Mrcs Part1

1.
questions:
1- Appearance of skull Xray in MM: Lytic lesions
2- High Ca, High AL, nor!al "# : 1ry hyperparathyroi$is!
%-Artery lia&le to in'ury $uring ligation at ()* +, $i$ it -rong, &ut ,
think the correct ans-er is superficial e.ternal pu$en$al a/
#- Lesion at anal 0erge, -hat is the L1s in0ol0e$
2- Lytic !etastatic &one lesion, -hat is !ost pro&a&le pri!ary :&reast
3-pathology associate$ -ith Crohn4s $isease :granulo!atous
infla!!ation.
5- Cells for!ing giant cells: !acrophage
6- Colorectal Ca going through to !esentry -ith 2 L1s in0ol0e$ :
7uke C
8- ancreatic tu!or -ith groin an$ &uttock rash seen at
$er!atology : glucagono!a
19- Athlete $ie$ $uring foot&al ga!e: :intercer&ral Hge;:
su&arachnoi$ hge
11-artery in0ol0e$ -ith patient co!ing -ith leg -eakness: : ACA
12- ten$on in0ol0e$ in anato!ical snuff &o.: e.tensor pollicis &re0is
1%- atient -ith enlarge$ lateral an$ %r$ 0entricles: stenosis at
aquecuct of (yl0ius.
1#- <hyroi$ carcino!a -ith cer0ical L1s !etastasis: papillary thyroi$
CA.
12- ,ntracranial &lee$ing -ith unilateral $ilate$ fi.e$ pupil:
trantentorial herniation.
13- 7eprsse$ skull fracture at 0erte., -hich 0ein in0ol0e$ : (((
15- 1er0e in'ure$ in posterior triangle of the neck: spinal accessory 1.
16- =olf player ha$ &lo- to the face, pro&a&le >" !uscle in'ury,
-hich in0estigation: ?(
18- ,nhale$ )@, -here it -ill settle: right lo-er lo&e
29- 1er0es supplying anal sphincter: (2,%,#
21- CatheteriAing a !ale, -hat is the tightest part: !e!&ranous
urethra
22- perinural paroti$ tu!our: :pleo!orphic a$eno!a
2%- (li! tall pregnant la$y -ith chest pain: : aortic $issection
+pro&a&le Marfan syn$ro!e/
2#- prgnant la$y -ith shock: : acute !assi0e >
22- pregnant la$y -ith pleuritic chest pain, hae!optysis: : pul!onary
infarction
23- 18 years ol$ &oy post appen$ececto!y, poor ?": 299 !ls gelo
25- ost stroke gentle!an, $ay 5, not eating: consi$er >= tu&e
26- $aily requir!ent post op patient: 1 L salineB 1.2 L hart!ann4s
28- #2 years ol$ gentle!a, kno-n @arrett4s oes, high gra$e
$ysplasia : : for oesophagecto!y
%9- A$0ance$ Ca oes -ith solitar li0er !et:: stent
%1- A la$y -ith kno-n iron $efeciency an$ $ysphagia oes 0arices
%2- young la$y, chest pain, nor!al >C= an$ enAy!es: oes spas!
%%- 1e-&orn, respiratory $istress, trachea shifte$, $isplace$ car$iac
ape.: : congenital $iaphrag!atic hernia
%#-1e-&orn, cyanotic, i!pro0es -ith crying: : su&glottic stenosis
%2- 1e-&orn, una&le to pass 1=, air in sto!ach: congenital oes
atresia -ith tracheo-oes fistula.
%3- e!&ryonic origin of right an$ left pul arteries.
%5- <u!our !arker for !e$ullary thyroi$ CA: calcitonin
%6- <u!our !arker for pheochro!ocyto!a: CMA
%8- rolonge$ constipation, L,) pain, fe0er: $i0erticulitis
#9- 7rug use$ in ,<? , i!portant in septic shock: nora$renaline
#1- ost thyroi$ecto!y teacher, una&le to sing: unilateral e.ternal
laryngeal 1 in'ury
#2- Co!itting, a&$o pain, s-elling at re0ersal of colosto!y site:
o&structe$ incisional hernia
#%- fannenstiel incision, -hich layer $i0i$e$: : rectus sheath
##- ?pper !i$line incision, -hich layer $i0i$e$: linea al&a
#2- @ullet going through 'unction of linea se!ilunaris an$ costal
!argin on right si$e, -hich structure in'ure$: =@
#3- (tructure at !e$ial part of fe!oral ring: lacunar lig
#5- puDsating neck s-elling, confir!e$ &y angio: caroti$ a aneurys!
#6- >nlarge$ ten$er li0er, !ultiple lesions, calcification: : hy$ati$
$isease
#8- 11 years ol$ chil$, painful scrotal % !! s-elling, separate$ fro!
testis: torsion hy$ati$ of Morgagni
29- Man acute scrotu!, oe$e!atous, ten$er he!iscrotu!: :
testicular torsion
21- &ig painless scrotal s-elling: hy$rocele
22- painless s-elling a&o0e testis: :epi$y$i!al cyst
2%- 23 years ol$ !ale, rapi$ly gro-ing s-elling -ithin testis: :
testicular tu!or
2#- site of ectopic testis: : &ase of penis
22- foot&aller -ith t-isting in'ury an$ ten$erness 'ust pro.i!al to
!e$ial part of knee 'oint: : !e$ial collateral lig in'ury
23- structure felt in C anteriorly at le0el fo cer0i.:: $o!e of
&la$$er; : &ase of &la$$er
25- Artery in'ure$ in upper chest -all &elo- cla0icle: :
thoracoacro!ial a.
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1- (tructure lia&le to in'ury $uring fi&ulecto!y: :peroneal artery
2- Eecoprical of a&solute risk: :nu!&er nee$e$ to treat
%- (ensiti0ity $efinition
#- 7ifference &et-een control an$ e.peri!ent: :a&solute risk
2- <ype of fracture in chil$: :greenstick
3- <ype of fracture in t-isting in'ury of ti&ia: :spiral
5- <ype of fracture in fe!ur after car acci$ent: , $i$ it o&lique +&ut , think correct
ans-er is trans0erse/
6- <ype of fracture in !etastatic;osteoporotic &one: :trans0erse
8- Hyperechoic lesion in li0er: :he!angio!a
19- Cirrhotic an$ hep C li0er: hepatocellular carcino!a
11- Another li0er lesion +canIt re!e!&er its $escription/: :!etastases
12- 1e-&orn -ith cyanosis, i!pro0es -ith crying: :choanal atresia
1%- ost thyroi$ecto!y una&le to cough an$ clear throat: superior laryngeal n
1#- 1eck s-elling that appeare$ &efore infront of sterno!astoi$: &ranchial cyst
12- 1eck s-elling at &ase of neck, transillu!inates in infant: cystic hygro!a
13- 1eck s-elling !o0es si$e-ays &ut not up an$ $o-n: :caroti$ &o$y tu!or
15- A &oy -ith septic arthritis in paper 1
16- <he!e in paper 2, +, think it -as first question on paper/ one of the! ha$
a0ascular necrosis an$ other ha$ (?)>:
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"rganis! causing tonsillitis: (. neu!oniae
"rganis! causing sinusitis +facial pain an$ post nasal $rip/ : ( neu!oniae
atient -ith ly!phe$e!a an$ infection: -hat organis!:
erianal a&scess organis!: > coli
@reast a&scess organis!: (taph
"rganis! causing infection -ith $ea$ tissue an$ cripitus: C perfringens
=angrene of hallu. +% the!es/ canIt re!e!&er the!
Manage!ent of ulcer ... one -ith &e$ sores of the heel: conser0ati0e or is it
$e&ri$e!ent +can anyone re!e!&er the other 2:/
arasitic infestations, one patient -ith o0a at anal 0erge: !e&en$aAole ... another
patient -ith o0a an$ cysts in faeces: !etroni$aAole
7eter!inant of cranial &loo$ flo- in a patient -ith lo- =C(: :intracranial pressure
)irst response to hge: :&aroreceptors
)irst su&stance that -oul$ $irectly cause 0asoconstriction: Ag ,, +so!e of !y
colleagues say that rennin causes CC:/
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Maher )a-Ay
$%&'()& $)*+,) $-./0& 123
@ack to professional !e$ical gui$e
4iscussion 5oard
Topic 6ie7
8tart Ne7 Topic
Topic9 $%&'()& $)*+,) $-./0& 123
Eeply to <opic
7isplaying posts 1 - %9 out of %9 &y # people.
ost H1
1 reply
Hala A$el -rote3 hours ago
MEC( art 1 ractice Guestions + hysiology / - 1 of %
Correct
A7H +Casopressin/ release in response to $ehy$ration causes
(ingle &est ans-er question J choose "1> true option only
7ecrease$ per!ea&ility of the collecting $ucts to -ater
7ecrease$ urine os!olality
,ncrease$ 1aB resorption in the ascen$ing li!& of the loop of Henle
,ncrease$ 1aB resorption in the $escen$ing li!& of the loop of Henle
,ncrease$ per!ea&ility of the collecting $ucts to -ater
Kour ans-er
A7H is release$ &y the posterior pituitary in response to $ehy$ration, fro! sti!ulation of
os!oreceptors a$'acent to the supraoptic nucleus, as -ell as 0olu!e receptors in the aorta atria
an$ great 0eins. Fater a&sorption in the collecting $ucts is in$epen$ent of so$iu!
concentration, an$ is un$er the control of A7H, -hich causes increase$ per!ea&ility of the
$ucts. ,ncrease$ A7H le0els -ill increase the os!olality of the urine 0ia this !etho$.
,n the $escen$ing li!& of the loop of Henle, so$iu! an$ -ater are passi0ely resor&e$. <he
ascen$ing li!& is i!per!ea&le to -ater, -ith acti0e so$iu! resorption, pro$ucing a
concentration gra$ient in the renal !e$ulla, -hich is essential for the !aintenance of -ater
&alance.
Correct
A -o!an, age$ 22, presents -ith features consistent -ith CushingIs syn$ro!e. (he is taking no
!e$ication. Her &asal cortisol an$ plas!a AC<H le0els are significantly raise$. (he has faile$ the
$e.a!ethasone suppression test.
Fhat is the !ost likely $iagnosis: (ingle &est ans-er question J choose "1> true option only
A$renal tu!our
CarneyIs syn$ro!e
CushingIs $isease
Kour ans-er
7epression
>ctopic AC<H-secreting tu!our
A raise$ a$renocorticotrophic hor!one +AC<H/ le0el -ith a raise$ cortisol i!plies the pro&le! is
cause$ &y e.cess AC<H pro$uction, other-ise negati0e fee$&ack -oul$ suppress AC<H. A lo-
AC<H le0el -oul$ therefore &e e.pecte$ in patients -ith an a$renal tu!our. CarneyIs syn$ro!e
co!prises atrial !y.o!a an$ freckles -ith high cortisol le0els in$epen$ent of AC<H. ituitary
tu!ours pro$ucing AC<H an$ a$renal sti!ulation are the cause of CushingIs $isease. Fhile
ectopic AC<H-secreting tu!ours are associate$ -ith significantly raise$ AC<H an$ cortisol le0els,
itIs unusual to $e0elop classic cushingoi$ features. )ailure of the $e.a!ethasone suppression
test can occur in patients -ith $epression, &ut cushingoi$ features are not e.pecte$.
Correct
@a&inski4s sign is pro$uce$ &y:
Lateral cere&ral sulcus lesions
Cere&ellar lesions
@asal ganglia lesions
Lesions of 0esti&ular nuclei
Lesions of the pyra!i$al tracts Kour ans-er
7iseases of the pyra!i$al syste! cause upper !otor neurone lesions. <he nor!al fle.or plantar
response &eco!es e.tensor +a positi0e @a&inskiIs sign/.
Correct
A 31-year-ol$ -o!an -ith kno-n C"7 is a&out to ha0e a laparoscopic cholecystecto!y. Ha0ing
esta&lishe$ a pneu!onperitoneu! the anaesthetist infor!s you that he is ha0ing $ifficulty
o.ygenating the patient. Fhich of the follo-ing factors is !ost likely responsi&le for this
$ifficulty:
A&$o!inal aorta co!pression
,ncrease$ )>C1 : )CC ratio
,ncrease$ peak air-ay pressures
Kour ans-er
,ncrease$ respiratory rate
Ee$uce$ 0enous return
Laparoscopic surgery is perfor!e$ through a transperitoneal or retroperitoneal approach -ith
insufflation of C"2 un$er pressure to create a -orking space. Car$io0ascular, respiratory, renal,
an$ !eta&olic changes occur secon$ary to the raise$ intra-a&$o!inal pressure +,A/ an$
a&sorption of C"2.
,n reference to the question the raise$ ,A associate$ -ith C"2 insufflation pushes the
$iaphrag! cephala$, re$ucing $iaphrag!atic !o0e!ents. )unctional resi$ual capacity, 0ital
capacity, an$ pul!onary co!pliance all $ecrease -ith raise$ ,A an$ peak air-ay pressures
!ay increase &y L29M. <hese changes are nor!ally -ell tolerate$ &ut patients -ith un$erlying
lung $isease ha0e poor lung co!pliance an$ are una&le to co!pensate. <hese patients often
require positi0e en$ e.piratory pressure in or$er to achie0e a$equate gas e.change.
,ncorrect
<he infusion of 1 litre of -hich of the follo-ing solutions -ill initially lea$ to the greatest increase
in e.tracellular flui$ 0olu!e:
=elatin colloi$ solution +e.g. =elofusinN or Hae!accelN/
Kour ans-er
Hypertonic 1aCl
Correct ans-er
1or!al +9.8 M/ 1aCl
2 M $e.trose solution
ure -ater
Colloi$s !ay &e natural +e.g. &loo$, hu!an al&u!in an$ gelatins/ or synthetic +e.g. $e.trans/.
<hey co!prise large &ranching !olecules -ith !olecular -eights in e.cess of %9,999. Assu!ing
intact capillary integrity, the 0olu!e effects of colloi$ infusion are, at least initially, confine$ to
the plas!a co!part!ent. ,n contrast, crystalloi$s, such as 1aCl solution, pass !ore rea$ily fro!
the plas!a flui$ co!part!ent an$ ha0e !ore of a 0olu!e effect on the e.tracellular flui$
co!part!ent. ,n the case of 2 M $e.trose solution, the $e.trose co!ponent is rapi$ly
!eta&olise$ an$ the re!aining -ater $istri&utes itself throughout the entire &o$y -ater +i.e.
intracellular an$ e.tracellular co!part!ents/.
<herefore, of the options liste$ a&o0e, infusions of 1aCl -ill ha0e the greatest initial increase in
e.tracellular flui$ 0olu!e. Hypertonic 1aCl -ill ha0e an e0en greater effect than nor!al
+appro.i!ately isotonic/ 1aCl, since hypertonic solutions -ill $ra- a$$itional -ater fro! the
intracellular flui$ co!part!ent &y os!osis.
Correct
,n a lung function test, the functional resi$ual capacity:
,s the su! of the ti$al 0olu!e an$ resi$ual 0olu!e
,s the su! of the inspiratory reser0e 0olu!e, the e.piratory reser0e 0olu!e an$ the ti$al 0olu!e
Can &e !easure$ $irectly &y spiro!etry
,s equal to the su! of the resi$ual 0olu!e an$ the e.piratory reser0e 0olu!e
Kour ans-er
,s that 0olu!e of air that re!ains in the lung after force$ e.piration
(piro!etry traces are easy to un$erstan$ if you re!e!&er the follo-ing t-o rules:
1. <here are # lung 0olu!es an$ 2 capacities that you nee$ to re!e!&er.
2. A capacity is !a$e up of 2 or !ore lung 0olu!es
<he # lung 0olu!es are:
O <i$al 0olu!e P 0olu!e of air inspire$ or e.pire$ -ith each nor!al &reath in quiet &reathingD
appro.i!ately 299!ls.
O Eesi$ual 0olu!e P that 0olu!e of air that re!ains in the lung after force$ e.piration.
O ,nspiratory reser0e 0olu!e P e.tra 0olu!e of air that can &e inspire$ o0er an$ a&o0e the
nor!al ti$al 0olu!e.
O >.piratory reser0e 0olu!e P e.tra 0olu!e of air that can &e e.pire$ &y forceful e.piration
after the en$ of a nor!al ti$al e.piration.
<he 2 lung capacities are:
O )unctional resi$ual capacity P that 0olu!e of air that re!ains in the lung at the en$ of quiet
e.piration. >qual to the su! of the resi$ual 0olu!e an$ the e.piratory reser0e 0olu!e.
O ,nspiratory capacity P inspiratory reser0e 0olu!e B ti$al 0olu!e
O >.piratory capacity P e.piratory reser0e 0olu!e B ti$al 0olu!e
O Cital capacity P inspiratory reser0e 0olu!e B ti$al 0olu!e B e.piratory reser0e 0olu!e +or
total lung capacity J resi$ual 0olu!e/
O <otal lung capacity P 0ital capacity B resi$ual 0olu!e
<he resi$ual 0olu!e +an$ therefore functional resi$ual capacity an$ total lung capacity/ cannot
&e !easure$ $irectly &y spiro!etry. <hey are !easure$ &y either -hole &o$y plethys!ography,
or &y using the heliu! $ilution or nitrogen -ashout techniques.
Correct
=luconeogenesis is &est $escri&e$ as a process &y -hich:
=lucose is generate$ fro! car&ohy$rate precursors
=lucose is generate$ &y the &reak$o-n of glycogen stores
=lucose is generate$ fro! non car&ohy$rate sources
Kour ans-er
=lucose is &roken $o-n to Acetyl CoA -hich enters the tri-car&o.ylic cycle
=lucagon is generate$ fro! car&ohy$rate precursors
=lucose is an essential source of nutrition for the central ner0ous syste! an$ re$ &loo$ cells.
=lycogenolysis +the &reak$o-n of glycogen stores to glucose/ -ill !aintain glucose le0els for
aroun$ 6-12 hours after -hich gluconeogensis -ill takeo0er. <he !ain su&strates for
gluconeogensis inclu$e lactate +pro$uce$ as the result of anaero&ic respiration/, glycerol
+$eri0e$ fro! the &reak$o-n of fat/ an$ a!ino aci$s +$eri0e$ fro! the &reak$o-n of protein/.
Correct
A 59kg -o!an recei0es appro.i!ately 25M full thickness &urns in a house fire to her chest an$
left ar! circu!ferentially. Ho- !uch flui$ $oes she require o0er the initial 2#hrs:
(ingle &est ans-er question - choose "1> true option only
1269 !l
2659 !l
%999 !l
2%29 !l
5239 !l
Kour ans-er
<he require$ flui$s !ay &e calculate$ &y the follo-ing-
2-# !ls flui$ per kg &o$y -eight per percent &o$y surface area &urns o0er 2#hrs.
<he Qrule of ninesR is a useful !etho$ use$ esti!ate the total &o$y surface area +@(A/ &urns.
<he a$ult @(A is $i0i$e$ up into areas of 8M +or !ultiples of 8M/-
S Hea$, face, ar!s all equal 8M @(A
S Chest, &ack, legs all equal 16M @(A
<hus, this patient @(A &urne$ is 25M +ar! 8M an$ chest 16M/
# +!l flui$/ . 59 +-t in kg/ P 269 !ls
269!ls . 25 P 5239!ls flui$ require!ent.
,t !ust &e stresse$ that the rule of nines only applies to a$ults as in chil$ren the hea$
represents a proportionally larger area. A useful esti!ation that can &e use$ for any patient is
that the pal!er surface of the patients han$ +inclu$ing the fingers/ represents appro.i!ately 1M
@(A.
,ncorrect
,n a star0ing patient, -hich of the follo-ing flui$ regi!ens -oul$ &e !ost appropriate for a 59kg
!an o0er a 2#hr perio$:
%L 1(aline -ith 29!!ols potassiu! chlori$e in each &ag
%L 7e.trose-saline
%L Hart!annIs solution
Kour ans-er
1L 1(aline -ith 29 !!ols potassiu! chlori$e an$, 2L 2M $e.trose -ith 29!!ols potassiu!
chlori$e in each &ag
Correct ans-er
%L 2M $e.trose -ith 29!!ols potassiu! chlori$e in each &ag
<he $aily flui$ an$ electrolyte require!ents are 1-1.2 !!ols 1aB ;Tg;2# hours, 1!!ols TB
;Tg;2# hours an$ #9!l H29 ;Tg;2# hours.
Ho-e0er, a$$itional flui$ shoul$ &e supple!ente$ if there are %r$ space losses +that co!!only
occur for instance in se0ere acute pancreatitis, &urns an$ post !a'or gastro-intestinal surgery/
an$ for other sources of flui$ loss inclu$ing 0o!iting, $iuresis an$ insensi&le losses
Correct
Fhich of the follo-ing state!ents regar$ing the flo- of air through the air-ays of the lung is
correct:
)lo- rate is proportional to the length of the air-ay
)lo- rate is proportional to the cu&e of the ra$ius of the air-ay
)lo- rate is proportional to the 0iscosity of the gas passing along the air-ay
)lo- rate is in0ersely proportional to the pressure gra$ient along the air-ay
1one of the a&o0e
Kour ans-er
<his question tests kno-le$ge an$ physiological application of oiseuilleIs La- -hich states that
for a rigi$, -i$e &ore tu&e:-
)lui$ flo- rate P pr#+7/
6hL
-here: r P ra$ius of the tu&e, 7 is the pressure gra$ient along the tu&e, h is the 0iscosity of the
flui$ running through the tu&e an$ L is the length of the tu&e.
<herefore, the flo- rate is proportional to the fourth po-er of the ra$ius an$ the pressure
gra$ient along the tu&e, &ut is in0ersely proportional to the 0iscosity of the flui$ an$ the length
of the tu&e
,ncorrect
A 55-year-ol$ !an presents -ith a history of 0o!iting un$igeste$ foo$. Eoutine &ioche!istry
sho-s a seru! &icar&onate concentration of %6 !!ol;l.
Fhich of the follo-ing fin$ings -oul$ !ost suggest that he ha$ a chronic !eta&olic alkalosis:
Alkaline urine
@ase e.cess 16 !!ol;l
>le0ate$ arterial p+C"2/
Correct ans-er
Hypokalae!ia
Kour ans-er
Hypo!agnesae!ia
<he &ase e.cess pro0i$es no a$$itional infor!ation: it is $irectly relate$ to the high &icar&onate
concentration. ,n prolonge$ !eta&olic alkalosis, the urine !ay &eco!e aci$ic, reflecting
increase$ pro.i!al &icar&onate resorption +a consequence of hypochlorae!ia/. =astric
secretions contain a&out 19 !!ol;l potassiu! an$, although potassiu! $epletion is likely to
&eco!e !ore se0ere the longer 0o!iting occurs, hypokalae!ia can $e0elop at any ti!e.
Ho-e0er, the $e0elop!ent of hypercapnoea as co!pensation for !eta&olic alkalosis ten$s to
take so!e ti!e. Although alkalosis inhi&its respiration, the ten$ency for p+C"2/ to increase acts
as a respiratory sti!ulant, though -ith ti!e, the sensiti0ity of the respiratory centre to car&on
$io.i$e !ay $ecline so that significant hypo0entilation $oes occur. Hypo!agnesae!ia is
frequently foun$ in patients -ith potassiu! $epletion
Correct
Fhich of the follo-ing is not associate$ -ith a !eta&olic aci$osis:
A fall in seru! &icar&onate
Tetosis
Hypokale!ia
Kour ans-er
Hypo0olae!ic shock
Hyper0entilation
(eru! potassiu! le0els are inti!ately linke$ -ith seru! HB le0els 0ia the so$iu! potassiu!
A<ase. <his cell !e!&rane pu!p principally e.changes intracellular so$iu! ions -ith
e.tracellular potassiu! ions in or$er to !aintain the cell !e!&rane potential. Ho-e0er,
potassiu! ions co!pete -ith hy$rogen ions in the e.change pu!p an$ therefore in the
presence of hypokale!ia, !ore hy$rogen ions -ill !o0e into the intracellular co!part!ent 0ia
this pu!p. Con0ersely, in the presence of hyperkalae!ia, less hy$rogen ions -ill !o0e out of
the e.tracellular co!part!ent -hich result in a !eta&olic aci$osis.
,ncorrect
A 2#-year-ol$ -o!an has un$ergone so!e &loo$ tests as part of an e!ploy!ent health screen.
(he reports she is in goo$ health an$, &eing 0ery health conscious, takes regular 0ita!in an$
!ineral supple!ents. (he is taking &en$rofluaAi$e 2.2 !g for hypertension an$ her &loo$
pressure is 1%2;62 !!Hg. <he only a&nor!ality is a seru! calciu! concentration of 2.8#
!!ol;l.
Fhich of the follo-ing is the !ost likely cause: (ingle &est ans-er question J choose "1> true
option only
7iuretic treat!ent
Kour ans-er
High $ietary calciu! intake
High $ietary 0ita!in 7 intake
"ccult !alignancy
ri!ary hyperparathyroi$is!
Correct ans-er
<hiaAi$es can cause hypercalcae!ia &ut it is usually only !il$. Cita!in 7 itself is physiologically
inacti0e an$, -hereas 1-hy$ro.ylate$ $eri0ati0es can &e a cause of hypercalcae!ia, 0ita!in 7 J
-hich has to &e !eta&olise$ to acti0ate it J is less co!!only so. ,ntestinal a&sorption of calciu!
is su&'ect to tight control, an$ a high intake $oes not cause hypercalcae!ia. <he t-o !ost
co!!on causes of hypercalcae!ia are pri!ary hyperparathyroi$is! an$ !alignancy. ,n an
asy!pto!atic in$i0i$ual, pri!ary hyperparathyroi$is! is the !ore likely cause
,ncorrect
Fhich >C= feature is classically present in hypother!ia:
<hyro.ine
Ee$uce$ E inter0al
<achycar$ia
Kour ans-er
? -a0es
* -a0es
Correct ans-er
<he * -a0e !ay &e present on the >C= in patients -ith hypother!ia an$ is an a$$itional up-ar$
peak i!!e$iately follo-ing the GE( co!ple.. <he ? -a0e !ay &e present on the >C= in
hypokalae!ia an$ is an a$$itional up-ar$ peak -hich follo-s the < -a0e. <achycar$ia an$ a
re$uction in the EE inter0al are >C= features of hyperther!ia.
,ncorrect
A patient un$ergoes respiratory function tests. Fhich of the follo-ing are nor!al rea$ings for a
59-kg !an:
eak e.piratory flo- of %53 l;!in
Kour ans-er
<otal lung capacity of %.2 litres
)unctional resi$ual capacity of %.2 litres
<i$al 0olu!e of 229 !l
,nspiratory reser0e 0olu!e of 2 litres
Correct ans-er
1or!al rea$ings for such a patient -oul$ &e:
peak e.piratory flo-
229J599 l;!in
total lung capacity
2J3.2 litres
functional resi$ual capacity
2J% litres
ti$al 0olu!e
299J599 !l
Correct
Fhat is the half life of free triio$othyronine +<%/ in the &loo$:
1 !inute
1 hour
1 $ay
Kour ans-er
1 -eek
1 !onth
Most of the <% an$ thyro.ine +<#/ are carrie$ in plas!a &oun$ to thyro.ine &in$ing glo&ulin, an$
are inacti0e in this state. "nly 1M of <% an$ 9.92M of <# is free. <%is the acti0e hor!one, an$ is
for!e$ fro! the intracellular $eio$ination of <# &y type 2 $eio$inase. <he half life of <# is 1
-eek, an$ of <% 1 $ay, suggesting that <# acts as a source of <%, rather than an acti0e hor!one
in its o-n right
Correct
Cere&ellar lesions pro$uce:
Fa$$ling gait
)estinant gait
Ata.ic gait Kour ans-er
(cissors gait
High-stepping gait
,n $isease of the lateral cere&ellar lo&es, the stance &eco!es &roa$ &ase$, unsta&le an$
tre!ulous. <he gait ten$s to 0eer to-ar$s the si$e of the !ore affecte$ cere&ellar lo&e.
Feakness of pro.i!al lo-er li!& !uscles +eg in poly!yositis or !uscular $ystrophy/ lea$s to
$ifficulty in rising fro! sitting or squatting. "nce upright, the patient -alks -ith a -a$$ling gait,
as each lo-er li!&, as it carries the full -eight of the &o$y, $oes not a$equately support the
pel0is. )estinant, or hurrie$ gait occurs in arkinsonIs $isease. @roa$-&ase$, high stepping or
sta!ping gait $e0elops in peripheral sensory lesions +eg polyneuropathy/ -hen there is loss of
proprioception. (pasticity causes stiffness an$ 'erkiness -hile -alking J scissors gait.
Correct
Fhich one of the follo-ing hor!ones is secrete$ &y the anterior pituitary:
<estosterone
".ytocin
<(H
Kour ans-er
CEH
A7H
<he pituitary glan$ +hypophysis/ is the con$uctor of the en$ocrine orchestra. ,t is $i0i$e$ into
&oth an anterior part an$ posterior part. <he anterior pituitary +a$enohypophysis or pars $istalis/
secretes 3 hor!ones na!ely:
)(H;LH: Eepro$uction
AC<H: (tress response
<(H: @asal !eta&olic rate
=H: =ro-th
rolactin: Lactation
<he posterior pituitary +neurohypophysis or pars ner0osa/ secretes only 2 hor!ones:
A7H +0asopressin/: "s!otic regulation
".ytocin: Milk e'ection an$ la&our
<estosterone is pro$uce$ fro! Ley$ig cells in the testis an$ fro! the a$renal glan$s. CEH is
pro$uce$ &y the !e$ian e!inence of the hypothala!us
Correct
Fhich of the follo-ing syste!ic effects are !ost likely to &e cause$ &y a space occupying lesion
in the &rain:
@ra$ycar$ia
Kour ans-er
Hypotension
<achycar$ia
<achypnoea
Cenous ulceration
<he craniu! is a fi.e$ 0olu!e containing &loo$, C() an$ &rain tissue in equili&riu!. ,ncreases in
one co!ponent can &e co!pensate$ &y a $ecrease in the other co!ponents -ithout increasing
intracranial pressure +the Monroe-Tellie $octrine/. @eyon$ a certain point, this co!pensation is
insufficient, an$ raise$ intracranial pressure results +greater than 19-12!!Hg/.
<he effects of raise$ intracranial pressure are hy$rocephalus, cere&ral ischae!ia +$ue to
$ecrease$ cere&ral perfusion pressure/ an$ syste!ic effects. <he syste!ic effects inclu$e
hypertension, &ra$ycar$ia, slo-e$ respiration an$ gastric ulceration +CushingIs ulcer/. <hese are
thought to &e $ue to autono!ic $ysregulation resulting fro! hypothala!ic co!pression.
,ncorrect
Fhich of the follo-ing &ioche!ical para!eters -oul$ not &e useful in $istinguishing hae!olysis
fro! hae!orrhage in an anae!ic patient:
(ingle &est ans-er question J choose "1> correct option only
(eru! ferritin Correct ans-er
(eru! haptoglo&in
(eru! L7H
@iliru&in
(eru! iron Kour ans-er
Fith hae!olysis, iron is recycle$ &y co!&ining -ith seru! haptoglo&in -hich falls as a result.
atients -ith hae!olytic states $o not therefore &eco!e iron $eficient, unlike patients -ho are
&lee$ing -ho lose on a0erage 1!g of iron -ith e0ery !L of &loo$. ?ncon'ugate$ &iliru&in is
!arker of hae!olyis an$ is generate$ &y the &reak$o-n of the Hae! ring fro! hae!oglo&in. ,n
a$$ition, L7H is release$ fro! re$ &loo$ cells if hae!olysis is intra0ascular.
,ncorrect
Fhich of the follo-ing physiological characteristics relates to the lining of the respiratory tract:
A&out 1 litre of !ucus is pro$uce$ e0ery $ay
<he cilia are un$er the control of a physiological !otor, $ynein
Correct ans-er
<he !ucociliary escalator !o0es at 9.2 c!;!inute
<he &ronchioles ha0e cartilage in their -all
<he &ronchioles ha0e $ia!eters up to 2 !!
Kour ans-er
A&out 199 !l of !ucus is pro$uce$ e0ery $ay. <he cilia are un$er the control of a physiological
!otor, $ynein +-hich is a&sent in TartagenerIs syn$ro!e/. <he !ucociliary escalator !o0es at 2
c!;!inute. <he &ronchioles $o not ha0e cartilage in their -all +-hich $istinguishes the! fro!
&ronchi/. <he &ronchioles can &e up to 1 !! in $ia!eter
Correct
<he Chief cells of the sto!ach pro$uce -hich of the follo-ing su&stances:
=astric aci$
,ntrinsic factor
epsinogen Kour ans-er
Mucus
(o!atostatin
Chief cells pro$uce pepsinogen -hich is a precursor an$ is acti0ate$ to pepsin &y gastric aci$.
epsin $igests protein. =astric parietal cells pro$uce gastric aci$ J hy$rochloric aci$. ,ntrinsic
factor is also pro$uce$ &y parietal cells an$ is necessary for 0ita!in @12 a&sorption in the
ter!inal ileu!. Mucus cells pro$uce !ucus -hich for!s a protecti0e layer o0er the gastric
!ucosa pre0enting auto$igestion.
,ncorrect
Hypothyroi$is! $ue to $isease of the thyroi$ glan$ is associate$ -ith increase$ plas!a le0el of:
Cholesterol
Correct ans-er
Al&u!in
E<%
,o$i$e
<hyroi$ &in$ing glo&ulin +<@=/
Kour ans-er
<hyroi$ hor!one lo-ers circulating cholesterol le0el. <he plas!a cholesterol le0el $rops &efore
the !eta&olic rate rises
Correct
Eegar$ing the clinical physiology of the a$renal glan$ in CushingIs $isease, -hich of the
follo-ing pertains: (ingle &est ans-er question J choose "1> true option only
<he Aona glo!erulosa of the corte. is pre$o!inantly responsi&le for se. steroi$ pro$uction
<he Aona fasciculata is pre$o!inantly controlle$ &y AC<H an$ is often hypertrophie$
A 2#-year-ol$ -o!an un$ergoes resection of the ter!inal ileu! -ith fashioning of an ileosto!y
for CrohnIs $isease. (o!e 2 -eeks after surgery, she is !aking a goo$ reco0ery, an$ is eating a
high-energy, lo--resi$ue $iet, &ut has a high ileosto!y 0olu!e, necessitating intra0enous flui$
replace!ent. Her seru! calciu! concentration is 1.62 !!ol;l, phosphate 1.26 !!ol;l, alkal
Eeply to HalaEeport
ost H2
Kour ans-er
<he Aona reticularis is pre$o!inantly responsi&le for !ineralocorticoi$ pro$uction
A&out 12M of glucocorticoi$ pro$uction takes place in the a$renal !e$ulla
<he Aona fasciculata is pri!arily responsi&le for !ineralocorticoi$ pro$uction
<he Aona glo!erulosa of the corte. is pre$o!inantly responsi&le for !ineralocorticoi$
pro$uction, the Aona fasciculata for glucocorticoi$ pro$uction an$ the Aona reticularis for se.
corticoi$ pro$uction. <he a$renal !e$ulla originates fro! the neural crest an$ hence there is
al!ost co!plete $e!arcation of function, -ith the !e$ulla &eing responsi&le for the pro$uction
of catechola!ine-relate$ co!poun$s
,ncorrect
Fhich of the follo-ing !eta&olic effects is !ost likely to &e cause$ &y thyroi$ hor!one:
7ecrease$ glycogenolysis in the li0er
,ncrease$ glucose a&sorption in the gut
Correct ans-er
7ecrease$ lipolysis
7ecrease$ e.pression of U a$renergic receptors
Kour ans-er
7ecrease$ o.ygen uptake in the !itochon$ria
<hyroi$ hor!one has -i$esprea$ !eta&olic effects.
,ncrease$ glycogenolysis in the li0er, increase$ glucose a&sorption in the gut an$ increase$
insulin &reak$o-n all ten$ to increase &loo$ glucose. <he glycogenolytic effects of
catechola!ines are also potentiate$. <hese effects can !ake the $iagnosis an$ !anage!ent of
$ia&etes in thyroto.icosis $ifficult.
<here is an o0erall lipolytic effect, -ith $ecrease$ seru! cholesterol seen in thyroto.icosis, an$
an increase in hypothyroi$is!.
<here is an increase$ e.pression of &-a$renergic receptors in !any tissues inclu$ing skeletal
an$ car$iac !uscle. <here is a positi0e inotropic effect -ith increase$ car$iac output an$ heart
rate.
A raise$ !eta&olic rate an$ increase$ heat pro$uction are $ue to increase$ o.ygen uptake an$
A< pro$uction in the !itochon$ria.
<here are also effects on &one, -ith an o0erall &reak$o-n of &one, so!eti!es lea$ing to
hypercalcae!ia. ,ncrease$ seru! 2,% 7= lea$s to a right shift of the hae!oglo&in $issociation
cur0e. <hyroi$ hor!ones are also essential for fetal $e0elop!ent, -ith $eficiency lea$ing to
cretinis!. <he fetus pro$uces its o-n hor!one fro! 16 -eeks of gestation.
Correct
A patient in the intensi0e care unit follo-ing li0er transplant surgery has a !eta&olic alkalosis.
Fhich of the follo-ing &ioche!ical a&nor!alities is M"(< specifically in$icati0e of this: (ingle
&est ans-er question - choose "1> true option only
Aci$ic urine
High arterial &loo$ pH +lo- hy$rogen-ion concentration/
High arterial partial pressure of car&on $io.i$e p+C"2/
High plas!a &icar&onate concentration
Kour ans-er
Hypochlorae!ia
Arterial pH is increase$ in &oth !eta&olic an$ respiratory alkalosis: plas!a &icar&onate is al-ays
increase$ in !eta&olic alkalosis an$ can &e lo- in chronic respiratory alkalosis. A high p+C"2/
can occur in !eta&olic alkalosis as a result of respiratory co!pensation, &ut it is also a feature
of respiratory aci$osis. Although the urine !ay &eco!e para$o.ically aci$ic in !eta&olic
alkalosis, it is nor!ally aci$ic, e.cept so!eti!es i!!e$iately follo-ing a !eal. Hypochlorae!ia
is present in !eta&olic alkalosis $ue to a loss of gastric aci$, &ut !ay not occur -ith alkalosis
fro! other causes.
Correct
Fhich of the follo-ing is 1"< a characteristic of the loop of Henle:
,s un$er the control of al$osterone
,s per!ea&le to -ater an$ electrolytes along its $istal li!&
ro.i!al li!& a&sorption is isotonic
=enerates high os!olality in the renal !e$ulla
,s i!per!ea&le to -ater along its $istal li!& Kour ans-er
<he loop of HenleIs !ain function is to pro$uce a high !e$ullary os!olality -hich is the $ri0ing
force for -ater rea&sorption fro! the collecting $ucts. ,n the loop of Henle there is a
concentration an$ re$uction in 0olu!e of filtrate as so$iu! an$ chlori$e pass into the
$escen$ing li!& an$ -ater is os!otically !o0e$ out. ,n the ascen$ing li!& there is acti0e
rea&sorption of so$iu! chlori$e fro! the filtrate pro$ucing a lo- os!olality filtrate. Al$osterone
acts on the $istal con0olute$ tu&ules an$ collecting $ucts.
Correct
Fhich of the follo-ing hor!ones is synthesise$ in the hypothala!us an$ secrete$ fro! the
posterior pituitary:
Anti $iuretic hor!one +A7H/
Kour ans-er
A$renocorticotrophic hor!one +AC<H/
Corticotrophin releasing hor!one +CEH/
<hyrotrophin releasing hor!one +<EH/
<hyroi$ sti!ulating hor!one +<(H/
Casopressin +A7H/ an$ o.ytocin are synthesise$ in the hypothala!ic nuclei an$ pass $o-n
a.ons to the posterior pituitary -here they are secrete$ into the &loo$ strea!.
,n contrast, the trophic hor!ones such as CEH an$ <EH are secrete$ &y the hypothala!us in
response to neural sti!uli, an$ $rain into the hypothala!oJhypophyseal portal 0essels to the
anterior pituitary. <here is then resultant sti!ulation of AC<H an$ <(H secretion. <he other
hor!ones pro$uce$ &y a si!ilar !echanis! &y the anterior pituitary are gro-th hor!one +=H/,
prolactin +EL/, lutenising hor!one +LH/ an$ follicle sti!ulating hor!one +)(H/.
,ncorrect
A 21-year-ol$ !ale !e$ical stu$ent -ho has &een feeling non-specifically un-ell for se0eral
$ays is notice$ to ha0e slightly icteric sclerae &y his girlfrien$ an$ has li0er function tests
perfor!e$. <he results of these are nor!al apart fro! a seru! &iliru&in concentration of ##
!!ol;l +%J15/. His urine $oes not contain &iliru&in.
Fhich of the follo-ing is the !ost likely $iagnosis: (ingle &est ans-er question J choose "1>
true option only
7u&inJ*ohnson syn$ro!e
=il&ertIs syn$ro!e
Correct ans-er
Here$itary spherocytosis
,nfectious !ononucleosis
Kour ans-er
Eotor syn$ro!e
7u&inJ*ohnson, Eotor an$ =il&ertIs syn$ro!es are all inherite$ $isor$ers of &iliru&in !eta&olis!.
Ho-e0er, in the first t-o, there is a $efect in the secretion of &iliru&in fro! the li0er an$ the
&iliru&in that accu!ulates in the plas!a is con'ugate$, -ater-solu&le an$ thus is e.crete$ in the
urine.
,nfectious !ononucleosis can cause hepatitis an$ 'aun$ice &ut an ele0ate$ transa!inase acti0ity
-oul$ &e e.pecte$. Here$itary spherocytosis is a chronic hae!olytic $isor$er $ue to a $efect in
the re$ cell !e!&rane +!ost frequently in spectrin, a structural protein/. ,t can present -ith a
-i$e range of se0erity, fro! 'aun$ice at &irth to asy!pto!atic anae!ia or 'aun$ice in a$ults,
&ut is !uch less co!!on +appro.i!ately 1:2999 in 1orthern >uropeans/ than =il&ertIs
syn$ro!e +appro.i!ately 1:29/.
Correct
Fhich of the follo-ing is 1"< a $efining feature of the syste!ic infla!!atory response
syn$ro!e +(,E(/:
<e!perature L%5.2 oC
Kour ans-er
Heart rate L89;!in
Eespiratory rate L29;!in
aC"2 V%2 !!Hg +#.% ka/
Fhite &loo$ cell count of L12 .198;l
(,E( is the syn$ro!e arising fro! the &o$yIs infla!!atory reaction to a $a!aging insult such as
infection, trau!a, &urns or acute pancreatitis. (,E( is recognise$ &y the presence of the
follo-ing clinical criteria:-
S <e!perature L%6 oC or V%3 oC
S Heart rate L89;!in
S Eespiratory rate L29;!in or aC"2 V%2 !!Hg +#.% ka/
S Fhite &loo$ cell count of L12 .198;l, or V# .198;l, or the presence of L19 M i!!ature for!s
Correct
Fhich of the follo-ing state!ents fulfil the criteria for the correct $efinition of sepsis:
<he presence of !icro-organis!s in the &loo$ strea!
<he presence of !icro-organis!s -ithin a nor!ally sterile 0iscus
Hypotension refractory to resuscitation in the presence of $e!onstra&le infection
A syste!ic infla!!atory response occurring as a $irect result of infection Kour ans-er
A raise$ respiratory rate , a high -hite cell count an$ the presence of a pro0en source of
infection
<he A!erican College of Chest hysicians an$ the (ociety of Critical Care ha0e $efine$ sepsis as
a syste!ic infla!!atory response syn$ro!e +(,E(/ as the result of a confir!e$ infectious
process.
<he (,E( is $efine$ -hen t-o of the follo-ing are present:
O yre.ia
O <achycar$ia
O <achypnoea
O A raise$ -hite cell count
As a (,E( can occur secon$ary to non infectious causes +e.g. trau!a, !alignancy/, sepsis is
$efine$ as a (,E( occurring as a $irect result of infection.
,ncorrect
<he %4 N 24 e.onuclease acti0ity possesse$ &y so!e 71A poly!erases that ena&les the enAy!e
to replace !isincorporate$ nucleoti$e is calle$ -hat:
roofrea$ing
Correct ans-er
Eeplication
Eeco!&ination
Kour ans-er
Eetrotransposition
(plicing
Eetrotransposition is transposition 0ia an E1A inter!e$iate +transposition is the !o0e!ent of a
genetic ele!ent fro! one site to another in a 71A !olecule/. (plicing is the re!o0al of introns
fro! the pri!ary transcript of a $iscontinuous gene.
Correct
Fhich of the follo-ing is pro$uce$ &y the $uo$enu!:
Cholecystokinin
(ecretin Kour ans-er
A!ylase
Lipase
>lastase
<he $uo$enu! secretes secretin in response to aci$ chy!e fro! the sto!ach. (ecretin
pro!otes pro$uction of -ater an$ &icar&onate fro! the pancreatic $uct cells.
,ncorrect
A 22-year-ol$ !an is a$!itte$ to hospital -ith persistent 0o!iting. He is clinically $ehy$rate$
an$ hypotensi0e. His seru! so$iu! concentration is 12# !!ol;l, potassiu! #.8 !!ol;l, urea 8.6
!!ol;l, creatinine 83 !!ol;l. ?rine so$iu! concentration in a speci!en passe$ on a$!ission is
32 !!ol;l.
Fhich of the follo-ing is the !ost likely cause of the hyponatrae!ia:
A$renal failure
Correct ans-er
Cere&ral salt -asting
=astrointestinal flui$ loss
Kour ans-er
Lo- so$iu! intake
(yn$ro!e of inappropriate anti$iuresis +(,A7/
1atriuresis in a $ehy$rate$, hyponatrae!ic patient suggests that there is uncontrolle$ renal loss
of so$iu!, such as occurs in a$renal failure. Cere&ral salt -asting can also cause $ehy$ration
an$ hyponatrae!ia $ue to e.cessi0e natriuresis, &ut typically occurs follo-ing a hea$ in'ury or
&rain surgery. Hyponatrae!ia an$ $ehy$ration $ue to gastrointestinal flui$ loss or so$iu!
$eficiency $ue to a lo- intake shoul$ lea$ to renal conser0ation of so$iu!. Although (,A7 is an
i!portant cause of hyponatrae!ia an$ so$iu! e.cretion !ay &e high, the hyponatrae!ia is $ue
to -ater e.cess an$ patients are not $ehy$rate$.
Correct
Kou are calle$ to ,C? to see a 32-year-ol$ patient -ho requires controlle$ !echanical 0entilation
after !a'or non-car$iac surgery &ut is &eco!ing hypo.ae!ic -hen the )i"2 is re$uce$ fro! 9.#
to 9.%.
Fhich of the follo-ing state!ents is true: (ingle &est ans-er question J choose "1> true option
only
(i!ple in$ices of circulatory status J such as urine output, &loo$ pressure an$ CC J correlate
-ell -ith outco!e fro! high-risk surgery
(ur0i0ors after !a'or surgery $ecrease their car$iac in$e. an$ o.ygen $eli0ery in the
perioperati0e perio$ &elo- &aseline nor!al 0alues
Measure!ent of !i.e$ 0enous o.ygen saturation +(C"2/ requires a pul!onary 0enous +C/
catheter to sa!ple pul!onary capillary &loo$
Car$iac in$e. an$ o.ygen $eli0ery correlate poorly -ith outco!e fro! high-risk surgery
re- or perioperati0e &eta-&locka$e can i!pro0e sur0i0al after !a'or non-car$iac surgery in
patients -ith pre-e.isting car$iac $isease
Kour ans-er
(i!ple in$ices of circulatory status J such as urine output, &loo$ pressure an$ CC J correlate
poorly -ith outco!e fro! high-risk surgery. (ur0i0ors after !a'or surgery increase their car$iac
in$e. an$ o.ygen $eli0ery in the perioperati0e perio$ a&o0e &aseline nor!al 0alues.
Measure!ent of !i.e$ 0enous o.ygen saturation +(C"2/ requires a pul!onary artery +A/
catheter to sa!ple pul!onary capillary &loo$. Car$iac in$e. an$ o.ygen $eli0ery correlate -ell
-ith outco!e fro! high-risk surgery. <-o recent !ulticentre trials ha0e confir!e$ the
a$0antage of using highly selecti0e pre- or perioperati0e &eta-&locka$e to i!pro0e sur0i0al after
!a'or non-car$iac surgery in patients -ith pre-e.isting car$iac $isease, eg pre0ious heart
failure, !o$erate hypertension an$ !yocar$ial infarction +M,/. <he regi!e is starte$ #6J52 h
preoperati0ely an$ continue$ for 1#J26 $ays post-surgery.
Correct
A 52 kg !an has suffere$ acute loss of 22 M of his &loo$ 0olu!e, has a pulse rate of 119;!in, a
0entilatory rate of 22;!in an$ a urine output of 22 !l;h. Fhich class of hae!orrhagic shock
!ost appropriately $escri&es this patient:
Class , hae!orrhagic shock
Class ,, hae!orrhagic shock Kour ans-er
Class ,,, hae!orrhagic shock
Class ,C hae!orrhagic shock
1one of the a&o0e
<he patient e.hi&its signs of class ,, hae!orrhagic shock. A<L(N gui$elines classify
hae!orrhagic shock into # categories as sho-n in the ta&le &elo-:-
Class Class , Class ,, Class ,,, Class ,C
@loo$ loss +!l/ V529 529 - 1299 1299 - 2999 L2999
M &loo$ 0ol lost V12M 12 - %9M %9 - #9M L#9M
ulse rate +!in/ V199 L199 L129 L1#9
(ystolic @ ?nchange$ ?nchange$ 7ecrease$ 7ecrease$
7iastolic @ ?nchange$ ,ncrease$ 7ecrease$ 7ecrease$
ulse ressure ?nchange$ 7ecrease$ 7ecrease$ 7ecrease$
?rine output +!l;h/ L%9 29 - %9 2 - 12 Anuria
C1( features (light an.iety Mil$ an.iety An.iety;Confusion Confusion
Correct
Myeloi$ ste! cells gi0e rise to se0eral $ifferent cell types. Fhich of the follo-ing is not one of
these:
1eutrophils
Monocytes
latelets
Ly!phocytes Kour ans-er
Macrophages
@one !arro- pro$uces pluripotential ste! cells -hich gi0e rise to t-o lines of cells J !yeloi$
an$ ly!phoi$ ste! cells. Myeloi$ ste! cells $ifferentiate into the poly!orphonuclear leucocytes
J neutrophils, eosinophils an$ &asophils. ,t also gi0es rise to !onocytes an$ !acrophages. <he
ly!phoi$ ste! cell line pro$uces ly!phocytes, &oth < an$ @ types.
,ncorrect
A 52-year-ol$ -o!an is &eing follo-e$ &y her = for suspecte$ $e0eloping pri!ary
hypothyroi$is!.
Fhich of the follo-ing &ioche!ical changes -oul$ you !ost e.pect to occur first:
)all in seru! free thyro.ine
Kour ans-er
)all in seru! thyro.ine-&in$ing glo&ulin
)all in seru! free triio$othyronine
)all in seru! total triio$othyronine
,ncrease in seru! <(H
Correct ans-er
Hypothyroi$is! $e0elops gra$ually, often o0er !any !onths or e0en years. ,n the early stages,
free thyro.ine concentrations are !aintaine$ in the nor!al range &y the increase$ secretion of
<(H. atients -ith a slightly ele0ate$ <(H an$ lo-Jnor!al thyro.ine are sai$ to ha0e
Wco!pensate$I or W&or$erlineI hypothyroi$is!. ,n so!e in$i0i$uals, it appears that this state can
&e !aintaine$ -ithout progression to frank hypothyroi$is!. <riio$othyronine concentrations
ten$ to fall later than thyro.ine concentrations in hypothyroi$is!D the concentration of
thyro.ine-&in$ing glo&ulin $oes not change significantly
,ncorrect
,n esti!ating the physiological clearance of 19 !l of an intra0enous su&stance -hich has &een
a$!inistere$ at 19 !g;!l, the plas!a concentration at equili&ration is 12 !g;litre, the urine
concentration is 129 !g;litre an$ the su&'ect pro$uces 1##9 !l of urine $uring a 2#h collection.
Fhat is the clearance of the su&stance: (ingle &est ans-er question J choose "1> true option
only
1 !l;!in
19 !l;!in
Correct ans-er
9.1 !l;!in
199 !l;!in
Cannot say fro! the infor!ation gi0en
Kour ans-er
Clearance is calculate$ using the for!ula +? X C/; -here ? P urine concentration in !g;!l, C P
urine pro$uction in !l;!in, P plas!a concentration in !g;!l.
<he &olus siAe of the su&stance is irrele0ant to the clearance.
,ncorrect
Fhich of the follo-ing organs has the greatest &loo$ flo- per 199 g of tissue:
@rain
Heart
(kin
Li0er
Kour ans-er
Ti$neys
Correct ans-er
"rgan
@loo$ flo- in !l;199g;!in
Ti$neys
#29.9
Heart
6#.9
Li0er
25.5
@rain
2#.9
(kin
12.6
,ncorrect
<he action potential of skeletal !uscle:
Has a prolonge$ plateau phase
(prea$ in-ar$s to all parts of the !uscle 0ia the < tu&es
Correct ans-er
Causes i!!e$iate uptake of Ca into the sarcoplas!ic reticulu!
Kour ans-er
,s longer than the action potential of car$iac !uscle
,s not essential for contraction
<he action potential of the skeletal !uscle sprea$s out fro! the !otor en$ plate, through the <
tu&e syste! this causes !o&iliAation of Ca2B fro! the sarcoplas!ic reticulu! to the cytoplas!
an$ this action potential is essential for contraction.
<he action potential of car$iac !uscle is longer than that of the skeletal !uscle an$ has plateau
phase.
,ncorrect
@otulinu! to.in has -hich of the follo-ing features:
,t is pro$uce$ &y a =ra!-positi0e, aero&ic &acillus
<he &acillus has 12 serotypes
,ts !ain acti0ity is at the presynaptic !e!&rane
Kour ans-er
,t !ay &e use$ in the treat!ent of !yasthenia gra0is
,t !ay &e use$ in the treat!ent of &lepharospas!
Correct ans-er
Clostri$iu! &otulinu! is a =ra!-positi0e, spore-for!ing, o&ligate anaero&e. <he &acillus has
se0en serotypes, A to =. <hey ha0e a -i$e range of therapeutic usage, fro! gla&ellar lines,
&lepharospas!, spasticity, anis!us, anal fissure to $ystonia. Ho-e0er, !yasthenia gra0is -oul$
&e e.pecte$ to -orsen -ith such treat!ent.
,ncorrect
A %#-year-ol$ -o!an -ith a &o$y !ass in$e. of ## kg;!2 seeks !e$ical help for her o&esity.
Fhich one of the follo-ing treat!ents offers her the highest pro&a&ility of achie0ing a long-ter!
re$uction in -eight: (ingle &est ans-er question J choose "1> true option only
An energy-$eficient $iet +399 kcal;$ay +Y 1#% *;$ay/ less than require!ents/ for 3 !onths
*a---iring an$ !ilk fee$ing for % !onths
<reat!ent -ith orlistat for 12 !onths
<reat!ent -ith si&utra!ine for 12 !onths
Kour ans-er
Certical &an$e$ gastroplication
Correct ans-er
@oth si&utra!ine an$ orlistat ha0e &een sho-n to in$uce an$ !aintain a greater -eight loss
than $iet alone, &ut a patientIs -eight often plateaus &efore a$equate -eight loss has occurre$.
"rlistat is only license$ for use for 1 year in the ?T, an$ si&utra!ine for 2 years. >nergy-
$eficient $iets, particularly if couple$ -ith increase$ e.ercise, are effecti0e, &ut the lost -eight
is al!ost in0aria&ly regaine$, as it is after 'a---iring an$ !ilk fee$ing. (urgery offers the &est
chance of achie0ing long-ter! -eight loss, the results fro! 0ertical &an$e$ gastroplication
co!&ine$ -ith a &y-pass proce$ure &eing e0en &etter than those -ith gastroplication alone
Correct
A %2-year-ol$ -o!an on nasogastric aspiration for paralytic ileus follo-ing surgery $e0elops a
!eta&olic alkalosis.
Fhich of the follo-ing intra0enous flui$s -oul$ &e the preferre$ treat!ent for the alkalosis:
2M $e.trose
7e.trose saline
1or!al +9.8M/ saline
Kour ans-er
EingerIs lactate
<-ice nor!al +1.6M/ saline
<he !eta&olic alkalosis secon$ary to a loss of gastric aci$ is a hypochlorae!ic alkalosis. <his is
perpetuate$ &y the hyperchlorae!ia, -hich pre0ents renal e.cretion of the e.cess &icar&onate
since its pro.i!al tu&ular rea&sorption +-ith so$iu!/ is enhance$. ro0ision of a$equate chlori$e
ions allo-s the e.cess &icar&onate to &e e.crete$ an$ corrects the alkalosis. 7e.trose 2M
contains no chlori$e an$ $e.trose saline contains insufficient for this purpose. <-ice nor!al
saline is occasionally use$ for treating se0ere hyponatrae!ia &ut has no place in this clinical
situation. EingerIs lactate is inappropriate, since the !eta&olis! of the lactate that it contains to
&icar&onate -oul$ e.acer&ate the alkalosis.
Correct
<he actions of acti0e Cita!in 7 inclu$e all of the follo-ing e.cept:
,ncrease$ calciu! e.cretion fro! the ki$neys
Kour ans-er
,nhi&ition of <H release fro! the parathyroi$ glan$s
,ncrease$ phosphate a&sorption fro! the intestines
,ncrease$ calciu! a&sorption fro! the intestines
,ncrease$ &one !ineralisation
Acti0e Cita!in 7 plays a crucial role in the ho!eostasis of calciu!. Fhether the source is fro!
the skin or $ietary, 22- an$ 1-alpha hy$ro.ylation is require$ in the li0er an$ ki$ney respecti0ely
to con0ert Cita!in 7 into its !eta&olically acti0e for!. ,ts !ain function in calciu! ho!eostasis
inclu$es an increase in the a&sorption of &oth calciu! an$ phosphate fro! the gut an$ the
sta&ilisation an$ the pro!otion of !ineraliAation in &one. ,t also acts $irectly on the parathyroi$
glan$ to inhi&it the release of <H. <his pro0i$es a negati0e fee$&ack !echanis! as <H is
require$ for hy$ro.ylation of Cita!in 7 in the ki$ney.
,ncorrect
Kou are aske$ to see a patient -ho ha$ a chest $rain re!o0e$ # $ays ago. <here appears to &e
so!e infection.
Fhat are the stages in the cell &iology of nor!al -oun$ healing:
7e!olition is the first phase
Kour ans-er
Maturation an$ re!o$elling can continue for up to a year
Correct ans-er
Acute infla!!ation usually lasts for 3J12 hours
>pithelial cell proliferation is the hall!ark of the $e!olition phase
Collagen $eposition is the key process $uring $e!olition
<he first phase in healing &y first intention is the phase of acute infla!!ation that lasts up to %
$ays, if unco!plicate$. <he initiating factor appears to originate fro! platelets acti0ate$ &y
!ature collagen e.pose$ in the -oun$. latelets first aggregate then release a 0ariety of acti0e
agents inclu$ing lysoso!al enAy!es, A<, serotonin an$ -oun$ cytokines. A fi&rin clot $e0elops,
-hich co!pletes hae!ostasis an$ pro0i$es strength an$ support to the -oun$. <he surface
$ries to for! a sca&. latelets an$ !acrophage factors cause local 0aso$ilatation, -hich
pro$uces -ar!th an$ increases capillary per!ea&ility, allo-ing seru! an$ -hite &loo$ cells to
accu!ulate an$ cause s-elling.
After the initial acute infla!!ation, !acrophages &eco!e acti0e as the !ain agents of
$e!olition, re!o0ing un-ante$ fi&rin, $ea$ cells an$ &acteria an$ creating flui$-fille$ spaces for
granulation tissue. Macrophages also release factors that sti!ulate the for!ation of ne-
capillary &u$s $uring this phase, an$ later they initiate an$ control fi&ro&last acti0ity $uring
repair. Fithin the connecti0e tissue, ran$o!ly orientate$ collagen &egins to for! after a fe-
$ays, reaching a peak of acti0ity after 2J5 $ays.
>pithelial cells at the e$ge of the -oun$ start to proliferate after 2# h an$ this phase can last for
up to % -eeks.
Eeply to HalaEeport
ost H%
)inally, the phase of !aturation an$ re!o$elling lasts for up to 12 !onths, $uring -hich ti!e
the tensile strength of the -oun$ increases an$ the ran$o! collagen is replace$ &y a !ore
sta&le for! orientate$ along lines of stress.
,ncorrect
Fhich of the follo-ing is the !ost i!portant $irect sti!ulus to respiration:
,ncrease$ pC"2 of the C()
Kour ans-er
,ncrease$ HB concentration of the C()
Correct ans-er
7ecrease$ arterial p"2
7ecrease$ arterial pH
7ecrease$ arterial pC"2
Che!oreceptors in0ol0e$ -ith the control of respiration are present in the central ner0ous
syste! an$ peripherally. <he central che!oreceptors are situate$ in the 0entral !e$ulla, an$
increase firing in response to the HB concentration of the &rain e.tra cellular flui$, -hich is
$irectly relate$ to the HB concentration in the C(). C"2 ; HC"% cannot cross the &loo$ &rain
&arrier, &ut C"2 $oes so rea$ily. <his frees HB ions, causing a lo- C() pH, increase$ firing of the
central che!oreceptors an$ increase$ 0entilation.
eripheral che!oreceptors are foun$ in the caroti$ &o$ies an$ aortic arch, an$ increase their
firing rate in response to $ecrease$ a"2, $ecrease$ arterial pH an$ increase$ paC"2. <hese
are !uch less i!portant, ho-e0er, in sti!ulating respiration than the central che!oreceptors.
,ncorrect
Fhat is the ter! for the 0olu!e of e.pire$ air at force$ e.piration:
)orce$ 0ital capacity +)CC/ Correct ans-er
)unctional resi$ual capacity +)EC/
>.piratory reser0e 0olu!e +>EC/ Kour ans-er
Eesi$ual 0olu!e +EC/
<otal 0olu!e +<C/
)CC is the a!ount of air e.pelle$ $uring force$ e.piration an$ has clinical significance. ,t is
re$uce$ in restricti0e $isease.
)EC is the 0olu!e of gas left in the lung at the en$ of quiet respiration.
>EC is the !a.i!u! 0olu!e of e.pire$ air.
EC is the 0olu!e of air re!aining in the lungs after force$ e.piration +)EC/.
<C is the total 0olu!e of air in the lungs an$ inclu$es the resi$ual 0olu!e.
,ncorrect
Eeply to HalaEeport
ost H#
MEC( part , 19 sept 2995 recalls
these are the questions i a&le to re!e!&er.
(@A questions
1/ young !an has pel0ic fracture ---L su$$en onset of acute urinary retention. Fhat is the
possi&le cause:
a/ urethral in'ury
&/ &la$$er rupture
c/ ureter in'ury
2/ Causes of raise (A
a/ rostatic ca
&/ prostitis
%/ @ee sting, presente$ -ith HE 129, @ 39;#9
first treat!ent....
a/ ,C antihista!ine
&/ ,C flui$
c/ ,C steroi$
$/ local antihista!ine
e/ s;c a$renaline
#/ nora$renaline &in$s to...
a/ a1 receptor
&/ a2 receptor
c/ &1 receptor
$ &2 receptor
2/ post op $e0elope$ high glucose le0el. prior to op, pt is not 7M. <his is $ue to .....
=H secretion post-op:
3/ pt has splenic rupture. $enie$ any trau!a. -hat infection can cause spenic rupture:
a/ >@C
&/ !u!ps
c/ !easles
5/ recurrent ?<,, pneu!uria, an$ irregular &o-el ha&its. C< sho-n !ass in0ol0e$ &oth the
sig!oi$ an$ &la$$er.
a/ $i0erticulitis
&/ sig!oi$ ca
c/ Crohn4s $s
$/ ?C
loss of appetite, !alaise, !ultiple ly!pha$enopathy in0ol0e!ent...a.illary, inguinal
a/ !alignant ly!pho!a
8/ -hat is the course of !e$ian ner0e relate$ to &rachial a.
.......fro! !e$ial to ant to lat to &rachial a.
19/ a cut a&o0e the ulnar olecranon cause un&ale to e.ten$ ?L. -hat is the ten$on &eing cut:
---L tricep ten$on
11/ sprinting $uirng playing foot&all --L pain an$ post of the thigh. later se0ere pain an$ the lat
si$e of the knee. una&le to e.ten$ knee $t pain. -hat is the ten$on &eing in0ol0e:
--L ten$on of &iceps fe!oris
12/ the first structure &eing note$ after open up the popliteal fossa
a/ popliteal 0ein
&/ fe!oral n
c/ popliteus
1%/ acci$ent --L !ultiple ti&ial an$ fi&ula H --L intra!e$ullary nailing $one. 3 hours later ---L
se0ere pain at leg
a/ 7C<
&/ co!part!ent syn$ro!e
1#/ !alaise, -eight loss, cer0ical ly!p no$es. &iopsy --L epithelio$ !acrophages an$ giant cell
----L <@
12/ the &or$er of the snuff &o.
a/ e.tensor pollicis longus
&/ a&$uctor pollicis &re0is
c/ fle.or $igitoru! longus
13/ cut at the !i$line &et-een the &ase of the little finger an$ the -rist ---L cause loss of thu!&
a$$uction po-er
-hat is the ner0e &eing in'ure$:
a/ superficial ulnar n
&/ $eep ulnar n
c/ !e$ial ner0e
$/ ra$ial n
15/ after the 0aricose 0ein surgery, loss sensation an$ the $orsal of the foot, una&le to $orsifle.
the foot
-hat is the ner0e &eing in'ure$:
a/ co!!on peroneal n
&/ sup peroneal n
c/ $eep peroneal n
1 2-$ays ol$ neonates, cyanoses at the LL. Feak pulse an$ LL. @ 39;#9 an$ &oth ?L.
-hat is the a&n
a/ pul!onary atresia
&/ aortic arch a&n
c/ C(7 -ith pul stenosis
18/ trau!a to the chest, CXE sho-n -i$ening of the !e$iastinu!. -hat of the structure &eing
rupture:
ascen$ing aorta
$escen$ing aorta
29/ a knife penetrate the !i$line of the sternal angle -ith in'ure
a/ trachea
&/ oesophagus
c/ sup 0ena ca0a
$/ aAygos C
21/ ,1 surgical ,C?, pt $e0elop !eta&olic aci$osis. -hat is the !ost co!!on cause:
a/ 0o!iting
&/ nasogastric aspiration
i -ill post later....pls other -ho! re!e!&er pls post
Eeply to HalaEeport
ost H2
-hat is the acute !anage!ent for gaining a air-ay in acute resp $istress:
a/ chest tu&e
&/ nee$le thro the cricothyroi$ !e!&rane
fresh &loo$ note$ at the chest tu&e, the &lee$ing is fro!:
a/ intersostal a
&/ pericar$iophrenic a
c/ r 0entricular
insulin $epen$ent, h;o chest infection starte$ -ith anti&iotic, a$!itte$ -ith $ro-siness --L 7TA
-hat is the electrolyte i!&alance
------L hyperkale!ia
non-alcoholic, -ith palpa&le no$ular li0er, &iopsy confir! is HCC. -hat is the cause for the
patient --L H@C cirrhosis
2 $egree partial thickness &urn, $e0elope$ &ilaterally LL s-elling. -hat is the cause: ------L
hypoal&u!ine!ia
hlo &ack pain, -alking cause pain at the L LL, loss os the sensation o0er the surface of the knee,
-hat is the cor$ lesion ----L L%
profuse L=,@, contrast accu!ulate at the left iliac fossa, for 0essel e!&olisation, -hich le0el of
artery is cannulate:
----L L% + inferior !esenteric artery /
$uring prolapse$ inter0entricular $isc, -hat is the structure co!presse$ on the ner0e: --L
nucleus pulposus
after the !astecto!y, the -o!an has a -ing scapula, -hat is the ner0e &eing in'ure$:
-----L long thoracic ner0e
Eeply to HalaEeport
ost H3
-o!an presente$ -ith the lu!p at ant neck, !o0e -ith s-allo-ing, )1AC $one confir! is
!alignancy......-hat is the CA --L papillary thyroi$ ca
a surgery $one for the s-eating pal! $issert at the &ase of the neck ant to the first ri&, -hat is
the co!plication
--L phrenic ner0e in'ury : E $iaphrag! ele0ation
$uring hypotensi0e shock -hat is the first su&stances to &e secrete$
-- angiotensinogen
-- angintensin,
-- angintensin ,,
-- al$osterone
-- renin
a !an ha0 a trau!a o0er the !e$ial part of the thigh, clean -oun$, closure $one. fe- $ay later
patient $e0elope$ pulsatile !ass...
----L false aneurys! of the fe!oral a.
hip replace!ent -o!an, -alk -ith the tre$elen&urg gait. -hat is the $efect:
-- sciatic ner0e
-- gluteus !e$iu!
-- fe!oral ner0e
-hat is the !echanis! of the counter-current in the nephron for the concentration of the urine:
--L i!per!ea&ility of the thick ascen$ing for the -ater
Eeply to HalaEeport
ost H5
MEC(98 *A1 1%<H G?>(<,"1;<H>M>(
Z&[1. FHA< ,( <H> A1<>E,"E @"?17AEK ") )>M"EAL CA1AL
2. FHA< ,( <H> "(<>E,"E FALL ") )>M"EAL CA1AL
%. 7,E>C< ,1=?,1AL H>E1,A ,( <H> F>AT1>(( ") FH,CH FALL 1AM>
#. anterior surface of heart is for!e$ &y
2. heart 0al0e is !a$e of
3. M>1 ,, & co!prises of
5. !e$ullary carcino!a presnts as
6. 1st -e& is supplie$ &y -hich ner0e
8. $istri&ution of supf peroneal ner0e
19. le0el of &ifurcation of aorta
11. le0el of hilu! of ki$ney
12. le0el of inf !esenteric artery
1%. le0el of e.t iliac artery
1#. $istri&ution of genitor fe!oral ner0e
12. $efinition of hypo.ia
13. tissue $e0elop!ent in H atrophy
15. tissue $e0elop!ent in spina &ifi$a hypoplasia
16. post gastrecto!y $eficiency of
18. pt -ith persistent 0o!iting &ioche! a&nor!ality
29. passi0e rectal incontinence sphinter en0ol0e$
21. presentation of long stan$ing catheter
22. tu&ercular cystitis
2%. ner0e supply of ant aspect of knee 't
2#. relation of str at popliteal fossa
22. !uscle attach to lat si$e of popliteal
23. nes of a$$uctor of thigh
25. fle.ion at $istal ip 't at ring finger
26. fle.ion at $istal ip 't at thu!&
28. relation of ulnar ner0e -ith ulnar artery
%9. ulnar in'ury at el&o-
%1. fo!ent sign test for
%2. ner0e for a$$uction of thu!&
%%. $eep &r of ulnar ner0e supply
%#. function of cortisol in stress
%2. ecg changes in pul! e!&olis!
%3. ner0e supply at angle of !outh
%5. lateral &or$er of tongue is supplie$ &y
%6. gastric ly!pho!a are !c of -hich type
%8. cut in'ury at si$e of face -ill cut
#9. epy$y!orchitis in se.ually acti0e !ale -ithout uti
#1. cause of s-elling scrotu! -ith sec neck
#2. !ultiple s-elling all o0er neck;a.ill ;inguinal !alignant ly!pho!a
#%. follicular tu!our thyroi$ ,"C
##. sesation o0er $eltoi$ !uscle
#2. in'ury !e$ial to $eltopectoral groo0e
#3. hea$ of ra$ius articulate -ith
#5. Hea$ of ra$ius is kept in place &y -hich liga!ent
#6. cere&eral perfusion pressure
#8. central che!o receptors
29. &aroreceptors
21. fora!ina for trans!ission of !an$i&ular ner0e
22. fora!ina for trans!ission of 0agus; hypoglossal
2%. fora!ina for trans!ission of !i$$le !eningeal artery
2#. nucleus of 3th an$ 5th cr. 1er0e is at -hich part of &rain
22. surface !arking of heart 0al0e
23. car$iac ta!pona$e can cuase su$$en $eath
25. peptic aci$ secretion is sti!ulate$ &y
26. &ee sting -ith &p 69;39 an$ p.rate 122;!t <t"C
28. $orsu! of foot supplie$ &y -hich ner0e
39. ligation of 0aricocele ulti!ately 0ein lea$in to gona$al 0n
31. relation of 0ein at renal hilu!
32. C"7
3%. &loo$ gas analysis
3#. &loo$ gas analysis
32. &loo$ gas analysis
33. $ifficulty in s!iling ner0e for it
35. pain in inf !olar ner0e responsi&le
36. ganglion for lacri!al $ut
38. ner0e in0ol0e$ in su&!an$i&ular glan$ e.cision
59. type of reaction rhinorrhea -ith rashes after t-o hrs
51. intrinsic factor a&sorption
52. ane!ia in gastrcto!y
5%. iron $eficiency anae!ia
5#. granulo!atous intestinal $is crohn.
52. &iopsy of gastric antru!
53. causati0e agent for gastric ulcer an$ &la$$er carcino!a
55. 0irus i!plicate$ for cer0ical cancer
56. 0irus i!plicate$ for anal cancer
58. 0irus i!plicate$ for Taposi sarco!a
69. pus in $ia&etic cholycystitis e. g. of
61. in'ury at thir$ intercostals space at sternu!
62. thir$ 0entricle to fourth cere&eral $uct of aque$uct
6%. ("L lt in parital causes herniation of
6#. 0erte&ral artey supplies -hich corte.
62. pituitary tu!our causing pressure at optic chias!a
63. erosion at lateral angle of eye &y s-ell in three years
65. position of a!pulla of 0ater opening
66. (CE;C";HE in cr$iogenic shock
68. (CE;C";HE in he!!orrafgicc
89. (CE;C";HE in septic
81. chil$ -ith ear $ischarge fe0er con0ulsion high gra$e fe0er
82. &est criteria fo acute pancreatitis
8%. $iagnostic !arker of carcinoi$
8#. in aneurys! $efect in arterial -all is
82. popliteal aneurys! siAe 2.2 cn!
83. no$ule in rheu!atoi$ arthritis
85. -rist $rop -ekness at el&o-
86. sensation of !i$$le finger root 0alue
88. sensation at lat calf $isc protrusion
86 sensation loss at great toe spinal le0et
199. lspinal le0el in uretric pain
191. passage of s!all stone cause
192. ns of lateral part of ar!
19% parasy!pathetic causes arterial 0aso constriction ;$ilatation
19# sa no$e is iner0ate$ &y
192 a$renaline causes st of -hich receptors
193 role of a$renaline
195 role of $o&uta!ine
196 role of ephe$rtine
198 changes in lung capacity in e!physe!a
119 )>C1;)CC is re$uce$ in
111 ,st to reponse to hae!!orrage
112 atent $uctus arteriosus $e0elop fro!n -hich arch
11% <rau!a to !e$ial thir$ of cla0icle -ill in'ure
11# @en$roflua$iAi$e acts at
112 ,nrease urine os!olalty in
op a$issonian crisis\
115 Left fe!oral hernia op for s!all &o-el o&struction lea$ to chest pain:
116 )actor controlling &p fro! ki$ney
118 ost operati0e hypocalce!ia in thyroi$ ecto!y
129 Mo$e of action in pth in ca !eta&olis!
121 Ca &reast role of in osteoporotic Calcitonin
122 Cuases of hypercalce!ia &urn:
12% &;l s-elling in 39M &urn pt $ue to hypoprotiene!ia
12# insulin is increase$ -ith c pepti$e
122 partail gastrecto!y result in $u!ping syn$ro!e
123 !ultiple neurological en0ol0e!ent in $ia&etes
125 insulin gi0en in hyper glyce!ic -ill
126 effect of cortisol on 0arious hor!one
128 &arretI esophagus L 2c! pathology en0ol0e$
1%9 para neoplastic syn$ro!e see in s!all cell tu!our
1%1 in fetal circulation &loo$ passes fro! rt atriu! to left atriu!
1%2 inter!ittent positi0e pressure incr;$ecreases 0enous return
1%% &asic !echanis! in pul! e!&olis!
1%# post splenecto!y $iffuse opacity lung
cause$ &y pneu!occocal pneu!onia
1%2 ca &rest operation ner0e en0ol0e$ in -inging of scapula
1%3 upper ar! in'ury -ith s-elling an$ pain fascioto!y
Eeply to HalaEeport
ost H6
Hala A$el replie$ to Hala4s post2 hours ago
MEC( art 1 ractice Guestions + hysiology / - 2 of %
Correct
,n a patient -ith anaphyla.is, -hich of the follo-ing shoul$ &e gi0en to inhi&it the i!portant
late-phase reaction: (ingle &est ans-er - choose "1> true option only
Antihista!ines
>pinephrine
Leukotriene inhi&itor
Hy$rocortisone
Kour ans-er
1(A,7
Hy$rocortisone &locks the generation of leukotrienes an$ prostaglan$ins, an$ hence pre0ents
the late-phase reaction often characterise$ &y asth!a. ,t shoul$ &e gi0en
intra0enously;intra!uscularly at a $ose of 199J299 !g. 1one of the other agents liste$ a&o0e
affect this aspect of anaphyla.is. Appro.i!ately %9M of $eaths relate$ to anaphyla.is occur as a
consequence of this late-phase reaction.
Correct
Fhich of the follo-ing is true of &ile:
,s secrete$ into the ter!inal ileu!
,s necessary for protein a&sorption
Contains uro&ilinogen Kour ans-er
,s pro$uce$ &y the cells lining the co!!on &ile $uct
,s concentrate$ in hepatocytes
@ile is a solution of &ile salts +&iliru&in/, pig!ents an$ cholesterol. ,t is secrete$ &y the
hepatocytes an$ concentrate$ in the gall &la$$er. )ollo-ing ingestion of a fat-containing !eal,
cholecystokinin sti!ulates the gall &la$$er -hich in turn contracts an$ e.pels &ile through the
cystic $uct into the co!!on &ile $uct. @ile is secrete$ into the $uo$enu!.
Correct
,n a patient -ith s!all &o-el ischae!ia, -hat !eta&olic picture -oul$ !ost likely &e seen on
&loo$ gas analysis:
Co!pensate$ !eta&olic aci$osis
Meta&olic aci$osis an$ increase$ anion gap
Kour ans-er
Meta&olic aci$osis an$ nor!al anion gap
Meta&olic alkalosis
Eespiratory aci$osis
<his patient has ha$ a significant operation $uring -hich infarcte$ &o-el has &een resecte$. <he
!ost likely a&nor!ality is a !eta&olic aci$osis secon$ary to !esenteric ischae!ia an$
hypo0olae!ia resulting in anaero&ic !eta&olis! an$ accu!ulation of lactic aci$. @y $efinition,
this patient -ill ha0e a lo- arterial pH an$ a lo- &icar&onate concentration. An increase$ anion
gap -ill also &e seen.
<he anion gap !ay &e calculate$ &yD
Z1aB[ B ZTB[ J ZCL-[ J ZHC"%-[
<he nor!al anion gap is 6-13!!ol;L. <he anion gap is a useful tool in $ifferentiating &et-een an
aci$osis $ue to the accu!ulation of organic aci$s e.g. lactic aci$ +as in this patient/ an$ aci$osis
that are secon$ary to the loss of &ase or ingestion of aci$ -here there -ill &e a nor!al anion
gap.
Correct
A&sorption of calciu! fro! the $igesti0e tract:
<akes place !ostly in the pro.i!al 'e'unu!
Kour ans-er
,s pre0ente$ &y the presence of s!all a!ounts of phytic aci$ in the $iet , e0en -hen an e.cess
calciu! is ingeste$
,s facilitate$ &y the presence of fat in foo$
Can &e re0erse$ +calciu! is secrete$ into &o-el lu!en/ -hen plas!a calciu! concentration is
raise$ &y a calciu! infusion
,s a&out as rapi$ as that of so$iu!
hytic aci$ pro$uces insolu&le calciu! phytate, -hen all phytic aci$ has &een precipitate$ the
e.cess calciu! is a&sor&e$.
)atty aci$s for! insolu&le calciu! salts +soaps/.
<he shift of calciu! ions across the intestinal !ucosa is 0irtually one -ay.
(o$iu! is a&sor&e$ at a spee$ fifty ti!es that for calciu! a&sorption
Correct
)ollo-ing a !otor&ike E<C, a young patient has a heart rate of #2 , @ of 59;#2 !!Hg, an$
-ar! peripheries. His &loo$ pressure $oes not i!pro0e $espite ,C flui$s. Fhat is the likely
$iagnosis:
Car$iogenic shock
Hypo0olae!ic shock
1eurogenic shock
Kour ans-er
(eptic shock
(eptic shock
1eurogenic shock is a result of interruption of the $escen$ing sy!pathetic path-ays of the
spinal cor$ causing loss of 0aso!otor tone. <here is su&sequent pooling of &loo$ in the
e.tre!ities an$ the $e0elop!ent of hypotension. A$$itionally if the lesion is a&o0e <3 there !ay
&e associate$ loss of car$iac sy!pathetic inner0ation, therefore, these patients are often
&ra$ycar$ic or are una&le to !ount an appropriate tachycar$ic response to hypo0olae!ia. As
the pri!ary pro&le! in these patients is loss of sy!pathetic tone the o&ser0e$ hypotension
$oes not respon$ to flui$s an$ !ust &e correcte$ -ith the use of 0asopressors that increase
0ascular tone an$ atropine if in$icate$ to counter the &ra$ycar$ia.
Correct
Fhich of the follo-ing respiratory physiology tests -oul$ &e consistent -ith a $iagnosis of
!o$erately esta&lishe$ cryptogenic fi&rosing al0eolitis:
7iffusion capacity $ecrease$, )>C1;)CC nor!al, total lung capacity re$uce$
Kour ans-er
7iffusion capacity increase$, )>C1;)CC nor!al, total lung capacity increase$
7iffusion capacity nor!al, )>C1;)CC re$uce$, total lung capacity re$uce$
7iffusion capacity $ecrease$, )>C1;)CC nor!al, total lung capacity n or!al
7iffusion capacity $ecrease$, )>C1;)CC increase$, total lung capacity increase$
7iffusion capacity is characteristically $ecrease$ in restricti0e lung $isor$ers. )>C1;)CC re$uce$
-oul$ &e seen in o&structi0e air-ays $isease, -hich -oul$ &e re0ersi&le in asth!a an$
irre0ersi&le in C"7. ,n restricti0e con$itions )>C1;)CC ratio is nor!al or increase$. <otal lung
capacity is re$uce$ in restricti0e lung $isease, -hilst it is nor!al or increase$ in o&structi0e
air-ays $isease.
Correct
<he plateau phase of the car$iac action potential is $ue to:
Magnesiu! influ.
otassiu! influ.
Calciu! influ.
Kour ans-er
Chlori$e efflu.
(o$iu! influ.
<he !ost i!portant source of acti0ator calciu! in car$iac !uscle re!ains its release fro! the
sarcoplas!ic reticulu!. Calciu! ho-e0er also enters fro! the e.tracellular space $uring the
plateau phase of the action potential. <his calciu! entry pro0i$es the sti!ulus that in$uces
calciu! release fro! the sarcoplas!ic reticulu! +calciu! in$uce$ calciu! release/.
<he result is that tension generate$ in car$iac, &ut not in skeletal, !uscle is profoun$ly
influence$ &oth &y e.tracellular calciu! le0els an$ factors that affect the !agnitu$e of the
in-ar$ calciu! current. <his is of practical 0alue in t-o key clinical situationsD in heart failure
-here $igo.in is utilise$ to increase car$iac contractility +&y increasing the intracellular calciu!
concentration/ an$ in hyperkalae!ia -here calciu! gluconate is use$ to sta&ilise the
!yocar$iu!.
<he plateau phase of the action potential in car$iac !uscle +principally $ue to calciu! influ./
!aintains the !e!&rane at a $epolarise$ potential for as long as 299!s. <he result is that the
cell !e!&rane is refractory throughout !ost of the !echanical response, largely $ue to the
inacti0ation of fast so$iu! channels. <his pre0ents tetany upon repetiti0e sti!ulation -hich
-oul$ &e $etri!ental to car$iac output. )urther!ore, the prolonge$ refractory perio$ in car$iac
!uscle allo-s the i!pulse that originates in the sino-atrial no$e to propagate throughout the
entire !yocar$iu! 'ust once, there&y pre0enting re-entry arrhyth!ias.
Correct
Fhich co!ponents of the nephron are !ost i!portant -ith regulation of e.tracellular flui$
os!olality:
ro.i!al con0olute$ tu&ule an$ $istal con0olute$ tu&ule
=lo!erulus an$ $istal con0olute$ tu&ule
Loop of Henle an$ collecting $ucts
Kour ans-er
=lo!erulus an$ pro.i!al con0olute$ tu&ule
=lo!erulus an$ loop of Henle
>ach co!ponent of the nephron is associate$ -ith particular pre$o!inant functions. <he
glo!erulus is in0ol0e$ -ith passi0e filtration of the plas!a an$ for!ation of tu&ular filtrate. <he
pro.i!al con0olute$ tu&ule is !ainly in0ol0e$ -ith conser0ation of filtere$ solutes an$ -ater as
-ell as secretion of certain -aste pro$ucts. <he $istal con0olute$ tu&ule plays a role in
regulating preferential rea&sorption of 1aB ions at the e.pense of TB an$ HB ions, un$er the
control of al$osterone. ,t is the loop of Henle an$ collecting $ucts -hich play the !ost i!portant
role in regulating e.tracellular flui$ os!olality. <he loop of Henle creates the large !e$ullary
interstitial os!otic $ri0ing force for the rea&sorption of -ater through the -alls of the collecting
$ucts -hose per!ea&ility is regulate$ &y anti$iuretic hor!one +arginine 0asopressin/.
Correct
A patient -ith a significant hea$ in'ury has a =C( of 3, a $ilate$ left pupil an$ is foun$ to &e
coning. Fhich of the follo-ing 0ital signs is this patient likely to e.hi&it:
Hypertensi0e an$ &ra$ycar$ic
Kour ans-er
Hypertensi0e an$ tachycar$ic
Hypotensi0e an$ &ra$ycar$ic
Hypotensi0e an$ nor!al heart rate
1or!otensi0e an$ tachycar$ic
<his patient has signs of raise$ intra-cranial pressure +,C/. <he $ilate$ left pupil reflects
oculo!otor ner0e co!pression secon$ary to transtentorial cere&ral herniation. Hypertension
an$ &ra$ycar$ia !ay &e o&ser0e$ in such patients, this is kno-n as CushingIs refle. an$ it
reflects an atte!pt to !aintain cere&ral perfusion in the face of rising ,C.
Cere&ral perfusion pressure +C/ is the Mean arterial pressure +MA/ !inus the intracranial
pressure +,C/.
i.e. C P MA J ,C.
<he Monroe-Tellie hypothesis states that the skull is a rigi$ &o. that contains &rain, C(), an$
&loo$,
therefore, ,C P CC() B C@rain B C@loo$.
,t stan$s to reason that if the 0olu!e of any one of these co!ponents increases i.e. an
intracere&ral hae!orrhage, the ,C -ill rise. <he rise in ,C !ay &e !ini!ally co!pensate$ &y a
$ecrease in the t-o other co!ponents, &ut after this point the ,C -ill rise steeply.
,ncorrect
Fhich one of the follo-ing state!ents a&out renin secretion is true:
Eenin is secrete$ &y the epithelial cells of the renal glo!erulus
Kour ans-er
Ee$uce$ $eli0ery of 1aCl to the !acula $ensa cells of nephrons increases renin secretion
Correct ans-er
A rise in pressure in the renal afferent arteriole increases renin secretion
Eenin secretion is re$uce$ &y increase$ acti0ity in the renal sy!pathetic ner0es
Eenin secretion is re$uce$ &y inhi&ition of angiotensin-con0erting enAy!e
Eenin is an enAy!e in0ol0e$ in acti0ating the angiotensin-al$osterone syste!. ,t is pro$uce$
an$ secrete$ &y !o$ifie$ s!ooth !uscle cells of the afferent arterioles of the ki$ney. Eenin
secretion is sti!ulate$ &y a local fall in &loo$ pressure in the afferent arterioles, &y re$uce$
$eli0ery of filtere$ 1aCl to the !acula $ensa cells of the nephrons +Wtu&ulo-glo!erular
fee$&ackI/ an$ &y increase$ acti0ity in the renal sy!pathetic ner0es. Eenin secretion is
increase$ &y inhi&ition of angiotensin-con0erting enAy!e since the resulting re$uction in
angiotensin ,, an$ al$osterone le0els re$uces the negati0e fee$&ack effect on renin secretion.
Correct
Al$osterone is secrete$ fro! the:
Li0er
]ona glo!erulosa of the a$renal corte.
Kour ans-er
*u.taglo!erular apparatus
A$renal !e$ulla
]ona fasciculata of the a$renal corte.
<he a$renal glan$ co!prises an outer corte. an$ an inner !e$ulla, -hich represent t-o
$e0elop!entally an$ functionally in$epen$ent en$ocrine glan$s -ithin the sa!e anato!ical
structure. <he a$renal !e$ulla secretes a$renaline +59M/ an$ nora$renaline +%9M/. <he a$renal
corte. consists of % layers, or Aones. <he layers fro! the surface in-ar$s !ay &e re!e!&ere$
&y the !ne!onic =)E:
= P ]ona glo!erulosa +secretes al$osterone/
) P ]ona fasciculata +secretes cortisol an$ se. steroi$s/
E P ]ona reticularis +secretes cortisol an$ se. steroi$s/
Al$osterone is a steroi$ hor!one that facilitates the rea&sorption of so$iu! an$ -ater an$ the
e.cretion of potassiu! an$ hy$rogen ions fro! the $istal con0olute$ tu&ule an$ collecting $ucts.
ConnIs syn$ro!e is characterise$ &y increase$ al$osterone secretion fro! the a$renal glan$s.
,ncorrect
A patient on enteral nutrition $e0elops constipation. Fhat coul$ e.plain the un$erlying clinical
physiology: (ingle &est ans-er question J choose "1> true option only
Hyperos!olar fee$
Kour ans-er
@acterial conta!ination
Lo- fee$ te!perature
,na$equate flui$ replace!ent
Correct ans-er
Ee$uce$ intestinal a&sorpti0e capacity
Hyperos!olar fee$, &acterial conta!ination, lo- fee$ te!perature, too rapi$ or irregular
a$!inistration, lactose intolerance, re$uce$ intestinal a&sorpti0e capacity can all e.plain
$iarrhoea.
,ncorrect
An o0er-eight %2-year-ol$ -o!an presents -ith a short history of painless 'aun$ice. <here is no
pre0ious history of illness an$, apart fro! the 'aun$ice, she has no signs of chronic li0er $isease.
,nitial in0estigations re0eal a hae!oglo&in of 12.5 g;$l, MCC 192 fl, seru! &iliru&in 132 !!ol;l,
A(< 1#2 ?;l, alkaline phosphatase 22# ?;l, ga!!a-gluta!yltransferase 299 ?;l.
true option only
Alcoholic li0er $isease
Correct ans-er
Autoi!!une chronic hepatitis
Carcino!a of the hea$ of the pancreas
Cholecystitis
Kour ans-er
Hepatitis A infection
*aun$ice -ith an ele0ation of &oth A(< an$ alkaline phosphatase suggests !i.e$ hepatocellular
$a!age an$ cholestatic li0er $isease, typical of acute alcoholic hepatitis on a &ackgroun$ of
chronic li0er $isease +an$ is not e.clu$e$ &y the lack of physical signs/. <he high ga!!a-
gluta!yltransferase len$s support to this +although it !ay &e increase$ in li0er $isease of any
cause/. Macrocytosis is typical of chronic e.cessi0e alcohol intake an$ is not a feature of the
other con$itionsD although -ere it not present, autoi!!une li0er $isease -oul$ nee$ to &e
consi$ere$.
,n hepatitis A, A(< is typically higher than alkaline phosphatase, -hile the re0erse is true of
pancreatic carcino!a. Chronic cholecystitis can cause 'aun$ice &ut it -oul$ &e unusual for there
to &e no history of acute episo$es.
Correct
Fhich of the follo-ing physiological characteristics relates to the lining of the respiratory tract:
A&out 1 litre of !ucus is pro$uce$ e0ery $ay
<he cilia are un$er the control of a physiological !otor, $ynein
Kour ans-er
<he !ucociliary escalator !o0es at 9.2 c!;!inute
Eeply to HalaEeport
ost H8
<he &ronchioles ha0e cartilage in their -all
<he &ronchioles ha0e $ia!eters up to 2 !!
A&out 199 !l of !ucus is pro$uce$ e0ery $ay. <he cilia are un$er the control of a physiological
!otor, $ynein +-hich is a&sent in TartagenerIs syn$ro!e/. <he !ucociliary escalator !o0es at 2
c!;!inute. <he &ronchioles $o not ha0e cartilage in their -all +-hich $istinguishes the! fro!
&ronchi/. <he &ronchioles can &e up to 1 !! in $ia!eter.
Correct
Fhich of the follo-ing hor!ones is secrete$ &y the ki$ney in response to sy!pathetic ner0ous
sti!ulation:
Al$osterone
Angiotensin ,
Angiotensin ,,
>rythropoetin
Eenin
Kour ans-er
Eenin is pro$uce$ &y the 'u.taglo!erular apparatus of the ki$ney in response to hypo0olae!ia,
0ia % !echanis!s:
1. increase$ catechola!ine le0els secon$ary to sy!pathetic sti!ulation fro! arterial receptors
2. $irect effect of hyponatrae!ia on the 'u.taglo!erular apparatus
%. re$uction of renal perfusion pressure 0ia afferent arteriolar &aroreceptors
Eenin acts to clea0e angiotensin , fro! angiotensinogen pro$uce$ in the li0er. Angiotensin
con0erting enAy!e is present in !any tissues, especially the lungs, an$ con0erts angiotensin ,
to angiotensin ,,. Angiotensin ,, is a po-erful 0asoconstrictor, causing 0asoconstriction of renal
arteries, as -ell as a positi0e inotropic effect on the heart. ,t also causes release of A7H an$
a$renaline. Along -ith al$osterone, -hose release is also sti!ulate$, Angiotensin ,, conser0es
1aB an$ H2" in the gut. Al$osterone acts to conser0e 1aB an$ H2" in the $istal renal tu&ule
an$ collecting $ucts. <hese !echanis!s co!&ine to restore the plas!a 0olu!e in
hypo0olae!ia.
>rythropoetin is release$ &y the ki$ney in response to hypo.ia an$ high le0els of the pro$ucts of
re$ cell &reak$o-n, an$ increases the rate of re$ cell pro$uction
Correct
,n !eta&olic alkalosis associate$ -ith prolonge$ nasogastric aspiration in postoperati0e ileus,
-hat is the !ost i!portant cause of the aci$J&ase $istur&ance:
Hypo0entilation
,ncrease$ renal &icar&onate rea&sorption
Loss of gastric aci$
Kour ans-er
otassiu! $epletion
(econ$ary al$osteronis!
Loss of un&uffere$ gastric aci$ is the cause of the !eta&olic alkalosis seen un$er these
circu!stances if there is ina$equate replace!ent of the flui$ lost -ith intra0enous physiological
saline. ,ncrease$ renal &icar&onate rea&sorption +nee$e$ to allo- a$equate renal so$iu!
rea&sorption in the presence of hypochlorae!ia/, potassiu! $epletion +gastric secretions
contain a&out 19 !!ol;l of potassiu!/ an$ secon$ary al$osteronis! +a result of e.tracellular
flui$ loss/ all help to !aintain the alkalosis, &ut they $o not cause it. Hypo0entilation is a
co!pensatory change: on its o-n, hypo0entilation causes car&on $io.i$e retention an$ a
respiratory aci$osis.
Correct
Fhich of the follo-ing !alignancies coul$ &e responsi&le for a hypercalcae!ia an$ lo- seru!
phosphate le0el:
"steoclasto!a
(qua!ous cell carcino!a of the lung
Kour ans-er
rostate cancer
<ransitional cell carcino!a of the @la$$er
@asal cell carcino!a
Metastatic cancerous &one lesions can result in the release of !ineralise$ calciu! an$
phosphate into the &loo$ strea! -hich can result in &oth hypercalcae!ia an$
hyperphosphate!ia.
(qua!ous cell carcino!a of the lung can result in hypercalcae!ia -ith a nor!al or lo-
phosphate le0el $ue to the release of <H relate$ pepti$e in a paraneoplastic pheno!enon. <H
relate$ pepti$e acts in si!ilar fashion to <H +although it -ill not &e $etecte$ &y stan$ar$ <H
assays/ &y increasing the acti0ation of Cit 7 an$ therefore increasing the a&sorption of calciu!
an$ phosphate fro! the intestines.
,n a$$ition, calciu! an$ phosphate is release$ fro! &one &y a $irect action on osteoclasts.
Ho-e0er, <H also increases the renal e.cretion of phosphate an$ the net effect can &e a lo- or
nor!al seru! phosphate le0el
Correct
<he e'ection fraction is $efine$ as:
<he ratio of the en$ $iastolic 0olu!e to stroke 0olu!e
<he ratio of stroke 0olu!e to en$ $iastolic 0olu!e
Kour ans-er
>n$ $iastolic 0olu!e !inus en$ systolic 0olu!e
>n$ systolic 0olu!e $i0i$e$ &y stroke 0olu!e
<he ratio of stroke 0olu!e to en$ systolic 0olu!e
7uring $iastole, filling of the 0entricles nor!ally increases the 0olu!e of each 0entricle to a&out
129!ls. <his 0olu!e is kno-n as the en$ $iastolic 0olu!e. <hen, as the 0entricles e!pty in
systole, the 0olu!e $ecreases a&out 59!ls, -hich is kno-n as the stroke 0olu!e. <he re!aining
0olu!e in each 0entricle, a&out 29!ls, is kno-n as the en$ systolic 0olu!e an$ acts as a
reser0e -hich can &e utilise$ to increase stroke 0olu!e in e.ercise.
<he fraction of en$ $iastolic 0olu!e that is e'ecte$ is calle$ the e'ection fraction J usually equal
to a&out 39M. <he e'ection fraction is often use$ clinically as an in$irect in$e. of contractility. ,t
is a particularly useful in assessing the state of the !yocar$iu! prior to aortic aneurys! repair
-here cross-cla!ping of the aorta places particular stress on the !yocar$iu!.
Correct
Hae!olytic $isease of the ne-&orn is typically restricte$ to the presence of Ehesus antigens on
re$ cells rather than A@" antigens. re$o!inantly, such anti-Eh anti&o$ies cross the placenta
$uring the thir$ tri!ester.
Fhich of the follo-ing state!ents &est e.plains the &ackgroun$ physiology:
(ingle &est ans-er - choose "1> true option only
Anti&o$ies to A@" &loo$ groups are ,gM, -hereas anti&o$ies to Ehesus antigens are ,g=
Kour ans-er
Anti&o$ies to A@" &loo$ groups are ,g=, -hereas anti&o$ies to Ehesus antigens are ,gM
Anti&o$ies to A@" &loo$ groups are ,gA, -hereas anti&o$ies to Ehesus antigens are ,g=
Anti&o$ies to Ehesus antigens are ,g7, -hereas anti-A@" &loo$ groups are ,gM
Anti&o$ies to Ehesus antigens are ,g>, -hereas anti-A@" &loo$ groups are ,g=
,g= anti&o$ies to Ehesus antigens can cross the placenta $uring the last tri!ester, -hereas A@"
anti&o$ies are ,gM an$ hence cannot cross the placenta. <he function of seru! ,g7 is unkno-n.
<he transplacental passage of i!!unoglo&ulin only applies to ,g=.
Correct
Fhich of the follo-ing <)<Is is suggesti0e of =ra0eIs $isease:
Eaise$ <(H, free <#, raise$ free <%
1or!al <(H, raise$ free <#, $ecrease$ <%
7ecrease$ <(H, raise$ free <#, raise$ free <%
Kour ans-er
7ecrease$ <(H, $ecrease$ free <#, $ecrease$ free <%
Eaise$ <(H, nor!al free <#, nor!al free <%
<he thyroi$ pro$uces <% an$ <# upon sti!ulation fro! <(H release$ fro! the anterior pituitary,
-hich in turn is regulate$ &y the hypothala!ic secretion of <EH +<hyrotophin releasing
hor!one/. <EH is transporte$ to the anterior pituitary along the hypophyseal tract. <he negati0e
fee$&ack effects of <% an$ <# le0els regulate the -hole !echanis!.
=ra0eIs $isease is the co!!onest cause of hyperthyroi$is! an$ is a result of ,g= anti&o$ies
&in$ing to <(H receptors, sti!ulating thyroi$ hor!one pro$uction. <he <)<Is in such patientIs
classically sho- a !uch-re$uce$ <(H concentration -ith inappropriately raise$ <% an$ <# le0els.
Correct
,n the t-o step hy$ro.ylation process for acti0ation of Cita!in 7, -here $oes the first
hy$ro.ylation take place:
Ti$ney
Lung
Li0er Kour ans-er
(kin
7uo$enu!
Cita!in 7 is a fat solu&le 0ita!in that is $eri0e$ fro! our $iet or 0ia the skin fro! $irect
sunlight. ,t is con0erte$ to 22-hy$ro.ycholecalciferol in the li0er an$ is further hy$ro.ylate$ in
the ki$ney to 1, 22-hy$ro.ycholecalciferol. ,n this acti0e for! it increases calciu! uptake in the
gut an$ pro!otes phosphate a&sorption too. ,t increases ki$ney rea&sorption of calciu! an$
phosphate an$ at 0ery high concentration -ill pro!ote osteoclastic rea&sorption of &one.
,ncorrect
A #2-year-ol$ -o!an -ith type-2 $ia&etes is !aking an apparently goo$ reco0ery 5 $ays after a
partial resection of the s!all intestine follo-ing trau!a sustaine$ in a sta&&ing inci$ent. (he is
recei0ing parenteral nutrition -ith a$$itional Wnor!alI saline an$, &ecause of a history of $eep
0ein thro!&osis so!e 19 years pre0iously, is on prophylactic heparin. @efore her a$!ission she
-as -ell, -ith no ongoing !e$ical pro&le!s an$ taking no regular !e$ication. (eru! electrolyte
results are as follo-s: so$iu! 128 !!ol;l, potassiu! 3.2 !!ol;l, &icar&onate 2# !!ol;l, urea
6.2 !!ol;l, creatinine 129 ^!ol;l, glucose 19.2 !!ol;l. Her potassiu! concentration has risen
o0er the past % $ays. <he potassiu! content of the parenteral fee$ has &een re$uce$ fro! 39 to
29 !!ol;2# h $uring this perio$. ?rine output is appropriate to her flui$ input. Her re$ cell,
-hite cell an$ platelet counts are all nor!al.
Fhat is the !ost likely cause of the hyperkalae!ia: (ingle &est ans-er question - choose "1>
true option only
Heparin treat!ent
Correct ans-er
"0erpro0ision of potassiu! in the parenteral fee$
Kour ans-er
ri!ary a$renal failure +A$$isonIs $isease/
seu$ohyperkalae!ia
Eenal i!pair!ent
Appro.i!ately 29 !!ol;2# h is the !ini!u! o&ligatory potassiu! output, -hile the typical
potassiu! require!ents for patients on parenteral fee$ing are #9J69 !!ol;2# h.
seu$ohyperkalae!ia is hyperkalae!ia occurring as a result of a loss of potassiu! fro! -hite
cells an$ platelets $uring clotting, usually seen in patients -ith high -hite cell or platelet counts.
<ypically, the plas!a potassiu! concentration is significantly lo-er than the seru! potassiu!
concentration in this con$ition. <he ele0ate$ urea !ay &e $ue to an e.cessi0e pro0ision of
a!ino aci$s, &ut neither it nor the creatinine le0el suggest sufficient renal i!pair!ent to cause
such a se0ere hyperkalae!ia. ,ncipient a$renal failure coul$ ha0e &een !a$e o0ert &y the stress
of surgery, &ut this is unco!!on. <he heparin is !ore likely to &e responsi&le: heparin inhi&its
al$osterone secretion &y the a$renal corte., lea$ing to i!paire$ renal potassiu! e.cretion,
particularly in patients -ith $ia&etes or those -ho are aci$otic
Correct
A !e$ical (H" is require$ to gi0e a &loo$ sa!ple to check his Hep@ status. He recei0e$ a course
of 0accinations nine !onths ago.
Fhat is his &loo$ test likely to sho-: (ingle &est ans-er - choose "1> true option only.
Anti-H@eA&
Anti-H@sA&
Kour ans-er
Anti-H@sA& B anti-H@cA&
H@sAg B H@cAg
,gM to H@cAg
(urface an$ core antigens +H@sAg, H@cAg/ are $etecta&le $uring acute infection. H&eAg
+en0elope/ is a goo$ !arker of high infecti0ity, -hile anti-H&eAg suggests a patient -ho is less
infecti0e. Acute infection is also i!plie$ &y ,gM to H&cAg, -hile ,g= to H@cAg suggests a
pre0ious infection. Ciral clearance an$ reco0ery correlate -ith the $isappearance of antigens
an$ the appearance of anti&o$ies. re0ious 0accination is suggeste$ &y the presence of only
anti-H@sA&.
Correct
,n -hich of the follo-ing types of shock is the pri!ary pro&le! $ue to loss of peripheral 0ascular
resistance !e$iate$ &y !icroorganis!s:
Car$iogenic
Anaphyla.is
(eptic Kour ans-er
1eurogenic
Hypo0olae!ic
(eptic shock is $ue to &acteria-!e$iate$ 0aso$ilation. <his results in a relati0e loss of circulating
&loo$ 0olu!e. atients are peripherally -ar! an$ pink in contrast to other types of chock -here
the skin is col$, cla!!y an$ shut$o-n. Car$iogenic shock arises $ue to a failure of the hearts
pu!p !echanis!, usually post-!yocar$ial infarction. Anaphyla.is is a se0ere allergic reaction
resulting in a profoun$ release of hista!ine an$ other infla!!atory !e$iators. <here is a
relati0e hypo0olae!ia $ue to 0aso$ilatation, ho-e0er &acteria are not i!plicate$ in the process.
,ncorrect
Fhich of the follo-ing !eta&olic effects is !ost likely to &e cause$ &y thyroi$ hor!one:
7ecrease$ glycogenolysis in the li0er
,ncrease$ glucose a&sorption in the gut
Correct ans-er
7ecrease$ lipolysis
Kour ans-er
7ecrease$ e.pression of U a$renergic receptors
7ecrease$ o.ygen uptake in the !itochon$ria
<hyroi$ hor!one has -i$esprea$ !eta&olic effects.
,ncrease$ glycogenolysis in the li0er, increase$ glucose a&sorption in the gut an$ increase$
insulin &reak$o-n all ten$ to increase &loo$ glucose. <he glycogenolytic effects of
catechola!ines are also potentiate$. <hese effects can !ake the $iagnosis an$ !anage!ent of
$ia&etes in thyroto.icosis $ifficult.
<here is an o0erall lipolytic effect, -ith $ecrease$ seru! cholesterol seen in thyroto.icosis, an$
an increase in hypothyroi$is!.
<here is an increase$ e.pression of &-a$renergic receptors in !any tissues inclu$ing skeletal
an$ car$iac !uscle. <here is a positi0e inotropic effect -ith increase$ car$iac output an$ heart
rate.
A raise$ !eta&olic rate an$ increase$ heat pro$uction are $ue to increase$ o.ygen uptake an$
A< pro$uction in the !itochon$ria.
<here are also effects on &one, -ith an o0erall &reak$o-n of &one, so!eti!es lea$ing to
hypercalcae!ia. ,ncrease$ seru! 2,% 7= lea$s to a right shift of the hae!oglo&in $issociation
cur0e. <hyroi$ hor!ones are also essential for fetal $e0elop!ent, -ith $eficiency lea$ing to
cretinis!. <he fetus pro$uces its o-n hor!one fro! 16 -eeks of gestation.
Correct
Fhich of the follo-ing factors is in0ol0e$ in the e.trinsic coagulation casca$e:
C,, Kour ans-er
C,,,
,X
X,
X,,
<he clotting casca$e is the or$ere$ step-ise enAy!e-controlle$ acti0ation of solu&le clotting
factors to pro$uce an insolu&le fi&rin !eshD a thro!&us. <here are t-o $ifferent path-ays,
intrinsic an$ e.trinsic. <he intrinsic path-ay is so calle$ as all the ele!ents necessary for its
acti0ation are in the &loo$. ,t is triggere$ &y e.posure of collagen in $a!age$ 0ascular
en$otheliu!. <he e.trinsic path-ay requires the release of tissue factors fro! $a!age$ tissues
to start the process. @oth path-ays con0erge in the co!!on path-ay. (equential acti0ation of
factors X,,, X,, ,X an$ C,,, co!prises the intrinsic path-ay. <he e.trinsic path-ay in0ol0es tissue
factor an$ acti0ate$ factor C,,. @oth the intrinsic an$ e.trinsic path-ays acti0ate factor X, ,, an$ ,
to for! fi&rin an$ this is the co!!on path-ay.
Correct
A 52-year-ol$ -o!an un$ergoes total gastrecto!y for carcino!a of sto!ach.
Fith -hich of the follo-ing nutrients is she !ost likely to require parenteral replace!ent: (ingle
&est ans-er - choose "1> true option only
Ascor&ic aci$
)olic aci$
,ron
Cita!in @12
Kour ans-er
Cita!in 7
1o significant a&sorption of nutrients takes place in the sto!ach. Ho-e0er, &ecause of the lack
of secretion of pepsin, an$ hence re$uce$ acti0ation of pancreatic proenAy!es, an$ the fact that
the a&ility to eat nor!al a!ounts of foo$ !ay &e greatly $ecrease$, patients -ho ha0e ha$ total
gastrecto!ies !ay require general nutritional supple!entation, eg -ith proprietary high-energy,
high-protein liqui$s. Ho-e0er, the a&sorption of 0ita!in @12, although it takes place in the
ter!inal ileu!, is critically $epen$ent on the a0aila&ility of intrinsic factor, -hich is only secrete$
&y the parietal +o.yntic/ cells of the sto!ach.
Correct
Eeply to HalaEeport
ost H19
A 22-year-ol$ !an is a$!itte$ to hospital -ith persistent 0o!iting. He is clinically $ehy$rate$
an$ hypotensi0e. His seru! so$iu! concentration is 12# !!ol;l, potassiu! #.8 !!ol;l, urea 8.6
!!ol;l, creatinine 83 !!ol;l. ?rine so$iu! concentration in a speci!en passe$ on a$!ission is
32 !!ol;l.
Fhich of the follo-ing is the !ost likely cause of the hyponatrae!ia:
A$renal failure
Kour ans-er
Cere&ral salt -asting
=astrointestinal flui$ loss
Lo- so$iu! intake
(yn$ro!e of inappropriate anti$iuresis +(,A7/
1atriuresis in a $ehy$rate$, hyponatrae!ic patient suggests that there is uncontrolle$ renal loss
of so$iu!, such as occurs in a$renal failure. Cere&ral salt -asting can also cause $ehy$ration
an$ hyponatrae!ia $ue to e.cessi0e natriuresis, &ut typically occurs follo-ing a hea$ in'ury or
&rain surgery. Hyponatrae!ia an$ $ehy$ration $ue to gastrointestinal flui$ loss or so$iu!
$eficiency $ue to a lo- intake shoul$ lea$ to renal conser0ation of so$iu!. Although (,A7 is an
i!portant cause of hyponatrae!ia an$ so$iu! e.cretion !ay &e high, the hyponatrae!ia is $ue
to -ater e.cess an$ patients are not $ehy$rate$.
,ncorrect
Fhich of the follo-ing state!ents regar$ing precautions -ith using colloi$s is true:
7e.trans $o not carry a risk of anaphyla.is
7e.trans are less likely to interfere -ith &loo$ cross-!atching than starches
Kour ans-er
=elatins are less likely to cause pruritis or anaphyla.is than starch solutions
Hae!accelN an$ &loo$ are co!pati&le through the sa!e ,C cannula
Colloi$s !ay -orsen peripheral oe$e!a
Correct ans-er
7e.trans +e.g. 7e.tran #9 or 59/ co!prise solutions of !ultiply-&ranche$ polysacchari$es. <hey
carry a risk of anaphyla.is, interfere -ith &loo$ cross-!atching an$ !ay re$uce platelet
a$hesion.
=elatins +e.g. =elofusinN an$ Hae!accelN/ are for!e$ fro! the hy$rolysis of &o0ine collagen.
<hey are !uch !ore likely than starch-&ase$ colloi$ solutions to cause pruritis or anaphyla.is. ,n
a$$ition, the calciu! content of Hae!accelN can cause &loo$ to clot if infuse$ through the
sa!e cannula.
All colloi$s !ay -orsen peripheral oe$e!a if there is loss of capillary -all integrity -ith resultant
leak of the colloi$ into the interstitial flui$ co!part!ent.
,ncorrect
Fith respect to 0o!iting -hich of the follo-ing state!ents is the &est ans-er:
Chief cells
<he C<] is outsi$e the &loo$ &rain &arrier
Correct ans-er
2H<% agonists !ay &e effecti0e in controlling cisplatin in$uce$ 0o!iting
H2 receptors are a&un$ant in the 0o!iting centre
<he 0o!iting centre is present in the reticular for!ation of the !i$ &rain
Kour ans-er
<he 0o!iting centre is present in the reticular for!ation of the !e$ulla, the C<] is outsi$e the
&loo$ &rain &arrier an$ the !ain receptors are $opa!inergic 72 receptors. 2H<% antagonist is
effecti0e in controlling 0o!iting. H1 receptors ha0e &een i$entifie$ in the 0o!iting centre.
Correct
Kou re0ie- a %8-year-ol$ sports!an -ho co!plains of knee pain. Arthroscopy re0eals $a!age to
the cartilage.
Fhich of the follo-ing ste!s &est $escri&es a property of hyaline cartilage:
,t has a &loo$ supply fro! s!all arterioles
,t is rich in type 1 collagen
Chon$rocytes secrete collagen only
,t is a0ascular
Kour ans-er
ressure fro! nor!al 'oint loa$ing accelerates $a!age to cartilage
Hyaline cartilage for!s the articular surface an$ is a0ascular, relying on $iffusion fro! syno0ial
flui$ for nutrients. ,t is rich in type ,, collagen an$ for!s a !esh-ork containing proteoglycan
!olecules that retain -ater. ,nter!ittent pressure fro! 'oint loa$ing is essential to !aintain
nor!al cartilage function. Chon$rocytes secrete proteoglycans an$ collagen an$ are e!&e$$e$
in the cartilage. <hey !igrate to the 'oint surface along -ith the !atri. that they pro$uce.
,ncorrect
)lo- through a 0essel or lu!en is:
,s in0ersely proportional to the pressure hea$ of flo-
,s in0ersely proportional to the ra$ius
Kour ans-er
,s $irectly proportional to the length of the tu&e
,s $irectly proportional to the 0iscosity of &loo$ passing through it
,s $irectly proportional to the fourth po-er of ra$ius
Correct ans-er
<he Hagen-oiseuille la- states that the flo- through a 0essel is:
O 7irectly proportional to the pressure hea$ of flo-
O 7irectly proportional to the fourth po-er of ra$ius
O ,n0ersely proportional to the 0iscosity
O ,n0ersely proportional to the length of the tu&e
<he ra$ius of the tu&e is therefore the !ost i!portant $eter!inant of flo- through a &loo$
0essel. <hus, $ou&ling the ra$ius of the tu&e -ill lea$ to a 13-fol$ increase in flo- at a constant
pressure gra$ient. <he i!plications of this are se0eral fol$.
)irst, o-ing to the fourth po-er effect on resistance an$ flo-, acti0e changes in ra$ius constitute
an e.tre!ely po-erful !echanis! for regulating &oth the local &loo$ flo- to a tissue an$ central
arterial pressure. <he arterioles are the !ain resistance 0essels of the circulation an$ their
ra$ius can &e acti0ely controlle$ &y the tension of s!ooth !uscle -ithin its -all.
(econ$, in ter!s of intra0enous flui$ replace!ent in hospital, flo- is greater through a
peripheral cannula than through central lines. <he reason is that peripheral lines are short an$
-i$e +an$ therefore of lo-er resistance an$ higher flo-/ co!pare$ to central lines, -hich are
long an$ possess a narro- lu!en. A peripheral line is therefore preferential to a central line
-hen urgent flui$ resuscitation, or &loo$, is require$.
Correct
,n esti!ating the physiological clearance of 19 !l of an intra0enous su&stance -hich has &een
a$!inistere$ at 19 !g;!l, the plas!a concentration at equili&ration is 12 !g;litre, the urine
concentration is 129 !g;litre an$ the su&'ect pro$uces 1##9 !l of urine $uring a 2#h collection.
Fhat is the clearance of the su&stance: (ingle &est ans-er question J choose "1> true option
only
1 !l;!in
19 !l;!in
Kour ans-er
9.1 !l;!in
199 !l;!in
Cannot say fro! the infor!ation gi0en
Clearance is calculate$ using the for!ula +? X C/; -here ? P urine concentration in !g;!l, C P
urine pro$uction in !l;!in, P plas!a concentration in !g;!l.
<he &olus siAe of the su&stance is irrele0ant to the clearance.
,ncorrect
Ho- !uch of 1 litre of 2M $e.trose infuse$ intra0enously -ill re!ain in the intra0ascular
co!part!ent:
229 !ls Kour ans-er
#99 !ls
V199 !ls
Correct ans-er
299 !ls
%%%.%% !ls
2M $e.trose has no oncotic properties +the $e.trose is a&sor&e$/ an$ therefore 1 litre of 2M
$e.trose -ill &e $istri&ute$ equally a!ongst the total &o$y -ater. 1;% of total &o$y -ater is
e.tracellular an$ 2;% intracellular. ,n a$$ition, aroun$ _ of e.tracellular flui$ is intra0ascular an$
therefore only 1;12th +1;% . _/ of infuse$ 2M $e.trose -ill re!ain in the intra0ascular space.
,n co!parison _ of 9.8M 1(aline -ill re!ain in the intra0ascular space as it contains 12#
!!ols;l of 1aB -hich is si!ilar to the concentration 1aB foun$ in the e.tracellular
co!part!ent.
Correct
Fhat is the site of action of anti$iuretic hor!one +A7H/ in a nephron:
ro.i!al con0olute$ tu&ule
Ascen$ing li!& of loop of Henle
7escen$ing li!& of loop of Henle
7istal con0olute$ tu&ule
Collecting $uct Kour ans-er
A7H is pro$uce$ &y the posterior pituitary glan$ in response to re$uce$ e.tracellular os!olality,
&loo$ 0olu!e an$ &loo$ pressure. ,t pro!otes rea&sorption of -ater fro! the collecting $ucts,
resulting in re$uce$ os!olality an$ e.pan$e$ &loo$ 0olu!e.
,ncorrect
Fhich i!!unoglo&ulin can fi. co!ple!ent 0ia the alternati0e path-ay:
,gA
Correct ans-er
,gM
,g=
Kour ans-er
,g>
,g7
,gA is unusual in that it can fi. co!ple!ent 0ia the alternati0e path-ay. ,g= an$ ,gM can fi.
co!ple!ent 0ia the classical path-ay through the )c portion of the i!!unoglo&ulin.
Correct
@y -hich process are particles !o0e$ along a concentration gra$ient across a selecti0ely
per!ea&le !e!&rane:
>n$ocytosis
7iffusion
Kour ans-er
>.ocytosis
"s!osis
hagocytosis
)at-solu&le !olecules, such as glycerol, can $iffuse through the !e!&rane easily. <hey $issol0e
in the phospholipi$ &ilayer an$ pass through it in the $irection of the concentration gra$ient,
fro! a high concentration to a lo- concentration. Fater, o.ygen an$ car&on $io.i$e can also
$iffuse through the &ilayer, passing easily through the te!porary s!all spaces &et-een the tails
of the phospholipi$s.
,ncorrect
(o!e 2# hours after sustaining !a'or trau!a in a roa$ traffic acci$ent, a 22-year-ol$ !an, not
kno-n to ha0e $ia&etes, is foun$ to ha0e a high &loo$ glucose concentration.
,ncrease$ secretion of -hich of the follo-ing su&stances is !ost likely to &e responsi&le: (ingle
&est ans-er - choose "1> true option only
A$renaline +epinephrine/
Correct ans-er
Cortisol
Kour ans-er
C-reacti0e protein
=ro-th hor!one
,nsulin
7uring the !eta&olic response to trau!a, there is increase$ secretion of catechola!ines,
cortisol, glucagon an$ gro-th hor!one. <he first three of these ten$ to increase &loo$ glucose
concentrationD catechola!ines, cortisol an$ glucagon act $irectly, -hereas gro-th hor!one
appears to potentiate the action of cortisol an$ opposes the action of insulin. A$renaline an$
glucagon act !ost rapi$ly, &y sti!ulating glycogenolysisD cortisol ten$s to act !ore slo-ly,
through the sti!ulation of gluconeogenesis. ,nsulin is a hypoglycae!ic hor!one. C-reacti0e
protein is a !arker of infla!!ation, &ut $oes not affect glucose ho!eostasis.
,ncorrect
Calcitonin
,ncreases plas!a calciu! le0els
ro!otes osteoclastic &one resorption
,ncreases renal e.cretion of phosphate Correct ans-er
,s pro$uce$ in the parathyroi$ glan$s
7eficiency causes osteoporosis Kour ans-er
Calcitonin is pro$uce$ &y thyroi$ C cells. <otal thyroi$ecto!y +a&sent calcitonin/ has no
significant skeletal effects. las!a calcitonin le0els rise -ith increasing seru! calciu!.
Calcitonin inhi&its osteoclastic &one resorption an$ increases renal e.cretion of calciu! an$
phosphate.
Correct
<he %4 N 24 e.onuclease acti0ity possesse$ &y so!e 71A poly!erases that ena&les the enAy!e
to replace !isincorporate$ nucleoti$e is calle$ -hat:
roofrea$ing
Kour ans-er
Eeplication
Eeco!&ination
Eetrotransposition
(plicing
Eetrotransposition is transposition 0ia an E1A inter!e$iate +transposition is the !o0e!ent of a
genetic ele!ent fro! one site to another in a 71A !olecule/. (plicing is the re!o0al of introns
fro! the pri!ary transcript of a $iscontinuous gene.
,ncorrect
An 61-year-ol$, nursing-ho!e resi$ent is a$!itte$ to hospital in an unconscious state. His &loo$
sugar is !easure$ as 1.2 !!ol;l +nor!al %J3 !!ol;l/. Kou a$!inister glucagon.
Fhich of the follo-ing &est $escri&es one of the !ain actions of glucagon:
7ecrease$ ketone &o$y pro$uction fro! fatty aci$s
,ncrease$ lipogenesis in a$ipose tissue
7ecrease$ glycogenolysis
7ecrease$ gluconeogenesis
Kour ans-er
,ncrease$ glycogenolysis an$ gluconeogenesis
Correct ans-er
=lucagon is pro$uce$ &y pancreatic islet cells an$ its !ain action is on the li0er to pro!ote
glycogenolysis an$ gluconeogenesis. ,t also increases lipolysis in a$ipose tissue an$ increases
ketone &o$y pro$uction fro! fatty aci$s. <he actions of glucagon on a$ipose tissue are
!e$iate$ &y cyclic AM to sti!ulate lipolysis, pro$ucing free fatty aci$s that can act as a !a'or
alternati0e energy source. Catechola!ines act in a si!ilar -ay to glucagon, &ut in a$$ition ha0e
effects on !uscle. ,nsulin pro!otes the synthesis of glycogen, protein an$ fat, inhi&iting lipolysis
an$ gluconeogenesis.
,ncorrect
Fhat is the a0erage $aily 0olu!e of gastric secretions +!l per $ay/:
299
1,999
1,299
Kour ans-er
2,999
Correct ans-er
2,299
Appro.i!ate a0erage flui$ secretion 0olu!es +!l per $ay/ for each of the co!ponent parts of
the a$ult hu!an gastrointestinal tract are gi0en &elo-:-
(ecretion
!l;$ay
(ali0a
1,299
=astric
2,999
@ile
299
ancreatic
1,299
(!all intestinal
1,299
<he 0ast !a'ority of this secrete$ flui$ is rea&sor&e$ &y the s!all intestine.
,ncorrect
,ncrease$ 0enous return to the heart is !ost likely to &e cause$ &y
7eep inspiration
Correct ans-er
)orce$ e.piration
Kour ans-er
Hypo0olae!ia
ositi0e pressure 0entilation
<ension pneu!othora.
@loo$ returns to the heart fro! the lo-er li!&s 0ia the action of the calf !uscle pu!ps, 0al0es
in the 0eins of the leg, an$ the effect of negati0e intra-thoracic pressure generate$ $uring
inspiration. Anything causing the intra thoracic pressure to &eco!e less negati0e -ill $ecrease
the 0enous return to the right atriu!. <ension pneu!othora., positi0e pressure 0entilation an$
force$ e.piration all cause this effect, an$ therefore re$uce the 0enous return. Although
hypo0olae!ia !ay cause 0asoconstriction in an atte!pt to increase 0enous return, it is unlikely
to increase a&o0e nor!al le0els.
Correct
A %#-year-ol$ -o!an -ith a &o$y !ass in$e. of ## kg;!2 seeks !e$ical help for her o&esity.
Fhich one of the follo-ing treat!ents offers her the highest pro&a&ility of achie0ing a long-ter!
re$uction in -eight: (ingle &est ans-er question J choose "1> true option only
An energy-$eficient $iet +399 kcal;$ay +Y 1#% *;$ay/ less than require!ents/ for 3 !onths
*a---iring an$ !ilk fee$ing for % !onths
<reat!ent -ith orlistat for 12 !onths
<reat!ent -ith si&utra!ine for 12 !onths
Certical &an$e$ gastroplication
Kour ans-er
@oth si&utra!ine an$ orlistat ha0e &een sho-n to in$uce an$ !aintain a greater -eight loss
than $iet alone, &ut a patientIs -eight often plateaus &efore a$equate -eight loss has occurre$.
"rlistat is only license$ for use for 1 year in the ?T, an$ si&utra!ine for 2 years. >nergy-
$eficient $iets, particularly if couple$ -ith increase$ e.ercise, are effecti0e, &ut the lost -eight
is al!ost in0aria&ly regaine$, as it is after 'a---iring an$ !ilk fee$ing. (urgery offers the &est
chance of achie0ing long-ter! -eight loss, the results fro! 0ertical &an$e$ gastroplication
co!&ine$ -ith a &y-pass proce$ure &eing e0en &etter than those -ith gastroplication alone.
Correct
A 12-year-ol$ youth -ith hae!ophilia A has suffere$ recurrent &lee$ing episo$es into his 'oints.
As a consequence he has arthropathies in his knees, el&o-s an$ -rists.
Fhat is the !ost likely coagulation $eficiency causing his &lee$ing ten$ency:
<hro!&o.ane
)actor X
rotein C
)actor ,X
)actor C,,,
Kour ans-er
7eficiency of either factor C,,, +hae!ophilia A/ or factor ,X +hae!ophilia @/, -hich together !ake
up the factor C,,,a;factor ,Xa intrinsic tenase enAy!atic co!ple., results in the clinical
phenotype co!!only kno-n as hae!ophilia. Hae!ophilia principally presents -ith hae!ato!a
for!ation, easy &ruising an$ &lee$ing at the site of 0enepuncture $uring the to$$ler perio$.
<he $isease e.ists in se0ere, !o$erate an$ !il$ for!s. <hese are classifie$ as such on the &asis
of a clinical la&oratory &loo$ coagulation test, -hich is perfor!e$ to assess the le0el of
functional coagulant protein +per cent acti0ity of factor C,,, or factor ,X/. <he pathological
pro&le! in &oth hae!ophilia A, factor C,,, $eficiency an$ hae!ophilia @, factor ,X $eficiency
+also calle$ WChrist!as $iseaseI/ is the ina&ility to for! a functional tenase co!ple. to acti0ate
factor X to factor Xa.
<he clinical features of hae!ophilia pre$o!inantly inclu$e &lee$ing into 'oints an$ soft tissues.
<he inci$ence of central ner0ous syste! &lee$ing has $ra!atically $ecrease$ -ith concentrate
therapy. <he life e.pectancy of people -ith se0ere hae!ophilia ha$ increase$ fro! 11 years at
the &eginning of the t-entieth century to appro.i!ately 39 years in the early 1869s, &efore the
$e0astating effects of &loo$-&orne 0iral $isease again shortene$ a0erage life e.pectancy.
Correct
A 21-year-ol$ !ale !e$ical stu$ent -ho has &een feeling non-specifically un-ell for se0eral
$ays is notice$ to ha0e slightly icteric sclerae &y his girlfrien$ an$ has li0er function tests
perfor!e$. <he results of these are nor!al apart fro! a seru! &iliru&in concentration of ##
!!ol;l +%J15/. His urine $oes not contain &iliru&in.
true option only
7u&inJ*ohnson syn$ro!e
=il&ertIs syn$ro!e
Kour ans-er
Here$itary spherocytosis
,nfectious !ononucleosis
Eotor syn$ro!e
7u&inJ*ohnson, Eotor an$ =il&ertIs syn$ro!es are all inherite$ $isor$ers of &iliru&in !eta&olis!.
Ho-e0er, in the first t-o, there is a $efect in the secretion of &iliru&in fro! the li0er an$ the
&iliru&in that accu!ulates in the plas!a is con'ugate$, -ater-solu&le an$ thus is e.crete$ in the
urine.
,nfectious !ononucleosis can cause hepatitis an$ 'aun$ice &ut an ele0ate$ transa!inase acti0ity
-oul$ &e e.pecte$. Here$itary spherocytosis is a chronic hae!olytic $isor$er $ue to a $efect in
the re$ cell !e!&rane +!ost frequently in spectrin, a structural protein/. ,t can present -ith a
-i$e range of se0erity, fro! 'aun$ice at &irth to asy!pto!atic anae!ia or 'aun$ice in a$ults,
&ut is !uch less co!!on +appro.i!ately 1:2999 in 1orthern >uropeans/ than =il&ertIs
syn$ro!e +appro.i!ately 1:29/.
Correct
Eeply to HalaEeport
ost H11
Fhich of the follo-ing is the !ost i!portant causati0e factor in the $e0elop!ent of o&esity in
the !a'ority of patients:
>nergy intake in e.cess of e.pen$iture
Kour ans-er
=enetic pre$isposition
,nsulin resistance
,ntrauterine !alnutrition
Leptin $eficiency
<he ulti!ate cause of o&esity is al-ays an intake of energy in e.cess of e.pen$iture, &ut !any
factors go0ern &oth intake an$ e.pen$iture. <here is un$ou&te$ly a genetic pre$isposition in
so!e in$i0i$uals. ,ntrauterine !alnutrition !ay &e i!portant in others. Leptin $eficiency is a
0ery rare cause of o&esity: !ore frequently, o&ese in$i0i$uals are resistant to the actions of
o&esity. ,nsulin resistance is pro&a&ly a consequence of o&esity, not a cause.
Correct
<he o.ygenJhae!oglo&in $issociation cur0e is shifte$ to the left &y -hich of the follo-ing
factors: (ingle &est ans-er - choose "1> true option only
Eise in pH
Kour ans-er
Eise in 2,%-7= +2,%-$iphosphoglycerate/
Eise in plas!a te!perature
Eise in &loo$ C"2 content
)all in plas!a &icar&onate concentration
All the a&o0e shift the $issociation cur0e to the right, -ith the e.ception of a rise in pH.
Correct
Fhich of the follo-ing cells secretes intrinsic factor:
=o&let cells
Tupffer cells
eptic cells
Chief cells
arietal cells
Kour ans-er
=o&let cells are !ucus-secreting cells, -i$ely $istri&ute$ throughout epithelial surfaces, &ut
especially $ense in the gastrointestinal an$ respiratory tracts.
Tupffer cells ha0e phagocytic properties an$ are foun$ in the li0er. <hey participate in the
re!o0al of ageing erythrocytes an$ other particulate $e&ris.
<he gastric !ucosa contains !any cell su&types, inclu$ing aci$-secreting cells +also kno-n as
parietal or o.yntic cells/, pepsin secreting cells +also kno-n as peptic, chief or Ay!ogenic cells/
an$ =-cells +gastrin-secreting cells/. eptic cells synthesise an$ secrete the proteolytic enAy!e,
pepsin. arietal cells acti0ely secrete hy$rochloric aci$ into the gastric lu!en, accounting for the
aci$ic en0iron!ent encountere$ in the sto!ach. Ho-e0er parietal cells are also in0ol0e$ in the
secretion of the glycoprotein, intrinsic factor.
,ntrinsic factor plays a pi0otal role in the a&sorption of 0ita!in @12 fro! the ter!inal ileu!.
Autoi!!une $a!age to parietal cells lea$s to a lack of intrinsic factor an$ hy$rochloric aci$,
lea$ing to 0ita!in @12 $eficiency an$ achlorhy$ria. <his is kno-n as pernicious anae!ia.
ernicious anae!ia is associate$ -ith a %-fol$ increase in gastric cancer risk.
Correct
1ociception +pain/
,s trans!itte$ faster through C fi&ers than through A $elta fi&ers
ain i!pulse recei0e$ in the $orsal horn can &e !o$ulate$ &y other $escen$ing spinal inputs
Kour ans-er
"pioi$s act on ^ receptors in the peripheral ner0es
(i$e effects of opioi$s can &e re0erse$ &y neostig!ine
=lycine is e.citatory pain neurotrans!itter
ain i!pulse recei0e$ &y $orsal horn can &e !o$ulate$ &y other ascen$ing an$ $escen$ing
spinal inputs +=ate <heory/. ain is trans!itte$ faster in !yelinate$ A $elta fi&ers, opioi$s act on
^ an$ : opioi$ receptors in the central ner0ous syste! an$ their effects can &e re0erse$ &y
nalo.one. =lycine is an inhi&itory neurotrans!itter.
,ncorrect
A 2#-year-ol$ -o!an un$ergoes resection of the ter!inal ileu! -ith fashioning of an ileosto!y
for CrohnIs $isease. (o!e 2 -eeks after surgery, she is !aking a goo$ reco0ery, an$ is eating a
high-energy, lo--resi$ue $iet, &ut has a high ileosto!y 0olu!e, necessitating intra0enous flui$
replace!ent. Her seru! calciu! concentration is 1.62 !!ol;l, phosphate 1.26 !!ol;l, alkaline
phosphatase 62 ?;l +nor!al V 129/, al&u!in %9 g;l, creatinine 69 ! !ol;l. rior to surgery, her
seru! calciu! concentration -as 2.16 !!ol;l, al&u!in %3 g;l.
Fhat is the !ost likely cause of her hypocalcae!ia: (ingle &est ans-er question J choose "1>
true option only
)or!ation of insolu&le calciu! salts in the intestine
Kour ans-er
Hypoal&u!inae!ia
Hypo!agnesae!ia
Correct ans-er
Mala&sorption of calciu!
Mala&sorption of 0ita!in 7
,!paire$ fat a&sorption can lea$ to the for!ation of insolu&le calciu! salts in the gut. )at an$
calciu! are a&sor&e$ in the pro.i!al s!all intestine, so, too, is 0ita!in 7. Although &ile salts are
a&sor&e$ $istally, an$ i!paire$ a&sorption can lea$ to a secon$ary $ecrease in pro.i!al fat
a&sorption, this is unlikely to &e responsi&le for hypocalcae!ia $e0eloping so quickly. <he
nor!al alkaline phosphatase le0el also !ilitates against 0ita!in 7 $eficiency. Hypocalcae!ia
-oul$ nor!ally &e e.pecte$ to sti!ulate parathyroi$ hor!one secretion an$ cause the plas!a
phosphate concentration to fall +<H is phosphaturic/. atients -ith ileosto!ies can lose large
a!ounts of !agnesiu! through their sto!asD hypo!agnesae!ia i!pairs <H secretion an$ can
cause hypocalcae!ia that is resistant to an increase$ pro0ision of calciu!.
Correct
A patient is foun$ to ha0e hyponatrae!ia. Fhich con$ition shoul$ &e e.clu$e$ &y su&sequent
in0estigations:
7ia&etes insipi$us
(yn$ro!e of inappropriate anti$iuretic hor!one secretion +(,A7H/
Kour ans-er
7ia&etes !ellitus
ConnIs syn$ro!e
CushingIs syn$ro!e
(,A7H causes e.cess -ater retention o0er so$iu! retention &y pro!oting -ater rea&sorption in
the collecting $ucts of the ki$neys. <his results in hyponatrae!ia. 7ia&etes insipi$us an$
$ia&etes !ellitus !ay &oth cause hypernatrae!ia &y resulting in e.cess -ater loss o0er 1a loss.
,n contrast, ConnIs syn$ro!e an$ Cushing syn$ro!e cause hypernatrae!ia &y pro!oting
e.cess so$iu! retention o0er -ater retention.
Correct
A 2-$ay-ol$ !ale infant is referre$ for a surgical opinion after his parents &ring hi! into the
>!ergency 7epart!ent -ith a&$o!inal $istension an$ -hat his parents $escri&e as Qgreen
0o!itingR. Fhich of the follo-ing -oul$ 1"< &e on your list of $ifferential $iagnoses:
7uo$enal Atresia
HirschprungIs $isease
yloric stenosis Kour ans-er
Malrotation
Meconiu! ,leus
yloric stenosis usually presents &et-een %-12 -eeks of age. <he 0o!it is 1"1-@,L,"?( $ue to
the high le0el of o&struction +the thickene$ pyloric !uscle/, -hich is a&o0e the entrance of the
co!!on &ile $uct into the $uo$enu!. 7istension is not usually a feature. @ilious 0o!iting in a
ne-&orn is a surgical e!ergency until pro0e$ other-ise. Malrotation is the $iagnosis, -hich
nee$s e.clusion -ith an upper =, contrast to look at the layout of the intestine, specifically
-hether the $uo$enal-'e'unal fle.ure is on the correct si$e of the 0erte&rae J the L>)< is the
correct si$e.
Correct
<he car$io0ascular effects of raise$ intracranial pressure inclu$e:
$ecrease$ &loo$ pressure, $ecrease$ heart rate, $ecrease$ cere&ral perfusion pressure
$ecrease$ &loo$ pressure, increase$ heart rate, $ecrease$ cere&ral perfusion pressure
increase$ &loo$ pressure, increase$ heart rate, $ecrease$ cere&ral perfusion pressure
increase$ &loo$ pressure, $ecreas$ heart rate, $ecrease$ cere&ral perfusion pressure
Kour ans-er
$ecrease$ &loo$ pressure, increase$ heart rate HE, increase$ cere&ral perfusion pressure
<he i!portant relationship &et-een the cere&ral perfusion, !ean arterial &loo$ pressure an$
intracranial pressure is as follo-s:
C P MA@ J ,C, -here C P cere&ral perfusion pressure
MA@ P !ean arterial &loo$ pressure
,C P intracranial pressure
,t ste!s fro! the fact that the a$ult &rain is enclose$ in a rigi$, inco!pressi&le &o., -ith the
result that the 0olu!e insi$e it !ust re!ain constant +Monroe-Telly $octrine/. A rise in
intracranial pressure therefore $ecreases cere&ral perfusion pressure +an$ hence cere&ral &loo$
flo-/.
,n raise$ intracranial pressure, as the &rainste! &eco!es co!presse$, local neuronal acti0ity
causes a rise in sy!pathetic 0aso!otor $ri0e an$ thus a rise in &loo$ pressure. <his is kno-n as
the CushingIs refle.. <his ele0ate$ &loo$ pressure e0okes a &ra$ycar$ia 0ia the &aroreceptor
refle.. <he CushingIs refle. helps to !aintain cere&ral &loo$ flo- an$ protect the 0ital centres of
the &rain fro! loss of nutrition if the intracranial pressure rises high enough to co!press the
cere&ral arteries.
Correct
Fith regar$ to C"2 transporte$ in the &loo$, !ost of the C"2 is
7issol0e$ in plas!a
,n the for! of car&a!ino co!poun$s for!e$ fro! plas!a proteins
,n the for! of car&a!ino co!poun$s for!e$ fro! hae!oglo&in
@oun$ to Chlori$e
,n the for! of HC"%-
Kour ans-er
Car&on $io.i$e is transporte$ in three !ain -ays:
S Car&a!ino co!poun$s &et-een C"2 an$ proteins. Most of these reactions are -ith the glo&in
portion of hae!oglo&in, accounting for 29-%9M of the transporte$ C"2.
S 7issol0e$ C"2 accounts for a&out 19M of the transporte$ C"2.
S HC"%- accounts for a&out 39-59M of the transporte$ C"2.
Correct
<he glo!erular filtration rate is increase$ &y:
(ingle &est ans-er J choose "1> true option only
,ncrease$ plas!a colloi$ os!otic pressure
Constriction of the glo!erular afferent arterioles
Constriction of the glo!erular efferent arterioles Kour ans-er
(aline $epletion
Eespiratory alkalosis
Constriction of the glo!erular efferent arterioles increases the hy$rostatic pressure -ithin the
glo!erulus an$ hence the filtration pressure.
Correct
)ollo-ing a $ecrease in core &o$y te!perature, -hat causes a rise in circulating plas!a
thyro.ine:
An increase pro$uction of thyro.ine &y the thyroi$ glan$
A $ecrease in renal e.cretion of thyro.ine
Eelease of thyrotrophin releasing hor!one fro! the hypothala!us
Kour ans-er
Eelease of thyroi$ sti!ulating hor!one fro! the anterior pituitary glan$
An increase in io$ine a&sorption fro! the intestines
<he hypothala!us is thought to &e the control centre for ther!oregulation. (tu$ies ha0e sho-n
that cooling the hypothal!ic area in the &rain -ill result in an increase in the secretion of
thyrotrophin releasing hor!one fro! the hypothala!us. <his in turn -ill result in an increase in
the secretion of thyroi$ sti!ulating hor!one fro! the anterior pituitary glan$ -hich acts $irectly
on the thyroi$ glan$ to increase the secretion of thyro.ine. <hyro.ine counters a $ecrease in
&o$y te!perature &y increasing the cellular !eta&olic rate in a process that can take se0eral
-eeks an$ can result in hypertrophy of the thyroi$ glan$.
Correct
Kou are aske$ to see a patient -ho ha$ a chest $rain re!o0e$ # $ays ago. <here appears to &e
so!e infection.
Fhat are the stages in the cell &iology of nor!al -oun$ healing:
7e!olition is the first phase
Maturation an$ re!o$elling can continue for up to a year
Kour ans-er
Acute infla!!ation usually lasts for 3J12 hours
>pithelial cell proliferation is the hall!ark of the $e!olition phase
Collagen $eposition is the key process $uring $e!olition
<he first phase in healing &y first intention is the phase of acute infla!!ation that lasts up to %
$ays, if unco!plicate$. <he initiating factor appears to originate fro! platelets acti0ate$ &y
!ature collagen e.pose$ in the -oun$. latelets first aggregate then release a 0ariety of acti0e
agents inclu$ing lysoso!al enAy!es, A<, serotonin an$ -oun$ cytokines. A fi&rin clot $e0elops,
-hich co!pletes hae!ostasis an$ pro0i$es strength an$ support to the -oun$. <he surface
$ries to for! a sca&. latelets an$ !acrophage factors cause local 0aso$ilatation, -hich
pro$uces -ar!th an$ increases capillary per!ea&ility, allo-ing seru! an$ -hite &loo$ cells to
accu!ulate an$ cause s-elling.
After the initial acute infla!!ation, !acrophages &eco!e acti0e as the !ain agents of
$e!olition, re!o0ing un-ante$ fi&rin, $ea$ cells an$ &acteria an$ creating flui$-fille$ spaces for
granulation tissue. Macrophages also release factors that sti!ulate the for!ation of ne-
capillary &u$s $uring this phase, an$ later they initiate an$ control fi&ro&last acti0ity $uring
repair. Fithin the connecti0e tissue, ran$o!ly orientate$ collagen &egins to for! after a fe-
$ays, reaching a peak of acti0ity after 2J5 $ays.
>pithelial cells at the e$ge of the -oun$ start to proliferate after 2# h an$ this phase can last for
up to % -eeks.
)inally, the phase of !aturation an$ re!o$elling lasts for up to 12 !onths, $uring -hich ti!e
the tensile strength of the -oun$ increases an$ the ran$o! collagen is replace$ &y a !ore
sta&le for! orientate$ along lines of stress.
Correct
A 22-year-ol$ patient suffere$ recurrent $eep 0ein thro!&oses an$ also one pul!onary
e!&olis!. (he -as e.tensi0ely in0estigate$ an$ $iagnose$ -ith protein C $eficiency.
Fhat pathological process is !ost likely to &e responsi&le for her 0enous thro!&oe!&olis!s:
Ee$uce$ $egra$ation of factors Ca an$ C,,,a
Kour ans-er
Ee$uce$ factor Xa co!ple.
Ee$uce$ inhi&ition of tissue-factor e.pression
Ee$uce$ protein (
Ee$uce$ synthesis of antithro!&in ,,,
rotein C acts to inacti0ate the acti0e for!s of the procoagulant cofactors, factors Ca an$ C,,,a.
rotein C is a 0ita!in T-$epen$ent serine protease structurally si!ilar to factors C,,, ,X an$ X.
<hro!&in acti0ates protein C -hen &oun$ to thro!&o!o$ulin, a protein -hich acts like an
en$othelial-cell receptor for thro!&in. (y!pto!atic !anifestations of protein C $eficiency are
si!ilar to those of antithro!&in ,,, $eficiency. 7eep 0enous thro!&osis, -ith or -ithout
pul!onary e!&olis!, occurs in 29M of patients &y the a
Eeply to HalaEeport
ost H12
MEC( art 1 ractice Guestions + hysiology / - % of %
Correct
Fhich of the follo-ing physiological a&nor!alities occurs as a $irect consequence of septic
shock:
A $ecrease in car$iac output
A $ecrease in syste!ic 0ascular resistance
Kour ans-er
A $ecrease in 0ascular per!ea&ility
A $ecrease in intra0ascular 0olu!e
An increase in car$iac contractility
(eptic shock is $efine$ as shock +$ecrease$ tissue perfusion resulting in en$-organ $ysfunction/
secon$ary to a $e!onstra&le source of infection J !ost co!!only &acterial in origin. >.oto.in in
&acterial cell -alls results in the pro$uction of cytokines an$ other infla!!atory !e$iators that
re$uce 0asuclar tone an$ increase 0ascular per!ea&ility. <his in turn can result in a loss of
intra0ascular flui$ across capillaries an$ intra0ascular 0olu!e $epletion as a secon$ary e0ent.
Car$iac output can &oth increase an$ $ecrease in septic shock $ue to the nor!al physiological
response to a $ecrease$ &loo$ pressure or car$iac $ysfunction cause$ &y circulating cytokines
an$ infla!!atory !e$iators respecti0ely.
Correct
@ile salt reuptake principally occurs in the:
7uo$enu!
*e'enu!
,leu!
Kour ans-er
Colon
Caecu!
89-82M of the &ile salts are a&sor&e$ fro! the s!all intestine an$ then e.crete$ again fro! the
li0erD !ost are a&sor&e$ fro! the ter!inal ileu!. <his is kno-n as the enterohepatic circulation.
<he entire pool recycles t-ice per !eal an$ appro.i!ately 3-6. per $ay.
7isruption of the enterohepatic circulation, either &y ter!inal ileal resection or through a
$isease$ ter!inal ileu! +e.g. CrohnIs $isease/, results in $ecrease$ fat a&sorption an$
cholesterol gallstone for!ation. <he latter is &elie0e$ to result &ecause &ile salts nor!ally !ake
cholesterol !ore -ater-solu&le through the for!ation of cholesterol !icelles. Loss of reuptake
also results in the presence of &ile salts in colonic contents, -hich alters colonic &acterial gro-th
an$ stool consistency.
,ncorrect
A 2#-year-ol$, unconscious !an is a$!itte$ to A`>. 1o history is a0aila&le. <he results of
arterial &loo$ gas analysis are: ZHB[ 69 n!ol;l +pH 5.1/, p+C"2/ 5.9 ka, p+"2/ 6.2 ka, ZHC"%J[
15.1 !!ol;l.
<hese results in$icate -hich one of the follo-ing aci$J&ase $istur&ances:
Meta&olic aci$osis -ith respiratory co!pensation
Mi.e$ !eta&olic an$ respiratory aci$osis
Correct ans-er
Kour ans-er
Eespiratory aci$osis -ith !eta&olic alkalosis
?nco!pensate$ !eta&olic aci$osis
<he high hy$rogen-ion concentration +lo- pH/ in$icates aci$osis. <he ele0ate$ p+C"2/ in$icates
a respiratory co!ponentD in co!pensate$ !eta&olic aci$osis, p+C"2/ is re$uce$D in an
unco!pensate$ !eta&olic aci$osis +a 0ery unusual situation, since the respiratory response to a
!eta&olic aci$osis is usually a rapi$ one/, it -oul$ &e nor!al. <he hy$rogen-ion concentration is
too lo- to &e accounte$ for &y a respiratory aci$osis alone: there !ust therefore &e a !eta&olic
aci$osis in a$$ition +as the lo- &icar&onate concentration also in$icates/.
,ncorrect
Concerning =lo!erular )iltration, -hich of the follo-ing is true of the pro.i!al con0olute$
tu&ule:
Eea&sor&s -ater &y so$iu! secretion
Eea&sor&s phosphate Correct ans-er
,ncreases the 0olu!e of rea&sor&e$ flui$ un$er al$osterone sti!ulation
Contains renin-secreting cells
Eecei0es !ost of its &loo$ supply fro! the 0asa recta Kour ans-er
<he pro.i!al con0olute$ tu&ule acti0ely rea&sor&s so$iu!. <his sets up an os!otic gra$ient an$
-ater is $ra-n out of the tu&ule. ,t is the site of &oth phosphate an$ calciu! rea&sorption un$er
control of parathyroi$ hor!one. Al$osterone acts on the $istal con0olute$ tu&ules. Eenin is
secrete$ &y the cells of the 'u.taglo!erular apparatus in the $istal con0olute$ tu&ules.
,ncorrect
Fhich of the follo-ing $o not nor!ally occur as a response to a $ecrease in core &o$y
te!perature:
@ra$ycar$ia
Casocontriction
A $ecrease in C1( !eta&olis!
A re$uction in plas!a catechola!ine le0els
Correct ans-er
A rise in plas!a thyro.ine
Kour ans-er
<he hypothala!us an$ the lo-er &rain ste! are the !ost i!portant neural structures that
regulate &o$y te!parature. A fall in core &o$y te!parature is associate$ -ith a $ecrease in C1(
acti0ity an$ can result in &ra$ycar$ia secon$ary to $epression of car$iac pace!aker cells. <he
&o$yIs response to a fall in te!parature inclu$es shi0ering, peripheral 0asoconstriction an$ the
release of !eta&olic factors inclu$ing thyro.ine, cortisol an$ catechola!ines.
,ncorrect
A 52-year-ol$ -o!an is foun$ to ha0e a seru! calciu! concentration of %.12 !!ol;l. Fhich of
the follo-ing clinical features, if present, -oul$ !ost $irect you to-ar$s a specific cause:
@one pain
Kour ans-er
Hilar ly!pha$enopathy
Correct ans-er
olyuria
(hort G< inter0al
?reteric colic
@one pain can occur -ith hypercalcae!ia secon$ary to !alignancy or hyperparathyroi$is!.
olyuria is a feature of se0ere hypercalcae!ia, irrespecti0e of the cause. A short G< inter0al is
also a feature of hypercalcae!ia. ?reteric colic is particularly associate$ -ith pri!ary
hyperparathyroi$is!, &ut is not specific to this cause. <he presence of hilar ly!pha$enopathy in
a patient -ith hypercalcae!ia shoul$ raise a suspicion that the latter is $ue to sarcoi$ +in -hich
the granulo!as secrete calcitriol, 1,22-$ihy$ro.ycholecalciferol/.
Correct
,n the respiratory syste!, physiological shunt:
,s greater than the anato!ical shunt
Kour ans-er
,s not present in healthy a$ult
Affects arterial car&on $io.i$e !ore than arterial o.ygen tension
Has the sa!e effect on respiratory gas e.change as $oes physiological $ea$ space
,s a&olishe$ -hen the su&'ect &reathes pure o.ygen
<he physiological shunt is the su! of the anato!ical shunt +&loo$ passing fro! the right
0entricle to the syste!ic circulation 0ia nor!al anato!ical path-ays, e.g. the &ronchial 0essels,
-ithout passing through the pul!onary al0eolar capillaries/, an$ the ele!ent of pul!onary
al0eolar capillary &loo$ that has passe$ through non or poorly aerate$ al0eoli. <herefore
physiological shunt is al-ays at least as great as or greater than the anato!ical shunt.
<here is al-ays a nor!al anato!ical shunt e0en in the young healthy a$ult.
<he $ifference in car&on $io.i$e tension &et-een arterial an$ !i.e$ 0enous &loo$ is a little less
than 1 ka, an$ therefore e0en a 29M shunt only increases arterial car&on $io.i$e tension &y
a&out 9.2 ka. A 29M shunt -oul$ re$uce arterial o.ygen tension fro! 1%.2ka to &elo- 8 ka.
<he physiological $ea$ space results pri!arily in a failure to re!o0e car&on $io.i$e fro!
al0eolar gas, i.e. a rise in arterial car&on $io.i$e tension if 0entilation not increase$.
<he &reathing of pure o.ygen cannot eli!inate the anato!ical right to left portion of the
physiological shunt.
Correct
A 59-year-ol$ !ale co!plains of constantly feeling col$ an$ lethargic. Fhat is the !ost likely
hor!onal $eficiency to account for this:
(o!atostatin
Cholecystokinin
<estosterone
<hyro.ine
Kour ans-er
,nsulin
<hyro.ine $eficiency is the !ost likely cause, particularly if other features of hypothyroi$is! are
present such as fatigue, -eight gain, $ry skin an$ hair, slo-ly-rela.ing refle.es an$ non-pitting
oe$e!a. A!ongst other roles, thyro.ine is i!portant in regulating &asal !eta&olic rate an$
&o$y heat pro$uction.
<estosterone $eficiency is likely to result in loss of li&i$o an$ secon$ary se.ual characteristics.
,nsulin $eficiency !ay present -ith features of $ia&etes !ellitus, such as thirst, polyuria an$
poly$ipsia. (o!atostatin an$ cholecystokinin are i!portant gastrointestinal regulatory pepti$es.
Correct
A patient has the follo-ing urea an$ electrolytes results:
(o$iu! 1#9 !!ol;l
otassiu! # !!ol;l
Chlori$e 192 !!ol;l
@icar&onate 29!!ol;l
Calculate the anion gap.
18 !eq;l
Kour ans-er
2 !eq;l
19 !eq;l
%9 !eq;l
9 !eq;l
Anion gap P +Z1aB[ B ZTB[/ - +ZClJ[ B ZHC"%J[/ +all units !!ol;l/.
1or!al range is 6J13 !eq;l
Correct
<he largest contri&ution to syste!ic 0ascular resistance +(CE/ is !a$e &y the
Aortic 0al0e
=reat arteries
Arterioles
Kour ans-er
Cenules
=reat 0eins
<he capillaries an$ arterioles each account for aroun$ 22M of the (CE. <he large surface area of
the capillaries, as -ell as the lo- flo- an$ pressure $rop through the capillary &e$s is 0ital to
their function in e.change of gases an$ nutrients. <he arterioles ha0e a&un$ant s!ooth !uscle
in their -alls, an$ flo- is regulate$ to a large $egree &y the sy!pathetic ner0ous syste!. <hey
therefore e.ert a great $eal of control o0er the flo- through the capillary &e$s, as -ell as -hich
capillary &e$s are open at a gi0en ti!e.
,ncorrect
Fithin nor!al physiological li!its, -hich of the follo-ing factors $oes not influence car$iac
stroke 0olu!e:
reloa$
Afterloa$
Correct ans-er
Heart rate
Kour ans-er
Car$iac sy!pathetic ner0e acti0ity
Eeply to HalaEeport
ost H1%
Myocar$ial contractility
,ncreases in preloa$ +up to a li!it/ increase stroke 0olu!e &y (tarlingIs La- of the heart.
(tarlingIs La- also in$icates that increases in afterloa$ +up to a li!it/, -hilst causing 0entricular
stretch an$ an increase in en$-$iastolic 0olu!e, $o not increase stroke 0olu!e &ut instea$
!aintain it. ,ncreases in !yocar$ial contractility increase the force of contraction $uring systole
an$ therefore increase stroke 0olu!e. ,f preloa$ $oes not &eco!e li!iting, increases in heart
rate increase !yocar$ial contractility, an$ therefore stroke 0olu!e, 0ia the @o-$itch effect +a
rate-relate$ pheno!enon thought to &e $ue to accu!ulation of intracellular calciu! in the
car$io!yocytes/. Car$iac sy!pathetic ner0e acti0ity increases stroke 0olu!e &y increasing
car$iac contractility an$ heart rate.
Correct
A 21-year-ol$ !an presents -ith a 2-$ay history of persistent 0o!iting an$ a&$o!inal pain. His
&loo$ gas sho-sD
pH 5.##
aC"2 5.% ka
a"2 12.9 ka
@ase e.cess B12 !!ol;l
HC"%- %6 !!ol;l
Cl- 89 !!ol;l
Fhat $oes this &loo$ gas $e!onstrate:
Co!pensate$ !eta&olic alkalosis Kour ans-er
Co!pensate$ respiratory alkalosis
?nco!pensate$ !eta&olic alkalosis
?nco!pensate$ !eta&olic aci$osis
,t can &e seen that the striking features of this &loo$ gas are a pH -ithin the nor!al
physiological range -ith ele0ate$ &icar&onate an$ &ase e.cess. <he 0o!iting in this patient has
resulte$ in the loss of hy$rochloric aci$ an$ loss of total &o$y HB concentration, causing a
!eta&olic alkalosis.
<his patient has co!pensate$ for this through respiratory hypo0entilation an$ retention of C"2
+an aci$ic gas/. ?lti!ately the aci$-&ase i!&alance cannot &e nor!alise$ &y respiratory
retention of C"2, this is !erely a co!pensatory !easure an$ requires renal !o$ulation of HB
an$ HC"%- le0els
Correct
<he action potential of skeletal !uscle:
Has a prolonge$ plateau phase
(prea$ in-ar$s to all parts of the !uscle 0ia the < tu&es
Kour ans-er
Causes i!!e$iate uptake of Ca into the sarcoplas!ic reticulu!
,s longer than the action potential of car$iac !uscle
,s not essential for contraction
<he action potential of the skeletal !uscle sprea$s out fro! the !otor en$ plate, through the <
tu&e syste! this causes !o&iliAation of Ca2B fro! the sarcoplas!ic reticulu! to the cytoplas!
an$ this action potential is essential for contraction.
<he action potential of car$iac !uscle is longer than that of the skeletal !uscle an$ has plateau
phase.
Correct
,n a star0ing patient, -hich of the follo-ing flui$ regi!ens -oul$ &e !ost appropriate for a 59kg
!an o0er a 2#hr perio$:
%L 1(aline -ith 29!!ols potassiu! chlori$e in each &ag
%L 7e.trose-saline
%L Hart!annIs solution
1L 1(aline -ith 29 !!ols potassiu! chlori$e an$, 2L 2M $e.trose -ith 29!!ols potassiu!
chlori$e in each &ag
Kour ans-er
%L 2M $e.trose -ith 29!!ols potassiu! chlori$e in each &ag
<he $aily flui$ an$ electrolyte require!ents are 1-1.2 !!ols 1aB ;Tg;2# hours, 1!!ols TB
;Tg;2# hours an$ #9!l H29 ;Tg;2# hours.
Ho-e0er, a$$itional flui$ shoul$ &e supple!ente$ if there are %r$ space losses +that co!!only
occur for instance in se0ere acute pancreatitis, &urns an$ post !a'or gastro-intestinal surgery/
an$ for other sources of flui$ loss inclu$ing 0o!iting, $iuresis an$ insensi&le losses.
Correct
=astric aci$ secretion is sti!ulate$ &y:
(o!atostatin
=astrin
Kour ans-er
(ecretin
<he glossopharyngeal ner0e
Cholecystokinin
=astric aci$ is sti!ulate$ &y % factors:
O Acetylcholine: )ro! parasy!pathetic neurones of the 0agus ner0e that inner0ate parietal cells
$irectly.
O =astrin: pro$uce$ &y pyloric =-cells.
O Hista!ine: ro$uce$ &y !ast cells. <his sti!ulates the parietal cells $irectly an$ also
potentiates parietal cell sti!ulation &y gastrin an$ neuronal sti!ulation. H2 &lockers such as
raniti$ine are therefore an effecti0e -ay of re$ucing aci$ secretion.
=astric aci$ is inhi&ite$ &y % factors:
O (o!atostatin
O (ecretin
O Cholecystokinin
<here are % classic phases of gastric aci$ secretion:
O Cephalic +preparatory/ phase Zsignificant[: Eesults in the pro$uction of gastric aci$ &efore foo$
actually enters the sto!ach. <riggere$ &y the sight, s!ell, thought an$ taste of foo$ acting 0ia
the 0agus ner0e.
O =astric phase Z!ost significant[: ,nitiate$ &y the presence of foo$ in the sto!ach, particularly
protein rich foo$.
O ,ntestinal phase Zleast significant[: <he presence of a!ino aci$s an$ foo$ in the $uo$enu!
sti!ulate aci$ pro$uction.
,ncorrect
<he rate at -hich a liqui$ !eal lea0es the sto!ach is:
=reater in the upright than in the supine position
roportional to the 0olu!e of sto!ach content
Correct ans-er
=reater if the !eal contains fat
(lo-er if the !eal is 2M glucose than if it is 29M glucose
(lo-er if 0agoto!y an$ $rainage proce$ure +such as gastroenterosto!y or pyloroplasty/ has
&een perfor!e$
Kour ans-er
=astric e!ptying accelerates on lying $o-n. <he rate of gastric e!ptying at any !o!ent is
proportional to the 0olu!e present in the sto!ach at that !o!ent
Fhen the fat reaches the $uo$enu! it sti!ulates !i.e$ hor!onal an$ 0agal !echanis!s that
slo- the rate of sto!ach e!ptying.
An isotonic !eal -ill e!pty at !a.i!al rate &ut os!otically stronger or -eaker solutions -ill
e!pty !ore slo-ly.
Cagoto!y !ay te!porarily slo- gastric e!ptying, &ut its long ter! effect is to increase the rate
of gastric e!ptying or lea0e it un change$ so if a $rainage proce$ure is acco!panie$ &y
0agoto!y there -ill &e a ten$ency to-ar$s accelerating gastric e!ptying.
Correct
7uring $igestion of a fatty !eal, -hich hor!one causes contraction of the gall &la$$er an$
rela.ation of the sphincter of "$$i:
Cholecystokinin
Kour ans-er
=astrin
,nsulin
(ecretin
(o!atostatin
Cholecystokinin secretion fro! the $uo$enal an$ 'e'unal !ucosa is sti!ulate$ &y the presence
of fatty aci$s, a!ino aci$s an$ pepti$es in the lu!en of the $uo$enu! an$ 'e'unu!. As -ell as
causing contraction of the gall &la$$er an$ rela.ation of the sphincter of "$$i, it sti!ulates
release of pancreatic enAy!es, an$ increases the secretin !e$iate$ secretion of HC9%- &y
pancreatic $uct cells. ,ts release is inhi&ite$ &y so!atostatin.
Correct
,n a &reathless patient, a pleural effusion -ith less than %g of protein per 199!l of flui$ is !ost
likely to &e cause$ &y
@ronchial carcino!a
Mitral regurgitation
Kour ans-er
neu!onia
<u&erculosis
<ricuspi$ regurgitation
An effusion -ith less than %g of protein per 199!l is a transu$ate. "ther &ioche!ical
characteristics of a transu$ate inclu$e L7H V 299 i?;l, FCC V 1999;!l, glucose !!ol;l.
<ransu$ati0e effusions are !ost co!!only $ue to factors such as $eco!pensate$ li0er failure
an$ left 0entricular failure. Malignancy an$ infection are causes of an e.u$ati0e pleural effusion.
ul!onary e!&olis! can cause either an e.u$ati0e or transu$ati0e effusion, although the
for!er is !ore co!!on.
,n this question, @ is !ore likely than > to &e associate$ -ith left 0entricular failure, an$
therefore a pleural effusion. <ricuspi$ regurgitation is usually functional an$ secon$ary to an
enlarge$ right 0entricle in right 0entricular failure, an$ causes a pulsatile li0er, peripheral
oe$e!a an$ ascites.
Correct
High titres of antithyroi$ !icroso!al an$ antithyroglo&ulin anti&o$ies -oul$ suggest -hich of
the follo-ing $iagnoses in a patient presenting -ith a co!plaint of tire$ness:
Hashi!otoIs thyroi$itis
Kour ans-er
Eei$elIs thyroi$itis
=ra0es $isease
Hypoparathyroi$is!
,$iopathic hypothyroi$is!
<his fin$ing in Hashi!otoIs thyroi$itis is characteristic, &ut lo-er titres can occur in Eei$elIs
thyroi$itis an$ =ra0es $isease. High titres of these anti&o$ies in euthyroi$ in$i0i$uals in$icate
the possi&ility of future thyroi$ failure, &ut this !ay &e !any years a-ayD hence the nee$ for
thyroi$ function tests e0ery 1J2 years in such in$i0i$uals.
Correct
Fhich of the follo-ing constituents is 1"< present in Hart!annIs solution:
1aB
Cl-
TB
Lactate
HC"%-
Kour ans-er
<he co!position of Hart!annIs solution is as follo-s:-
1aB P 1%1 !!ol;l
Cl- P 111 !!ol;l
TB P 2 !!ol;l
Ca2B P 2 !!ol;l
Lactate P 28 !!ol;l
<herefore, the os!olality of Hart!annIs solution is +1%1B111B2B2B28/ P 256 !!ol;l.
<he lactate present in the solution is !eta&olise$ in 0i0o to for! HC"%-. @icar&onate is not
a$$e$ to Hart!annIs solution since this -oul$ result in the precipitation of calciu! car&onate in
the storage container.
,ncorrect
Fhat is the !ain !etho$ &y -hich intracellular pH is regulate$:
<he &icar&onate &uffer syste!
Kour ans-er
<he phosphate &uffer syste!
Cytoplas!ic proteins
Correct ans-er
Car&onic anhy$rase
<he glo&in co!ponent of hae!oglo&in
Cytoplas!ic proteins pro0i$e the !ain contri&ution to pH &uffering of the intracellular
co!part!ent.
,n the interstitial +i.e. e.tracellular an$ e.tra0ascular/ co!part!ent, the &icar&onate syste! is
the !ain !echanis! of pH &uffering.
,n the intra0ascular +plas!a/ co!part!ent, pH &uffering !echanis!s inclu$e:-
S <he &icar&onate &uffer syste!: C"2 B H2" a H2C"% a HB B HC"%- catalyse$ &y the enAy!e
car&onic anhy$rase
S <he phosphate &uffer syste!: H"#2- B HB a H2"#-
S las!a proteins
S <he glo&in co!ponent of hae!oglo&in
,ncorrect
A 39-year-ol$ o&ese s!oker has &een a$!itte$ to hospital -ith chest pain $ue to unsta&le
angina. A nitrate infusion is starte$ to relie0e his chest pain.
Fhich &loo$ 0essels are !ost sensiti0e to the 0aso$ilatatory effect of nitrates:
Large arteries
Coronary arteries
Kour ans-er
Capillaries
Large 0eins
Correct ans-er
ul!onary arteries
<he antianginal an$ hae!o$yna!ic effects are !e$iate$ pre$o!inantly &y 0aso$ilatation of the
0enous syste!, lea$ing to a fall in left 0entricular preloa$ an$ car$iac -ork.
Correct
A patient on total parenteral nutrition +<1/ regi!en presents -ith $ro-siness an$ a&nor!al
seru! electrolytes.
Fhat is the !ost likely cause: (ingle &est ans-er - choose "1> true option only
Hypocalcae!ia
Hypercalcae!ia
Hypernatrae!ia
Hypophosphatae!ia
Kour ans-er
Hypo!agnesae!ia
A$!inistering car&ohy$rate lo-ers seru! phosphate &y sti!ulating the release of insulin, -hich
!o0es phosphate an$ glucose into cells. <his so-calle$ refee$ing syn$ro!e occurs -hen
star0ing or chronically !alnourishe$ patients are re-fe$ or gi0en intra0enous +i0/ glucose.
hosphate $eficiency co!!only i!pairs neurological function, -hich !ay &e !anifeste$ &y
confusion, seiAures, an$ co!a. eripheral neuropathy an$ ascen$ing !otor paralysis, si!ilar to
=uillainJ@arrb syn$ro!e, !ay also occur. Feakness of skeletal or s!ooth !uscle is the !ost
co!!on clinical !anifestation of phosphate $eficiency. ,t can in0ol0e any !uscle group, alone
or in co!&ination, ranging fro! ophthal!oplegia to pro.i!al !yopathy, to $ysphagia or ileus.
Eespiratory insufficiency !ay occur in so!e patients -ith se0ere hypophosphatae!ia,
particularly -hen the un$erlying cause is !alnourish!ent. ,!paire$ car$iac contractility occurs,
lea$ing to generalise$ signs of !yocar$ial $epression. <he hypophosphatae!ic !yocar$iu!
also has a re$uce$ threshol$ for 0entricular arrhyth!ias.
,ncorrect
A 39 kg !an suffers 29 M &urns. Fhat is the esti!ate$ 0olu!e of intra0enous flui$ replace!ent
that shoul$ &e a$!inistere$ in the first 6 hours fro! the ti!e of the &urn:
699 J 1,999 !l
1,999 J 1,299 !l
1,299 J 2,#99 !l
Correct ans-er
2,#99 J #,699 !l
Kour ans-er
#,699 J 2,999 !l
,ntra0enous flui$s +crystalloi$ or colloi$/ shoul$ &e a$!inistere$ if &urns of greater than 12 M in
a$ult or 19 M in pae$iatric patients are present. <he rate of flui$ a$!inistration ulti!ately
e!ploye$ is $epen$ent on clinical in$ices, such as urine output, capillary refill an$ peripheral
perfusion, central 0enous pressure an$ core:peripheral te!perature $ifferentials.
Carious for!ulae are a0aila&le for esti!ating initial rates of intra0enous flui$ replace!ent in
&urns 0icti!s. <hese initial rates of flui$ a$!inistration are then !o$ifie$ &ase$ on clinical
response.
<-o -i$ely-use$ for!ulae are as follo-s:-
arklan$ for!ula : 2 J # !l;kg;M&urn +full or $eep partial thickness/ in first 2# h fro! ti!e of
&urn. Half of this calculate$ 0olu!e +crystalloi$/ shoul$ &e a$!inistere$ in the first 6 h an$ the
re!ain$er a$!inistere$ in the su&sequent 13 h.
Mount Cernon )or!ula <his for!ula su&$i0i$es flui$ a$!inistration into $iscrete ti!e perio$s
o0er the first 2# h: #, #, #, 3, 3 an$ 12 h fro! the ti!e of &urn. <he a!ount of flui$ +colloi$/
a$!inistere$ in each of these perio$s is calculate$ as: +patient -eight in kg . M&urn/;2
Correct
A %--eek-ol$ &a&y e.hi&its pro'ectile 0o!iting shortly after fee$ing an$ failure to thri0e. "n
e.a!ination an oli0e-shape$ !ass is palpa&le in the right upper qua$rant of the a&$o!en. A
clinical $iagnosis of pyloric stenosis is !a$e. Fhat &ioche!ical la&oratory features -oul$
support the $iagnosis:
Hypokalae!ia, !eta&olic alkalosis, lo- urinary pH
Kour ans-er
Hyperkalae!ia, !eta&olic aci$osis, high urinary pH
Hypokalae!ia, !eta&olic aci$osis, high urinary pH
Hyperkalae!ia, !eta&olic alkalosis, lo- urinary pH
Hypokalae!ia, !eta&olic alkalosis, high urinary pH
)ollo-ing a $iagnosis of pyloric stenosis, the first concern is to correct the !eta&olic
a&nor!alities that in0aria&ly coe.ist -ith the con$ition. <he seru! electrolytes an$ capillary
gases shoul$ &e !easure$ an$ correcte$ prior to surgery.
Fith prolonge$ 0o!iting, the infant &eco!es $ehy$rate$, -ith a hypochlorae!ic !eta&olic
alkalosis. <he alkalosis is a result of loss of un&uffere$ hy$rogen ions in gastric 'uice -ith
conco!itant retention of &icar&onate.
)lui$ loss sti!ulates renal so$iu! rea&sorption, &ut so$iu! can only &e rea&sor&e$ either -ith
chlori$e, or in e.change for hy$rogen an$ potassiu! ions +to !aintain electroneutrality/. =astric
'uice has a high concentration of chlori$e an$ patients losing gastric secretions &eco!e
hypochlorae!ic. <his !eans that less so$iu! than nor!al can &e rea&sor&e$ -ith chlori$e.
Ho-e0er, it appears that the $efence of e.tracellular flui$ 0olu!e takes prece$ence o0er aci$-
&ase ho!eostasis an$ further so$iu! rea&sorption occurs in e.change for hy$rogen ions
+perpetuating the alkalosis/ an$ potassiu! ions +lea$ing to potassiu! $epletion/. <his e.plains
the apparently para$o.ical fin$ing of aci$ic urine in patients -ith pyloric stenosis. otassiu! is
also lost in the gastric 'uice an$ thus patients frequently &eco!e potassiu!-$eplete$ an$ yet
are losing potassiu! in their urine.
Correct
A 52-year-ol$ -o!an is &eing follo-e$ &y her = for suspecte$ $e0eloping pri!ary
hypothyroi$is!.
Fhich of the follo-ing &ioche!ical changes -oul$ you !ost e.pect to occur first:
)all in seru! free thyro.ine
)all in seru! thyro.ine-&in$ing glo&ulin
)all in seru! free triio$othyronine
)all in seru! total triio$othyronine
,ncrease in seru! <(H
Kour ans-er
Hypothyroi$is! $e0elops gra$ually, often o0er !any !onths or e0en years. ,n the early stages,
free thyro.ine concentrations are !aintaine$ in the nor!al range &y the increase$ secretion of
<(H. atients -ith a slightly ele0ate$ <(H an$ lo-Jnor!al thyro.ine are sai$ to ha0e
Wco!pensate$I or W&or$erlineI hypothyroi$is!. ,n so!e in$i0i$uals, it appears that this state can
&e !aintaine$ -ithout progression to frank hypothyroi$is!. <riio$othyronine concentrations
ten$ to fall later than thyro.ine concentrations in hypothyroi$is!D the concentration of
thyro.ine-&in$ing glo&ulin $oes not change significantly.
,ncorrect
<he acute &loo$ loss of 1.2 liters lea$s to a $ecrease in:
<he rate of o.ygen e.traction &y the peripheral tissues
Eenin secretion
latelet count
Kour ans-er
<he car$iac output
Correct ans-er
Coronary an$ cere&ral &loo$ flo- $ue to sy!pathetic o0eracti0ity
<he rate of o.ygen e.traction &y the peripheral tissues is increase$ in response to acute &loo$
loss, renin secretion is also increase$ $ue to renal hypoperfusion.
latelet count is increase$ an$ car$iac output $ecrease$ as the stroke 0olu!e $ecreases.
<he &loo$ flo- to the &rain an$ the heart re!ains unchange$.
Correct
A patient recei0es too !any infusions after an operation resulting in a 29M increase in his &loo$
0olu!e.
Fhat is the physiological process that is !ost likely to correct this a&nor!ality:
Ee$uce$ acti0ity of arterial pressure sensors
,ncrease$ acti0ity of renal sy!pathetic ner0es
Al$osterone release
Atrial natriuretic pepti$e +A1/ release
Kour ans-er
Cenous $ilatation
<he atria contain granulate$ cells that release pepti$es, atrial natriuretic pepti$e +A1/, in
response to stretch. <his natriuretic agent also rela.es the peripheral 0asculature an$ there&y
opposes the actions of the sy!pathetic an$ reninJangiotensin syste!s.
Correct
A 2#-year-ol$ -o!an has un$ergone so!e &loo$ tests as part of an e!ploy!ent health screen.
(he reports she is in goo$ health an$, &eing 0ery health conscious, takes regular 0ita!in an$
!ineral supple!ents. (he is taking &en$rofluaAi$e 2.2 !g for hypertension an$ her &loo$
pressure is 1%2;62 !!Hg. <he only a&nor!ality is a seru! calciu! concentration of 2.8#
!!ol;l.
Fhich of the follo-ing is the !ost likely cause: (ingle &est ans-er question J choose "1> true
option only
7iuretic treat!ent
High $ietary calciu! intake
High $ietary 0ita!in 7 intake
"ccult !alignancy
ri!ary hyperparathyroi$is!
Kour ans-er
<hiaAi$es can cause hypercalcae!ia &ut it is usually only !il$. Cita!in 7 itself is physiologically
inacti0e an$, -hereas 1-hy$ro.ylate$ $eri0ati0es can &e a cause of hypercalcae!ia, 0ita!in 7 J
-hich has to &e !eta&olise$ to acti0ate it J is less co!!only so. ,ntestinal a&sorption of calciu!
is su&'ect to tight control, an$ a high intake $oes not cause hypercalcae!ia. <he t-o !ost
co!!on causes of hypercalcae!ia are pri!ary hyperparathyroi$is! an$ !alignancy. ,n an
asy!pto!atic in$i0i$ual, pri!ary hyperparathyroi$is! is the !ore likely cause.
Correct
A 23-year-ol$ -o!an sustains a !yocar$ial infarction. (< ele0ation an$ G -a0es are present in
lea$s C#JC3, , an$ ACL.
Fhich of the follo-ing aspects of the heart is !ost likely to ha0e &een in0ol0e$ in the infarct:
Anterior
Anterolateral
Kour ans-er
Anteroseptal
,nferior
Lateral
<his co!&ination suggests an anterolateral infarct. urely anterior infarcts ten$ to in0ol0e the
chest lea$s only +typically C2JC2/, anteroseptal C1JC%, lateral infarcts chest lea$s only +,, ,,, ACL/
an$ inferior infarcts ,,, ,,, an$ AC).
Correct
A parathyroi$ a$eno!a -ill &e !ost likely to cause
7ecrease$ osteoclastic acti0ity
7ecrease$ urinary phosphate e.cretion
Hypocalcae!ia
,ncrease$ osteo&lastic acti0ity
,ncrease$ osteoclastic acti0ity
Kour ans-er
<he parathyroi$ glan$s pro$uce parathyroi$ hor!one +<H/ in response to seru! calciu! le0els
0ia a negati0e fee$&ack !echanis!. High le0els of seru! Ca2B inhi&it <H secretion, an$ lo-
le0els sti!ulate <H secretion. <he response to Ca2B le0els is 0ery rapi$, so effects are seen
0ery quickly after re!o0al of the glan$s.
<H affects calciu! le0els &y its action on the &one, ki$ney an$ gut.
,n &one, increase$ osteoclastic acti0ity causes calciu! le0els to rise. <his is $ue firstly to aci$
secretion onto the &one surface, an$ secon$ly to proteases $issol0ing the !atri..
,n the ki$ney, <H controls the hy$ro.ylation of 22,hy$ro.y cholecalciferol 7 to 1,22 hy$ro.y
cholecalciferol. <his has the in$irect effect of increasing calciu! uptake in the gut. ,n the
pro.i!al tu&ule, <H increases the urinary e.cretion of phosphate, -hich in turn increases the
ionisation of calciu!. <here is also an increase in Ca2B rea&sorption in the $istal tu&ule.
@icar&onate resorption is inhi&ite$ in the ki$ney, causing a hyperchlorae!ic aci$osis -hich
increase calciu! ionisation an$ resorption fro! &one.
<H e.cess therefore causes hypercalcae!ia, hypophosphatae!ia an$ hyperchlorae!ia, as -ell
as raise$ urinary phosphate.
Correct
A 29-year-ol$ !an presents -ith !il$ 'aun$ice follo-ing a flu-like illness. )ollo-ing re0ie- &y a
gastroenterologist, he has &een tol$ that a $iagnosis of =il&ertIs syn$ro!e is pro&a&le.
Fhich la&oratory test is !ost likely to confir! this $iagnosis:
A&sence of &iliru&in in the urine
Kour ans-er
7ecrease$ seru! haptoglo&in concentration
>le0ate$ seru! aspartate a!inotransferase +transa!inase, A(</ acti0ity
,ncrease$ reticulocyte count
,ncrease$ urinary uro&ilinogen e.cretion
,n =il&ertIs syn$ro!e, the e.cess &iliru&in is uncon'ugate$, an$ $oes not appear in the urine.
<he sa!e is true for 'aun$ice secon$ary to hae!olysis. Ho-e0er, in hae!olytic 'aun$ice, urinary
uro&ilinogen is increase$ +increase$ pro$uction of &iliru&in, an$ hence of uro&ilinogen/, the
reticulocyte count !ay &e ele0ate$ an$ seru! haptoglo&in concentration $ecrease$.
Hae!olysis !ay also cause a slight increase in seru! a!inotransferase +transa!inase/ acti0ity.
Correct
Fhich of the follo-ing physiological responses occur in an acute hypoglycae!ic episo$e:
A rise in seru! insulin
A $ecrease in li0er glycogen
A $ecrease in seru! glucagon
A rise seru! a$renaline
Kour ans-er
A rise in seru! ketone &o$ies
Acute hypoglycae!ia co!!only occurs in insulin $epen$ant $ia&etic patients -ho fail to !atch
their car&ohy$rate intake -ith their insulin $ose. ,t also occurs in patients -ith &eta cell
pancreatic tu!ours +insulino!a/ $ue to a pathological o0erpro$uction of insulin.
<he acute response to hypoglycae!ia is the result of an increase in seru! a$renaline, glucagon
+&oth of -hich are gluconeogenic/ an$ $ue to a lack of glucose a0aila&le for the &rain +ter!e$
neuroglycopenia/. <hese result in Qflight or frightR sy!pto!s, the feeling of hunger an$ a 0ariety
of neurological sy!pto!s inclu$ing &lurre$ 0ision, slurre$ speech an$ i!paire$ !ental function.
Correct
Fhich of the follo-ing is not a -ell recognise$ feature of e.cessi0e glucocorticoi$ le0els:
Hypertension
Hyperglycae!ia
Alopecia
Kour ans-er
Acne
Eeply to HalaEeport
ost H1#
"steoporosis
Cortisol an$ its analogues are glucocorticoi$s an$ le0els are raise$ either en$ogenously in
CushingIs $isease, or e.ogenously causing CushingIs syn$ro!e. <here are nu!erous si$e
effects of glucocorticoi$ e.cess. Hypertension as a result of increase$ renal rea&sorption of
so$iu! an$ -ater. Hyperglycae!aia as a result of !ineralocorticoi$ acti0ity. Acne an$
hirsutis!, not alopecia are a result of an$rogenic acti0ity. "ther si$e effects are osteoporosis,
-eakene$ skin, !uscle -asting, i!!unosuppression an$ increase$ rates of infection, cataracts
an$ fat re$istri&ution to gi0e the !oon face an$ &uffalo hu!p appearance.
Correct
Fhich of the follo-ing is not typically a cause of hypercalcae!ia:
Hyperparathyroi$is!
Hypothyroi$is!
Kour ans-er
MilkJalkali syn$ro!e
(arcoi$
(qua!ous-cell carcino!a
<-o of co!!onest causes of hypercalcae!ia in the -estern -orl$ are pri!ary
hyperparathyroi$is! an$ !alignancy. ,n pri!ary hyperparathyroi$is! there is e.cess
pro$uction of parathyroi$ hor!one +<H/D although usually fro! a &enign a$eno!a, this
so!eti!es results fro! hyperplasia of the parathyroi$ glan$s an$, in rare cases, a carcino!a.
<hyroto.icosis can cause hypercalcae!ia as -ell as osteoporosis. <he !ilkJalkali syn$ro!e can
occur in patients -ho suffer fro! $yspepsia an$ $rink !ilk an$ alkali-containing antaci$s, -hich
!ay re$uce the renal e.cretion of calciu!. Aroun$ one-fifth of those -ith sarcoi$ ha0e increase$
calciu! le0els. Carious !echanis!s cause raise$ hypercalcae!ia of !alignancy.
Correct
Fhich of the follo-ing is the site of renin pro$uction:
Collecting $ucts
ro.i!al con0olute$ tu&ule
Loop of Henle
*u.taglo!erular apparatus Kour ans-er
Li0er
<he 'u.taglo!erular apparatus is for!e$ of specialise$ 'u.taglo!erular cells in the -all of
afferent arterioles an$ !acula $ensa of the $istal con0olute$ $ucts. Eenin secretion is
sti!ulate$ &y re$uce$ renal perfusion. Angiotensinogen is pro$uce$ &y the li0er an$ is catalyse$
&y renin to for! angiotensin ,. <his is in turn catalyse$ &y angiotensin con0erting enAy!e +AC>/
to pro$uce angiotensin. Angiotensin has se0eral functions -hich ai! to increase &loo$ pressure
an$ restore renal perfusion. ,t causes 0asoconstriction, sti!ulates the a$renal corte. to pro$uce
al$osterone -hich pro!otes renal rea&sorption of so$iu! an$ -ater fro! the $istal con0olute$
tu&ules an$ collecting $ucts.
,ncorrect
Hypothyroi$is! $ue to $isease of the thyroi$ glan$ is associate$ -ith increase$ plas!a le0el of:
Cholesterol
Correct ans-er
Al&u!in
E<%
Kour ans-er
,o$i$e
<hyroi$ &in$ing glo&ulin +<@=/
<hyroi$ hor!one lo-ers circulating cholesterol le0el. <he plas!a cholesterol le0el $rops &efore
the !eta&olic rate rises.
,ncorrect
Fhich one of the follo-ing is M"(< likely to increase $uring e.ercise:
eripheral 0ascular resistance
ul!onary 0ascular resistance
(troke 0olu!e
Correct ans-er
7iastolic pressure
Cenous co!pliance
Kour ans-er
7uring e.ercise, increase$ o.ygen consu!ption an$ increase$ 0enous return to the heart result
in an increase in car$iac output an$ an increase in &loo$ flo- to &oth skeletal !uscle an$
coronary circulation, -hen o.ygen utiliAation is greatest. <he increase in car$iac output is $ue to
an increase in &oth heart rate an$ stroke 0olu!e. (yste!ic arterial pressure also increases in
response to the increase in car$iac output. Ho-e0er, the fall in total peripheral resistance, -hich
is cause$ &y $ilatation of the &loo$ 0essels -ithin the e.ercising !uscles, results in a $ecrease
in $iastolic &loo$ pressure. <he pul!onary 0essels un$ergo passi0e $ilatation as !ore &loo$
flo-s into the pul!onary circulation. As a result, pul!onary 0ascular resistance $ecreases. <he
$ecrease in 0enous co!pliance, cause$ &y sy!pathetic sti!ulation, helps to !aintain
0entricular filling $uring $iastole.
Correct
<he function of luteinising hor!one in the !ale is:
ro!otion of sper!atogenesis
(ti!ulation of testosterone secretion Kour ans-er
ro!otion of a$renal an$rogen secretion
(ti!ulation of (ertoliIs cells to pro$uce inhi&in
ro!otion of sper!iogenesis
)ollicle-sti!ulating hor!one +)(H/ an$ testosterone are require$ for sper!atogenesis +$i0ision
of sper!atogonia to for! sper!ati$s/ an$ sper!iogenesis +!aturation of sper!ati$s to !ature
sper!/. )(H also sti!ulates (ertoliIs cells to pro$uce an$rogen-&in$ing proteins an$ inhi&in.
A$renal an$rogen secretion is not affecte$ &y luteinising hor!one.
,ncorrect
ul!onary gas e.change occurs un$er -hich of the follo-ing physiological principles: (ingle
&est ans-er question J choose "1> true option only
=as e.change can occur in the final se0en &ranches of the &ronchoal0eolar tree
Correct ans-er
<he first 12 &ranches of the &ronchial tree are collecti0ely kno-n as the con$ucting Aone
<he equili&ration of gases takes a&out 2.2 s in the resting lung
"nly a&out 9.12M of o.ygen is carrie$ in solution in the plas!a
Car&on $io.i$e is less -ater-solu&le than o.ygen
=as e.change can occur in the final se0en &ranches of the &ronchoal0eolar tree +the respiratory
Aone/. <he first 13 &ranches of the &ronchial tree are collecti0ely kno-n as the con$ucting Aone.
<he equili&ration of gases takes a&out 9.22 s in the resting lung. "nly a&out 1.2M of o.ygen is
carrie$ in solution in the plas!a. Car&on $io.i$e is !ore -ater-solu&le than o.ygen, &et-een 2
an$ 19M of an$ this is the pre$o!inant !etho$ of carriage of C"2 is carrie$ in $issol0e$ for!.
Correct
Eeply to HalaEeport
ost H12
(plenecto!y increases suscepti&ility to -hich of the follo-ing organis!s:
(treptococcus pyogenes
(chistoso!a hae!ato&iu!
@acteroi$es fragilis
1eisseria !eningiti$is
Kour ans-er
(taphylococcus aureus
<he spleen plays an i!portant role in the re!o0al of $ea$ an$ $ying erythrocytes an$ in the
$efence against !icro&es. Ee!o0al of the spleen +splenecto!y/ lea0es the host suscepti&le to a
-i$e array of pathogens, &ut especially to encapsulate$ organis!s.
Certain &acteria ha0e e0ol0e$ -ays of e0a$ing the hu!an i!!une syste!. "ne -ay is through
the pro$uction of a Wsli!yI capsule on the outsi$e of the &acterial cell -all. (uch a capsule
resists phagocytosis an$ ingestion &y !acrophages an$ neutrophils. <his allo-s the! not only
to escape $irect $estruction &y phagocytes, &ut also to a0oi$ sti!ulating <-cell responses
through the presentation of &acterial pepti$es &y !acrophages. <he only -ay that such
organis!s can &e $efeate$ is &y !aking the! !ore Wpalata&leI &y coating their capsular
polysacchari$e surfaces in opsonising anti&o$y.
<he pro$uction of anti&o$y against capsular polysacchari$e pri!arily occurs through <-cell
in$epen$ent !echanis!s. <he spleen plays a central role in &oth the initiation of the anti&o$y
response an$ the phagocytosis of opsonise$ encapsulate$ &acteria fro! the &loo$strea!. <his
helps to e.plain -hy the asplenic in$i0i$uals are !ost suscepti&le to infection fro!
encapsulate$ organis!s, nota&ly (treptococcus pneu!oniae +pneu!ococcus/, 1eisseria
!eningiti$is +!eningococcus/ an$ Hae!ophilus influenAae.
<he risk of acquiring such infections is re$uce$ &y i!!unising in$i0i$uals against such
organis!s an$ &y placing patients on prophylactic penicillin, in !ost cases for the rest of their
li0es. ,n a$$ition, asplenic in$i0i$uals shoul$ &e a$0ise$ to -ear a Me$icAlert &racelet to -arn
other health care professionals of their con$ition.
Correct
Fhich >C= feature is classically present in hypother!ia:
<hyro.ine
Ee$uce$ E inter0al
<achycar$ia
? -a0es
* -a0es
Kour ans-er
<he * -a0e !ay &e present on the >C= in patients -ith hypother!ia an$ is an a$$itional up-ar$
peak i!!e$iately follo-ing the GE( co!ple.. <he ? -a0e !ay &e present on the >C= in
hypokalae!ia an$ is an a$$itional up-ar$ peak -hich follo-s the < -a0e. <achycar$ia an$ a
re$uction in the EE inter0al are >C= features of hyperther!ia.
,ncorrect
Fhich of the follo-ing is a function of atrial natruretic pepti$e +A1/:
,ncreases renin secretion
7ecreases al$osterone secretion Correct ans-er
ro!otes the effects of anti$iuretic hor!one +A7H/ Kour ans-er
Causes renal 0asoconstriction
ro!otes the feeling of thirst
A1 is release$ fro! atrial !uscle cells -hen the atria are stretche$ $ue to increase$ circulating
&loo$ 0olu!e. <herefore A1 -orks to re$uce &loo$ 0olu!e &y inhi&iting the release of renin,
al$osterone an$ A7H resulting in increase$ so$iu! an$ -ater e.cretion. ,t pro!otes renal
0aso$ilatation.
Correct
Concerning the sali0ary glan$s
<hey secrete aroun$ 129 !l of sali0a per $ay
<hey secrete sali0a -ith a pH of #-2
<hey secrete sali0a -hich is hypertonic
<hey are supplie$ &y the parasy!pathetic ner0ous syste!
Kour ans-er
<hey secrete sali0a containing trypsinogen
(ali0a is secrete$ fro! the acini, an$ transporte$ 0ia the sali0ary $ucts to the oral ca0ity. <he
secretion fro! the su&lingual glan$ is pre$o!inately !ucous, the paroti$ serous an$ the
su&!an$i&ular !i.e$. <he pH of sali0a 0aries fro! 5-6, an$ aroun$ 1.2L is pro$uce$ per $ay. As
-ell as a-a!ylase, sali0a contains lipase an$ glycoproteins to lu&ricate foo$ an$ protect the oral
!ucosa. LysoAy!e, ,gA an$ lactoferrin act as &acteriostatic agents, an$ proteins protect the
tooth ena!el.
<he sali0a is isotonic -hen it is e.crete$ fro! the aciniD 1aB an$ Cl- are e.change$ for TB an$
HC9%- in the $ucts, an$ the sali0a &eco!es hypotonic &y the ti!e it reaches the !outh.
Correct
Fhich of the follo-ing is the !ost i!portant $irect sti!ulus to respiration:
,ncrease$ pC"2 of the C()
,ncrease$ HB concentration of the C()
Kour ans-er
7ecrease$ arterial p"2
7ecrease$ arterial pH
7ecrease$ arterial pC"2
Che!oreceptors in0ol0e$ -ith the control of respiration are present in the central ner0ous
syste! an$ peripherally. <he central che!oreceptors are situate$ in the 0entral !e$ulla, an$
increase firing in response to the HB concentration of the &rain e.tra cellular flui$, -hich is
$irectly relate$ to the HB concentration in the C(). C"2 ; HC"% cannot cross the &loo$ &rain
&arrier, &ut C"2 $oes so rea$ily. <his frees HB ions, causing a lo- C() pH, increase$ firing of the
central che!oreceptors an$ increase$ 0entilation.
eripheral che!oreceptors are foun$ in the caroti$ &o$ies an$ aortic arch, an$ increase their
firing rate in response to $ecrease$ a"2, $ecrease$ arterial pH an$ increase$ paC"2. <hese
are !uch less i!portant, ho-e0er, in sti!ulating respiration than the central che!oreceptors.
Correct
Casopressin +A7H/
,s synthesise$ in the posterior pituitary glan$
7eficiency lea$s to a risk of -ater into.ication
>.cessi0e secretion usually results in $ia&etes insipi$us
,ncrease$ plas!a os!olarity is the pri!ary physiological sti!ulus
Kour ans-er
Acts on the pro.i!al con0olute$ tu&ules of the ki$ney
Casopressin is synthesise$ in the supraoptic nucleus of the hypothala!us an$ transporte$ to the
posterior pituitary 0ia the a.ons. >.cessi0e secretion is associate$ -ith the risk of i!paire$
-ater e.cretion. 7ia&etes insipi$us results fro! $eficient secretion or action of this hor!one
lea$ing to thirst an$ polyuria. ,t acts !ainly on the $istal con0olute$ tu&ules an$ the collecting
$ucts of the ki$ney.
,ncorrect
<he follo-ing !eta&olic changes occur in the e&& phase +first 2# hours/ of response to in'ury:
las!a pH increases
<he plas!a le0el of free fatty aci$s $ecreases
Hypoglyce!ia
<he plas!a le0el of non protein nitrogen $ecreases
Kour ans-er
las!a glycerol increases
Correct ans-er
<here is usually aci$osis +pH $ecreases/. Lipolysis increases lea$ing to increase in fatty aci$s
an$ glycerol.
<here is hyperglyce!ia an$ an increase$ le0el of non protein nitrogen.
,ncorrect
Fhich of the follo-ing flui$s -oul$ &e the !ost appropriate to replace the flui$ &eing lost in a
patient -ith a paralytic ileus $raining 2 litres of flui$ a $ay through a nasogastric tu&e:
Co!poun$ so$iu! lactate +Hart!annIs solution/
Kour ans-er
2M $e.trose
19M $e.trose
9.16M so$iu! chlori$e -ith #M $e.trose +W$e.trose salineI/
9.8M so$iu! chlori$e +Wnor!al salineI/
Correct ans-er
,n this situation, it is essential to supply sufficient chlori$e ions to replace the chlori$e &eing lost
in the gastric flui$ +gastric 'uice is essentially $ilute hy$rochloric aci$/. ,f this is not $one, a
!eta&olic alkalosis can ensue. <he appropriate flui$ is Wnor!al salineI. <he t-o $e.trose
solutions contain no chlori$e, an$ W$e.trose salineI contains insufficient for this purpose.
Hart!annIs solution coul$ e.acer&ate any ten$ency to alkalosis as the lactate it contains is
!eta&olise$ to &icar&onate.
Correct
Fhich one of the follo-ing is higher at the ape. of the lung than at the &ase -hen a person is
stan$ing: (ingle &est ans-er question J choose "1> true option only
C;G ratio
Kour ans-er
Centilation
aC"2
Co!pliance
@loo$ flo-
<he al0eoli at the ape. of the lung are larger than those at the &ase so their co!pliance is less.
@ecause of the re$uce$ co!pliance, less inspire$ gas goes to the ape. than to the &ase. Also,
&ecause the ape. is a&o0e the heart le0el, less &loo$ flo-s through the ape. than through the
&ase. Ho-e0er, the re$uction in air flo- is less than the re$uction in &loo$ flo-, so that the C;G
ratio at the top of the lung is greater than it is at the &otto!. <he increase$ C;G ratio at the ape.
!akes aC"2 lo-er an$ a"2 higher at the ape. than they are at the &ase
Correct
A #8-year-ol$ post!enopausal -o!an of (outhern Asian origin co!plains of !uscle -eakness.
(he is foun$ to ha0e hypocalcae!ia, an$ X-ray e.a!ination re0eals t-o LooserIs Aones in her
left upper fe!ur.
A $efect in -hich of the follo-ing physiological processes is !ost likely to &e the cause of her
illness: (ingle &est ans-er question J choose "1> true option only.
A&sorption of calciu! fro! the gut
Kour ans-er
"steo&lastic acti0ity
"steoclastic acti0ity
arathyroi$ hor!one secretion
Eenal e.cretion of calciu!
<he fin$ings in this -o!an suggest osteo!alacia, an$ the !ost i!portant reason for the
i!paire$ !ineralisation of &one is re$uce$ intestinal calciu! a&sorption consequent on 0ita!in
7 $eficiency. <he $ecrease$ a0aila&ility of calciu! to !ineralise &one lea$s to increase$
osteo&lastic acti0ity +an$ hence increase$ osteoi$ for!ation/. Hypocalcae!ia causes increase$
parathyroi$ hor!one secretion +secon$ary hyperparathyroi$is!/, -hich sti!ulates renal calciu!
rea&sorption +hence re$uce$ e.cretion/. <hus, -hile this -o!an !ay ha0e increase$
osteo&lastic acti0ity an$ increase$ <H secretion, &oth these are secon$ary to 0ita!in 7
$eficiency an$ $ecrease$ intestinal a&sorption of calciu!.
"steoporosis +post!enopausal osteoporosis is $ue to increase$ osteoclastic acti0ity/ is not
associate$ -ith hypocalcae!ia.
,ncorrect
,n relation to the nutritional physiology of patients, -hich of the follo-ing -oul$ represent
appropriate nitrogen require!ents +g 1;kg per $ay/ an$ calorie require!ents +kcal;kg per $ay/:
Ee$uce$ foo$ intake: nitrogen require!ent 9.% g 1;kg per $ay, calorie require!ent %2 kcal;kg
per $ay
Kour ans-er
Mo$erate in'ury: nitrogen require!ent 9.12 g 1;kg per $ay, calorie require!ent 22 kcal;kg per
$ay
Mo$erate sepsis: nitrogen require!ent 9.% g 1;kg per $ay, calorie require!ent 12 kcal;kg per
$ay
(e0ere in'ury: nitrogen require!ent 9.% g 1;kg per $ay, calorie require!ent %2 kcal;kg per $ay
Correct ans-er
(e0ere sepsis: nitrogen require!ent 9.2 g 1;kg;$ay, calorie require!ent 12 kcal;kg;$ay
?sual ranges for:
re$uce$ foo$ intake:
nitrogen require!ent 9.12J9.2 g 1;kg per $ay
calorie require!ent 22J%9 kcal;kg per $ay
!o$erate in'ury;sepsis:
nitrogen require!ent 9.2J9.% g 1;kg per $ay
calorie require!ent %9J%2 kcal;kg per $ay
se0ere in'ury;sepsis:
nitrogen require!ent 9.%J9.%2 g 1;kg per $ay
calorie require!ent %2J#9 kcal;kg per $ay
Correct
Kou are calle$ to see a 23-year-ol$ !an 2 h after a car$iac catheterisation. He is acti0ely
&lee$ing fro! his catheter site an$ his $ressings an$ &e$clothes are soake$ -ith &loo$.
Fhich of the follo-ing state!ents is true: (ingle &est ans-er - choose "1> true option only
=ra$e , shock applies -ith up to a 29M loss of circulating &loo$ 0olu!e
Loss of 2 litres of &loo$ is consistent -ith nor!al systolic &loo$ pressure
<he pulse can re!ain nor!al in patients -ith gra$e , shock
Kour ans-er
Anuria is pathogno!onic of gra$e ,,, shock
=ra$e ,C shock is seen -ith a %9M loss of circulating &loo$ 0olu!e
=ra$e , shock
Loss of up to 12M +529!l/ of &loo$ 0olu!eD &loo$ pressure is nor!al &ut there !ay &e a slight
tachycar$ia
=ra$e ,, shock
12J%9M +529 !l J 1.2 l/ &loo$-0olu!e loss, systolic &loo$ pressure is usually nor!al &ut a
tachycar$ia is present
=ra$e ,,, shock
%9J#9M +1.2J2 litres/ loss, hypotension, tachycar$ia an$ fall in urine output seen
=ra$e ,C shock
L #9M +L 2 l/ &loo$-0olu!e loss, anuria an$ se0ere shock o&ser0e$
Correct
)or!ation of the e.ternal genitalia in the !ale fetus is $epen$ent on:
<estosterone
A$renal an$rogens
<he K chro!oso!e
7ihy$rotestosterone Kour ans-er
Mullerian inhi&iting su&stance
7ihy$rotestosterone is the !ost potent an$rogen an$ is responsi&le for $e0elop!ent of the
e.ternal genitalia in the f
,ncorrect
Lung co!pliance:
,s $efine$ as the change in pressure per unit 0olu!e
Kour ans-er
,s synony!ous -ith elastance
,s increase$ in e!physe!a
Correct ans-er
,s equal in inflation an$ $eflation
,s re$uce$ &y the presence of surfactant
Co!pliance is e.presse$ as 0olu!e change per unit change in pressure. >lastance is the
reciprocal of co!pliance. <he pressure-0olu!e cur0e of the lung is non-linear -ith the lungs
&eco!ing stiffer at high 0olu!es. <he cur0es -hich the lung follo-s in inflation an$ $eflation are
$ifferent. <his &eha0iour is kno-n as hysteresis. <he lung 0olu!e at any gi0en pressure $uring
$eflation is larger than $uring inflation. <his &eha0iour $epen$s on structural proteins +collagen,
elastin/, surface tension an$ the properties of surfactant.
(urfactant is for!e$ in an$ secrete$ &y type ,, pneu!ocytes. <he acti0e ingre$ient is $ipal!itoyl
phosphati$ylcholine. ,t helps pre0ent al0eolar collapse &y lo-ering the surface tension &et-een
-ater !olecules in the surface layer. ,n this -ay it helps to re$uce the -ork of &reathing +!akes
the lungs !ore co!pliant/ an$ per!its the lung to &e !ore easily inflate$.
Carious $isease states are associate$ -ith either a $ecrease or increase in the lung co!pliance.
)i&rosis, atelectasis an$ pul!onary oe$e!a all result in a $ecrease in lung co!pliance +stiffer
lungs/. An increase$ lung co!pliance occurs in e!physe!a -here an alteration is elastic tissue
is pro&a&ly responsi&le +secon$ary to the long ter! effects of s!oking/. <he lung effecti0ely
&eha0es like a Qsoggy &agR so that a gi0en pressure change results in a large change in 0olu!e
+i.e. the lungs are !ore co!pliant/. Ho-e0er, $uring e.piration the air-ays are less rea$ily
supporte$ an$ collapse at higher lung 0olu!es resulting in gas trapping an$ hyperinflation.
,ncorrect
<he infusion of 1 litre of -hich of the follo-ing solutions -ill initially lea$ to the greatest increase
in e.tracellular flui$ 0olu!e:
=elatin colloi$ solution +e.g. =elofusinN or Hae!accelN/
Kour ans-er
Hypertonic 1aCl
Correct ans-er
1or!al +9.8 M/ 1aCl
2 M $e.trose solution
ure -ater
Colloi$s !ay &e natural +e.g. &loo$, hu!an al&u!in an$ gelatins/ or synthetic +e.g. $e.trans/.
<hey co!prise large &ranching !olecules -ith !olecular -eights in e.cess of %9,999. Assu!ing
intact capillary integrity, the 0olu!e effects of colloi$ infusion are, at least initially, confine$ to
the plas!a co!part!ent. ,n contrast, crystalloi$s, such as 1aCl solution, pass !ore rea$ily fro!
the plas!a flui$ co!part!ent an$ ha0e !ore of a 0olu!e effect on the e.tracellular flui$
co!part!ent. ,n the case of 2 M $e.trose solution, the $e.trose co!ponent is rapi$ly
!eta&olise$ an$ the re!aining -ater $istri&utes itself throughout the entire &o$y -ater +i.e.
intracellular an$ e.tracellular co!part!ents/.
<herefore, of the options liste$ a&o0e, infusions of 1aCl -ill ha0e the greatest initial increase in
e.tracellular flui$ 0olu!e. Hypertonic 1aCl -ill ha0e an e0en greater effect than nor!al
+appro.i!ately isotonic/ 1aCl, since hypertonic solutions -ill $ra- a$$itional -ater fro! the
intracellular flui$ co!part!ent &y os!osis.
Correct
Eeply to HalaEeport
ost H13
C7# <-cells
C76 <-cells
Kour ans-er
@ cells
<H1 cells
<H2 cells
Ly!phocytes can &e $i0i$e$ into t-o !ain su&types J < cells an$ @ cells.
@ cells +or plas!a cells/ secrete anti&o$ies.
< cells can &e $i0i$e$ into t-o further su&types J C7# <-cells an$ C76 <-cells. C7# +helper/ <-
cells can recognise antigen only in the conte.t of MHC Class ,,, -hereas C76 +cytoto.ic/ <-cells
recognise cell-&oun$ antigens only in association -ith Class , MHC. <his is kno-n as MHC
restriction.
C7# an$ C76 <-cells perfor! $istinct &ut so!e-hat o0erlapping functions. <he C7# helper <-cell
can &e 0ie-e$ as a !aster regulator. @y secreting cytokines +solu&le factors that !e$iate
co!!unication &et-een cells/, C7# helper <-cells influence the function of 0irtually all other
cells of the i!!une syste! inclu$ing other <-cells, @-cells, !acrophages an$ natural killer cells.
<he central role of C7# cells is tragically illustrate$ &y the H,C 0irus -hich cripples the i!!une
syste! &y selecti0e $estruction of this <-cell su&set. ,n recent years t-o functionally $ifferent
populations of C7# helper <-cells ha0e &een recognise$ J <H1 cells an$ <H2 cells, each
characterise$ &y the cytokines that they pro$uce. ,n general, <H1 cells facilitate cell-!e$iate$
i!!unity, -hereas <H2 cells pro!ote hu!oral-!e$iate$ i!!unity.
C76 cytoto.ic <-cells !e$iate their functions pri!arily &y acting as cytoto.ic cells +i.e. they are
<-cells that kill other cells/. <hey are i!portant in the host $efence against cytosolic pathogens.
<-o principal !echanis!s of cytoto.icity ha0e &een $isco0ere$ J perforin-granAy!e-$epen$ent
killing an$ )as-)as ligan$ $epen$ent killing.
Correct
Eeply to HalaEeport
ost H15
MEC( art 1 ractice Guestions + Anato!y / - 1 of 2
Here are so!e questions for re0ision:
MEC( art 1 - Anato!y M<)
<he right co!!on caroti$ artery
,ncorrect
&ifurcates at the le0el of the upper &or$er of the cricoi$ cartilage <rue)alse
,ncorrect
is a &ranch of the aortic arch <rue)alse
,ncorrect
has the cer0ical sy!pathetic chain as an anterior relation <rue)alse
,ncorrect
lies lateral to the lateral lo&e of the thyroi$ glan$ <rue)alse
,ncorrect
is separate$ fro! the phrenic ner0e &y the pre0erte&ral fascia <rue)alse
,ncorrect
is enclose$ -ithin the caroti$ sheath throughout <rue)alse
<he right co!!on caroti$ artery &ranches off the &rachiocephalic artery. ,t &ifurcates at the
le0el of the upper &or$er of the la!ina of the thyroi$ cartilage. ,t lies posterior to the lo&es of
the thyroi$ glan$ an$ anterior to &oth the cer0ical sy!pathetic chain an$ the phrenic ner0e on
the scalenus anterior !uscleD the latter is separate$ fro! the artery &y pre0erte&ral fascia.
Eecognise$ co!plications of sclerotherapy for 0aricose 0eins inclu$e
,ncorrect
trash foot <rue)alse
,ncorrect
&ro-n $iscoloration of the skin <rue)alse
,ncorrect
$eep 0ein thro!&osis +7C</ <rue)alse
,ncorrect
ulceration of the skin <rue)alse
,ncorrect
(u$eck4s $ystrophy <rue)alse
>.tra0asation of the sclerosing agent !ay cause skin $a!age an$ ulceration. atients shoul$ &e
-arne$ a&out the possi&ility of &ro-n pig!entation of the skin. (clerotherapy is in$icate$ for
resi$ual an$ recurrent 0aricosities after 0aricose 0ein surgery. (u$eck4s atrophy is a recognise$
co!plication of trau!a.
<he superior !esenteric artery
,ncorrect
supplies the entire ileu! an$ 'e'unu! <rue)alse
,ncorrect
lies to the left of the inferior !esenteric artery <rue)alse
,ncorrect
passes posterior to the splenic 0ein <rue)alse
,ncorrect
lies to the right of the superior !esenteric 0ein <rue)alse
,ncorrect
crosses anterior to the thir$ part of the $uo$enu! <rue)alse
<he superior !esenteric artery supplies the gut fro! the !i$-secon$ part of the $uo$enu! to a
le0el 'ust short of the splenic fle.ure of the colon. ,t is $irecte$ $o-n-ar$s &ehin$ the splenic
0ein an$ &y the pancreas, -ith the superior !esenteric 0ein on its right si$e. ,t lies anterior to
the thir$ part of the $uo$enu!.
Clinical signs suggesti0e of a urethral in'ury inclu$e
,ncorrect
&loo$ at the e.ternal urethral !eatus <rue)alse
,ncorrect
a W&utterflyI hae!ato!a <rue)alse
,ncorrect
@attleIs sign <rue)alse
,ncorrect
high ri$ing prostate <rue)alse
,ncorrect
hae!aturia <rue)alse
<he ina&ility to 0oi$, an unsta&le pel0ic fracture, &loo$ at the e.ternal urethral !eatus, a
W&utterflyI hae!ato!a, or a high ri$ing prostate on $igital rectal e.a!ination +7E>/ are
in$ications for the surgeon to request a retrogra$e urethrogra! to confir! that the urethra is
intact prior to inserting a urethral catheter. ,n the case of a $isrupte$ urethra a suprapu&ic
catheter shoul$ &e inserte$.
Eeflu. oesophagitis
,ncorrect
is al-ays present -ith hiatus hernia <rue)alse
,ncorrect
is prefera&ly treate$ -ith surgery <rue)alse
,ncorrect
if untreate$ !ay cause stricturing of the oesophagus <rue)alse
,ncorrect
$oes not require !ore than alteration of lifestyle to treat <rue)alse
,ncorrect
is treate$ surgically principally &y atte!pting to narro- the gastro-oesophageal 'unction
<rue)alse
<he !ainstay of treat!ent for sy!pto!atic reflu. oesophagitis is -ith aci$ suppression therapy.
,f untreate$, structuring is co!!on. (urgery restores a$equate oesophageal length +high
pressure/ in the a&$o!en.
<he follo-ing state!ents concern the root 0alues of peripheral ner0es:
,ncorrect
sciatic ner0e +L#,2,(1,2/ <rue)alse
,ncorrect
phrenic ner0e +C2,%,#/ <rue)alse
,ncorrect
iliohypogastric ner0e +L1/ <rue)alse
,ncorrect
o&turator ner0e +L2,%,#/ <rue)alse
,ncorrect
!e$ial plantar ner0e +L#,2/ <rue)alse
<he sciatic ner0e is L#,2,(1,2,%D an$ the phrenic ner0e C%,#,2.
es planus
,ncorrect
is the con$ition -here the !e$ial &or$er of the foot is in contact -ith the groun$ -hen stan$ing
<rue)alse
,ncorrect
is often cause$ &y a &ony &ri$ge &et-een talus an$ calcaneus <rue)alse
,ncorrect
typically presents -ith pain aroun$ age 3 years <rue)alse
,ncorrect
can &e treate$ &y arthro$esis of thesu&talar an$ !i$tarsal 'oints <rue)alse
,ncorrect
!ay &e $ue to peroneal !uscle paralysis <rue)alse
es planus P pes 0algus P flat foot. <he -hole foot is rotate$ into e0ersion aroun$ its
longitu$inal a.is. ,t is asy!pto!atic in the 0ast !a'ority of cases. <here are t-o types: !o&ile
an$ rigi$. Eigi$ flat foot is often cause$ &y synostosis &et-een t-o of the tarsal &ones:
talocalcaneal an$ talona0icular. <here is typically pain an$ li!itation of !o0e!ent in the foot
aroun$ age of 12 years. <riple fusion is so!eti!es necessary if pain is the pre$o!inant feature,
&ut !ost sy!pto!atic cases are treate$ conser0ati0ely -ith splintage or plaster. W(pas!o$icI
flat foot is $ue to contraction of the peroneal !uscles.
Coronary artery &ypass grafting is the usual for! of treat!ent for patients -ith
,ncorrect
sta&le angina an$ triple 0essel coronary artery $isease <rue)alse
,ncorrect
single or $ou&le 0essel coronary artery $isease <rue)alse
,ncorrect
stenosis of the left !ain coronary artery <rue)alse
,ncorrect
post-!yocar$ial infarction unsta&le angina <rue)alse
,ncorrect
0al0ular heart $isease requiring surgery an$ coronary artery $isease <rue)alse
Accor$ing to the Coronary Artery (urgery (tu$y the patient groups that $eri0e particular &enefit
fro! coronary artery &ypass grafting +CA@=/ are those -ith triple 0essel $isease, an$ those -ith
L29M left !ain ste! stenosis. <hose -ith single or $ou&le 0essel $isease are usually !ore
a!ena&le to percutaneous inter0ention. ost-!yocar$ial infarction, unsta&le angina is a pri!ary
in$ication for urgent CA@=. Cal0ular $isease -ith conco!itant coronary artery $isease is usually
treate$ operati0ely.
<he thoracic $uct
,ncorrect
lies on the posterior intercostal 0essels <rue)alse
,ncorrect
has no 0al0es <rue)alse
,ncorrect
runs through the thoracic inlet to the left of the oesophagus <rue)alse
,ncorrect
recei0es the right &roncho!e$iastinal ly!ph trunk <rue)alse
,ncorrect
arches o0er the left suprapleural !e!&rane <rue)alse
<he cisterna chyli runs &et-een the aorta an$ the right crus of the $iaphrag!, passes through
the aortic $iaphrag! opening an$ $rains into the thoracic $uct. <he thoracic $uct ascen$s
anterior to the posterior intercostal 0essels an$ has se0eral 0al0es. At the thoracic inlet, it lies to
the left of the oesophagus an$ arches for-ar$ o0er the $o!e of the left pleura, $raining into the
left &rachiocephalic 0ein. <he right &roncho!e$iastinal trunk $rains into the right su&cla0ian
0ein.
Fhich of the follo-ing are correct: <he internal caroti$ artery
,ncorrect
Co!!ences at the le0el of C3 <rue)alse
,ncorrect
asses through the fora!en o0ale <rue)alse
,ncorrect
Has no e.tra-cranial &ranches <rue)alse
,ncorrect
=i0es off the ophthal!ic artery <rue)alse
,ncorrect
7i0i$es into the !i$$le an$ anterior cere&ral arteries <rue)alse
<he co!!on caroti$ artery &ifurcates into the e.ternal an$ internal caroti$s at the le0el of the
upper part of the C# 0erte&ra ie the upper &or$er of the thyroi$ cartilage, ho-e0er this
&ifurcation is frequently higher, near the tip of the great horn of the hyoi$ &one +C% le0el/. <he
internal caroti$ artery has no e.tra cranial &ranches an$ enters the &ase of the skull in the
petrous te!poral &one through the caroti$ canal. <he internal caroti$ on entering the skull
passes for-ar$s through the te!poral &one up-ar$s into the ca0ernous sinus, turns for-ar$ an$
up-ar$s through the roof of the sinus to lie !e$ial to the anterior clinoi$ process &efore turning
&ack on itself a&o0e the ca0ernous sinus an$ then passing once !ore lateral to the optic
chias!a to en$ &y $i0i$ing into the anterior an$ !i$$le cere&ral arteries. <he ophthal!ic artery
originates fro! the internal caroti$ artery i!!e$iately a&o0e the roof of the ca0ernous sinus.
Eegar$ing an anterior $islocation of the shoul$er:
,ncorrect
it co!!only occurs after an epileptic fit <rue)alse
,ncorrect
it !ay pro$uce $ecrease$ sensation o0er the lateral aspect of the $eltoi$ !uscle <rue)alse
,ncorrect
it al-ays nee$s re$uction un$er a general anaesthetic <rue)alse
,ncorrect
it is not associate$ -ith any fractures <rue)alse
,ncorrect
it occurs less co!!only than a inferior $islocation of the shoul$er <rue)alse
7islocation of the shoul$er can occur in thee $irections: !ost co!!on is anteriorly, follo-e$ &y
posteriorly an$ rarely inferiorly. An anterior $islocation pro$uces a flattening in the $eltoi$
!uscleD the a.illary ner0e !ay &e in'ure$ causing $ecrease$ sensation in the lateral aspect of
this !uscle +Wregi!ental &a$ge areaI/. Anterior $islocations !ay &e associate$ -ith a
co!pressional fracture of the hu!eral hea$ kno-n as a WHillJ(achI $efor!ity.
osterior $islocation is !ore $ifficult to $iagnoseD this occurs !ore co!!only follo-ing seiAures
an$ has a characteristic Wlight &ul&I appearance $ue to rotation of the upper en$ of the hu!erus.
Fith reference to co!plications of total hip arthroplasty, the follo-ing are true:
,ncorrect
sciatic ner0e in'ury is a recognise$ co!plication <rue)alse
,ncorrect
loosening is the co!!onest cause of long-ter! failure <rue)alse
,ncorrect
there is no e0i$ence that prophylactic anti&iotics re$uce infection rate <rue)alse
,ncorrect
unfractionate$ heparin is !ore effecti0e in pre0enting $eep 0ein thro!&osis +7C</ than lo-
!olecular -eight heparin <rue)alse
,ncorrect
unce!ente$ arthroplasty has &etter sur0i0al than ce!ente$ arthroplasty <rue)alse
Most $islocations occur -ithin 3 !onths of surgery an$ are treate$ conser0ati0ely. (ciatic ner0e
in'ury co!plicates 1M of cases. rophylactic anti&iotics, genta!icin-i!pregnate$ ce!ent an$
ultra-clean air enclosures ha0e re$uce$ infection rate. Loosening !ay &e $ue to a&sorption of
ce!ent aroun$ the i!plant, hypersensiti0ity, lo- gra$e infection an$;or i!perfect prosthetic
$esign, an$ is foun$ in a&out 29M of patients 19 years post-operati0ely. Ce!ente$ arthroplasty
is generally consi$ere$ to &e &etter than unce!ente$ arthroplasty.
<he su&!an$i&ular glan$
,ncorrect
lies &elo- the $igastric !uscle <rue)alse
,ncorrect
has the hypoglossal ner0e running through it <rue)alse
,ncorrect
lies &oth &elo- an$ a&o0e the lo-er !an$i&le <rue)alse
,ncorrect
is superficial to the hyoglossus !uscle <rue)alse
,ncorrect
has the facial artery running through it <rue)alse
<he su&!an$i&ular glan$ consists of a $eep an$ a superficial part. <he superficial part lies in the
$igastric triangle +a&o0e an$ &et-een the t-o &ellies of the $igastric !uscle/. <he hypoglossal
ner0e runs !e$ial to the superficial part of the glan$. <he glan$ is superficial to the !ylohyoi$
an$ hyoglossus !uscles. A thir$ of the su&!an$i&ular glan$ lies &elo- the lo-er &or$er of the
!an$i&le an$ t-o-thir$s a&o0e it.
,n'ury to the sciatic ner0e in the &uttock causes
,ncorrect
loss of acti0e e.tension at the knee 'oint <rue)alse
,ncorrect
loss of strength of the ha!string !uscles <rue)alse
,ncorrect
co!plete loss of sensation &elo- the knee <rue)alse
,ncorrect
-eakness of $orsifle.ion at the ankle 'oint <rue)alse
,ncorrect
-eakness of e0ersion of the foot <rue)alse
<he sciatic ner0e, arising fro! ner0e roots L#, L2, (1J%. ,t is really t-o ner0es the ti&ial, an$ the
co!!on peroneal ner0e -hich are &oun$ together in the sa!e connecti0e tissue sheath. <he
ti&ial ner0e supplies fle.or !uscles, an$ the co!!on peroneal ner0e supplies e.tensor an$
a&$uctor !uscles. <he anterior fe!oral co!part!ent containing the qua$riceps e.ten$s the
knee an$ is supplie$ &y the fe!oral ner0e.
Anato!y of the or&it
,ncorrect
the supraor&ital ner0e passes through the superior or&ital fissure <rue)alse
,ncorrect
the ophthal!ic artery passes through the superior or&ital fissure <rue)alse
,ncorrect
the optic ner0e is surroun$e$ &y pia, arachnoi$ an$ $ura !ater <rue)alse
,ncorrect
the frontal ner0e passes through the ten$inous !e!&rane <rue)alse
,ncorrect
the nasociliary ner0e supplies the cornea <rue)alse
,ncorrect
sectioning of the inferior ra!us of the oculo!otor ner0e -ill pro$uce a ptosis <rue)alse
,ncorrect
the ophthal!ic artery is a &ranch of the internal caroti$ artery <rue)alse
<he frontal ner0e arises fro! the ophthal!ic $i0ision of the trige!inal ner0e in the lateral -all of
the ca0ernous sinus. ,t enters the or&its through the superior or&ital fissure. *ust &efore it
reaches the or&ital !argin it $i0i$es into the supratrochlear an$ supraor&ital ner0es. <he
supraor&ital ner0e passes through the supraor&ital fora!en, an$ supplies the skin of the
forehea$. <he ophthal!ic artery &ranches off the internal caroti$ artery at the ca0ernous sinus,
an$ passes through the optic canal -ith the optic ner0e. <he optic ner0e is surroun$e$ &y a
sheath of pia, arachnoi$ an$ $ura !ater. <he nasociliary ner0e arises fro! the ophthal!ic
$i0ision of the trige!inal ner0e in the lateral fourth of the ca0ernous sinus, an$ enters the or&it
through the superior or&ital fissure -ithin the ten$inous ring. <he &ranches of the nasociliary
ner0e supply the eth!oi$al sinuses, sphenoi$al sinuses, skin of the upper eyeli$s an$ nose. <he
inferior ra!us of the oculo!otor ner0e gi0es off &ranches to the inferior rectus, !e$ial rectus
an$ the inferior o&lique !uscles. <he superior ra!us of the oculo!otor ner0es supplies the
le0ator palpe&rae superioris, so !ay gi0e rise to a ptosis if cut.
7eri0ati0es of the !esonephric $ucts:
,ncorrect
ureters <rue)alse
,ncorrect
uterus <rue)alse
,ncorrect
prostate <rue)alse
,ncorrect
part of the 0as $eferens <rue)alse
,ncorrect
part of the 0agina <rue)alse
<he epi$i$y!is, 0as $eferens, se!inal 0esicle, e'aculatory $uct an$ &la$$er trigone are $eri0e$
fro! the !esonephric $uct.
<he pancreas
,ncorrect
o0erlies the right ki$ney <rue)alse
,ncorrect
lies in the transpyloric plane <rue)alse
,ncorrect
has an uncinate process lying anterior to the superior !esenteric 0ein <rue)alse
,ncorrect
gi0es attach!ent to the trans0erse !esocolon <rue)alse
,ncorrect
has the inferior !esenteric 0ein passing &ehin$ the neck <rue)alse
<he hea$ of the pancreas is relate$ to the hilu! &ut $oes not o0erlie the right ki$ney. ,t is,
ho-e0er, anterior to the left ki$ney. <he transpyloric plane +L1/ transects the pancreas
o&liquely, passing through the !i$point of the neck, -ith !ost of the hea$ &elo- the plane, an$
!ost of the &o$y an$ tail a&o0e. <he trans0erse !esocolon is attache$ to the hea$, neck an$
&o$y of the pancreas. <he uncinate process lies posterior to the superior !esenteric 0essels,
an$ the inferior !esenteric 0ein passes &ehin$ the &o$y of the pancreas, -here it 'oins the
splenic 0ein.
High anal fistula
,ncorrect
Are !ore co!!on than lo- fistula <rue)alse
,ncorrect
"pen into the rectu! a&o0e the pu&orectalis !uscle <rue)alse
,ncorrect
Are associate$ -ith CrohnIs $isease <rue)alse
,ncorrect
May &e lai$ open -ithout haAar$ <rue)alse
,ncorrect
Can &e !anage$ &y a loose seton <rue)alse
High fistulae are unco!!on &ut !ay &e $ue to carcino!a, $i0erticular $isease, tu&erculosis,
Crohn4s $isease, ulcerati0e colitis, trau!a or ra$iotherapy. Laying open $i0i$es the sphincter
an$ pro$uces incontinence.
"steochon$ritis of the na0icular &one
,ncorrect
is thought to &e $ue to increase 0ascularity pro$ucing early calcification <rue)alse
,ncorrect
!ainly affects teenagers <rue)alse
,ncorrect
usually resol0es spontaneously in a year <rue)alse
,ncorrect
usually presents -ith pain an$ a li!p <rue)alse
,ncorrect
treat!ent in0ol0es analgesia an$ continue$ acti0ity <rue)alse
"steochon$ritis of the na0icular &one is kno-n as TchlerIs $isease an$ affects chil$ren age %J2
years. <hey co!plain of pain o0er the !e$ial si$e of the foot an$ noticea&ly li!p. ,t is thought to
&e $ue to a $istur&ance of the &loo$ supply. 1or!ally sy!pto!s $isappear after a fe- -eeks of
strapping the foot an$ restricting acti0ity, &ut, rest in a cast !ay &e necessary if there is se0ere
pain. >0entually the foot &eco!es nor!al clinically an$ ra$iologically o0er a perio$ of !onths.
Fhich of the follo-ing are correct: ?!&ilical hernia in chil$ren an$ infants
,ncorrect
"ccur through the u!&ilical cicatri. <rue)alse
,ncorrect
,s an e.a!ple of a sli$ing hernia <rue)alse
,ncorrect
Can &e treate$ -ith a corset <rue)alse
,ncorrect
Has a higher inci$ence in &lack than -hite chil$ren <rue)alse
,ncorrect
Can &e treate$ -ith a Mayo repair <rue)alse
An u!&ilical hernia protru$es through the u!&ilical cicatri. to lie in the su&cutaneous tissues.
<hey -ill often resol0e as the chil$ gro-s an$ fe- -ill require surgical treat!entJthose that $o
can &e repaire$ -ith the Mayo W0est-o0er-pantsI approach.
<he surface of the right lung is in$ente$ &y the
,ncorrect
trachea <rue)alse
,ncorrect
oesophagus <rue)alse
,ncorrect
superior 0ena ca0a <rue)alse
,ncorrect
right 0entricle <rue)alse
,ncorrect
su&cla0ian 0ein <rue)alse
,!pressions on the !e$iastinal surface of the right lung inclu$e the trachea, 0agus, superior
0ena ca0a, right atriu! an$ su&cla0ian artery. <he oesophagus groo0es the left lung a&o0e the
arch of the aorta an$ &elo- the hilu!.
)or Le )ort , fractures, -hich of the follo-ing are true
,ncorrect
@ilateral is !ore co!!on than unilateral Le )ort , fractures <rue)alse
,ncorrect
<he fracture line passes a&o0e the palate <rue)alse
,ncorrect
,s associate$ -ith Le )ort ,, in'ury <rue)alse
,ncorrect
,ntercanthal $istance is usually increase$ <rue)alse
,ncorrect
Air-ay shoul$ &e protecte$ -ith an oropharyngeal tu&e <rue)alse
<he )rench surgeon Le )ort perfor!e$ e.peri!ents on ca$a0ers in early 1899s an$ classifie$
facial fractures into ,, ,, an$ ,,,. ,n Le )ort , in'uries the fracture line passes a&o0e the palate,
fracturing the pyri!a$al processes of the !a.illa on each si$e, the 0o!er an$ the lo-er parts of
the pterygoi$ processes. @ilateral Le )ort , fractures represent 2%M of these in'uries, unilateral
11M. Le )ort , an$ ,, fractures occur together in 21M of cases. Le )ort ,, in'uries in0ol0e the
eth!oi$s an$ so increase intercanthal $istance. 1asopharyngeal intu&ation is preferre$ to
oropharyngeal intu&ation to secure the air-ay.
Fhich of the follo-ing are true: <he hepatic portal 0ein
,ncorrect
,s for!e$ &y the union of the splenic an$ superior !esenteric 0eins <rue)alse
,ncorrect
Euns &ehin$ the epiploic fora!en <rue)alse
,ncorrect
Lies posterior to the co!!on hepatic artery <rue)alse
,ncorrect
Lies anterior to the first part of the $uo$enu! <rue)alse
,ncorrect
)or!s posterior to the neck of the pancreas <rue)alse
<he portal 0ein for!s the anterior &oun$ary of the epiploic fora!en, lying &ehin$ the &ile $uct
an$ hepatic artery. ,t lies in front of the inferior 0ena ca0a, as it lies &ehin$ the pancreas an$ the
first part of the $uo$enu!.
"n the $orsu! of the foot the
,ncorrect
$orsalis pe$is artery lies !e$ial to the e.tensor hallucis longus ten$on <rue)alse
,ncorrect
$eep peroneal ner0e lies !e$ial to the $orsalis pe$is artery <rue)alse
,ncorrect
L2 $er!ato!e is present <rue)alse
,ncorrect
great saphenous 0ein lies anterior to the !e$ial !alleolus <rue)alse
,ncorrect
inferior e.tensor retinaculu! loops un$er the !e$ial longitu$inal arch <rue)alse
<he $orsalis pe$is artery lies &et-een the e.tensor hallucis longus ten$on !e$ially, an$ the
$eep peroneal ner0e lies laterally. <he L2 $er!ato!e lies o0er the !e$ial half of the $orsu! of
the foot. <he great saphenous 0ein is foun$ anterior to the !e$ial !alleolus, an$ the lo-er li!&
of the e.tensor retinaculu! passes un$er the !e$ial longitu$inal arch an$ &len$s -ith the
plantar aponeurosis.
Eeply to HalaEeport
ost H16
Fhich of the follo-ing are true: 7ifferential $iagnosis of a fe!oral hernia inclu$es
,ncorrect
Caricocele <rue)alse
,ncorrect
soas a&scess <rue)alse
,ncorrect
(aphena 0ari. <rue)alse
,ncorrect
<roisierIs no$e <rue)alse
,ncorrect
(pigelian hernia <rue)alse
7ifferential $iagnosis of a fe!oral hernia inclu$es: inguinal hernia, saphena 0ari.,
ly!pha$enopathy, psoas a&scess, lipo!a, fe!oral aneurys!, sarco!a, ectopic testes an$
o&turator hernia. <roisiers no$e is supracla0icular. (pigelian hernia arises fro! the se!ilunar
line.
Fhich of the follo-ing are correct: Fith regar$s to the anato!y of the pancreas
,ncorrect
,t lies along the transpyloric plane <rue)alse
,ncorrect
(uperior !esenteric 0essels pass un$er the uncinate process <rue)alse
,ncorrect
<he inferior 0ena ca0a +,CC/ is a posterior relation <rue)alse
,ncorrect
<he lesser sac is an anterior relation <rue)alse
,ncorrect
<he portal 0ein is for!e$ &ehin$ the pancreatic neck <rue)alse
<he pancreas has a hea$, neck, &o$y an$ tail an$ lies along the transpyloric plane. <he hea$ is
&oun$ laterally &y the cur0e$ $uo$enu! an$ the tail e.ten$s to the hilu! of the spleen. <he
superior !esenteric 0essels pass &ehin$ the pancreas, then anteriorly, o0er the uncinate
process an$ thir$ part of the $uo$enu! into the root of the s!all &o-el !esentery. <he inferior
0ena ca0a, coeliac ple.us, left ki$ney, an$ the left a$renal glan$ are posterior pancreatic
relations.
Fhich of the follo-ing structures are parts of the hin$&rain:
,ncorrect
cere&ellu! <rue)alse
,ncorrect
cere&ral aque$uct <rue)alse
,ncorrect
pons <rue)alse
,ncorrect
&asal ganglia <rue)alse
,ncorrect
tectu! <rue)alse
<he gross structure of the &rain can &e $i0i$e$ into the fore&rain, !i$&rain an$ hin$&rain. <he
!ain structures that for! the hin$&rain are the pons, !e$ulla o&longata an$ cere&ellu!. <he
fourth 0entricle an$ central canal are also foun$ in this region.
Concerning trau!atic $iaphrag!atic in'ury, -hich of the follo-ing are true:
,ncorrect
,s !ore co!!only $iagnose$ on the left si$e <rue)alse
,ncorrect
@lunt in'uries pro$uce larger tears than penetrating trau!as <rue)alse
,ncorrect
<he co!!onest site for tears is the posterolateral aspect of the $iaphrag! <rue)alse
,ncorrect
,nsertion of a naso-gastric tu&e is a&solutely contrain$icate$ in left-si$e$ $iaphrag!atic rupture
<rue)alse
,ncorrect
A&$o!inal co!pute$ to!ography is the !ost sensiti0e in0estigation to i$entify $iaphrag!atic
in'ury <rue)alse
7iaphrag!atic in'uries result fro! either &lunt or penetrating trau!a. A trau!atic
$iaphrag!atic rupture is !ore co!!only $iagnose$ on the left si$e, perhaps &ecause the li0er
o&literates the $efect or protects it on the right si$e. ,n a$$ition, the appearance of &o-el,
sto!ach or a nasogastric +1=/ tu&e is !ore easily $etecte$ in the left si$e of the chest. Eight
$iaphrag!atic ruptures are rarely $iagnose$ in the early post-in'ury perio$. <he li0er often
pre0ents herniation of other a&$o!inal organs into the chest. <his, ho-e0er, !ay not &e
representati0e of the true inci$ence of laterality an$ autopsy stu$ies ha0e re0eale$ that left-
an$ right-si$e$ ruptures occur al!ost equally. @lunt trau!a pro$uces large ra$ial tears
!easuring 2J12 c!, !ost often at the posterolateral aspect of the $iaphrag!. ,n contrast,
penetrating trau!a usually create only s!all linear incisions or perforations, -hich are less than
2 c! in siAe an$ !ay often take so!e ti!e, e0en years, to $e0elop into $iaphrag!atic hernias.
,f a laceration of the left $iaphrag! is suspecte$, a 1= tu&e shoul$ &e inserte$. ,f the tu&e
appears in the thoracic ca0ity on the chest fil!, the nee$ for special contrast stu$ies can &e
eli!inate$. Mini!ally in0asi0e en$oscopic proce$ures +thoracoscopy/ !ay &e helpful in
e0aluating the in'ury to the $iaphrag! in in$eter!inate cases. A&$o!inal co!pute$
to!ography scan is usually not helpful &ecause of its poor 0isualisation of the $iaphrag!.
Magnetic resonance i!aging is !ore accurate in 0isualising the anato!y of the $iaphrag!. ,t is
0ery sensiti0e an$ specific an$ so is the in0estigation of choice. (urgical repair is necessary,
e0en for s!all tears, &ecause the $efect -ill not heal spontaneously.
<he superior 0ena ca0a +(CC/
,ncorrect
has a 0al0e at its entry into the left atriu! <rue)alse
,ncorrect
$rains only the hea$, neck an$ upper &o$y <rue)alse
,ncorrect
recei0es the thoracic $uct <rue)alse
,ncorrect
en$s &ehin$ the secon$ costal cartilage <rue)alse
,ncorrect
enters the heart at the le0el of the sternal angle <rue)alse
<he (CC $rains all the structures a&o0e the $iaphrag! e.cept the heart an$ lungs. ,t also
recei0es the aAygos 0ein, -hich $rains the lu!&ar an$ su&costal regions. <he (CC is for!e$
&ehin$ the first costal cartilage &y the union of the right an$ left &rachiocephalic 0eins. ,t en$s
&ehin$ the thir$ costal cartilage as it enters the right atriu!. <he (CC has no 0al0es. <he
thoracic $uct $rains into the left &rachiocephalic 0ein +or so!eti!es into the su&cla0ian or
internal 'ugular 0ein/.
,n the surgical anato!y of the li0er
,ncorrect
seg!ent , lies to the left of the portal 0ein <rue)alse
,ncorrect
seg!ent ,, lies !e$ial to the porta hepatis <rue)alse
,ncorrect
the cau$ate lo&e lies anterior to the portal 0ein <rue)alse
,ncorrect
the portal 0ein lies anterior to the Finslo-Is fora!en <rue)alse
,ncorrect
three hepatic 0eins $i0i$e the li0er into four sectors <rue)alse
<he cau$ate lo&e +seg!ent , accor$ing to Couinau$Is 1825 classification/ lies posterior to the
portal 0ein &ut anterior to the inferior 0ena ca0a. <hree !ain hepatic 0eins $i0i$e the li0er into
four sectors, each of -hich recei0es a portal pe$icle, -ith an alternation &et-een hepatic 0eins
an$ portal pe$icles. Accor$ing to this functional anato!y, the li0er is $i0i$e$ into he!ili0ers
+right an$ left/ &y the !ain portal scissura calle$ CantlieIs line.
1er0es in $irect contact -ith the hu!erus inclu$e:
,ncorrect
!e$ian <rue)alse
,ncorrect
ra$ial <rue)alse
,ncorrect
!usculocutaneous <rue)alse
,ncorrect
a.illary <rue)alse
,ncorrect
ulnar <rue)alse
<here are three ner0es that co!e into close contact -ith the hu!erus: <he ra$ial ner0e contacts
the hu!erus in the spiral groo0eD the a.illary at the surgical neckD an$ the ulnar at the !e$ial
epicon$yle.
7upuytren4s $isease
,ncorrect
is cause$ &y contraction of the pal!ar fascia <rue)alse
,ncorrect
is !ore co!!on in Caucasians than in people of African origin <rue)alse
,ncorrect
!ost co!!only affects the little finger <rue)alse
,ncorrect
causes contracture of the intrinsic !uscles of the han$ <rue)alse
,ncorrect
!ay &e associate$ -ith retroperitoneal fi&rosis <rue)alse
7upuytrenIs $isease is a con$ition of unkno-n aetiology characterise$ &y contraction of the
pal!ar or $igital fascia. ,t affects 1J%M of the population of 1orth >urope an$ the ?(A. ,t is rare
in the )ar >ast an$ Africa. ,t is three ti!es !ore co!!on in !ales. ,ts inci$ence increases -ith
age. ,t has a strong here$itary $isposition. <he ring finger is the !ost co!!only affecte$ fingerD
the little finger is the ne.t !ost co!!only affecte$ $igit.
7upuytrenIs $isease causes contracture of the intrinsic !uscles of the han$ lea$ing to fle.ion of
the !etacarpophalangeal 'oints an$ e.tension of the pro.i!al interphalangeal 'oints J the so-
calle$ intrinsic plus appearance. <he follo-ing con$itions are associate$ -ith 7upuytrenIs
$isease:
knuckle pa$s +=arro$Is pa$s/ penile fi&rous plaques +eyronieIs $isease/ plantar fi&ro!atosis
+Le$$erhose $isease/.
Ho-e0er, retroperitoneal fi&rosis, ho-e0er, is not associate$ -ith 7upuytrenIs $isease.
A C< scan section through the !anu&riosternal 'oint -ill $e!onstrate
,ncorrect
the &ifurcation of the &rachiocephalic artery <rue)alse
,ncorrect
the co!!ence!ent of the aortic arch <rue)alse
,ncorrect
<# 0erte&ral &o$y <rue)alse
,ncorrect
the &ifurcation of the trachea <rue)alse
,ncorrect
the thoracic $uct crossing the !i$line <rue)alse
A C< section at this le0el is at the le0el of <#. At this le0el, the arch of the aorta is co!!encing,
the aAygos 0ein enters the superior 0ena ca0a +(CC/, the left recurrent laryngeal ner0e loops
roun$ the liga!entu! arteriosu! an$ the &ifurcation of the pul!onary trunk can &e seen. <he
thoracic $uct crosses the !i$line at <2.
At the !anu&riosternal 'oint you ha0e:
- &ifurcation of the trachea
- start of the aortic arch
- aAygous 0ein entering the superior 0ena ca0a
,n the !ain &ronchial air-ays
,ncorrect
the left &ronchus is longer than the right <rue)alse
,ncorrect
the right !ain &ronchus has a -i$er $ia!eter than the left <rue)alse
,ncorrect
aspiration pneu!onitis is !ore co!!on in the right lo-er lo&e than the left <rue)alse
,ncorrect
the left !ain &ronchus $i0i$es &efore entering the lung <rue)alse
,ncorrect
foreign &o$ies lo$ge !ore co!!only in the right than in the left !ain &ronchus <rue)alse
<he right !ain &ronchus is shorter +appro.i!ately 2.2 c! long/, -i$er an$ runs !ore 0ertically
than the left !ain &ronchus. <he right !ain &ronchus gi0es off the upper lo&e &ranch +&efore
entering the lung/ an$ passes inferior to the pul!onary artery &efore entering the hilu! of the
lung +appro.i!ately <2/. ,t is i!portant to re!e!&er the aAygos 0ein, -hich arches o0er the
right !ain &ronchus fro! the posterior aspect as it passes to the (CC, an$ the pul!onary artery,
-hich lies inferior an$ then anterior to it. <he left !ain &ronchus is a&out 2 c! long an$, unlike
the right, $oes not gi0e off any &ranches &efore entering the hilu! of the left lung at the le0el of
<3.
<he a&$o!inal inferior 0ena ca0a +,CC/
,ncorrect
runs in the free e$ge of the lesser o!entu! <rue)alse
,ncorrect
ascen$s to the right of the aorta <rue)alse
,ncorrect
!ay &e $irectly in contact -ith the right suprarenal glan$ <rue)alse
,ncorrect
for!s the posterior -all of the epiploic fora!en <rue)alse
,ncorrect
recei0es $irect $rainage fro! &oth the right an$ left suprarenal 0eins <rue)alse
<he ,CC co!!ences opposite the L2 0erte&ra. ,t runs on the right si$e of the aorta, up-ar$s
&eyon$ the aortic opening of the $iaphrag! an$ e.ten$s to the central ten$on of the
$iaphrag!, -hich it pierces at the le0el of <6. <he ,CC lies &ehin$ the portal 0ein near the
pancreas an$ &ile $uct, an$ for!s the posterior -all of the epiploic fora!en of Finslo-. <he
right 0ein of the suprarenal glan$ is usually only a fe- !illi!etres long an$ enters the ,CC
$irectly. <he left suprarenal 0ein is longer an$ enters the left renal 0ein.
<he spleen:
,ncorrect
May &e in'ure$ &y a sta& -oun$ o0er the left tenth ri& <rue)alse
,ncorrect
,s a retroperitoneal structure <rue)alse
,ncorrect
Cenous $rainage fro! the spleen passes into the portal syste! <rue)alse
,ncorrect
<he splenic artery passes to the splenic hilu! in the gastrosplenic liga!ent <rue)alse
,ncorrect
May &e a&sent an$ replace$ -ith !ultiple splenunculi <rue)alse
<he spleen lies in the conca0ity of the left he!i$iaphrag! -ith its long a.is lying along the tenth
ri&. ,t is fully in0este$ in peritoneu!, !aking it a peritoneal structure. <he arterial supply is the
splenic artery, -hich reaches the spleen 0ia the lienorenal liga!ent. Cenous $rainage is 0ia the
splenic 0ein into the portal 0ein. "ccasionally the spleen !ay &e replace$ -ith !ultiple
splenunculi.
<rench foot
,ncorrect
is cause$ &y acute e.posure to te!peratures &et-een J6dC an$ J2dC <rue)alse
,ncorrect
is $ue to !icro0ascular en$othelial $a!age an$ 0ascular occlusion <rue)alse
,ncorrect
appears &lack e0en in the a&sence of $eeper tissue $estruction <rue)alse
,ncorrect
is characterise$ &y pruritic, re$Jpurple lesions <rue)alse
,ncorrect
can lea$ to gangrene <rue)alse
Eeply to HalaEeport
ost H18
<rench foot or col$ i!!ersion foot +or han$/ is cause$ $ue to a non-freeAing in'ury of the han$s
or feet. <his is typically seen in sol$iers, sailors, or fisher!en, -ho are chronically e.pose$ to
-et con$itions an$ te!peratures 'ust a&o0e freeAing, i.e. 1.3dC to 19dC +%2d) to 29d)/. ,t occurs
$ue to !icro0ascular en$othelial $a!age, stasis an$ 0ascular occlusion. Although the entire foot
!ay appear &lack, $eep tissue $estruction !ay not &e present. An alternating arterial
0asospas! an$ 0aso$ilatation occurs, -ith the affecte$ tissue first col$ an$ anaesthetic,
progressing to hyperae!ia in 2# to #6 h. <his then lea$s to an intense painful &urning an$
$ysaesthesia, as -ell as tissue $a!age characterise$ &y oe$e!a, &listering, re$ness,
ecchy!osis, an$ ulcerations. ruritic, re$Jpurple skin lesions are a feature of chil&lain or pernio.
Co!plications of trench foot inclu$e local infection, cellulitis, ly!phagitis, an$ gangrene.
<he follo-ing state!ents concern neuronal tracts in the spinal cor$:
,ncorrect
the fasciculus gracilis for!s part of the $orsal colu!n <rue)alse
,ncorrect
the lateral corticospinal tracts control skille$ 0oluntary !o0e!ents <rue)alse
,ncorrect
fine touch an$ proprioception are carrie$ &y crosse$ ascen$ing neurones <rue)alse
,ncorrect
the fasiculus cuneatus !ainly carries sensory neurones fro! the lo-er li!& <rue)alse
,ncorrect
the lateral spinothala!ic tracts con$uct pain an$ te!perature sensation <rue)alse
<he $orsal colu!ns are -hite !atter tracts for!e$ &y the fasciculus gracilis an$ fasciculus
cuneatus. <he fasciculus gracilis lies !e$ial to the fasciculus cuneatus. <hey carry fine touch
an$ proprioception. ?ncrosse$ fi&res are a$$e$ fro! !e$ial to lateral as the cor$ is ascen$e$.
<herefore the fasciculus gracilis !ainly carries sensory fi&res fro! the lo-er li!&s, an$ the
fasciculus cuneatus carries those fro! the upper li!&s. <he lateral spinothala!ic tracts carry
crosse$ a.ons con$ucting pain an$ te!perature sensations.
Consi$er the hin$gut
,ncorrect
<he hin$gut structures inclu$e the $istal one-thir$ of the trans0erse colon, the $escen$ing colon,
sig!oi$ colon, rectu!, an$ anal canal to the pectinate line <rue)alse
,ncorrect
@ranches of the inferior !esenteric artery supply the hin$gut <rue)alse
,ncorrect
<he $escen$ing colon is secon$arily retroperitoneal <rue)alse
,ncorrect
<he rectu! contains taeniae coli, haustrations, an$ o!ental appen$ages <rue)alse
,ncorrect
)ailure of neural crest cells to !igrate into the hin$gut results in HirschsprungIs $isease
<rue)alse
<he $escen$ing colon, the rectu!, an$ the anal canal are secon$arily retroperitoneal. <he $istal
one-thir$ of the trans0erse colon an$ the sig!oi$ colon are peritoneal. <he $istal one-thir$ of
trans0erse colon, $escen$ing an$ sig!oi$ colons contain taeniae coli, haustrations an$ o!ental
appen$ages. <he sig!oi$Jrectal 'unction !arks the en$ of the taeniae coli, the haustrations,
an$ the o!ental appen$ices. HirschsprungIs $isease is cause$ &y a failure of neural crest cells
either to !igrate into the hin$gut or to $ifferentiate into ter!inal parasy!pathetic ganglia in the
-alls of the hin$gut.
<he paroti$ $uct
,ncorrect
is appro.i!ately 1 c! long <rue)alse
,ncorrect
crosses the !asseter <rue)alse
,ncorrect
is co!presse$ &y the &uccinator <rue)alse
,ncorrect
con0eys !ainly !ucous secretions <rue)alse
,ncorrect
lies on the !i$$le thir$ of a line &et-een the intertragic notch of the auricle an$ the !i$point of
the philtru! <rue)alse
<he paroti$ $uct is appro.i!ately 2 c! long. ,t crosses the !asseter, turning aroun$ its anterior
&or$er to pass through the &uccal fat pa$ an$ pierce the &uccinator. Fhen intraoral pressure is
raise$, the su&!ucous part of the paroti$ $uct is co!presse$ &y the &uccinator. <he paroti$
glan$ is !ainly a serous glan$
Fhen the right !ain &ronchus is $issecte$, the follo-ing structures !ay &e encountere$
,ncorrect
the right phrenic ner0e <rue)alse
,ncorrect
the right 0agus ner0e <rue)alse
,ncorrect
the right recurrent laryngeal ner0e <rue)alse
,ncorrect
the he!iaAygos ner0e <rue)alse
,ncorrect
the aAygos 0ein <rue)alse
<he 0agus ner0e lies 'ust posterior to the right !ain &ronchus an$ the aAygos 0ein is at first
posterior an$ then arches o0er the &ronchus. <he phrenic ner0e is anterior to the &ronchus. <he
right recurrent laryngeal ner0e hooks aroun$ the right su&cla0ian artery superior to the right
!ain &ronchus.
<he follo-ing structures are retroperitoneal:
,ncorrect
ancreas <rue)alse
,ncorrect
(pleen <rue)alse
,ncorrect
Li0er <rue)alse
,ncorrect
A&$o!inal aorta <rue)alse
,ncorrect
7escen$ing colon <rue)alse
@oth li0er an$ spleen are in0este$ -ith peritoneu!, -hereas the other three structures are to &e
foun$ attache$ to the posterior a&$o!inal -all co0ere$ &y the peritoneu!. 1ote that &lee$ing
fro! the li0er an$ spleen -ill result in peritoneal &loo$, &ut pancreatic an$ aortic &lee$ing -ill
cause a retroperitoneal hae!ato!a J often !anifesting as flank $iscoloration.
<ransection of the anterior $i0ision of the !an$i&ular ner0e +C1 Cc/ in the infrate!poral fossa
results in
,ncorrect
ipsilateral paralysis of the &uccinator !uscle <rue)alse
,ncorrect
$ysphagia <rue)alse
,ncorrect
ipsilateral anaesthesia of the !an$i&ular teeth <rue)alse
,ncorrect
$e0iation of the 'a- to the si$e of the lesion on protrusion <rue)alse
,ncorrect
ipsilateral anaesthesia of the !ucosa of the oral 0esti&ule <rue)alse
<he anterior $i0ision of C1 Cc has one sensory &ranch +the &uccal ner0e to the skin of the cheek
an$ !ucosa of the 0esti&ule/. All other &ranches are !otor to the !uscles of !astication +the
!asseter, te!poralis an$ lateral pterygoi$/. <he lo-er 'a- teeth are supplie$ &y the inferior
al0eolar &ranch of the posterior $i0ision of C1 Cc. <he &uccinator !uscle is supplie$ &y the C,,th
cranial ner0e. ?noppose$ contraction of the contralateral lateral pterygoi$ !uscle $e0iates the
'a- to the si$e of the lesion $uring protrusion. 1one of the !uscles of the pharyn. are supplie$
&y the anterior $i0ision of C1 Cc, so $ysphagia is not a feature of $a!age to this ner0e.
?!&ilical hernia
,ncorrect
is !ore co!!on in Caucasians than in other races <rue)alse
,ncorrect
is co!!only associate$ -ith hypothyroi$is! <rue)alse
,ncorrect
!ust &e operate$ on &efore t-o years of age <rue)alse
,ncorrect
&eco!es o&structe$ in 2M of cases <rue)alse
,ncorrect
is !ore likely to resol0e spontaneously if s!all <rue)alse
?!&ilical hernias are !ost frequently seen in lo- &irth-eight an$ &lack infants. Although it is a
feature of hypothyroi$is!, !ost infants -ith u!&ilical hernias $o not ha0e hypothyroi$is!. <he
!a'ority of hernias -ill $isappear &y one year of age, strangulation is rare, an$ operation is only
in$icate$ if the hernia persists until age %J# years, causes sy!pto!s, or &eco!es progressi0ely
larger.
Fhich of the follo-ing !uscles are foun$ in the !e$ial fascial co!part!ent of the thigh:
,ncorrect
A$$uctor &re0is <rue)alse
,ncorrect
(artorius <rue)alse
,ncorrect
"&turator e.ternus <rue)alse
,ncorrect
=racilis <rue)alse
,ncorrect
Ha!string portion of a$$uctor !agnus <rue)alse
<he !e$ial fascial co!part!ent of the thigh contains a$$uctor longus, a$$uctor &re0is,
a$$uctor portion of a$$uctor !agnus, gracilis an$ o&turator e.ternus. (artorius lies in the
anterior fascial co!part!ent an$ the ha!string portion of a$$uctor !agnus lies in the posterior
fascial co!part!ent of the thigh.
A Tocher4s incision
,ncorrect
$i0i$es the CollesI fascia <rue)alse
,ncorrect
$i0i$es only the anterior rectus sheath <rue)alse
,ncorrect
$i0i$es the e.ternal o&lique !uscle <rue)alse
,ncorrect
in0ol0es the area inner0ate$ &y <19 ner0e root <rue)alse
,ncorrect
$i0i$es the fascia trans0ersalis !uscle <rue)alse
,ncorrect
$i0i$es the rectus a&$o!inis !uscle <rue)alse
(carpaIs fascia is $i0i$e$ in a TocherIs incision. <19 correspon$s to the u!&ilical area. <he
rectus sheath is $eficient posteriorly only &elo- the arcuate line, &ut is present in t-o layers in
the su&costal region.
Concerning the fe!ale &reast:
,ncorrect
the &reast e.ten$s fro! the 2n$ to the 2th ri& <rue)alse
,ncorrect
the &reast e.ten$s fro! the lateral !argin of the sternu! to the !i$-a.illary line <rue)alse
,ncorrect
the greater part of the glan$ lies in the $eep fascia <rue)alse
,ncorrect
the !a!!ary glan$ is attache$ to the skin &y CooperIs liga!ents <rue)alse
,ncorrect
the !a!!ary glan$ consists of 12J29 lo&es <rue)alse
<he &reast e.ten$s fro! the 2n$ to the 3th ri&, an$ fro! the lateral !argin of the sternu! to
the !i$-a.illary line. <he greater part of the glan$ lies in the superficial fascia, an$ the glan$ is
attache$ to the skin &y suspensory liga!ents +CooperIs liga!ents/. <he !a!!ary glan$
consists of 12J29 lo&es, -hich ra$iate out fro! the nipple.
7irect &ranches of the coeliac ple.us inclu$e the
,ncorrect
splenic artery <rue)alse
,ncorrect
co!!on hepatic artery <rue)alse
,ncorrect
superior pancreatico$uo$enal artery <rue)alse
,ncorrect
right gastric artery <rue)alse
,ncorrect
gastro$uo$enal artery <rue)alse
As soon as the aorta passes &elo- the aortic hiatus, it gi0es off the celiac ple.us +<12/. <he
ple.us has three $irect &ranches: left gastric, hepatic an$ splenic +!ne!onic: left-han$ si$e/.
<he right gastric an$ gastro$uo$enal arteries are &ranches of the hepatic artery. <he superior
pancreatico$uo$enal artery is a &ranch of the gastro$uo$enal artery.
<he right renal artery
,ncorrect
&ranches se0eral ti!es &efore entering the ki$ney <rue)alse
,ncorrect
gi0es a &ranch to the ureter <rue)alse
,ncorrect
lies anterior to the renal 0ein <rue)alse
,ncorrect
lies anterior to the inferior 0ena ca0a <rue)alse
>ach renal artery usually $i0i$es into fi0e seg!ental &ranches &efore entering the renal pel0is. ,t
supplies the ureter an$ lies posterior to the renal 0ein, &ut anterior to the renal pel0is. After
&ranching off the aorta, the renal artery passes &ehin$ the inferior 0ena ca0a.
At the le0el of the <# 0erte&ra, a co!pute$ to!ography scan of the &o$y trans0ersely sho-s the
,ncorrect
arch of aorta <rue)alse
,ncorrect
&ifurcation of trachea <rue)alse
,ncorrect
left &rachiocephalic 0ein <rue)alse
,ncorrect
aAygos 0ein <rue)alse
,n the plane of Louis, the aAygos 0ein arches o0er the hilu! of the right lung &efore $raining into
the superior 0ena ca0a.
Eegar$ing fractures of the a.is +C2/ 0erte&ra, -hich of the follo-ing are true:
,ncorrect
Appro.i!ately 39M of all a.is fractures in0ol0e the o$ontoi$ process <rue)alse
,ncorrect
<ype , o$ontoi$ fractures occur through the &ase of the $ens <rue)alse
,ncorrect
<ype ,,, o$ontoi$ fractures are the co!!onest type <rue)alse
,ncorrect
(urgical fi.ation is in$icte$ for type ,, o$ontoi$ fractures <rue)alse
,ncorrect
osterior ele!ent fractures are $ue to an e.tension type of in'ury <rue)alse
Acute fractures of the a.is +C2/ 0erte&ra represent a&out 16M of all cer0ico-spinal in'uries an$
appro.i!ately 39M of a.is fractures in0ol0e the o$ontoi$ process. <he o$ontoi$ process is a
peg-shape$ &ony protu&erance that pro'ects up-ar$ an$ is nor!ally positione$ in contact -ith
the anterior arch of C1. ,t is hel$ in place pri!arily &y the trans0erse liga!ent. <ype , o$ontoi$
fractures in0ol0e the tip of the o$ontoi$ peg, type ,, fractures are through the &ase of the $ens
+in0ol0ing the 'unction of the o$ontoi$ peg -ith the &o$y/ an$ type ,,, fractures occur at the &ase
of the $ens an$ e.ten$ o&liquely into the &o$y of the a.is. "$ontoi$ fractures are initially
i$entifie$ &y a lateral cer0ico-spinal fil! or open-!outh o$ontoi$ 0ie-s. ,n !any cases, ho-e0er,
a co!pute$ to!ography +C</ scan is require$ to further $elineate the type an$ e.tent of the
fracture. ,n chil$ren younger than 3 years of age, on plain ra$iography, the epiphysis !ay &e
pro!inent an$ !ay look like a fracture at this le0el. <ype ,, is the co!!onest type of o$ontoi$
fractures. <hey require surgical re$uction an$ i!!o&ilisation -ith a Halo an$ &o$y cast. ,f the
fracture is not heale$ +an$ so unsta&le/ at 12 -eeks, posterior fusion of C1 to C2 !ay &e
in$icate$. <he posterior ele!ents of C2, ie, the pars interarticularis !ay &e fracture$ +a
hang!anIs fracture/ &y an e.tension type of in'ury. atients -ith this fracture shoul$ &e
!aintaine$ in e.ternal i!!o&ilisation until specialise$ care is a0aila&le. <hese fractures
represent appro.i!ately 29M of all a.is fractures.
)or acute tongue s-elling, -hich one of the follo-ing is true
,ncorrect
"ccurs as a si$e-effect of angiotensin-con0erting enAy!e +AC>/ inhi&itors <rue)alse
,ncorrect
,nitial treat!ent is -ith &eta-&lockers <rue)alse
,ncorrect
Air-ay o&struction is not a feature <rue)alse
,ncorrect
(teroi$s are contrain$icate$ <rue)alse
,ncorrect
Antihista!ines usually take 3 hours for full effect <rue)alse
Angio-neurotic oe$e!a is tongue s-elling secon$ary to AC> inhi&itors. <he !ost i!portant initial
!anage!ent is to secure the air-ayD a nasotracheal tu&e !ay &e require$. (teroi$s +-hich !ay
take 3 hours to take full effect/ an$ antihista!ine shoul$ &e co!!ence$ i!!e$iately.
Crohn4s $isease
,ncorrect
is typically a su&!ucosal infla!!ation <rue)alse
,ncorrect
is associate$ -ith WrosethornI ulcers on &ariu! stu$ies <rue)alse
,ncorrect
is associate$ -ith !outh ulcers <rue)alse
,ncorrect
!ay lea$ to a patient requiring lifelong parenteral nutrition <rue)alse
,ncorrect
!ost co!!only affects the $istal colon an$ then sprea$s pro.i!ally <rue)alse
,nfla!!ation is classically $escri&e$ as trans!ural. WEosethornI ulcers are $eep ulcers that
tra0erse &eyon$ the la!ina propria an$ ha0e a characteristic appearance. Apthous ulcers occur
any-here fro! the !outh to the anus. (hort-&o-el syn$ro!e is -hy -e try to a0oi$ surgery
-hene0er possi&le -ith CrohnIs $isease, &ut in 0ery se0ere cases -here less than 29 c! of
s!all &o-el re!ains, !ala&sorption of essential fat solu&le 0ita!ins +A, 7, > an$ T/ as -ell as
other essential nutrients requires lifelong parenteral nutrition. CrohnIs colitis is not unco!!on
&ut the s!all &o-el is !ore often in0ol0e$ an$ usually seen &y the ti!e a colitis occurs. CrohnIs
sprea$s as Wskip lesionsI an$, unlike ulcerati0e colitis, the sprea$ is not usually in a continuous
fashion.
@arrettIs oesophagus
,ncorrect
occurs in appro.i!ately #9M of patients -ith gastro-oesophageal reflu. $isease +="E7/
<rue)alse
,ncorrect
ne0er pro$uces ulceration <rue)alse
,ncorrect
presents -ith !alignancy in one-thir$ of cases <rue)alse
,ncorrect
pro$uces strictures at the squa!ocolu!nar 'unction <rue)alse
,ncorrect
hista!ine H2 &lockers are the treat!ent of choice <rue)alse
19M of patients -ith gastro-oesophageal reflu. $isease +="E7/ -ill $e0elop @arrettIs
oesophagus. ,t !ay ulcerate if left untreate$, &ut !e$ical treat!ent shoul$ &e -ith proton pu!p
inhi&itors. (trictures are co!!on an$ !ay lea$ to the sy!pto!s of $ysphagia -ith -hich the
patient presents.
Fhich of the follo-ing !uscles a&$uct the thigh:
,ncorrect
Gua$ratus fe!oris <rue)alse
,ncorrect
=luteus !a.i!us <rue)alse
,ncorrect
=luteus !e$ius <rue)alse
,ncorrect
=luteus !ini!us <rue)alse
,ncorrect
irifor!is <rue)alse
@oth gluteus !e$ius an$ gluteus !ini!us a&$uct an$ !e$ially rotate the thigh at the hip 'oint.
=luteus !a.i!us e.ten$s an$ laterally rotates the thigh at the hip 'oint. Gua$ratus fe!oris an$
pirifor!is &oth contri&ute to lateral rotation of the thigh.
Fhich of the follo-ing are true: Eegar$ing the !uscles of respiration:
,ncorrect
Guiet inspiration is pre$o!inantly $ue to the action of the $iaphrag!
<rue)alse
,ncorrect
Acti0e inspiration is cause$ &y the internal intercostal !uscles
<rue)alse
,ncorrect
<he scalene !uscles play an i!portant role in quiet e.piration
<rue)alse
,ncorrect
,nternal an$ e.ternal o&lique !uscles are i!portant in acti0e e.piration <rue)alse
,ncorrect
<he e.ternal intercostal !uscles pull the ri&s !e$ially an$ inferiorly $uring acti0e e.piration
<rue)alse
Eeply to HalaEeport
ost H29
<he pre$o!inant !uscle of inspiration $uring quiet &reathing is the $iaphrag!, a $o!e-shape$
!usculofi&rous septu! separating the thora. fro! the a&$o!inal ca0ity. As the $iaphrag!
contracts, pleural pressure $rops, -hich lo-ers the al0eolar pressure. <his $ra-s air into the
lungs $ue to the pressure gra$ient fro! the !outh to the al0eoli. >.piration $uring quiet
&reathing is a passi0e process. <his is cause$ &y the rela.ation of the respiratory !uscles an$
the return of the elastic lung an$ chest -all to their nor!al resting 0olu!e. 7uring e.ertion or
acti0ity, the e.ternal intercostals help in inspiration &y raising the lo-er ri&s superiorly an$
laterally, so increasing the lateral an$ antero-posterior $ia!eters of the thoracic ca0ity. <he
scalene !uscles an$ sternoclei$o!astoi$s also help &y raising an$ pushing out the upper ri&s
an$ the sternu!. Acti0e e.piration is helpe$ &y the contraction of the a&$o!inal -all !uscles
+internal o&lique, e.ternal o&lique, trans0ersus a&$o!inus an$ rectus a&$o!inus/. ,t increases
the intra-a&$o!inal pressure, -hich pushes up the $iaphrag!, so raising the pleural pressure
an$ $ri0es the air out of the lungs. <he internal intercostals also help in acti0e e.piration &y
$ecreasing the thoracic 0olu!e +&y pulling $o-n !e$ially an$ inferiorly/.
<he portal 0ein
,ncorrect
is for!e$ &ehin$ the &o$y of the pancreas <rue)alse
,ncorrect
lies anteriorly to the free e$ge of the lesser o!entu! <rue)alse
,ncorrect
$rains the spleen <rue)alse
,ncorrect
for!s the central 0ein of each li0er lo&ule <rue)alse
,ncorrect
lies to the right of the superior !esenteric artery <rue)alse
,ncorrect
is a&out 19 c! in length <rue)alse
<he portal 0ein is for!e$ &y the confluence of the superior !esenteric 0ein +lying to the right of
the artery/ an$ the splenic 0ein, &ehin$ the neck of the pancreas. ,t is a&out 2 c! long. <he
portal 0ein lies &et-een the t-o layers of the lesser o!entu!, running al!ost 0ertically in the
free e$ge -here the lesser o!entu! for!s the anterior &oun$ary of the epiploic fora!en. <he
ter!inals of the portal 0ein an$ the hepatic artery for!, -ith the hepatic $uctules, the tria$s of
the li0er in the corners of the he.agonal lo&ules. <he central 0eins $rain into the hepatic 0eins.
<he follo-ing coul$ &e appropriate !anage!ent for a gunshot in'ury to the upper part of the
neck +a&o0e the angle of the !an$i&le/
,ncorrect
Arteriogra! <rue)alse
,ncorrect
>n$oscopy <rue)alse
,ncorrect
@ariu! s-allo- <rue)alse
,ncorrect
Clinical o&ser0ation <rue)alse
,ncorrect
(urgical e.ploration <rue)alse
,t is not appropriate to o&ser0e gunshot in'uries: they nee$ to &e e.plore$. An arteriogra! !ay
&e of &enefit: 0ascular in'ury is the greatest concern here, an$ it !ay &e possi&le to e!&olise a
&lee$ing 0essel. <his area is a&o0e the le0el of the trachea an$ oesophagus.
Colorectal carcino!a
,ncorrect
is associate$ -ith a lo--fi&re, high-fat $iet <rue)alse
,ncorrect
presents -ith rectal !ass in appro. #2M of cases <rue)alse
,ncorrect
is foun$ in the rectu! in 22M of cases <rue)alse
,ncorrect
is co!!only associate$ -ith Truken&ergIs tu!ours <rue)alse
,ncorrect
is treate$ &y a&$o!inal perineal resection as the surgical proce$ure of choice for tu!ours a&out
12 c! fro! the anal canal <rue)alse
Appro.i!ately #2M of colorectal tu!ours are foun$ in the rectu!. Truken&ergIs tu!ours are
!ore co!!only secon$aries fro! gastric an$ o0arian cancer though can arise fro! colorectal
tu!ours. A&$o!inal perineal resections are use$ for lo- rectal tu!ours, -here tu!ours are
a&out 6 c! fro! the anal canal.
,n oesophageal $isor$ers
,ncorrect
patients -ith oesophageal achalasia are usually younger than those presenting -ith
oesophageal carcino!a <rue)alse
,ncorrect
in oesophageal carcino!a, $ysphagia is progressi0e unlike achalasia <rue)alse
,ncorrect
oesophageal achalasia is treata&le &y $ilating the lo-er oesophagus <rue)alse
,ncorrect
oesophagitis $ue to Herpes si!ple. occurs in i!!uno-co!pro!ise$ patients <rue)alse
,ncorrect
!e$ical treat!ent of gastro-oesophageal reflu. is successful in relie0ing regurgitation or
0o!iting <rue)alse
,n achalasia, patients ha0e equal $ifficulty in s-allo-ing &oth liqui$s an$ soli$s. ,n carcino!a,
$ifficulties &egin -ith s-allo-ing soli$s an$ progress to inclu$e liqui$s. ,n 82M of cases, only
surgery, if properly $one, has any effect on curing regurgitation.
<he recurrent laryngeal ner0e
,ncorrect
supplies the cricothyroi$ !uscle <rue)alse
,ncorrect
partially supplies the trachea <rue)alse
,ncorrect
lies alongsi$e the inferior thyroi$ artery <rue)alse
,ncorrect
shoul$ &e retracte$ $uring tracheosto!y to a0oi$ $a!age <rue)alse
,ncorrect
runs &et-een the oesophagus an$ trachea in the neck <rue)alse
,ncorrect
supplies the !ucous surface of the 0ocal cor$s <rue)alse
<he recurrent laryngeal ner0e supplies all the intrinsic !uscles of the laryn. e.cept the
cricothyroi$ an$ is sensory inferior to the 0ocal fol$s. ,n the neck the recurrent laryngeal ner0es
on &oth si$es follo- the sa!e course, ascen$ing in the tracheo-oesophageal groo0e. As the
ner0e passes the lateral lo&e of the thyroi$ it is closely relate$ to the inferior thyroi$ artery. <he
superior laryngeal ner0e supplies the 0ocal cor$ !ucosa.
Fhich of the follo-ing are correct: ?n$er-ater - seale$ chest $rains
,ncorrect
A0oi$ &uil$-up of positi0e intrathoracic pressure in case of al0eolar air leak <rue)alse
,ncorrect
A 26 )r $rain is usually use$ to $rain &loo$ or pus <rue)alse
,ncorrect
7oes not get &locke$ <rue)alse
,ncorrect
Ee$uces the risk of positi0e-pressure 0entilation <rue)alse
,ncorrect
Accurately !easures &loo$ loss <rue)alse
A chest $rain is a con$uit to re!o0e air or flui$ fro! the pleural ca0ity allo-ing re-e.pansion of
the un$erlying lung. 7rainage occurs $uring e.piration -hen pleural pressure is positi0e. ?nless
it is an e!ergency situation, preproce$ure chest X -ray shoul$ &e perfor!e$. <he $rain is usually
inserte$ un$er local anaesthesia using aseptic technique into the 2th intercostal space in the
!i$-a.illary line, an$ o0er the upper &or$er of the ri&, to a0oi$ intercostal 0essels an$ ner0es. A
large $rain +26 )r or a&o0e/ shoul$ &e use$ to $rain &loo$ or pus.
@enign prostatic hyperplasia +@H/
,ncorrect
!ainly affects the peripheral Aone <rue)alse
,ncorrect
is a recognise$ cause of ele0ate$ seru! prostate-specific antigen +(A/ <rue)alse
,ncorrect
inci$ence is increase$ in !ales castrate$ &efore pu&erty <rue)alse
,ncorrect
sy!pto!s i!pro0e -ith o.y&utynin <rue)alse
,ncorrect
can &e treate$ -ith 2-alpha re$uctase inhi&itors <rue)alse
@enign prostatic hyperplasia +@H/ !ainly affects the inner transitional Aone. <he outer
peripheral Aone is usuallyco!presse$ an$ feels s!ooth to $igital rectal e.a!ination. Any
palpa&le no$ule or irregularity shoul$ raise the possi&ility of !alignancy. @H see!s to &e an
an$rogen-$ri0en $isease. Castration prior to pu&erty see!s to pre0ent the $isease. Alpha
&lockers cause rela.ation of s!ooth !uscles an$ i!pro0e sy!pto!s, -hereas anticholinergic
$rugs coul$ -orsen sy!pto!s an$ precipitate acute urinary retention.
Fhat are the $ifferences &et-een the right an$ left lungs
,ncorrect
<he right lung has three lo&es <rue)alse
,ncorrect
<he right lung is shorter than the left <rue)alse
,ncorrect
<he right lung is larger an$ hea0ier <rue)alse
,ncorrect
<he anterior !argin of the right lung is straight, unlike that of the left lung <rue)alse
<he right lung has three lo&es, the left lung has t-o. <he right lung is larger an$ hea0ier than
the left &ut it is also shorter an$ -i$er &ecause the right $o!e of the $iaphrag! is higher an$
the heart &ulge !ore to the left. <he anterior !argin of the left lo&e has the car$iac notch.
<he follo-ing are recognise$ co!plications of a rolling hiatus hernia:
,ncorrect
oesophagitis <rue)alse
,ncorrect
gastric 0ol0ulus <rue)alse
,ncorrect
inhalational pneu!onia <rue)alse
,ncorrect
inter!ittent $ysphagia <rue)alse
,ncorrect
gangrene <rue)alse
<he !a'ority of hiatus herniae are sli$ing or a.ial in nature, these are often asy!pto!atic &ut
are associate$ -ith oesophagitis, stricture for!ation, $ysphagia, chronic anae!ia an$
inhalational pneu!onitis. Eolling herniae or para-oesophageal hiatal herniae usually affect
el$erly patients -ho present -ith inter!ittent $ysphagia, pain after eating $ue to $istension of
the intrathoracic part of the sto!ach, car$iac sy!pto!s $ue to pressure effects on the heart,
an$ hiccough $ue to phrenic ner0e irritation. Co!plications inclu$e incarceration, gangrene an$
gastric 0ol0ulus.
osterior hip $islocation
,ncorrect
classically occurs -hen the hip is in the e.ten$e$ position <rue)alse
,ncorrect
is a co!!on in'ury <rue)alse
,ncorrect
can occur -ith a0ascular necrosis <rue)alse
,ncorrect
!ay inclu$e $a!age to the fe!oral ner0e <rue)alse
,ncorrect
is characterise$ &y the leg &eing hel$ fle.e$ an$ !e$ially rotate$ <rue)alse
osterior hip $islocation is an unco!!on in'ury often occurring -hen the hip is fle.e$ e.g. a roa$
traffic acci$ent. <he t-o !ain co!plications are sciatic ner0e $a!age an$ a0ascular necrosis.
(ciatic ner0e $a!age occurs &ecause the sciatic ner0e lies in close pro.i!ity to the posterior
aspect of the 'oint capsule so is at risk in posterior $islocation. A0ascular necrosis occurs $ue to
tearing of the 'oint capsule, causing a $istur&ance of the &loo$ supply to the fe!oral hea$.
<he trige!inal ner0e
,ncorrect
supplies the &uccinator !uscle <rue)alse
,ncorrect
supplies the !uscles of !astication <rue)alse
,ncorrect
has ophthal!ic an$ !a.illary $i0isions, -hich are only sensory <rue)alse
,ncorrect
is sensory to the te!poro!an$i&ular 'oint <rue)alse
,ncorrect
supplies sensation to the angle of the !an$i&le <rue)alse
<he trige!inal +C/ ner0e has sensory fi&res to the greater part of the skin of the face, !ucous
!e!&ranes of the !outh, nose an$ paranasal air sinuses. ,t pro0i$es !otor inner0ation to the
!uscles of !astication +te!poralis, !asseter, pterygoi$/. <he &uccinator !uscle is supplie$ &y
the facial ner0e. <he angle of the !an$i&le is supplie$ &y the great auricular ner0e +C2JC%/.
Eeply to HalaEeport
ost H21
Eegar$ing spinal cor$ syn$ro!es, -hich of the follo-ing are true:
,ncorrect
Central cor$ syn$ro!e results fro! 0ascular co!pro!ise of the cor$ along the $istri&ution of
the anterior spinal artery <rue)alse
,ncorrect
osition an$ 0i&ration sense are preser0e$ in anterior cor$ syn$ro!e <rue)alse
,ncorrect
<here is ipsilateral !otor loss an$ contralateral loss of pain an$ te!perature sensation in
@ro-nJ(equar$ syn$ro!e <rue)alse
,ncorrect
<he ar!s are !ore affecte$ than the legs in central cor$ syn$ro!e <rue)alse
,ncorrect
Anterior cor$ syn$ro!e has the &est prognosis a!ong all inco!plete spinal in'uries <rue)alse
<he central cor$ syn$ro!e is thought to &e $ue to 0ascular co!pro!ise of the cor$ in the
$istri&ution of the anterior spinal artery. ,nfarction of the cor$ in the territory of this artery coul$
also result in the anterior cor$ syn$ro!e. Anterior cor$ syn$ro!e is characterise$ &y paraplegia
an$ a $issociate$ sensory loss -ith loss of pain an$ te!perature sensation. osition, 0i&ration
an$ $eep pressure sensations, all functions of the posterior colu!n, are preser0e$. @ro-nJ
(equar$ syn$ro!e, resulting fro! he!isection of the cor$, usually causes ipsilateral !otor loss
an$ contralateral loss of pain an$ te!perature sensationD there is also associate$ loss of position
sense. <he central cor$ syn$ro!e is characterise$ &y a $isproportionately greater loss of !otor
po-er in the upper e.tre!ities than in the lo-er e.tre!ities, -ith 0arying $egrees of sensory
loss. <he ar!s an$ han$s are !ost se0erely affecte$ since the !otor fi&res to the cer0ical
seg!ents are topographically arrange$ to-ar$ the centre of the cor$. Anterior cor$ syn$ro!e
has the poorest prognosis of all inco!plete spinal in'uries.
Fhich of the follo-ing are posterior relations of the ki$neys:
,ncorrect
soas !a'or <rue)alse
,ncorrect
(u&costal ner0e <rue)alse
,ncorrect
eritoneu! <rue)alse
,ncorrect
7iaphrag! <rue)alse
,ncorrect
leura <rue)alse
<he ki$neys are retroperitoneal therefore the peritoneu! is an anterior relation. osterior
relations of the ki$neys inclu$e the $iaphrag!, qua$ratus lu!&oru!, psoas !a'or, su&costal
0ein, su&costal artery, su&costal ner0e an$ ilioinguinal ner0e. <he costo$iaphrag!atic recess of
the pleura is an i!portant posterior relation of the ki$ney as it can &e ina$0ertently $a!age$
$uring nephrecto!y resulting in a pneu!othora..
<he fe!oral canal
,ncorrect
allo-s for e.pansion of the fe!oral 0essels <rue)alse
,ncorrect
is a clinically i!portant site of herniation of the s!all &o-el <rue)alse
,ncorrect
contains CloquetIs no$e <rue)alse
,ncorrect
contains the fe!oral artery <rue)alse
,ncorrect
has the fe!oral 0ein lying !e$ially <rue)alse
<he fe!oral sheath is a fascial tu&e $eri0e$ fro! e.traperitoneal intra-a&$o!inal fascia. ,t
e.ten$s un$er the inguinal liga!ent to surroun$ the fe!oral 0essels. <he canal is a s!all space
&et-een the !e$ial part of the sheath an$ the fe!oral 0ein. ,t contains fat an$ CloquetIs no$e.
)e!oral hernias can &e $ifferentiate$ fro! inguinal hernias &y locating the neck of a fe!oral
hernia &elo- an$ lateral to the inguinal canal.
Co!pare$ -ith the lo-er en$ of the ileu!, the upper en$ of the 'e'unu! has
,ncorrect
a thicker -all <rue)alse
,ncorrect
less fat at the !esenteric &or$er <rue)alse
,ncorrect
fe-er circular fol$s <rue)alse
,ncorrect
a -i$er lu!en <rue)alse
,ncorrect
!ore aggregate$ ly!phatic follicles +eyerIs patches/ <rue)alse
,ncorrect
!ore arterial arca$es <rue)alse
<he 'e'unu! has a thicker -all, less !esenteric fat, !ore plicae circulares, a -i$er lu!en, fe-er
eyerIs patches an$ fe-er arterial arca$es than the ileu!.
<he 1st ri&
,ncorrect
has scalenus anterior !uscle inserte$ onto the scalene tu&ercle <rue)alse
,ncorrect
has the su&cla0ian 0ein o0erlying the 0erte&ral trans0erse processes <rue)alse
,ncorrect
has the su&cla0ian 0ein running lateral to the artery <rue)alse
,ncorrect
is relate$ to the pleura <rue)alse
,ncorrect
is relate$ to the cer0icothoracic +stellate/ sy!pathetic ganglion <rue)alse
,ncorrect
is relate$ to the upper t-o roots of the &rachial ple.us <rue)alse
<he 1st ri& has the scalenus anterior !uscle attache$ to the scalene tu&ercle, separating the
su&cla0ian 0ein +anteriorly/ fro! the artery +posteriorly/.
<he right suprarenal glan$
,ncorrect
lies against the &are area of the li0er <rue)alse
,ncorrect
e.ten$s &ehin$ the inferior 0ena ca0a +,CC/ <rue)alse
,ncorrect
recei0es &loo$ fro! the right inferior phrenic artery <rue)alse
,ncorrect
$rains into the right renal 0ein <rue)alse
,ncorrect
lies on the ninth ri& <rue)alse
<he &are area of the li0er is in $irect contact -ith the right suprarenal glan$ an$ the $iaphrag!.
<he right suprarenal glan$ e.ten$s !e$ially &ehin$ the ,CC, separate$ fro! the 12th ri& &y the
$iaphrag!. ,t typically has three arterial sources. ,t recei0es &loo$ fro! the inferior phrenic
artery, fro! a &ranch of the renal artery an$ fro! a &ranch $irectly fro! the aorta. <he 0enous
$rainage is into the ,CC &y a 0ery short 0essel. <he left suprarenal glan$ $rains into its
correspon$ing renal 0ein.
Mi$line s-ellings of the neck inclu$e
,ncorrect
cystic hygro!as <rue)alse
,ncorrect
plunging ranulae <rue)alse
,ncorrect
su&hyoi$ &ursae <rue)alse
,ncorrect
&ranchial cysts <rue)alse
,ncorrect
arterio0enous fistulae <rue)alse
(-ellings of the neck consi$ere$ to &e !i$line inclu$e thyroglossal cysts, pharyngeal pouches,
plunging ranulae, su&hyoi$ &ursae, laryngoceles an$ lesions in the thyroi$ isth!us.
(ti!ulation of the parasy!pathetic ner0ous syste! lea$s to
,ncorrect
pupillary constriction <rue)alse
,ncorrect
increase$ heart rate <rue)alse
,ncorrect
s!ooth !uscle rela.ation <rue)alse
,ncorrect
increase$ glan$ular secretion <rue)alse
,ncorrect
$ecrease$ force of contraction of the heart <rue)als
Eeply to HalaEeport
ost H22
MEC( art 1 ractice Guestions + Anato!y / - 2 of 2
Here4s the secon$ part, =oo$ Lucke
,nter0erte&ral $isc collapse &et-een L2 an$ (1
,ncorrect
-oul$ crush the L2 spinal ner0e <rue)alse
,ncorrect
-oul$ i!pinge into the sacral seg!ents of the cor$ <rue)alse
,ncorrect
usually causes pain to ra$iate o0er the !e$ial !alleolus <rue)alse
,ncorrect
-oul$ e.aggerate the ten$on refle. at the ankle <rue)alse
,ncorrect
!ay cause re$uce$ s-eating o0er the posterior aspect of the calf <rue)alse
A collapse$ L2J(1 $isc presses on the (1 spinal ner0e +the L2 ner0e passes a&o0e the prolapse$
$isc in the inter0erte&ral fora!en an$ so escapes $a!age/. At the le0el of prolapse, the spinal
canal contains the cau$a equina an$ not cor$ per se. <he (1 $er!ato!e lies o0er the lateral
!alleolus. >.aggerate$ refle.es are $iagnostic of an upper !otor neurone lesion. <he (2
$er!ato!e occupies the posterior aspect of the calf.
<he anal canal
,ncorrect
lies &elo- the le0ator ani !uscle <rue)alse
,ncorrect
has a longitu$inal !uscular coat <rue)alse
,ncorrect
has a ly!phatic $rainage 0ia the inguinal ly!ph no$es <rue)alse
,ncorrect
has an e.ternal sphincter inner0ate$ &y the pu$en$al ner0e <rue)alse
,ncorrect
possesses 0al0es <rue)alse
<he le0ator ani for!s part of the $eep e.ternal anal sphincter. <he anal canal has no
longitu$inal !uscular coat. Ly!ph fro! the lo-er anal canal $rains 0ia the superficial inguinal
no$es. <he entire anal sphincter is inner0ate$ &y the inferior rectal &ranch of the pu$en$al
ner0e +(2J(#/. <he upper anal canal is thro-n into 0ertical fol$s calle$ anal colu!ns. <he anal
0al0es are for!e$ &y horiAontal se!ilunar fol$s of !ucous !e!&rane 'oining a$'acent colu!ns
at their lo-er en$. Anal 0al0es are re!nants of the procto$eal !e!&rane. <he anococcygeal
&o$y lies &et-een the anal canal an$ the coccy..
<he left &rachiocephalic 0ein $rains the
,ncorrect
cer0ical 0erte&rae <rue)alse
,ncorrect
&ronchi <rue)alse
,ncorrect
intercostal spaces <rue)alse
,ncorrect
thoracic $uct <rue)alse
,ncorrect
thyroi$ glan$ <rue)alse
<he left &rachiocephalic 0ein $rains &loo$ fro!: the cer0ical 0erte&rae 0ia &oth 0erte&ral 0einsD
the thyroi$ glan$ &y the inferior thyroi$ 0einsD the first left intercostal space 0ia the left superior
intercostal 0einsD an$ all the anterior intercostal spaces &y the anterior intercostal 0eins $raining
into the internal thoracic 0eins. <he thoracic $uct enters the 0ein at its co!!ence!ent &ehin$
the left sternocla0icular 'oint. <he &ronchial 0eins $rain into the aAygos;he!iaAygos syste!s.
)racture of the follo-ing &ones is rare an$ in$icates high energy trau!a -hich coul$ &e
associate$ -ith hi$$en se0ere in'uries
,ncorrect
(capula <rue)alse
,ncorrect
Cla0icle <rue)alse
,ncorrect
(ternu! <rue)alse
,ncorrect
19th ri& <rue)alse
,ncorrect
1st ri& <rue)alse
,ncorrect
(haft of hu!erus <rue)alse
<hese &ones are $ifficult to &reak, the fin$ing of such an in'ury is -orriso!e, an$ a further
pathology !ust &e sought.
<he tongue
,ncorrect
recei0es sensory inner0ation fro! the 0agus ner0e <rue)alse
,ncorrect
protru$es to the si$e of a unilateral lo-er !otor neurone lesion <rue)alse
,ncorrect
is acti0e $uring the 0oluntary phase of s-allo-ing <rue)alse
,ncorrect
is retracte$ &y the hyoglossus !uscle <rue)alse
,ncorrect
contains ly!phoi$ tissue <rue)alse
,ncorrect
has intrinsic !uscles that are not attache$ to any &one <rue)alse
<he sensory inner0ation to the tongue is fro! the C,,th, C,,,th an$ ,Xth cranial ner0es. <he
tongue $e0iates to the si$e of a X,,th cranial ner0e lesion on protrusion, is acti0e $uring the first
stage of s-allo-ing an$ contains the lingual tonsil in the $orsu! of its posterior thir$. <he
tongue is retracte$ up an$ &ack &y the styloglossus !uscle, protru$e$ &y genioglossus an$
$epresse$ &y the hyoglossus.
<he phrenic ner0es
,ncorrect
are sensory to the peritoneu! <rue)alse
,ncorrect
trans!it afferent fi&res fro! the !e$iastinal pleura <rue)alse
,ncorrect
recei0e sensory fi&res fro! the lungs <rue)alse
,ncorrect
supply the &ronchi <rue)alse
,ncorrect
pass anterior to scalenus anterior !uscles <rue)alse
<he phrenic ner0e arises fro! the spinal cor$ seg!ents C%J2 an$ lie in front of the scalenus
anterior !uscle, passing &et-een the su&cla0ian 0ein anteriorly an$ the su&cla0ian artery
posteriorly. ,t crosses o0er the lateral surfaces of the !e$iastinal structures passing in front of
the lung root to reach the $iaphrag!. <he phrenic ner0e supplies !otor fi&res to the $iaphrag!
an$ carries sensory fi&res fro! the $iaphrag!atic peritoneu!, !e$iastinal pleura an$ the
parietal pericar$iu!. <he &ronchi an$ lungs the!sel0es are supplie$ &y &ranches of the
autono!ic ner0es, principally 0ia the pul!onary ple.uses.
Eeply to HalaEeport
ost H2%
Ly!phatic $ucts
,ncorrect
contract $ue to filling <rue)alse
,ncorrect
ha0e no 0al0es <rue)alse
,ncorrect
if o&structe$, lea$ to ly!phoe$e!a <rue)alse
,ncorrect
ha0e a parasy!pathetic inner0ation <rue)alse
,ncorrect
e!pty &y pu!p action of the calf !uscles <rue)alse
,ncorrect
$ilate in oe$e!a <rue)alse
<he function of ly!phatic 0essels is to return the plas!a capillary filtrate to the circulation. <his
task is achie0e$ &y increase$ tissue pressure, facilitate$ &y inter!ittent skeletal !uscle acti0ity,
contractions of ly!phatic 0essels an$ an e.tensi0e syste! of one--ay 0al0es. Ly!phoe$e!a is
an accu!ulation of tissue flui$ resulting fro! a fault in the ly!phatic syste! J 0ery often,
patients are $iagnose$ as ha0ing ly!phoe$e!a -hen the oe$e!a is $ue to another cause.
Ly!phoe$e!a can occur as a result of ly!phatic o&struction secon$ary to infiltration of ly!ph
no$es, frequently $eep in the pel0is.
<ransection of the cer0ical part of the sy!pathetic chain at the root of the neck results in
,ncorrect
0aso!otor changes in the ar! <rue)alse
,ncorrect
ptosis <rue)alse
,ncorrect
pupillary $ilatation <rue)alse
,ncorrect
a&lation of sy!pathetic supply to the pul!onary ple.us <rue)alse
,ncorrect
loss of s-eating o0er the C# $er!ato!e <rue)alse
,n HornerIs syn$ro!e there is: ptosis, pupillary constriction an$ occasional enophthal!os, an$
$ryness an$ flushing of the skin of the hea$ an$ neck. <he sy!pathetic supply to the lungs is
preser0e$ as this originates &elo- the lesion $irectly fro! the <1J<# ganglia of the sy!pathetic
chain. (y!pathetic fi&res pass to the ar! 0ia grey ra!i fro! the !i$$le an$ inferior cer0ical
sy!pathetic ganglia through all the roots of the &rachial ple.us.
<he !usculocutaneous ner0e
,ncorrect
supplies skin o0er the shoul$er <rue)alse
,ncorrect
supplies the &iceps &rachii <rue)alse
,ncorrect
&eco!es the lateral cutaneous ner0e of the forear! +lateral ante&rachial cutaneous ner0e/
<rue)alse
,ncorrect
supplies the !uscles of the anterior aspect of the ar! <rue)alse
,ncorrect
supplies skin on the !e$ial aspect of the ar! <rue)alse
<he !usculocutaneous ner0e supplies the coraco&rachialis, &iceps &rachii an$ &rachialis
!uscles. ,t pierces the $eep fascia 'ust pro.i!al to the el&o- 'oint an$ &eco!es superficial. ,t is
then calle$ the lateral cutaneous ner0e of the forear!, supplying skin on the lateral aspect of
the ar!.
A&$o!inal aortic aneurys!s +AAAs/
,ncorrect
are $ue to $ia&etes !ellitus in !ost cases <rue)alse
,ncorrect
e.pan$ at 19 !! per year <rue)alse
,ncorrect
are infla!!atory in 5M of cases <rue)alse
,ncorrect
!easuring 5 c! in $ia!eter ha0e a 2 year rupture rate of #9M <rue)alse
A&$o!inal aortic aneurys!s +AAAs/ are cause$ &y atherosclerosis in !ost cases. <hey e.pan$
at appro.i!ately # !! per year. <he 2-year rupture rate for aneurys!s !easuring 5 c! is
appro.i!ately 52M.
,nspiration in0ol0es
,ncorrect
$escent of the he!i$iaphrag!s <rue)alse
,ncorrect
re$uction of the 0ertical $i!ension of the chest <rue)alse
,ncorrect
up-ar$;for-ar$ !o0e!ent of the first ri& <rue)alse
,ncorrect
contraction of the intercostal !uscles <rue)alse
,ncorrect
the long thoracic ner0e of @ell +supplying the serratus anterior/ <rue)alse
<he 0ertical $i!ension of the chest increases on inspiration. <he ri&s !o0e up-ar$s an$
out-ar$s. Ho-e0er, the first ri& $oes not !o0e $uring respiration. <he serratus anterior
+supplie$ &y the long thoracic ner0e/ is in0ol0e$ in respiration.
<he follo-ing state!ents concern the ankle 'oint
,ncorrect
<he $eltoi$ liga!ent is attache$ to the lateral !alleolus <rue)alse
,ncorrect
<he &o$y an$ articular surface of the talus is -i$er anteriorly than posteriorly <rue)alse
,ncorrect
<he ankle is !ost sta&le in plantarfle.ion <rue)alse
,ncorrect
<he capsular liga!ents in front of an$ &ehin$ the ankle 'oint are -eak <rue)alse
,ncorrect
<he inter!alleolar $istance increases as the ankle plantarfle.es <rue)alse
<he ankle +ti&iotalar/ 'oint is a hinge 'oint. As -ith !ost hinge 'oints there is strong support at
the si$es &ut not in front an$ &ehin$. <he $eltoi$ liga!ent is attache$ a&o0e to the !e$ial
!alleolus an$ fans out to attach &elo-, !ainly on the talus, &ut also on the calcaneus. "n the
lateral si$e there are three s!aller liga!ents +anterior an$ posterior talofi&ular liga!ents an$
calcaneofi&ular liga!ent/. <he ankle 'oint is !ost sta&le in $orsifle.ion. <he inter!alleolar
$istance increases in $orsifle.ion $ue to the increase$ -i$th of the anterior part of the talus
&one.
Lo-er li!& a!putation
,ncorrect
through the knee affor$s the &est reha&ilitation <rue)alse
,ncorrect
a&o0e the knee usually heals -hen equal anterior an$ posterior flaps are use$ <rue)alse
,ncorrect
&elo- the knee is classically perfor!e$ -ith equal flaps <rue)alse
,ncorrect
!ay &e perfor!e$ using a ske- flap technique &elo- the knee <rue)alse
,ncorrect
using (y!e4s technique is the operation of choice in patients -ith peripheral 0ascular $isease
<rue)alse
<he &est a!putation -hich affor$s goo$ reha&ilitation is a &elo- the knee proce$ure preser0ing
the 'oint. Classically, for a &elo- knee a!putation +@TA/, a long posterior flap is fashione$
containing !uscle an$ 0essels, -hich is then fol$e$ o0er the &ase to for! an e0en stu!p. More
recently, ske- flaps ha0e &een intro$uce$ to !ake use of areas of tissue -here the &loo$ supply
is opti!al. A&o0e knee proce$ures usually heal -hen equal anterior an$ posterior flaps are use$.
=enerally, (y!e4s a!putation shoul$ not &e use$ in patients -ith peripheral 0ascular $isease,
an$ one-thir$ are su&sequently re0ise$ to a higher le0el &ecause of poor healing, ulceration or
poor function.
<he processus 0aginalis
,ncorrect
is for!e$ &y 0isceral peritoneu! <rue)alse
,ncorrect
for!s a sac in -hich the testis $escen$s through the inguinal canal <rue)alse
,ncorrect
-hen present in a$ults, pre$isposes to $irect inguinal hernia <rue)alse
,ncorrect
for!s the tunica 0aginalis in the a$ult <rue)alse
,ncorrect
in0ests the a$ult 0as $eferens <rue)alse
<he processus 0aginalis is a parietal peritoneal sac -hich passes through the internal ring of the
inguinal canal in the fetus, &ut -hich is nor!ally o&literate$ after &irth e.cept for a s!all part
that &eco!es the tunica 0aginalis of the testis. <he testis $escen$s through the canal as a
retroperitoneal structure an$ is therefore outsi$e an$ &ehin$ the processus 0aginalis. ,n cases of
a persistent processus 0aginalis, in$irect inguinal hernias can ensue.
Carpal tunnel syn$ro!e is associate$ -ith
,ncorrect
regnancy <rue)alse
,ncorrect
7ia&etes !ellitus <rue)alse
,ncorrect
@ennettIs fracture <rue)alse
,ncorrect
Hypothyroi$is! <rue)alse
,ncorrect
=olferIs el&o- <rue)alse
Eeply to HalaEeport
ost H2#
Carpal tunnel syn$ro!e is associate$ -ith rheu!atoi$ arthritis, !y.oe$e!a, nephrotic
syn$ro!e, acro!egaly, !ultiple !yelo!a, a!yloi$osis, $ia&etes !ellitus, alcoholis!,
hae!ophilia, pregnancy, gout, -rist fractures an$ the !enopause. A @ennettIs fracture is a
fracture of the first !etacarpal an$ therefore $oes not affect the -rist.
<he ner0e roots
,ncorrect
of the ulnar ner0e are C6, <1, an$ so!eti!es C5 <rue)alse
,ncorrect
of the !usculocutaneous ner0e are C2JC3 <rue)alse
,ncorrect
of the a.illary ner0e are C2JC6 <rue)alse
,ncorrect
of the ra$ial ner0e are C2JC6, an$ <1 <rue)alse
,ncorrect
of the long thoracic ner0e are C2JC5 <rue)alse
<he ner0e roots of the !usculocutaneous ner0e are C2JC5, an$ those of the a.illary ner0e are
C2 an$ C3. <he ner0e roots of the !e$ian ner0e are C2JC6, an$ <1.
,n the &ase of the skull the:
,ncorrect
fora!en !agnu! trans!its the &asilar artery <rue)alse
,ncorrect
fora!en spinosu! trans!its the C,,th cranial ner0e +C1 C,,/ <rue)alse
,ncorrect
fora!en rotun$u! trans!its the !a.illary ner0e <rue)alse
,ncorrect
fora!en o0ale trans!its the greater petrosal ner0e <rue)alse
,ncorrect
fora!en laceru! trans!its the !an$i&ular ner0e <rue)alse
<he fora!en !agnu! trans!its the 0erte&ral arteries -hich unite at the lo-er &or$er of the
pons to for! the &asilar artery.
<he fora!en spinosu! trans!its the !i$$le !eningeal 0essels an$ the !eningeal &ranch of the
!an$i&ular ner0e. <he fora!en rotun$u! contains the !a.illary ner0e. <he fora!en o0ale
trans!its the !an$i&ular ner0e, lesser petrosal ner0e an$ accessory !eningeal artery. <he
fora!en laceru! trans!its the internal caroti$ an$ greater petrosal ner0e, -hich lea0es as a
ner0e of the pterygoi$ canal.
,n surgical anato!y of the thyroi$ glan$
,ncorrect
the thyroi$ glan$ has a $efinite, fine capsule <rue)alse
,ncorrect
@erryIs liga!ent connects the thyroi$ to the cricoi$ cartilage an$ upper trachea <rue)alse
,ncorrect
the inferior parathyroi$ glan$s are !ore constant in position than the superior parathyroi$
glan$s <rue)alse
,ncorrect
the !i$$le thyroi$ 0eins are !ore constant in position than the superior an$ inferior thyroi$
0eins <rue)alse
,ncorrect
unilateral recurrent laryngeal ner0e $i0ision results in the contralateral 0ocal cor$ lying in the
!i$- or ca$a0eric position <rue)alse
<he thyroi$ glan$ has a $efinite, fine capsule, -hich allo-s a capsular $issection to preser0e the
recurrent laryngeal ner0es. <he superior parathyroi$ glan$s are !ore constant in position than
the inferior. @ecause of their e!&ryological !igration, the inferior glan$s !ay &e situate$
a!ong the pretracheal ly!ph no$es or in the thy!us as far as 19 c! fro! the thyroi$. <he
!i$$le thyroi$ 0eins are the least constant of the thyroi$ 0eins. <he superior 0eins $rain into the
internal 'ugular 0einD the inferior 0eins are 0ery constant an$ $rain into the &rachiocephalic
0einsD an$ the !i$$le 0eins are 0ery 0aria&le an$ often !ultiple. ?nilateral recurrent laryngeal
ner0e section results in the ipsilateral 0ocal cor$ lying !otionless in the !i$- or ca$a0eric
position. <he 0oice is hoarse an$ -eak. ,f &oth recurrent laryngeal ner0es are $i0i$e$, then the
glottic space is narro-e$ an$ stri$or $e0elops.
Eecognise$ co!plications of en$oscopic sphincteroto!y $uring >EC inclu$e
,ncorrect
Acute pancreatitis <rue)alse
,ncorrect
=astrointestinal hae!orrhage <rue)alse
,ncorrect
(!all &o-el o&struction <rue)alse
,ncorrect
(!all &o-el perforation <rue)alse
,ncorrect
>nterocutaneous fistula <rue)alse
7i0ision of the sphincter of "$$i -ith the sphincteroto!e !ay cause pancreatitis, $uo$enal
perforation or &lee$ing. Many patients ha0e a transiently increase$ seru! a!ylase &ut a fe-
$e0elop true acute pancreatitis -ith pain an$ ultrasoun$ e0i$ence of pancreatitis.
<he fe!oral triangle
,ncorrect
contains the $eep inguinal ly!ph no$es <rue)alse
,ncorrect
is &oun$e$ &y the inguinal liga!ent inferiorly <rue)alse
,ncorrect
is &oun$e$ &y sartorius laterally <rue)alse
,ncorrect
has a floor for!e$ &y the fascia lata <rue)alse
,ncorrect
contains the fe!oral ner0e, artery an$ 0ein <rue)alse
<he fe!oral triangle is &oun$e$ &y the inguinal liga!ent superiorly, sartorius laterally an$
a$$uctor longus !e$ially. ,ts floor is for!e$ &y the iliopsoas an$ pectineus. ,ts roof is for!e$ &y
the fascia lata. ,t contains the fe!oral 0ein, artery an$ ner0e fro! !e$ial to lateral an$ also
contains the $eep inguinal no$es.
A surgeon $issecting &ehin$ the right !ain &ronchus is likely to encounter the
,ncorrect
0agus ner0e <rue)alse
,ncorrect
phrenic ner0e <rue)alse
,ncorrect
recurrent laryngeal ner0e <rue)alse
,ncorrect
he!iaAygos 0ein <rue)alse
,ncorrect
aAygos 0ein <rue)alse
<he aAygos 0ein arches superiorly o0er the right &ronchus. <he 0agus ner0e lies 'ust posterior to
the right !ain &ronchus, -hereas the phrenic ner0e is anterior.
Co!plete rectal prolapse
,ncorrect
,n0ol0es all layers of the rectal -all <rue)alse
,ncorrect
,s co!!on in infants <rue)alse
,ncorrect
,s co!!oner in !en <rue)alse
,ncorrect
May &e co!plicate$ &y rectal gangrene <rue)alse
,ncorrect
May &e treate$ &y 7eLor!eIs proce$ure <rue)alse
artial rectal prolapse occurs in chil$ren. Co!plete rectal prolapse is a $isease of el$erly
-o!en. 7eLor!eIs proce$ure +e.cision of the !ucosal co!ponent of the prolapse an$ plication
of the !uscle fro! &elo-/ has a lo- !or&i$ity &ut a high inci$ence of incontinence an$
recurrence. "pen or laparoscopic rectope.y is the proce$ure of choice.
Eegar$ing !assi0e hae!othora., -hich of the follo-ing are true:
,ncorrect
Eesults fro! a rapi$ accu!ulation of !ore than 1299 !l of &loo$ in the chest ca0ity <rue)alse
,ncorrect
,s co!!only associate$ -ith $isten$e$ neck 0eins <rue)alse
,ncorrect
Eesults in a $ull percussion note o0er the affecte$ si$e he!i-thora. <rue)alse
,ncorrect
,!!e$iate e0acuation of 1299 !l of &loo$ is an in$ication for early thoracoto!y <rue)alse
,ncorrect
>!ergency thoracoto!y is necessary in a&out 69M of patients <rue)alse
A hae!othora. !ay result fro! a &lunt +$eceleration in'ury/ or penetrating in'ury +$isruption of
the syste!ic or hilar 0essels/ to the thoracic ca0ity. Massi0e hae!othora. results fro! the rapi$
accu!ulation of !ore than 1299 !l of &loo$ or one-thir$ or !ore of the patientIs &loo$ 0olu!e
in the chest ca0ity. 7istension of neck 0eins is rareD they are usually flat secon$ary to se0ere
hypo0ole!ia. Earely -ill the !echanical effects of !assi0e intrathoracic &loo$ shift the
!e$iastinu! enough to cause $isten$e$ neck 0eins or a tracheal shift. <he neck 0eins, ho-e0er,
!ay &e $isten$e$ if there is an associate$ tension pneu!othora.. <he i!portant signs an$
sy!pto!s of a !assi0e hae!othora. inclu$e hypo.ia, chest pain, $ecrease$ chest e.pansion,
a&sence of &reath soun$s on the affecte$ si$e an$ percussion $ullness o0er the affecte$
he!ithora.. Chest tu&e place!ent to $eco!press the chest ca0ity, along -ith si!ultaneous
restoration of &loo$ 0olu!e, is the first step in the !anage!ent of !assi0e trau!atic
hae!othora.. @loo$ fro! the chest tu&e shoul$ &e collecte$ in a $e0ice suita&le for auto-
transfusion. ,f 1299 !l is i!!e$iately e0acuate$, it is highly likely that the patient -ill require
an early thoracoto!y. ,n a$$ition, patients -ho ha0e an initial 0olu!e output of less than 1299
!l &ut continue to &lee$ +299 !l;h for 2J# h/ also require a thoracoto!y. <he $ecision shoul$ &e
!a$e in such patients &ase$ on their physiological status rather than the rate of continuing
&loo$ loss. <he !a'ority of the patients can &e !anage$ conser0ati0ely -ith appropriate flui$
resuscitation an$ chest $eco!pression. >!ergency thoracoto!y is require$ in only a&out 19M
of patients -ith !assi0e hae!othora..
Eeply to HalaEeport
ost H22
Consi$er the !ale e.ternal genitalia
,ncorrect
<he corpora car0enosa for!s the glans penis <rue)alse
,ncorrect
<he corpus spongiosu! is a continuation of the crura of the penis <rue)alse
,ncorrect
<he paraurethral glan$s of Littrb are a$'acent to the penile urethra an$ function to lu&ricate the
penile urethra <rue)alse
,ncorrect
@uckIs fascia encloses the three erectile &o$ies of the penis <rue)alse
,ncorrect
)i&ro!atosis of @uckIs fascia !ay cause eyronie $isease <rue)alse
<he corpus spongiosu! is situate$ at the 0entral part of the penis, is a continuation of the &ul&
of the penis an$ for!s the glans penis. <he t-o corpora ca0ernosa are e.tensions of the crura
an$ are situate$ on the $orsal aspect of the penis. @uckIs fascia encloses the erectile &o$ies, the
$orsal arteries an$ 0eins, an$ the $orsal ner0es of the penis.
Caricose 0eins
,ncorrect
are !ost co!!on in patients of Me$iterranean origin <rue)alse
,ncorrect
are !ore co!!on in patients engage$ in occupations in0ol0ing long perio$s of stan$ing
<rue)alse
,ncorrect
seen in pregnancy ten$ to regress after parturition <rue)alse
,ncorrect
!ay &e associate$ -ith a pre0ious history of $eep 0ein thro!&osis <rue)alse
Caricose 0eins affect fe!ales of 1orthern >uropean origin fi0e ti!es !ore co!!only than !en
an$ are particularly associate$ -ith pre0ious $eep 0ein thro!&osis +7C</. Ceins are !ost
pronounce$ in patients -ho stan$ for long perio$s.
Fhich of the follo-ing are correct: <he right atriu!
,ncorrect
,s separate$ e.ternally &y the crista ter!inalis <rue)alse
,ncorrect
,s separate$ internally &y the sulcus ter!inalis <rue)alse
,ncorrect
<he crista ter!inalis e.ten$s &et-een the t-o 0ena ca0al orifices. <rue)alse
,ncorrect
,t contains the fossa o0alis in its anterolateral -all <rue)alse
,ncorrect
<he opening of the coronary sinus contains a 0al0e <rue)alse
<he t-o parts of the right atriu! are separate$ e.ternally &y a groo0e on the posterior aspect of
the atriu! kno-n as the sulcus ter!inalis an$ internally &y the crista ter!inalis, -hich e.ten$s
&et-een the t-o 0ena ca0al orifices. <he fossa o0alis is foun$ on the interatrial septu!, -hich
for!s the postero!e$ial -all of the right atriu!. <he opening of the coronary sinus is guar$e$
&y a se!icircular 0al0e that closes the orifice $uring contraction of the right atriu!.
Fhich of the follo-ing are correct: aroti$ neoplas!s
,ncorrect
Are co!!only &ilateral <rue)alse
,ncorrect
Are !alignant in 29M <rue)alse
,ncorrect
resentation -ith facial ner0e palsy i!plies !alignancy <rue)alse
,ncorrect
?sually present -ith !a.illary nu!&ness <rue)alse
,ncorrect
Magnetic resonance i!aging +ME,/ rather than co!pute$ to!ography +C</ is the ra$iological
in0estigation of choice for staging of paroti$ carcino!as <rue)alse
aroti$ neoplas!s are usually unilateral, only 12J29M of paroti$ tu!ours are !alignant. <he
!ain !o$e of presentation is a sy!pto!-less s-elling often $ating &ack se0eral years.
resentation -ith facial ner0e palsy is 0ery suggesti0e of a !alignancy. Eare presentations
inclu$e tris!us an$ referre$ pain 0ia the trige!inal ner0e. ME, is use$ for ra$iological staging as
there is &etter soft tissue $iscri!ination, i!aging can &e carrie$ out in !ultiple planes an$ it is
easier to $etect cer0ical ly!pha$enopathy.
Fhich of the follo-ing are correct: Car$iac surgery
,ncorrect
,s perfor!e$ -ith controlle$ hypertension <rue)alse
,ncorrect
May &e co!plicate$ &y car$iac ta!pona$e <rue)alse
,ncorrect
Earely results in postoperati0e arrhyth!ias <rue)alse
,ncorrect
Al-ays requires car$io-pul!onary &ypass <rue)alse
,ncorrect
Eoutine coronary artery &ypass grafting +CA@=/ is associate$ -ith a !ortality rate of 3M
<rue)alse
Car$iac surgery is perfor!e$ -ith controlle$ hypotension, together -ith hypother!ia. <he
hypother!ia is use$ to $ecrease cellular !eta&olis! an$ re$uce energy require!ents of the
tissues. Car$iac ta!pona$e is a -ell kno-n co!plication of car$iac surgery, it usually presents
in the early post-operati0e perio$ -ith $eteriorating car$iac function an$ car$iac arrest. CA@=
can so!eti!es &e perfor!e$ -ithout car$iopul!onary &ypass +Woff pu!pI/. Arrhyth!ias +usually
atrial fi&rillation/ occur in 29J#9M of patients follo-ing surgery. Eoutine CA@= is associate$ -ith
a !ortality rate of aroun$ 2M.
<he e.ternal 'ugular 0ein
,ncorrect
recei0es a &ranch fro! the retro!an$i&ular 0ein <rue)alse
,ncorrect
lies anterior to scalenus anterior <rue)alse
,ncorrect
'oins the su&cla0ian 0ein <rue)alse
,ncorrect
has no 0al0es <rue)alse
,ncorrect
pierces the $eep cer0ical fascia <rue)alse
<he e.ternal 'ugular 0ein $rains !ost of the scalp an$ si$e of the face. ,t &egins near the angle
of the !an$i&le an$ is for!e$ fro! the union of retro!an$i&ular an$ postauricular 0eins,
recei0ing &ranches fro! the posterior e.ternal an$ trans0erse cer0ical 0eins. <he e.ternal
'ugular 0ein has t-o pairs of 0al0es -hich $o not pre0ent regurgitation of the &loo$, or the
passage of in'ection fro! &elo- up-ar$. <he lo-er pair are place$ at its entrance to the
su&cla0ian 0ein, the upper +in !ost cases/ a&out #c! a&o0e the cla0icle. <he e.ternal 'ugular
0ein lies anterior to scalenus anterior an$ pierces the $eep fascia of the neck, usually posterior
to the cla0icular hea$ of the sternoclei$o!astoi$ !uscle &efore $raining into the su&cla0ian
0ein.
Fhich one of the follo-ing is correct: <he a.illary artery
,ncorrect
=i0es off no &ranches in its first part <rue)alse
,ncorrect
,s the continuation of the e.ternal caroti$ <rue)alse
,ncorrect
,s enco!passe$ &y the first $igitation of serratus anterior <rue)alse
,ncorrect
,s in0este$ in a fascial sheath <rue)alse
<he first part of the a.illary artery gi0es off one &ranch the superior thoracic. <he a.illary artery
is the continuation of the su&cla0ian. <he upper part of serratus anterior lies posterior to the first
part of the a.illary artery. ,t is in0este$ in a fascial sheath arising fro! the pre0erte&ral fascia.
Eegar$ing trau!atic aortic $isruption, -hich of the follo-ing are true:
,ncorrect
,!!e$iate $eath !ay &e pre0ente$ &y pseu$oaneurys! containe$ &y the a$0entitial layer
<rue)alse
,ncorrect
Coul$ lea$ to $e0iation of the trachea to the right <rue)alse
,ncorrect
<he aortic kno& !ay &e o&literate$ in plain ra$iography <rue)alse
,ncorrect
<ransoesophageal echocar$iography is the gol$ stan$ar$ in the $iagnosis of this con$ition
<rue)alse
,ncorrect
,n an unsta&le patient, helical contrast-enhance$ co!pute$ to!ographic +C</ scan is the !ost
appropriate first-line in0estigation <rue)alse
<rau!atic aortic $isruption, a ti!e-sensiti0e in'ury, is a co!!on cause of su$$en $eath after an
auto!o&ile collision or a fall fro! great height. A co!plete tear through the tunica inti!a, !e$ia
an$ a$0entitia usually lea$s to rapi$ e.sanguination an$ $eath. ,n aortic rupture sur0i0ors,
i!!e$iate $eath is pre0ente$ $ue to the 0ascular continuity !aintaine$ &y a pseu$oaneurys!
-ithin an intact a$0entitial layer or a !e$iastinal hae!ato!a. A large !e$iastinal hae!ato!a
!ay shift the trachea to the right. <his con$ition has a 0aria&le course ranging fro! a relati0ely
clinically silent perio$ $ue to the containe$ rupture +pseu$oaneurys!/, to rupture of the
pseu$oaneurys!, e.sanguination an$ $eath. Ea$iographic fin$ings !ay inclu$e a -i$ene$
!e$iastinu!, o&literation of the aortic kno&, $e0iation of the trachea to the right, o&literation of
the space &et-een the pul!onary artery an$ the aorta +o&scuration of A +aorto-pul!onary/
-in$o-/, $epression of the left !ain ste! &ronchus, $e0iation of the oesophagus +nasogastric
tu&e/ an$ fractures of the first or secon$ ri& or scapula. )alse-positi0e an$ false-negati0e
fin$ings occur -ith each ra$iographic sign an$, rarely +1J2M/, no !e$iastinal or initial chest X-
ray a&nor!ality is present in patients -ith great 0essel in'ury. Although transoesophageal
echocar$iography is a useful, less in0asi0e $iagnostic tool, aortography is the gol$ stan$ar$ in
the $iagnosis of &lunt aortic rupture. Helical contrast-enhance$ co!pute$ to!ography +C</ of
the chest is also an accurate screening !etho$ for patients -ith suspecte$ &lunt aortic in'ury.
Ho-e0er, a patient -ho is hae!o$yna!ically a&nor!al shoul$ not &e place$ in a C< scanner. ,n
sta&le patients, if enhance$ helical C< of the chest is negati0e for !e$iastinal hae!ato!a an$
aortic rupture, no further $iagnostic i!aging is necessary. ,f it is positi0e for &lunt aortic rupture,
the e.tent of the in'ury can &est &e ascertaine$ &y aortography
<he lesser o!entu!
,ncorrect
is supplie$ &y gastroepiploic arteries <rue)alse
,ncorrect
is attache$ to the li0er in the fissure of the liga!entu! 0enosu! <rue)alse
,ncorrect
encloses the right gastric 0essels <rue)alse
,ncorrect
has the co!!on hepatic &ile $uct in its free e$ge <rue)alse
,ncorrect
is attache$ to the first part of the $uo$enu! <rue)alse
,ncorrect
has consi$era&le !o&ility <rue)alse
<he right an$ left gastric arteries supply the lesser o!entu! as they lie &et-een its t-o
peritoneal layers. <he free e$ge of the lesser o!entu! is attache$ to the first 2 c! of the first
part of the $uo$enu! &elo- an$ the fissure of the liga!entu! 0enosu! a&o0e. <he co!!on
hepatic $uct is 'oine$ &y the cystic $uct to for! the co!!on &ile $uct in the free e$ge of the
lesser o!entu!. <he greater o!entu! is quite !o&ile.
<he &asilic 0ein
,ncorrect
&egins on the !e$ial si$e of the $orsal 0enous arch <rue)alse
,ncorrect
$rains into the su&cla0ian 0ein <rue)alse
,ncorrect
is acco!panie$ &y the !e$ial cutaneous ner0e of the forear! <rue)alse
,ncorrect
pierces the $eep fascia in the ar! <rue)alse
,ncorrect
lies !e$ial to the &iceps ten$on in the cu&ital fossa <rue)alse
<he &asilic 0ein is a continuation of the ulnar ste! of the $orsal 0enous arch in the han$. ,t lies
!e$ial to the &iceps ten$on in the cu&ital fossa an$ is !e$ial to the !e$ial cutaneous ner0e of
the forear! in the ar!. <he &asilic 0ein ascen$s in the superficial fascia on the !e$ial si$e of
the &iceps. ,t then pierces the $eep fascia in the !i$$le of the upper ar!, is 'oine$ &y the 0enae
co!itantes of the &rachial artery, an$ &eco!es the a.illary 0ein at the lo-er &or$er of the teres
!a'or !uscle.
Eeply to HalaEeport
ost H23
<he $iaphrag!
,ncorrect
contracts $uring force$ e.piration <rue)alse
,ncorrect
is partially supplie$ -ith !otor fi&res &y the intercostal ner0es <rue)alse
,ncorrect
has its central ten$on pierce$ &y the inferior 0ena ca0a <rue)alse
,ncorrect
has its costal co!ponents $eri0e$ !ainly fro! the septu! trans0ersu! <rue)alse
,ncorrect
has its left $o!e at a higher le0el than its right $o!e <rue)alse
<he central part of the $iaphrag! is !ainly $eri0e$ fro! the septu! trans0ersu!, -hereas its
periphery has &o$y -all co!ponents. <he intercostal ner0es pro0i$e sensory fi&res to the
peripheral parts of the $iaphrag!, &ut the phrenic ner0es supply all the !otor fi&res. <he
$iaphrag! contracts $uring inspiration &ut rela.es $uring e.piration an$ is $isplace$ up-ar$s
&y raise$ intra-a&$o!inal pressure. <he ca0al hiatus lies in the central ten$on, -hereas the
oesophageal hiatus is surroun$e$ &y !uscle fi&res of the $iaphrag!atic crura.
(qua!ous-cell carcino!a of the oral ca0ity
,ncorrect
Are !ore co!!on on the Asian su&continent <rue)alse
,ncorrect
Cer0ical ly!ph no$e in0ol0e!ent is usually treate$ -ith ra$iotherapy <rue)alse
,ncorrect
Leucoplakia is pre!alignant <rue)alse
,ncorrect
Ea$iotherapy is usually not require$ after co!plete surgical e.cision <rue)alse
,ncorrect
7oes not occur in non-s!okers <rue)alse
(qua!ous cell carcino!a +(CC/ of the !outh is relate$ to &etel nut che-ing, co!!on in Asia.
Ly!ph no$e !etastasis is treate$ -ith ra$ical neck $issection, usually follo-e$ &y ra$iotherapy.
(i!ilarly pri!ary e.cision is usually follo-e$ &y ra$iotherapy. Leucoplakia is a risk factor,
especially if associate$ -ith se0ere epithelial $ysplasia. 7ue to the genetic &asis of cancer,
anyone is at riskD ho-e0er it is rare in non-s!okers.
<he ophthal!ic artery
,ncorrect
is a &ranch of the internal caroti$ artery <rue)alse
,ncorrect
enters the or&it through the superior or&ital fissure <rue)alse
,ncorrect
supplies the eth!oi$al air sinuses <rue)alse
,ncorrect
supplies the cornea <rue)alse
,ncorrect
supplies the skin of the forehea$ <rue)alse
<he ophthal!ic artery is a &ranch of the internal caroti$ artery. ,t passes through the optic canal
an$ supplies the eth!oi$al air cells, part of the lateral -all of the nose, e.ternal nose, eyeli$s
an$ forehea$. ,t also supplies all the !uscles of the or&it.
Fhich of the follo-ing are correct: Me$ial liga!ent of the ankle
,ncorrect
Has three separate &an$s <rue)alse
,ncorrect
<he $eep part is longest <rue)alse
,ncorrect
,nserts into the calcaneu! <rue)alse
,ncorrect
Has a superficial part <rue)alse
,ncorrect
Can &e seen on X-ray analysis <rue)alse
<he !e$ial, or $eltoi$ liga!ent of the ankle is attache$ at its ape. to the !e$ial !alleolus.
@elo-, the $eep fi&res are attache$ to the non-articular area on the &o$y of the talus. <he
superficial fi&res are fan shape$ an$ e.ten$s to the tu&erosity of the na0icular, the spring
liga!ent, the sustentaculu! tali an$ the posterior tu&ercle of the talus.
Fhich of the follo-ing are correct: ,n$ication for resection of a lung tu!our
,ncorrect
,s preclu$e$ &y a !alignant pleural effusion <rue)alse
,ncorrect
,s contrain$icate$ if ipsilateral hilar ly!ph no$es are in0ol0e$ <rue)alse
,ncorrect
,s curati0e in 39M of squa!ous carcino!a <rue)alse
,ncorrect
,nclu$es palliation <rue)alse
,ncorrect
,nclu$es s!all cell carcino!a <rue)alse
A lung tu!our !ust &e sufficiently localise$ to &e suita&le for resection. ,n0ol0e!ent of
ipsilateral hilar ly!ph no$es is not usually a contrain$ication to resection &ut the presence of
!alignant cells in a pleural effusion is. <he 2-year sur0i0al rate follo-ing co!plete resection of
non-s!all-cell lung cancer is in the region of %9J#9M. (!all-cell lung cancers +also kno-n as oat-
cell carcino!a/ are highly !alignant tu!ours that are usually $isse!inate$ at presentation. )or
the !a'ority of patients che!otherapy is the treat!ent of choice, s!all-cell lung cancers are
rarely suita&le for surgical !anage!ent.
<he transpyloric plane:
,ncorrect
Lies !i$--ay &et-een the 'ugular notch an$ the pu&ic sy!physis <rue)alse
,ncorrect
Lies at the le0el of the first lu!&ar 0erte&ra <rue)alse
,ncorrect
7efines the le0el at -hich the coeliac a.is lea0es the aorta <rue)alse
,ncorrect
,s the plane -here the portal 0ein is for!e$ <rue)alse
,ncorrect
Crosses the right costal !argin at the tip of the ninth costal cartilage, the surface !arking of the
gall-&la$$er fun$us <rue)alse
<he transpyloric plane is a con0enient -ay to relate anato!ical structures. ,t is an i!aginary
trans0erse plane -ith a surface !arking !i$--ay &et-een the 'ugular notch an$ the pu&ic
sy!physis. <his correspon$s to the le0el of the first lu!&ar 0erte&ra. <he surface !arking of the
fun$us of the gall-&la$$er is at its 'unction -ith the right costal cartilage. ,t represents the point
at -hich the superior !esenteric artery lea0es the aorta an$ -here the splenic an$ superior
!esenteric 0eins 'oin to for! the portal 0ein.
<he !e$ial liga!ent of the ankle
,ncorrect
co!prises three separate &an$s <rue)alse
,ncorrect
is $a!age$ in a Wspraine$I ankle <rue)alse
,ncorrect
inserts into the calcaneu! <rue)alse
,ncorrect
has a superficial part <rue)alse
,ncorrect
!ay &e associate$ -ith an a0ulsion fracture on X-ray <rue)alse
<he !e$ial liga!ent of the ankle, other-ise kno-n as the W$eltoi$ liga!entI, has t-o layers. <he
$eep part is narro- an$ !uch shorter than the superficial part, -hich is triangular in shape. <he
superficial part of the !e$ial liga!ent is attache$ to the &or$ers of the ti&ial !alleolus, an$ has
a continuous attach!ent fro! the !e$ial tu&ercule of the talus along the e$ge of the
sustentaculu! tali an$ spring liga!ent to the tu&erosity of the na0icular &one. <he lateral
liga!ent consists of three separate &an$s, an$ it is this liga!ent -hich is usually $a!age$ in
in0ersion in'uries +a sprain/ of the ankle. <he liga!ents the!sel0es cannot &e seen on X-ray,
although a0ulsion fractures !ay &e $etecta&le on X-ray.
ortal hypertension !ay &e cause$ &y
,ncorrect
ylephle&itis after acute appen$icitis <rue)alse
,ncorrect
(plenecto!y <rue)alse
,ncorrect
<ricuspi$ 0al0e inco!petence <rue)alse
,ncorrect
Alcoholic cirrhosis <rue)alse
,ncorrect
@u$$JChiari syn$ro!e <rue)alse
ortal hypertension -ith a pressure of o0er 29 !!Hg is co!!only cause$ &y prehepatic
pro&le!s such as portal 0ein thro!&osis, hepatic $isease such as cirrhosis an$ post hepatic
pro&le!s such as tricuspi$ 0al0e inco!petence an$ @u$$JChiari syn$ro!e of hepatic 0ein
thro!&osis.
Fhich of the follo-ing are true: <he right suprarenal glan$
,ncorrect
Has a longer 0ein than the left suprarenal glan$ <rue)alse
,ncorrect
Eecei0es an arterial supply $irectly fro! the aorta <rue)alse
,ncorrect
,s crescentic in shape <rue)alse
,ncorrect
<ouches the &are area of the li0er <rue)alse
,ncorrect
Lies anterior to the inferior 0ena ca0a <rue)alse
<he left suprarenal 0ein is longer than the right, entering the left renal 0ein. @oth glan$s recei0e
an arterial supply $irectly fro! the aorta, as -ell as fro! the renal an$ inferior phrenic arteries.
<he right suprarenal glan$ is pyra!i$al in shapeD the left is crescentic in shape. <he anterior
surface of the right suprarenal glan$ is o0erlappe$ !e$ially &y the inferior 0ena ca0a.
(tructures superficial to the sternoclei$o!astoi$ !uscle inclu$e the
,ncorrect
trans0erse cer0ical ner0e <rue)alse
,ncorrect
trans0erse cer0ical artery <rue)alse
,ncorrect
great auricular ner0e <rue)alse
,ncorrect
e.ternal 'ugular 0ein <rue)alse
,ncorrect
inferior thyroi$ artery <rue)alse
<he trans0erse cer0ical ner0e e!erges as a single trunk &ehin$ the posterior &or$er of the
sternoclei$o!astoi$ an$ is superficial to the !uscle. <he trans0erse cer0ical artery is foun$ in
the posterior triangle of the neck 'ust a&o0e the cla0icle. <he great auricular ner0e +C2JC%/ is a
large trunk that passes 0ertically up-ar$s o0er the sternoclei$o!astoi$. <he e.ternal 'ugular
0ein co!!ences &ehin$ the angle of the !an$i&le, for!e$ &y the union of the posterior
auricular 0ein an$ the posterior $i0ision of the retro!an$i&ular 0ein. ,t $escen$s o&liquely
across to the sternoclei$o!astoi$ an$ $rains into the su&cla0ian 0ein.
)or &asal cell carcino!a +@CC/ of the face, -hich one of the follo-ing is true
,ncorrect
,s the co!!onest !alignant facial skin tu!our <rue)alse
,ncorrect
@asal cell carcino!as co!!only !etastasise <rue)alse
,ncorrect
Ea$iotherapy is the current treat!ent of choice for &asal cell carcino!as <rue)alse
,ncorrect
(!all @CCs +less than 1 c!/ shoul$ &e e.cise$ -ith a !a.i!u! !argin of 2 !! to i!pro0e
cos!etic appearance <rue)alse
,ncorrect
Aggressi0e recurrence !ay occur -ith @CCs on the forehea$ if the $isease is not era$icate$
sufficiently. <rue)alse
@CC is the co!!onest skin tu!our on the face an$ 89M of all @CCs occur in the hea$ an$ neck
region. (unlight e.posure an$ genetic factors are the !ain risk factors. @CCs rarely, if e0er,
!etastasise an$ treat!ent is -ith co!plete surgical e.cision. Ea$iotherapy is reser0e$ for
recurrences, -hich are typically aggressi0e if they recur on the cheeks, nasola&ial fol$s, !e$ial
canso an$ preauricular region. <he phrase Wrather a large scar than a s!all to!&I +(ir Harol$
=illies/ shoul$ al-ays &e taken into consi$eration -hen planning surgical e.cision J tu!ours
un$er 1 c! shoul$ ha0e at least a 2-!! e.cision !argin an$ those o0er 1 c! shoul$ ha0e at
least a 1-c! !argin.
,n the in0estigation of 0aricose 0eins
,ncorrect
a negati0e A soun$ using 7oppler ultrasoun$ +?;(/ signifies 0al0ular inco!petence <rue)alse
,ncorrect
7oppler ?;( has a sensiti0ity of up to 69M <rue)alse
,ncorrect
ascen$ing phle&ography is the !ost 0alua&le technique for i$entifying perforators <rue)alse
,ncorrect
0aricography has little 0alue in the assess!ent of 0essels -ith unusual anato!y <rue)alse
,n 7oppler ultrasoun$ +?;(/, the A soun$ is pro$uce$ &y squeeAing the calf. Fhen pressure is
release$ there is no soun$ if the 0al0es are co!petent, this is ter!e$ a positi0e A soun$.
7oppler ?;( has a sensiti0ity of up to 85MD 65M of perforating 0eins are localise$ &y ascen$ing
phle&ography.
<he true 0ocal fol$s are
,ncorrect
line$ &y respiratory epitheliu! <rue)alse
,ncorrect
for!e$ &y the lo-er free e$ge of the qua$rangular !e!&ranes <rue)alse
,ncorrect
a&$ucte$ &y the lateral cricoarytenoi$ !uscles <rue)alse
,ncorrect
a&$ucte$ &y the posterior cricoarytenoi$ !uscles <rue)alse
,ncorrect
tense$ &y contractions of the cricothyroi$ !uscles <rue)alse
,ncorrect
inner0ate$ &y sensory fi&res of the internal laryngeal ner0es <rue)alse
<he true 0ocal fol$s ha0e a stratifie$ squa!ous epitheliu!, inner0ate$ &y the recurrent
laryngeal &ranch +C1 X/, an$ are for!e$ &y the 0ocal liga!ent +the free e$ge of the
qua$rangular !e!&rane for!s the false 0ocal cor$/. A&o0e the 0ocal cor$s, the laryn. is
sensorily inner0ate$ &y the internal laryngeal ner0e +C1 X/. <he cor$s are a$$ucte$ &y the
lateral cricoarytenoi$ !uscle, a&$ucte$ &y the posterior cricoarytenoi$ an$ tense$ &y tilting the
thyroi$ cartilage $o-n-ar$s an$ for-ar$s &y contracting the cricothyroi$ !uscle. All the
laryngeal !uscles are supplie$ &y the recurrent laryngeal ner0e e.cept for cricothyroi$, -hich is
supplie$ &y the e.ternal laryngeal ner0e.
Fhich of the follo-ing are true: <he paroti$ $uct
,ncorrect
,s appro.i!ately 1 c! long <rue)alse
,ncorrect
Crosses the !asseter <rue)alse
,ncorrect
,s co!presse$ &y &uccinator <rue)alse
,ncorrect
Con0eys !ainly !ucous secretions <rue)alse
,ncorrect
Lies on the !i$$le thir$ of a line &et-een the intertragic notch of the auricle an$ the !i$-point
of the philtru! <rue)alse
<he paroti$ $uct is appro.i!ately 2 c! long. ,t crosses the !asseter, turning aroun$ its anterior
&or$er to pass through the &uccal fat pa$ an$ pierce the &uccinator. Fhen intraoral pressure is
raise$ the su&!ucous part of the paroti$ $uct is co!presse$ &y the &uccinator. <he paroti$
glan$ is !ainly a serous glan$.
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An upper !i$line laparoto!y in0ol0es incising:
,ncorrect
<he linea al&a <rue)alse
,ncorrect
<he rectus a&$o!inis <rue)alse
,ncorrect
<he trans0ersus a&$o!inis <rue)alse
,ncorrect
<he trans0ersalis fascia <rue)alse
,ncorrect
<he 0isceral peritoneu! <rue)alse
A !i$line laparoto!y is not a !uscle cutting incision. <he incision passes through the skin,
su&cutaneous flat, the linea al&a, e.traperitoneal fat, trans0ersalis fascia an$ parietal
peritoneu!.
<he +co!!on/ &ile $uct
,ncorrect
lies to the left of the hepatic artery in the lesser o!entu! <rue)alse
,ncorrect
is supplie$ &y the cystic artery <rue)alse
,ncorrect
usually opens into the $uo$enu! separately fro! the pancreatic $uct <rue)alse
,ncorrect
crosses in front of the neck of the pancreas <rue)alse
,ncorrect
passes anterior to the right renal 0ein <rue)alse
<he co!!on &ile $uct lies to the right of the hepatic artery. ,t 'oins the pancreatic $uct at the
a!pulla of Cater. <he a!pulla itself usually opens into the $uo$enu!. ,t crosses a groo0e
&et-een the hea$ of the pancreas an$ the secon$ part of the $uo$enu!, in front of the right
renal 0ein.
<he facial ner0e
,ncorrect
pierces &uccinator !uscle <rue)alse
,ncorrect
is the !ain supplier of the !uscles of !astication <rue)alse
,ncorrect
is in0ol0e$ in taste <rue)alse
,ncorrect
inclu$es the su&!an$i&ular &ranch as one of the three !ain $i0isions originating fro! -ithin the
paroti$ glan$ <rue)alse
,ncorrect
e!erges fro! the skull through the stylo!astoi$ fora!en <rue)alse
<he &uccal &ranch of the ner0e $oes pierce &uccinator !uscle after supplying it an$ the !uscles
of the upper lip. <he trige!inal +C/ ner0e is pre$o!inantly associate$ -ith the !uscles of
!astication. <hese inclu$e the !asseter, te!poralis an$ pterygoi$ !uscles. <here are fi0e, not
three, !ain $i0isions of the ner0e originating fro! the paroti$ glan$, an$ the lo-est or fifth
&ranch is the cer0ical. <he facial ner0e $oes pass through the stylo!astoi$ fora!en
A se0erely $isplace$ CollesI fracture
,ncorrect
!ay lea$ to $elaye$ rupture of the e.tensor pollicis longus ten$on <rue)alse
,ncorrect
has the $istal ra$ius $isplace$ in a 0olar $irection <rue)alse
,ncorrect
usually requires 3 -eeksI i!!o&ilisation <rue)alse
,ncorrect
!ore co!!only requires e.ternal fi.ation in the ol$er rather than the younger patient <rue)alse
,ncorrect
can &e associate$ -ith (u$ekIs atrophy <rue)alse
Eupture of the e.tensor pollicis longus ten$on !ay occur as a late co!plication of a $isplace$
CollesI fracture. A (!ithIs fracture is the re0erse CollesI fracture -here the $istal seg!ent is
pal!ar fle.e$ rather than $orsifle.e$. Most CollesI fractures are treate$ in plaster for 3 -eeks,
&ut in young patients it !ay &e necessary to restore nor!al align!ent &y internal fi.ation,
especially -hen cos!etic appearances or type of occupation !ay &e a$0ersely affecte$ &y
resi$ual $efor!ity or loss of !o0e!ent. (u$ekIs atrophy can follo- tri0ial han$ in'uries an$ is
thought to &e relate$ to autono!ic $ysfunction.
A&out the knee
,ncorrect
the popliteal !uscle is intracapsular <rue)alse
,ncorrect
the !e$ial longitu$inal liga!ent is attache$ to the !e$ial !eniscus <rue)alse
,ncorrect
the !enisci are co0ere$ in syno0ial !e!&rane <rue)alse
,ncorrect
the anterior cruciate liga!ent is attache$ to the !e$ial con$yle <rue)alse
,ncorrect
the posterior cruciate liga!ent is stretche$ -hen the knee is in full e.tension <rue)alse
O <he popliteal ten$on is intracapsular.
O <he !e$ial collateral liga!ent is attache$ to the !e$ial left !eniscus, -hich is thus less
!o&ile than the lateral !eniscus.
O <here is no syno0ial !e!&rane o0er the articulating surfaces of syno0ial 'oints.
O <he anterior cruciate liga!ent is attache$ to the lateral fe!oral con$yle.
O @oth cruciate liga!ents are tense in full e.tension.
Consi$er the hip 'oint
,ncorrect
it is a hinge 'oint <rue)alse
,ncorrect
a thick an$ tight fi&rous capsule increases sta&ility <rue)alse
,ncorrect
the qua$ratus fe!oris is a lateral rotator of the hip <rue)alse
,ncorrect
the iliofe!oral liga!ent pre0ents o0ere.tension of the hip 'oint <rue)alse
,ncorrect
the ri! of the aceta&ular la&ru! increases hip sta&ility <rue)alse
<he hip 'oint is a &all an$ socket syno0ial 'oint. <he capsule is thicker an$ tighter than that of the
shoul$er 'oint. <he aceta&ular la&ru! encloses the fe!oral hea$ &eyon$ its equator, increasing
the sta&ility of the 'oint.
Fhich of these !uscles are co!!only inner0ate$ &y the o&turator ner0e:
,ncorrect
=racilis <rue)alse
,ncorrect
(e!i!e!&ranosus <rue)alse
,ncorrect
ectineus <rue)alse
,ncorrect
A$$uctor longus <rue)alse
,ncorrect
"&turator internus <rue)alse
<he o&turator ner0e +L2, L%, L#/ e.its the o&turator fora!en an$ $i0i$es into anterior an$
posterior &ranches. <he anterior &ranch inner0ates a$$uctor &re0is, a$$uctor longus, gracilis
an$ pectineus. <he posterior &ranch inner0ates o&turator e.ternus an$ part of a$$uctor !agnus.
(e!i!e!&ranosus is one of the ha!string !uscles an$ is inner0ate$ &y the ti&ial portion of the
sciatic ner0e. "&turator internus is inner0ate$ &y the ner0e to o&turator internus, -hich, also
supplies the superior gla!ellus.
Concerning the a.illary artery:
,ncorrect
it &egins at the !e$ial &or$er of the first ri& <rue)alse
,ncorrect
it en$s at the inferior &or$er of the teres !a'or <rue)alse
,ncorrect
the pectoralis !inor $i0i$es the a.illary artery into three parts <rue)alse
,ncorrect
the first part of the a.illary artery gi0es off the thoracoacro!ial artery <rue)alse
,ncorrect
the lateral thoracic artery &ranches fro! the secon$ part of the a.illary artery an$ is larger in
!en than in -o!en <rue)alse
<he a.illary artery &egins at the lateral &or$er of the first ri& as the continuation of the
su&cla0ian artery, an$ en$s at the inferior &or$er of the teres !a'or. )or $escripti0e purposes
the a.illary artery is $i0i$e$ into three parts &y the pectoralis !inor. <he first part has one
&ranch +superior thoracic/, the secon$ part gi0es off t-o &ranches +thoracoacro!ial an$ lateral
thoracic/, an$ the thir$ part gi0es off three &ranches +su&scapular, anterior circu!fle. hu!eral,
an$ posterior circu!fle. hu!eral/. <he lateral thoracic artery is larger in -o!en, an$ it supplies
the lateral part of the !a!!ary glan$.
<he recurrent laryngeal ner0e
,ncorrect
supplies all intrinsic laryngeal !uscles <rue)alse
,ncorrect
supplies the cricothyroi$ !uscle <rue)alse
,ncorrect
supplies sensation to the su&glottic region <rue)alse
,ncorrect
is sensory to the supraglottic region <rue)alse
,ncorrect
supplies the sternothyroi$ !uscle <rue)alse
<he recurrent laryngeal ner0es are sensory to the su&glottic region an$ supply all the intrinsic
!uscles e.cept the cricothyroi$ !uscle.
haeochro!ocyto!as:
,ncorrect
are usually !alignant <rue)alse
,ncorrect
are associate$ -ith !ultiple en$ocrine neoplasia type 2a +M>12a/ <rue)alse
,ncorrect
are rarely &ilateral <rue)alse
,ncorrect
are associate$ -ith !ultiple en$ocrine neoplasia type 1 +M>11/ <rue)alse
,ncorrect
secrete al$osterone <rue)alse
haeochro!ocyto!as are tu!ours of chro!affin tissue that secrete catechola!ines. atients
present -ith hypertension an$ sy!pathetic hyperacti0ity. 19M of such tu!ours are !alignant,
19M are &ilateral, 19M are e.tra-a$renal an$ 19M are fa!ilial. <hey are associate$ -ith M>12a
an$ 2&.
(tructures relate$ to the superficial part of the su&!an$i&ular glan$ inclu$e
,ncorrect
platys!a <rue)alse
,ncorrect
the !an$i&ular &ranch of the facial ner0e <rue)alse
,ncorrect
the facial artery <rue)alse
,ncorrect
the facial 0ein <rue)alse
,ncorrect
$eep cer0ical fascia <rue)alse
<he su&!an$i&ular glan$ is a lo&ulate$ glan$ !a$e up of a superficial an$ a $eep part, -hich
are continuous -ith each other aroun$ the posterior &or$er of the !ylohyoi$ !uscle. art of the
glan$ lies inferolaterally, enclose$ in an in0esting layer of $eep cer0ical fascia, platys!a !uscle
an$ skin. Laterally it is crosse$ &y the cer0ical &ranch of the facial ner0e an$ 0ein. <he facial
artery is relate$ to the posterior an$ superior aspects of the superficial part of the glan$.
Fhich of the follo-ing are correct: <he follo-ing structures -oul$ &e encountere$ $uring a
caroti$ en$artecto!y
,ncorrect
Hypoglossal ner0e <rue)alse
,ncorrect
"!ohyoi$ <rue)alse
,ncorrect
)acial 0ein <rue)alse
,ncorrect
(uperior thyroi$ artery <rue)alse
,ncorrect
,nternal 'ugular 0ein <rue)alse
All of the a&o0e are near to the caroti$ arteries an$ -oul$ &e e.pecte$ to &e encountere$ $uring
the course of a caroti$ en$artecto!y.
Fhich of the follo-ing are correct: Left coronary artery:
,ncorrect
7i0i$es into circu!fle. an$ left anterior $escen$ing arteries <rue)alse
,ncorrect
(upplies the left atriu! <rue)alse
,ncorrect
(upplies the sinoatrial +(A/ no$e in !ost cases <rue)alse
,ncorrect
(upplies the atrio0entricular +AC/ no$e in !ost cases <rue)alse
,ncorrect
Arises fro! the anterior aortic sinus <rue)alse
<he left coronary artery arises fro! the left posterior aortic sinus &ehin$ the pul!onary trunk.
After a short course it $i0i$es into t-o !ain arteries, the circu!fle. an$ the left anterior
$escen$ing, other-ise kno-n as the anterior inter0entricular artery. Aroun$ 39M of hearts ha0e
the right coronary artery supplying the (A no$e an$ in #9M of hearts the (A no$al artery arises
fro! the left coronary artery. <he right coronary artery supplies the atrio0entricular +AC/ no$e.
<he left coronary artery supplies the 0ast !a'ority of the left 0entricle an$ left atriu!. art of the
right 0entricle is supplie$ &y the left coronary artery.
@lee$ing fro! the !i$$le !eningeal artery follo-ing hea$ in'ury
,ncorrect
!ainly affects the posterior &ranch <rue)alse
,ncorrect
results in an e.tra$ural hae!ato!a <rue)alse
,ncorrect
!ay pro$uce ipsilateral pupillary constriction <rue)alse
,ncorrect
is usually cause$ &y a tri0ial inci$ent <rue)alse
,ncorrect
typically causes a &icon0e.-shape$ lesion on C< <rue)alse
@lee$ing fro! the !i$$le !eningeal artery follo-ing hea$ in'ury usually lea$s to an e.tra$ural
hae!ato!a. <his is usually a tear of the anterior &ranch of the !i$$le !eningeal artery, -ith an
un$erlying linear skull fracture. <he characteristic picture is of a hea$ in'ury -ith a &rief episo$e
of unconsciousness follo-e$ &y a luci$ inter0al. <he patient then $e0elops a progressi0e
he!iparesis, stupor an$ rapi$ transtentorial coning -ith an ipsilateral $ilate$ pupil. <his is
follo-e$ &y &ilateral fi.e$ $ilate$ pupils, tetraplegia an$ $eath.
Fhich of the follo-ing are true: <he inguinal canal
,ncorrect
,s a&out 1.2 c! long <rue)alse
,ncorrect
Has the fascia trans0ersalis along the -hole length of its posterior -all <rue)alse
,ncorrect
Has a $eep inguinal ring lying 2 c! a&o0e the !i$$le of the inguinal liga!ent <rue)alse
,ncorrect
Has the lacunar liga!ent in the !e$ial part of its floor <rue)alse
,ncorrect
Has the inferior epigastric artery !e$ial to its $eep ring <rue)alse
<he inguinal canal is a&out # c! long. <he posterior -all of the canal has the con'oint ten$on
!e$ially an$ the trans0ersalis fascia throughout. <he $eep inguinal ring lies a&out 1.22 c!
a&o0e the !i$-point of the inguinal liga!ent. <he floor of the inguinal canal is the unrolle$ lo-er
e$ge of the inguinal liga!ent, re-inforce$ !e$ially &y the lacunar liga!ent.
Fhich of the follo-ing are true: Eegar$ing the spinothala!ic tract:
,ncorrect
Con0eys 0i&ration an$ position sense to the &rain
<rue)alse
,ncorrect
<he secon$ary a.ons of the tract synapse in the thala!us <rue)alse
,ncorrect
A.ons fro! the lu!&ar region synapse !e$ially
<rue)alse
,ncorrect
Lesion to this tract coul$ lea$ to loss of pain sensation on the opposite si$e of the lesion
<rue)alse
,ncorrect
Lesion to this tract coul$ lea$ to $i!inishe$ te!perature an$ touch sensation fro! the sa!e
si$e of the &o$y as the lesion
<rue)alse
<he spinothala!ic tract con0eys pain, te!perature, touch an$ pressure sensations fro! one
si$e of the &o$y to the opposite si$e of the &rain. Ci&ration an$ position sense are con0eye$ 0ia
the posterior colu!n. <he first neurone of the spinothala!ic tract synapses in the posterior hornD
the ne.t neurone crosses to the right si$e of the spinal cor$ an$ synapse in the thala!us, after
ascen$ing through the cor$ an$ &rainste!D the thir$ neurone arises in the thala!us to pass to
the corte.. <he secon$ary a.ons of the spinothala!ic tract ascen$ through the &rainste! to
synapse in the thala!us. A.ons fro! the cer0ical region synapse !e$ially -hile a.ons fro! the
lu!&ar region synapse laterally. A lesion of the spinothala!ic tract any-here in the &rainste!
-oul$ lea$ to a loss of pain sensations fro! the opposite si$e of the &o$y. <e!perature an$
touch sensations -oul$ also &e $i!inishe$ fro! the opposite si$e of the &o$y &ut not totally lost
&ecause other path-ays !ay also con0ey these !o$alities. A lesion of the spinothala!ic tract at
the le0el of the spinal cor$ -oul$ lea$ to loss of pain sensations on the opposite si$e, &eginning
one le0el &elo- the le0el of the lesion.
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