid
endarterectomy

Back 216

closure with a patch decreases the risk of recurrent
stenosis

Front 217

A 65-year-old man presents with angina, and a left neck
bruit is heard. Where might the bruit be coming from?

Back 217

the bruit may be arising from the aortic valve

Front 218

With regards to varicose veins, tell me some facts

Back 218

a varicose veins are dilated, tortuous and visible when
the patient is standing
b valvular incompetence is an integral component of the
pathogenesis of varicose veins
c the principal superficial venous systems of the lower
limbs are the long and the short saphenous systems
d the principal route of venous drainage from the lower
limb is NOT via the superficial venous system
e the principal driver of venous drainage from the legs in
the erect position is the calf pump

Front 219

Patients with
varicose veins may present to their doctor because of:

Back 219

b a superficial ulcer on the ankle
c aching discomfort in the calf after prolonged
standing
d superficial thrombophlebitis
e spontaneous bleeding from a varix

Front 220

When to treat varicose vein?

Back 220

patients with varicose veins and who have
haemosiderin deposits and liposclerosis at the ankle
should be treated

Front 221

Gimme some facts in the management
of patients with varicose veins?

Back 221

a below-knee-length elastic stockings may be definitive
treatment in the patient in whom surgery is
contraindicated because of co-morbidities
b injection with a sclerosing agent followed by elastic
compression for 4–6 weeks can be beneficial
c using a below-knee elastic stocking may help decide if
calf symptoms are due to varices
d surgical trials have demonstrated that it is
necessary to remove the long saphenous vein in the
thigh
e endoscopic techniques to divide incompetent
perforating veins have been developed

Front 222

Primary lymphoedema:

Back 222

should be investigated with lymphoscintography
before deciding on treatment

Front 223

Gimme some facts with respect to
upper tract urinary calculi?

Back 223

a approximately 80% of upper tract stones pass
spontaneously
b calcium oxalate is the commonest component of these
stones
c diuresis at the time of an episode of ureteric colic
d urate calculi may be dissolved with alkalinisation of
urine
e infection stones are most commonly associated with
Proteus species of bacteria, which contain urease

Front 224

Which of the following is correct with respect to prostate
cancer?

Back 224

the obturator, internal iliac and presacral lymph
nodes are commonly involved in prostate cancer
metastases

Front 225

What kind of hyperplasia is BPH?

Back 225

benign prostatic hyperplasia (BPH) is predominantly a
stromal hyperplasia

Front 226

What's the whizz on MSU?

Back 226

a a mid-stream specimen of urine (m/s/u) submitted for
microscopy, culture and sensitivities (m/c/s) remains
the standard approach for diagnosing a urinary tract
infection
b vesico-ureteric reflux of infected urine in infancy
causes reflux nephropathy
c patients with reflux nephropathy are at risk for
developing chronic pyelonephritis, hypertension and
renal failure
d E. coli is the bacterium responsible for most urinary
tract infections

Front 227

Your recommendation for a 45-year-old man with a
history of suspected haematuria 2 weeks earlier, who is
currently asymptomatic, is:

Back 227

an m/s/u submitted for m/c/s, voided urinary
cytology, intravenous urography and
cystourethroscopy

Front 228

Penile cancer has the following characteristics:

Back 228

a almost exclusively found in the uncircumcised male
b commonly associated with the human papilloma virus
c usually a squamous cell carcinoma
d commonly involves the inguinal lymph nodes

Front 229

testicular
cancer

Back 229

arises most commonly from germ cells

Front 230

The coronary artery bypass graft conduit with the
highest patency after 5 and 10 years is:

Back 230

left internal thoracic artery

Front 231

Regarding the results of coronary artery bypass
grafting:

Back 231

patients with poor left ventricular function have a
higher operative mortality

Front 232

Regarding cardiac valve prosthesis:

Back 232

structural failure is extremely rare in mechanical
valves

Front 233

Complications of cardiac valve replacement surgery
include:

Back 233

a anticoagulant (warfarin) related haemorrhage
b cerebral thromboembolism
c prosthetic valve endocarditis
d structural deterioration of tissue valves after 10 to
15 years

Front 234

Which of the following clinical signs are present in a
patient with a tension pneumothorax?

Back 234

a tachypnoea
b hypotension
c elevated jugular venous pressure
e hyper-resonant percussion note on the side of the
pneumothorax
tracheal deviation away from affect side

Front 235

Immediate insertion of a chest tube may be lifesaving in
which condition?

Back 235

tension pneumothorax

Front 236

The pathological type of carcinoma of the lung with the
worst prognosis is:

Back 236

small-cell carcinoma

Front 237

The greatest chance of long-term survival in a patient
with a localised carcinoma of the lung is provided
by:

Back 237

surgical excision

Front 238

The most common cause of constipation is:

Back 238

inadequate dietary fibre and fluids

Front 239

A 31-year-old lady lawyer has chronic constipation not
responding to laxatives. She has 80% of transit markers
retained in the ascending colon 5 days after ingestion.
Thyroid function tests, defecating proctogram and anorectal physiologic tests were otherwise normal. The
most appropriate management is:

Back 239

total colectomy and ileorectal anastomos

Front 240

A 24-year-old female secretary has constipation for
3 weeks after starting a new job. There are no other
abdominal symptoms and no family history of colorectal
cancer. The most appropriate management is:

Back 240

try taking enough dietary fibre and fluids

Front 241

A 43-year-old mother of two children complains of
difficulty in initiating rectal evacuation. She feels there is
a lump in the perineum which requires vaginal reduction
prior to effective evacuation. The most appropriate
management is:

Back 241

defecating proctogram

Front 242

After a previous hysterectomy, a 55-year-old mother of 3
children complains of constipation. Defecating
proctogram showed lack of relaxation of the puborectalis
paradoxus at defecation. The most appropriate
management is:

Back 242

anorectal biofeedback therapy

Front 243

Which of the following is CORRECT with faecal
incontinence?

Back 243

specialised testing with endoanal ultrasond and
anorectal physiology could be helpful in managing
severe faecal incontinence

Front 244

Faecal incontinence:

Back 244

is often improved by pelvic floor exercises

Front 245

Most patients presenting with massive rectal bleeding:

Back 245

should have a proctosigmoidoscopy performed before
a colonoscopy

Front 246

Patients with massive rectal bleeding:

Back 246

should be appropriately resuscitated

Front 247

Tell me about black,
tarry stools NOW

Back 247

a it is usually an indication of bleeding from the upper
gastrointestinal tract
b it can be mimicked by the ingestion of iron medication
d It can be present without other symptoms
e it is often but not universally associated with
haematemesis

Front 248

The causes of haematemesis and melaena include

Back 248

a oesophageal varices
b gastric ulceration
c epistaxis with swallowed blood
e gastritis
f Mallory–Weiss tear

Front 249

The following statements apply to the patient who has
suffered a GI bleed

Back 249

a be pale and sweaty
c be faint and have a tachycardia
d require urgent resuscitation with normal saline initially
e appear quite well with normal supine blood pressure

Front 250

Tell me about
the diagnosis of the cause of the bleeding episode?

Back 250

b may be suspected from a history of NSAID (non
steroidal inflammatory drug) intake
c can made by early endoscopy of upper GI tract
d can often be combined with treatment at the initial
endoscopy
e surgical intervention is required for ongoing blood
loss

Front 251

statement on haematemesis and melaena:

Back 251

a is a serious condition with a high mortality and
morbidity rate?
b now occurs in an older age group of patients.
d when associated with oesophageal varices may require
repeated interventions for control.
e is best managed in a dedicated specialist treatment
unit.

Front 252

Which of the following conditions may be a cause of
obstructive jaundice?

Back 252

a choledochal cyst
c hydatid disease
d scleroderma
e chronic pancreatitis

but not UC

Front 253

Drugs which may cause hepatotoxic drug reactions

Back 253

a paracetamol
c nitrofurantoin
d flucloxacillin
e oestrogen

Front 254

Which of the following clinical features is found in a
patient presenting with acute abdominal pain who has
generalised peritonitis?

Back 254

motionless with pain, worse with movement

Front 255

Acute epigastric pain is common in

Back 255

a acute pancreatitis
b acute cholecystitis
c perforated peptic ulcer
e ruptured abdominal aortic aneurysm

but unusual in acute diverticulitis

Front 256

Immediate laparotomy would be recommended in a
patient diagnosed as having which of the following
conditions?

Back 256

a mesenteric infarction
b perforated peptic ulcer with generalised peritonitis
d acute cholecystitis
e ruptured abdominal aortic aneurysm

but not recommended in acute pancreatitis

Front 257

Which of the following parameters is the most practical
for monitoring the progression of the underlying
pathological process responsible for acute abdominal
pain in a patient being initially managed
non-operatively?

Back 257

WCC

Front 258

Pelvic abscess that occurred 5 days after an anterior
resection of rectum:

Back 258

is usually due to anastomotic leak

Front 259

Common causes of post-surgical pelvic abscess include:

Back 259

appendicectomy

Front 260

In portal hypertension:

Back 260

there is increased portal blood volume

Front 261

The following conditions are typically associated with
ascites:

Back 261

abdominal tuberculosis

Front 262

In patients with ascites:

Back 262

may be relieved by spironolactone

Front 263

In jaundiced patients with ascites:

Back 263

there is a poor prognosis when operating for
malignant disease

Front 264

The following cancers are commonly associated with the
development of ascites:

Back 264

ovarian

Front 265

The most common cause of enlargement of the
jugulodigastric lymph node in a child 9 years of
age is:

Back 265

tonsillitis

Front 266

Metastatic involvement of the posterior triangle nodes in
the neck is most likely to be due to:

Back 266

squamous cell carcinoma of the posterior scalp

Front 267

The symptoms of dysphagia include

Back 267

b may be associated with reflux symptoms
c may be associated with significant pain
d can present acutely with total obstruction of the
oesophagus
e may be associated with diminished pharyngeal
propulsion

Front 268

The causes of dysphagia may be the following

Back 268

a classified as pharyngo-oesophageal and oesophageal
b pharyngo-oesophageal causes are often neurological
in origin, e.g. CVA
c associated with altered motility of the oesophagus
e be associated with an adenocarcinoma of the mucosal
lining

Front 269

The cause of dysphagia can often be identified by

Back 269

a upper GI endoscopy
b barium swallow examination
d CT examination of the chest
e oesophageal manometry

Front 270

Patients with dysphagia may complain of

Back 270

a regurgitation of fluid and food when recumbent at
night
b difficulty with swallowing fluids more than solid food
c difficulty with swallowing solid food more than liquids
d may have significant weight loss
e may have no weight loss

Front 271

dysphagia can be caused by

Back 271

a benign strictures in the oesophagus
b squamous carcinoma of the oesophagus
c pharyngeal diverticulum
d oesophageal spasm

it isn't caused by uncomplicated sliding hiatus-hernias

Front 272

A 65-year-old woman has a chronic leg ulcer. Which of
the following are possible reasons

Back 272

a squamous cell carcinoma
c superficial venous valvular incompetence
d deep venous valvular incompetence
e trauma

Front 273

The most important measure to get a chronic venous
ulcer to heal is:

Back 273

apply compression bandaging/stockings

Front 274

Which of the following is true regarding chronic leg
ulcers?

Back 274

a biopsy is best done of the ulcer edge

Front 275

Which of the following is true regarding the calf-muscle
pump?

Back 275

it depends on good ankle movement

Front 276

Bilateral leg swelling with pitting oedema may be caused
by

Back 276

a reduced lymphatic removal of exudate
b increased capillary permeability
d reduced oncotic pressure
e excessive fluid intake

Front 277

A 75-year-old female underwent a right-sided total hip
replacement. On post-operative day 10, she complained
of discomfort and swelling over her right thigh and calf.
She has been ambulating satisfactorily. Which of the
following statements is true?

Back 277

a Doppler study of the lower limb deep venous system should be performed

Front 278

The following statements on acute lymphangitis of the
lower limb are correct

Back 278

a improperly managed, it may lead to lymphadenitis
c rest and elevation of the affected limb is appropriate
d cellulitis may be the initiating cause
e appropriate antibiotics should include cover for
streptococcal infection

Front 279

Eight days following a low anterior resection for
carcinoma of the rectum, a 65-year-old man developed
unilateral gross swelling of his right lower limb. Select the
correct statement:

Back 279

ilio-femoral thrombosis is likely as it commonly follows pelvic surgery

Front 280

A 24-year-old female at 32 weeks’ gestation presents
with loin pain and haematuria. The best initial radiologic
study is:

Back 280

renal ultrasound

Front 281

The best evaluation of the lower urinary tract is with:

Back 281

cystourethroscopy

Front 282

You are asked to see a 65-year-old man who 3 days
previously underwent a laparotomy for a perforated
duodenal ulcer. He has become confused and is causing
a disturbance in the ward. You see from the notes that
he suffers with chronic obstructive pulmonary disease
and normally drinks three glasses of wine a day. The only
medication he was taking prior to admission was
atenolol. To this stage his post-operative recovery has
been uneventful and he has been given morphine
regularly. Your first action should be to:

Back 282

attach a face mask and administer oxygen

Front 283

You are called to see a 56-year-old man with dyspoea
and pleuritic chest pain. Five days earlier he underwent a
laparotomy and gastric resection. On examination he has
a temperature of 37.5◦C, a tachypnoea of 25, a pulse
rate of 90 and a blood pressure of 130/95 mm Hg. His
heart sounds are normal and there are no added sounds
or murmurs. There is good air entry to both bases and
the percussion note is resonant in all areas. A chest X-ray
and a ventilation-perfusion scan are performed. Which
one of the following combinations of test results
indicates a high probability of a pulmonary embolus in a
particular zone of the lung:
chest X-ray ventilation scan perfusion scan

Back 283

normal normal reduced

Front 284

You are asked to see a 65-year-old woman who feels
unwell and faint. Seven days previously she underwent
an elective sigmoid colectomy for carcinoma. The
procedure was uncomplicated and until now, she had
been making an uneventful recovery. On examination
she has a temperature of 39.5◦C, a pulse rate of
100 beats per minute and a blood pressure of 90/60 mm
Hg. Her respiratory rate is 15 breaths per minute. She
has cool clammy peripheries. Her abdomen is tender in
the left iliac fossa, around the wound site. Which of the
following is the most reasonable explanation for her
current problem?

Back 284

septic shock

Front 285

A 72-year-old diabetic develops a discharge from his
midline abdominal wound 7 days after surgery for
perforated diverticular disease. The most likely cause of
the discharge is:

Back 285

wound infection

Front 286

An otherwise fit 57-year-old man spikes a temperature
of 39◦C 5 days after an open appendicectomy for acute
appendicitis. There is a tender, reddened and fluctuant
swelling at the medial end of the wound. What is the
most appropriate initial action to take?

Back 286

open the wound to allow free drainage

Front 287

The claw hand:

Back 287

includes metacarpophalangeal joint extension of the
involved fingers

Front 288

From which of the following blood vessels does the
bleeding in a patient with massive haemopytsis usually
occur?

Back 288

bronchial artery

Front 289

Which of the following lung conditions are
common causes of massive haemoptysis?

Back 289

b pulmonary arteriovenous malformation
c tuberculosis
d lung abscess
e aspergillosis

lung carcinoma- not so much

Front 290

The investigation which will most reliably determine the
site of bleeding in a patient with massive haemoptysis
is:

Back 290

bronchoscopy

Front 291

Definitive therapy in a patient with massive haemoptysis
may include:

Back 291

a broad-spectrum antiobiotics
b surgical resection of the bleeding source
c pulmonary arterial embolisation
d radiotherapy

Front 292

Severe epistaxis in the elderly patient is most likely to be
due to:

Back 292

HT

Front 293

An L4–5 disc prolapse is most likely to cause:

Back 293

weakness of extensor hallucis longus

Front 294

A cauda equina syndrome:

Back 294

requires urgent decompression

Front 295

Which of the following features are true of complete
testicular torison?

Back 295

a most common between puberty and the age of
25 years
b is not associated with tenderness of the cord
d usually shows changes on colour Doppler ultrasound
e requires urgent surgical treatment

Front 296

Torsion of a testicular appendage:

Back 296

involves the hydatid of Morgagni

Front 297

Acute epididymo-orchitis is characterised by the
following features

Back 297

a history of urinary tract infection
c swollen tender testes
d tenderness of the cord
e pyrexia and leucocytosis

pain onset usually not sudden

Front 298

A 30-year-old man presents with 1 week of right sciatica
and has numbness on the dorsum of his right foot and
weak dorsiflexion at the ankle. Which of the following is
true?

Back 298

he can be managed initially with rest and analgesics

Front 299

A 35-year-old woman presents with acute lumbar back
pain, bilateral sciatica, difficulty in voiding and on
examination has weakness in the ankles and feet, absent
ankle reflexes and decreased sensation in the soles of
both feet. Tell me about it

Back 299

a she has developed an acute cauda equina compression
c central disc prolapse at L5–S1 is a likely cause
d urgent magnetic resonance imaging is required
e urgent surgery will be required

Front 300

A 30-year-old diabetic presents with a severe mid and
lower thoracic pain, radiation of the pain to the
mid-abdomen, and on examination he is tender in the
thoracic spine at the level of T10, has weak lower limbs
and finds it difficult to walk. tell me about it

Back 300

a CT scan will be helpful as an initial investigation
b he should have an FBE and ESR
c he may have a dissecting aneursym of the aorta
e an MRI is indicated and urgent surgery should be
considered

Front 301

Post-traumatic confusion commonly occurs due to the
following conditions

Back 301

a cerebral contusion
b intracerebral haematoma
c hypoxia
e venous engorgement

Front 302

Post-traumatic confusion may require the following
treatments

Back 302

a i.v. sedatives
c i.v. morphine
d physical restraint
e oxygen supplementation

Front 303

With reference to the actions of the extra-ocular
muscles, which of the following is correct?

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in abduction, the inferior rectus depresses the eye.

Front 304

The muscle most employed in reading is:

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superior oblique

Front 305

When investigating a case of diplopia, a helpful sign is

Back 305

the patient prefers to fixate on a target with the eye
with healthy muscles.