Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
305 Cards in this Set
- Front
- Back
Without the use of prophylaxis the risk of deep calf vein
thrombosis in a patient undergoing an anterior resection for rectal cancer is likely to be at least: a 10% b 20% c 30% d 50% |
d
|
|
Which of the following measures is most likely to reduce
the risk of post operative wound infection with MRSA? a 5 days of broad spectrum prophylactic antibiotics b ensuring the patient showers with chlorhexidine wash prior to surgery c a policy of staff handwashing between patients d screening patients for MRSA carriage prior to surgery |
c
|
|
Which of the following constitute the legal standard for
the information that should be passed to a patient to meet the requirements of ‘informed consent’? a what a patient in that position would regard as reasonable b what a reasoned body of medical opinion holds as reasonable c a list of all possible complications contained within a patient information booklet d all serious complications that occur in more than 1% of patients |
a
|
|
The best indicator of cardiorespiratory capacity and
reserve for surgery is: a transthoracic echocardiography b arterial blood gas analysis c thallium persantin nuclear imaging of the heart d functional exercise capacity e electrographic stress test |
d
|
|
The commonest reason for poor outcome after
anaesthesia is: a inadequate pre-operative assessment and optimisation b poor anaesthetic assistance c blood product unavailability d poor choice of anaesthetic agents e inadequate intravenous access |
a
|
|
Absolute contraindications to performing neuraxial
(epidural or spinal) local anaesthetic blockade include all of the following except: a coagulopathy b patient refusal c systemic sepsis d local infection at insertion site e pre-existing neurologic deficit |
e
|
|
Patients with obstructive sleep apnoea are often
undiagnosed. Clinical features of obstructive sleep apnoea include all of the following except: a snoring during sleep b excessive daytime somnolence c feelings of choking during sleep d pulmonary hypertension e aortic stenosis |
e
|
|
Airway assessment should include all of the following
except: a ability to open mouth b subluxability of the temporomandibular joint c thyro-mental distance d cervical spine mobility and stability e size of the uvula |
e
|
|
A 78-year-old woman develops an arrhythmia 2 days
after a laparotomy for perforated diverticular disease. The ECG shows a bradycardia of 30 beats/min and spiked T waves. The only biochemical abnormalities are a potassium level of 6.3 mmol/L (normal range 3.8–5.2) and a creatinine level of 0.2 mmol/L (normal range 0.05–0.12). Her monitored vital signs (including ECG) are normal. What should be your first course of action? a give a rapid intravenous infusion of 1 L of 10% dextrose containing 25 units of soluble insulin b give an intravenous infusion of 20 mL of calcium gluconate c start the patient on haemodialysis d administer an enema of calcium resonium e give an intravenous infusion of 30 mmol of sodium bicarbonate |
b
|
|
A 40-year-old man is confused and restless the second
day after upper abdominal surgery and repair of a hiatus hernia. The most probable cause of his condition is: a pulmonary embolism b narcotic overdose c pulmonary atelectasis d electrolyte imbalance e starvation ketosis |
c
|
|
You are asked to see a patient in your ward, 7 days
following a left hemicolectomy. The patient has a discharging wound. The discharge oozes freely between the sutures and is profuse, watery and blood-stained. There are no signs of inflammation. What is the most likely diagnosis: a dehiscence of the wound b an anastomotic leak c discharge from a wound haematoma d wound infection e a seroma |
a
|
|
You have been asked to see a 68-year-old woman
who has developed abdominal distension 5 days after a total hip replacement. Her abdomen is distended but soft. There is no localised tenderness, and rectal examination is unremarkable. A few scattered bowel sounds can be heard. The plain abdominal film shows gas all the way to the rectum and a dilated caecum and ascending colon. The radiological diameter of the caecum measures 14 cm. What will you do as immediate management of this patient? a arrange decompression of the caecum by a caecostomy b arrange a contrast (gastrografin) enema to exclude mechanical obstruction c prepare the patient for laparotomy and right hemicolectomy d arrange for decompression by colonoscopy e insert a rectal flatus tube |
d
|
|
A previously fit 55-year-old man has undergone an
emergency right hemicolectomy for a perforated caecal carcinoma. Two days after the operation you note the following on his fluid balance sheet – intravenous input 2 L, nasogastric aspirate 2 L, drain losses 700 mL, urine output 500 mL. Biochemistry shows [Na+] 135 mmol/L, [K+] 3.0 mmol/L, [Cl−] 100 mmol/L, [HCO− 3 ] 27 mmol/L. Which of the fluid balance regimens below would you order for the next 24-hour period? a 2 L N saline + 3 L dextrose 5% + 50 meq KCl b 2 L N saline + 1 L dextrose 5% + 50 meq KCl c 1 L N saline + 3 L dextrose 5% + 100 meq KCl d 3 L N saline + 2 L dextrose 5% + 100 meq KCl e 1 L N saline + 1 L dextrose 5% + 100 meq KCl |
d
|
|
Universal precautions:
a protect operating theatre staff from electric shocks b prevent polluted air from entering the operating theatre c impose a physical barrier between patients and carers d are only to be used when operating on patients e protect only against bacterial pathogens |
c
|
|
Endoscopic surgery:
a has a very limited role in general surgical practice b is inherently unsafe because the surgeon cannot touch the structures being operated on c is associated with greater post-operative pain and immobility d enables cholecystectomy to be performed as day case surgery in some patients e can only be used for part of an operation |
d
|
|
Sutures:
a should be left in the skin for a minimum of 2 weeks b often need to be removed with local anaesthetic c must be tied tightly so that arterial inflow into tissues is not possible d made of catgut lose tensile strength within 3 weeks e of all types must eventually be removed |
d
|
|
Surgical drains:
a are removed when they are no longer necessary b should always be removed the day after surgery c are removed under general anaesthesia d are not necessary with modern surgical techniques e are required after the majority of general surgery procedures |
a
|
|
Nutritional markers include the following except:
a skin fold thickness b mid-arm muscle circumference c total leucocyte count d serum albumin e skin recall antigens |
c
|
|
The requirement for intravenous nutrition per day is:
a 20 kcal/kg body weight b 30 kcal/kg body weight c 40 kcal/kg body weight d 50 kcal/kg body weight e 60 kcal/kg body weight |
d
|
|
Marasmus is characterised by the following
characteristics except: a inadequate intake of an otherwise balanced diet b cachexia in the adult c fluid retention d decreased metabolic rate e easy correction with standard nutrition |
c
|
|
Treatment of critically ill patients in an intensive care unit:
a increases the cost of care but does not improve the prognosis b is associated with a 50% survival rate overall c is associated with a 15% death rate overall d is required for 25% of all hospital patients at some point in their illness e is not indicated for any patient over 80 years of age |
c
|
|
Infection in critical illness is:
a almost always followed by dysfunction in multiple organ systems b only able to be diagnosed in the presence of septic shock c rarely associated with septic shock d rarely caused by common bacteria e often found in the lungs or abdomen |
e
|
|
The systemic inflammatory response syndrome:
a consists of at least two from a list of four categories of physiological and haematological abnormality b nearly always implies the presence of invasive bacterial or fungal infection c rarely occurs after cardiopulmonary bypass procedures d helps in the clinical differential diagnosis between infection types e is associated with more than a 50% mortality rate |
a
|
|
Intravenous fluid resuscitation of hypotensive,
hypovolaemic critically ill patients should be: a slow and gentle using only colloids b rapid and partial using crystalloids only c slow and complete using colloids only d rapid and complete using crystalloids or colloids or both e composed mostly of a solution of 4% albumin |
d
|
|
Commonly applied critical care organ support involves all
except one of the following: a mechanical ventilation for hypercarbia b vasopressor infusions for low cardiac output states c haemodiafiltration for uraemia d platelet transfusion for thrombocytopaenia e inotropic infusions for low cardiac output states |
b
|
|
The best prophylaxis against infection in dirty wounds is
achieved by: a avoiding the use of local anaesthesia b inserting a drain into the wound c administering a large dose of an appropriate antibiotic d administering tetanus antitoxin e removing foreign bodies and devitalised tissues |
e
|
|
Opportunistic infections caused by Candida albicans and
fungi are not associated with: a cancer b amyloid sclerosis c diabetes d the administration of cytotoxic drugs e the use of immunosuppressant drugs after cardiac transplantation |
b
|
|
Which of the following is not an example of metastatic
infection? a colo-vesical fistula due to diverticular disease of the colon b liver abscess after portal pyaemia c infection in a prosthetic heart valve d brain abscess secondary to a furuncle e staphylococcal osteomyelitis in the absence of trauma |
a
|
|
Appendisectomy wounds are classified as being:
a clean b clean-contaminated c contaminated d contaminated-dirty e dirty |
b
|
|
The concept of Universal Precautions is based on:
a the ‘barrier nursing’ of all patients with a nosocomial virus infection b the resheathing of all used needles c the need to regard all patients as being potentially infectious d the importance of taking a detailed social history from every patient e the routine screening of patients for blood-borne viruses |
c
|
|
Immunosuppression:
a is only required for organ transplants where the donor and recipient are unrelated b has the side effects of increased risk of infection and malignancy c aims to knockout bone marrow and stem cells d should be doubled if two organs are transplanted (e.g. kidney and pancreas) |
b
|
|
Organ donation:
a between husband and wife is doomed to failure b from deceased donors exceeds current demand for organs from deceased donors c requires that brain stem death criteria are fulfilled d in Australia is amongst the highest in the developed nations |
c
|
|
Kidney transplantation:
a has a 5-year kidney survival rate of approximately 75–85% b requires immunosuppression for transplantation between monozygotic twins c is one of the least commonly performed organ transplants d leads to only poor quality of life in most recipients |
a
|
|
Liver transplantation:
a is contra-indicated if jaundice is present b cannot be performed from live donors c requires no immunosuppression because of the antigen filtering system in the liver d can be life saving in cases of fulminant hepatic failure |
d
|
|
Pancreas transplantation:
a can be undertaken using the whole pancreas or just the islets of Langerhan b is used in patients with pancreatic enzyme deficiency syndromes c using the whole pancreas has a patient survival rate of 15% at 2 years d does not allow successful recipients to stop exogenous insulin |
a
|
|
Ionising radiation is particularly effective in treatment
except in: a Hodgkins disease b Carcinoma of the breast c Cancer of the rectum d Cancer of the uterine cervix e Cutaneous melanoma |
e
|
|
Screening for malignant disease is effective in the
following situations except: a Where a tumour is detected at a stage where it can be cured by treatment b Screening is undertaken on an individual patient basis c There is high public acceptance of the process d Specificity of screening is high e Sensitivity of screening is high |
b
|
|
The following statements in relation to simultaneous
regional lymph node dissection at the time of primary tumour excision are true except: a Allows more accurate tumour staging b Allows provision of appropriate prognosis to the patient c Can be undertaken with little morbidity d Allows appropriate adjuvant treatment to be undertaken e May confer a survival advantage |
c
|
|
In gastro-oesophageal reflux, the following statements
are true except a alcohol consumption and smoking are important aggravating factors b is often associated with disordered oesophageal motility c a hiatus hernia is invariably present d barretts oesophagus may develop e iron deficiency anaemia may occur as a result of chronic blood loss |
c
|
|
The following statements on the management of
gastro-oesophageal reflux are correct except a 24-hour oesophageal manometry and pH monitoring is mandatory in the presence of oesophagitis demonstrated endoscopically b a proton pump inhibitor is an effective treatment c laryngeal spill-over is an indication for surgery d the most appropriate operation is a laparoscopic fundoplication e dysphagia may complicate anti-reflux surgery |
a
|
|
For patients suffering from oesophageal cancer, which
of the following symptoms indicates the WORST prognosis? a hoarseness of voice b weight loss of more than 10% of usual body weight c dysphagia to solid and semi-solid food d regurgitation of swallowed food e odynophagia |
a
|
|
A 75-year-old man complains of progressive dysphagia
for 2 months. He has loss of 10 lb in weight and can only tolerate a liquid diet. Oesophageal cancer is suspected. Which of the following investigations is MOST likely to detect evidence of distant metastases from his cancer? a upper endoscopy b endoscopic ultrasonography c positron emission tomography d ultrasound +/− fine needle aspiration of neck e CT scan |
c
|
|
Out of the following, the MOST LIKELY risk factor for
the development of a squamous cell cancer of the oesophagus is: a smoking b alcohol intake c obesity d history of cancer of the larynx e achalasia |
d
|
|
The most common benign tumour of the oesophagus is:
a adenosquamous carcinoma b fibrovascular polyp c leiomyoma d haemangioma e neurofibroma |
c
|
|
The diagnosis of chylous leak after oesophagectomy is
NOT helped by: a analysis of chylomicrons in the chest tube output b lymphangiogram c milk challenge d gastrografin contrast swallow e test for triglyceride in chest tube output |
d
|
|
With a perforation of a duodenal ulcer which occurred 6
h ago, which of the following features is LEAST likely to be present? a generalised abdominal tenderness and guarding b the bowel sounds are hyperactive c percussion over the liver may demonstrate resonance d the respiration is shallow and the abdominal muscles are held rigid e plain radiograph shows free gas under the diaphragm |
b
|
|
Which of the following factors is MOST likely to be
associated with a significant risk of rebleeding from a duodenal ulcer? a no further bleeding within 72 hours of the initial bleed b a clean based ulcer seen on endoscopy c age less than 50 years d a visible vessel with adherent clot seen on endoscopy e the patient is female |
d
|
|
The treatment of choice for a perforated duodenal ulcer
in a 56-year-old man with a strong history of ulcer disease and signs of peritonitis after 12 hours is a conservative management with nasogastric suction and intravenous fluids b vagotomy and pyloroplasty c omental patch repair and peritoneal lavage d highly selective vagotomy e partial gastrectomy |
c
|
|
Following a gastric resection for a stage III gastric cancer
the patient asks whether any further therapy will improve their prognosis. Which of the following statements is true? a chemotherapy is of no use in this setting b chemoradiotherapy may improve outcome c radiotherapy may improve outcome d adjuvant chemotherapy is standard treatment |
b
|
|
A 67 year old man is found to have a submucosal 5 cm
tumour in the body of his stomach. The treating physician considers that this may be a gastrointestinal stromal tumour. Which one of the following statements is correct? a this tumour has a propensity to spread to lymph nodes b this tumour is benign and unlikely to metastasize c it is difficult to predict how this tumour will behave d the tumour is very aggressive and survival is normally limited |
c
|
|
Following gastric resection a patient is told that they
have a T2 N1 (stage II) cancer of the stomach. They ask about 5-year survival, how many patients from 100 with such a tumour would be alive at 5 years? a 10 b 30 c 60 d 90 |
c
|
|
Endoscopic ultrasound is used in the staging of gastric
cancer. Which of the following statements is true? a when good quality CT scan is available, EUS adds little to staging accuracy b CT scan is better than EUS in assessing N stage c the availability of EUS removes the need for staging laparoscopy d EUS is better than CT in assessing T stage |
d
|
|
An 80-year-old woman presents with biliary pain and
stones are seen in the gall bladder on ultrasound. The probability of the pain being due to a stone in the common bile duct is approximately: a 5% b 10% c 20% d 30% e 50% |
d
|
|
A 73-year-old man presents with cholangitis. He has had
no previous abdominal operation. The definitive treatment should be: a cholecystectomy and choledocholithotomy b ERCP and sphincterotomy with stone extraction c antibiotic therapy followed by laparoscopic cholecystectomy d choledocholithotomy e ERCP, sphincterotomy with stone extraction and later consideration of cholecystectomy |
e
|
|
Which of the following is the appropriate investigation in
a patient presenting with a recent episode of right upper quadrant pain and a normal physical examination? a abdominal CT scan b ERCP c plain X-ray of the abdomen d upper abdominal ultrasound e cholescintigraphy |
d
|
|
The following investigation should always be performed
when investigating obstructive jaundice: a liver ultrasound b ERCP c CT scan d MRCP e PTC |
a
|
|
Bile duct injury during laparoscopic cholecystectomy is
more common: a in the presence of cholecystitis b when the surgeon is inexperienced c if the biliary anatomy is unusual d when the operation is complicated by haemorrhage e all of the above |
e
|
|
Cholangiocarcinoma is most commonly found:
a in the periphery of the liver b in the gall bladder c at the biliary confluence d in the distal bile duct e in the duodenum |
c
|
|
Primary sclerosing cholangitis is not associated with:
a inflammatory bowel disease b carcinoma of the bile duct c gallstones d multifocal biliary strictures e hepatocellular carcinoma |
e
|
|
Primary hepato-cellular carcinoma may be caused by all
of the following except: a alcohol b haemochromatosis c hepatitis B virus d steroids e gallstones |
d
|
|
Liver metastases may be treated by all of the following
except: a arterial embolisation b cryotherapy c laparoscopic resection d open lobectomy e regional chemotherapy |
d
|
|
Regarding pyogenic liver abscesses, which one of the
following is true? a commonest source for sepsis is the small bowel b a single organism is usually causal c obstructive jaundice is a common symptom of pyogenic abscess d drainage of the abscess and appropriate antibiotic therapy are the mainstay of management e open surgical drainage of the abscess is an essential part of present treatment |
d
|
|
Regarding amoebic liver absesses, which one of the
following is false? a it is an uncommon disease in Australia and is endemic in South and Southeast Asia b intestinal amoebiasis, which leads to liver abscess, is transmitted by the faeco-oral route c amoebic serology is usually positive in these patients d mainstay of treatment is antimicrobial therapy e amoebic liver abscess must never be drained by percutaneous technique |
e
|
|
Regarding hydatid disease, which one of the following is
incorrect? a the human is an end host, which breaks the development cycle of the parasite b initial infection occurs through the alimentary tract and is asymptomatic c the natural history of a hydatid cyst in the human is one of slow progressive growth d rupture of a hydatid cyst is a common event e most symptoms are related to pressure effects on the liver and surrounding organs |
d
|
|
Which one of the following statements regarding the
management of hydatid cysts is false? a extremely small cysts may be managed conservatively provided they are followed up to monitor growth b medical management is successful in the majority of cases c medical therapy is usually used to supplement surgical intervention d the most common surgical technique is that of evacuation of the content and de-roofing of the cyst and the placement of an omental patch in the cavity e prevention of spillage of the contents into the peritoneal cavity is of critical importance |
b
|
|
The following are true of liver infestations:
a the liver fluke Fasciola hepatica is acquired from sheep and cattle and infests the biliary tree b the flat worm Clonorchis sinensis is usually ingested by eating raw fish c Clonorchis sinensis infestation leads to recurrent cholangitis and a high incidence of cholangiocarcinoma d biliary ascariasis is caused by the migration of the common intestinal roundworm into the biliary tree e all of the above |
e
|
|
The following are causes of pancreatitis:
a gallstones b alcohol c mumps d ampulla of Vater tumours e all of the above |
e
|
|
The pancreas is protected from autodigestion by:
a only secreting enzymes following stimulation by a meal b secreting enzymes in an inactivated form c secreting activated enzymes into the pancreatic duct d packaging the activated enzymes in zymogen granules e all of the above |
b
|
|
Severity of acute pancreatitis is determined by:
a concentration of serum amylase b amount of urinary amylase secreted over 24 hours c clinical scoring systems (Ranson/Imrie) d amount of peripancreatic fluid collection as determined by CT scan e all of the above |
c
|
|
The only feature regarding antibiotic use in acute
pancreatitis which is not of importance is: a antibiotic uptake by pancreatic necrotic tissue b therapeutic level in serum c effective against Staphylococcus aureus d broad-spectrum cover, including anaerobes e none of the above |
c
|
|
Patients who suffer from chronic pancreatitis are totally
cured of their disease by: a surgical removal of the pancreas b endoscopic drainage of the pancreatic duct via a stent c total abstinence from alcohol d all of the above e none of the above |
e
|
|
Which of the following is an incorrect statement about
pancreatic carcinoma: a most pancreatic cancers are incurable b palliation can be achieved with a biliary stent c palliation can be achieved by surgical bypass of the tumour d ampullary cancer has a worse prognosis than carcinoma of the body of the pancreas e survival rate of 5% at 5 years from diagnosis can be expected |
e
|
|
Which of the following investigations has little value in
determining the curability of pancreatic carcinoma: a Ultrasound b ERCP c CT scanning d Serum markers e Pancreatic biopsy |
c
|
|
Regarding the portal circulation in the normal healthy
adult, which one of the following is true? a normal portal venous pressure is between 20 and 30 mm Hg b the portal vein is formed by the confluence of the superior mesenteric vein and the splenic vein behind the neck of the pancreas c splenic vein thrombosis does not cause localised portal hypertension d portal venous flow provides approximately 30–40% of total liver blood flow e the portal venous system contains unidirectional valves at specific points |
b
|
|
Which one of following physical signs is not usually
found in a patient with portal hypertension? a caput medusae b hepatomegaly c ascites d splenomegaly e lower limb varicose veins |
e
|
|
Regarding patients suffering from portal hypertension,
which one of the following is true? a hepatocyte destruction caused by cirrhosis account for the majority of the causes of portal hypertension b the main diseases leading to cirrhosis in the Australian population are alcoholic liver disease and chronic viral hepatitis c encephalopathy is the most common cause of death in patients with portal hypertension d peritonitis complicating ascites in these patients is usually due to perforated duodenal ulcer e the commonest source of bleeding varices are the haemorrhoidal veins |
b
|
|
Considering the management of patients with portal
hypertension, which one of the following statements is true? a upper gastrointestinal endoscopy should not be performed unless there is evidence of variceal bleeding b liver biopsy is rarely required as a part of the diagnostic process in determining the underlying disease c intravenous infusion of drugs such as octreotide and terlipressin which reduce splanchnic blood flow play an important role in the prevention of early re-bleed of oesophageal varices d the mainstay of management of bleeding oesophageal varices is the insertion of a Sengstaken–Blakemore tube e surgical porto-caval shunts remain the definitive management of bleeding varices |
c
|
|
Which of the following does not play an important role
in the prevention of the first variceal bleed in patients with portal hypertension? a surveillance upper gastrointestinal endoscopy b prophylactic banding of visible varices c the use of β-blockers d prophylactic sclerotherapy e surgical porta-systemic shunt |
e
|
|
A 52-year-old man develops symptoms of small bowel
obstruction over a 24-h period. Which of the following MOST SUGGESTS development of bowel strangulation? a profuse vomiting b constant abdominal pain associated with abdominal guarding c tachycardia d high nasogastric aspirate e hypokalaemic alkalosis |
b
|
|
In acute proximal small bowel obstruction:
a the symptoms are prolonged with abdominal distension prior to vomiting b there is a tendency towards dehydration, with hyponatraemia and hypokalaemic, hypochloraemic metabolic alkalosis c the vomitus is usually faeculent d a common cause is gallstone ileus e decompression with nasogastric tube is not often required |
b
|
|
Spontaneous cholecystoenteric fistula:
a occurs more frequently in young patients b can be diagnosed by plain abdominal X-rays c most frequently occurs between the gall bladder and ileum d frequently causes obstructive jaundice e is the most common cause of small bowel obstruction in females |
b
|
|
Common causes of small bowel obstruction do NOT
include: a post-surgical adhesions b inguinal hernia c incisional hernia d small bowel tumour e faecal impaction |
e
|
|
Investigations in a patient with acute small bowel
obstruction would NOT include: a supine and erect abdominal radiographs b blood urea and electrolyte estimation c gastrografin small bowel follow-through d technetium-labelled iminodiacetic acid (HIDA) scan e computed tomography of the abdomen |
d
|
|
The following are common causes of large bowel
obstruction except: a intra-abdominal adhesions b sigmoid volvulus c carcinoma of the colon d diverticular disease e carcinoma of the rectum |
a
|
|
Large bowel obstruction requires urgent treatment
because: a fluid and electrolyte imbalance is often life threatening b intracolonic bacterial overgrowth leads to septicaemia c there is a significant risk of colonic perforation d small bowel obstruction with ischaemia will eventually occur |
c
|
|
Sigmoid volvulus:
a is common in the under 50 years age group b is uncommon in Africans c may lead to ischaemia and perforation of the colon d is rarely treated successfully by sigmoidoscopic decompression e is best treated surgically by subtotal colectomy |
c
|
|
Colonic pseudo-obstruction:
a is common in the elderly and debilitated b should initially be treated by colonoscopic decompression c should be treated with sympathetomimetic agents d is not associated with a risk of caecal perforation e is liable to require surgical treatment |
a
|
|
Complete left-sided large bowel obstruction:
a should be treated by self-expandable metallic stents b will mostly require treatment by a three-staged surgical procedure c is commonly caused by a Crohn’s disease stricture d should be treated by Hartman’s procedure |
b
|
|
Three days after elective repair of an abdominal aortic
aneurysm, a 70-year-old man developed left iliac fossa pain, abdominal distension, bloody diarrhoea and a fever of 38◦C. The most helpful investigation would be: a mesenteric angiography b limited flexible sigmoidoscopy and biopsy c gastroscopy d barium small bowel follow-through e abdominal ultrasound |
b
|
|
Three days after a myocardial infarction with cardiogenic
shock, a 75-year-old man develops abdominal pain and distension. The abdomen is slightly tender with reduced bowel sounds. A plain abdominal X-ray shows distended small bowel without fluid levels. Blood tests reveal a metabolic acidosis. The most likely diagnosis is: a perforated peptic ulcer b mesenteric ischaemia c pseudo-obstruction of the colon d acute pancreatitis e diverticulitis |
b
|
|
Following massive small bowel resection for mesenteric
venous thrombosis, the following may develop EXCEPT: a dehydration b malnutrition c lactose intolerance d fat malabsorption e adaptation of the colon to absorb vitamin B12 |
e
|
|
Right iliac fossa pain and nausea in a 62-year-old woman
may be due to the following EXCEPT: a acute appendicitis b caecal cancer c urinary tract infection d mittelschmerz pain e sigmoid diverticulitis |
d
|
|
The INCORRECT statement on sepsis associated with
appendicectomy for acute appendicitis is: a may present with a pelvic abscess b may present as a wound infection c is reduced by prophylactic peri-operative antibiotics d is increased by laparoscopic rather than open appendicectomy e is most often associated with anaerobic bacteria |
d
|
|
The incorrect statement on Meckel’s diverticulum:
a may cause small bowel obstruction due to intussusception b may simulate acute cholecystitis c may present with meal-related central abdominal pain d may present with melaena and a normal upper gastrointestinal endoscopy e may be diagnosed with a sodium technetium-99 m scan in some cases |
b
|
|
Adenocarcinoma of the small bowel is most commonly
associated with: a familial adenomatous polyposis b tuberculosis of the small bowel c lymphoma d prolonged use of cytotoxic chemotherapy for breast cancer e ulcerative colitis |
a
|
|
Carcinoid tumour of the appendix is associated with the
following features EXCEPT: a most are asymptomatic b tumours less than 2 cm in size require no further therapy other than appendicectomy c it is always malignant d carcinoid syndrome arises when hepatic metastases have occurred e synchronous carcinoid tumour in the distal ileum may be present |
c
|
|
The following are appropriate managements for familial
adenomatous polyposis EXCEPT: a restorative proctocolectomy and ileoanal pouch anastomosis b regular surveillance with flexible sigmoidoscopy c enrolment in a familial adenomatous polyposis registry d identification of presymptomatic carrier by molecular genetic testing e prophylactic histamine H2 receptor antagonist, as duodenal cancer is a common cause of death |
e
|
|
The INCORRECT statement on FAP:
a inheritance is in autosomal dominant fashion b the condition accounts for 10% of all colorectal cancers c most affected individuals develop polyps by the age of 10 years d desmoid tumour is an association e all affected patients will develop colorectal carcinomas with time |
b
|
|
The HNPCC syndrome:
a is inherited in an autosomal dominant pattern b tends to affect younger patients c has a predilection for cancer in the proximal colon d is often associated with metachronous colorectal cancers e is linked to hereditary adenomatous polyposis |
e
|
|
Hamartomatous polyposis includes:
a Peutz–Jeghers syndrome b familial adenomatous polyposis c HNPCC syndrome d tubulovillous adenoma e haemangioma |
a
|
|
The oncologic outcome of rectal cancer is:
a improved by precise pre-operative staging, including endorectal ultrasound b better if the surgery is performed by a surgeon who has large case volume of rectal cancer c improved by multimodality therapy for high-risk cancer d improved by pre-operative chemotherapy alone, if pre-operative endorectal ultrasound indicates that it is a T3 cancer e equivalent whether laparoscopic or conventional open resection is performed. |
d
|
|
A 72-year-old woman presents with left iliac fossa pain,
fever and abdominal distension. Abdominal X-ray reveals two dilated loops of small bowel. The most likely diagnosis is: a left ureteric calculus b tubo-ovarian abscess c irritable bowel syndrome d acute diverticulitis e sigmoid volvulus |
d
|
|
Diverticular disease of the colon is associated with:
a thickening of the longitudinal but not circular muscle of the colon b narrowing of the lumen from mucosal hyperplasia c increased intraluminal pressure within the colon d high-fibre and high-fat diet e a high incidence of anastomotic breakdown in elective surgery |
c
|
|
Surgical management of perforated diverticular disease
with faecal peritonitis includes: a pre-operative mechanical bowel preparation b Hartmann’s procedure and sigmoid end colostomy c pre-operative barium enema to define the anatomy d anterior resection and primary colorectal anastomosis whenever possible e use of peri-operative antibiotics optimally with penicillin and gentamycin |
b
|
|
The complications of sigmoid diverticular disease include
the following EXCEPT: a sigmoid inflammatory phlegmon b colonic bleeding c purulent peritonitis d colovaginal fistula e colon cancer |
e
|
|
Extra-intestinal manifestations of ulcerative colitis include
the following EXCEPT: a pyoderma gangrenosum b iritis c sacroileitis d sclerosing cholangitis e eczema |
e
|
|
The following features may occur in both ulcerative
colitis and Crohn’s disease EXCEPT: a proctitis b erythema nodosum c toxic megacolon d non-caseating granuloma e response to mesalazine |
d
|
|
Which of the following statements about Crohn’s disease
is correct? a adenocarcinoma of the small bowel is a recognised complication of Crohn’s disease b when operative resection is required, the sites of anastomosis should be completely normal c strictureplasty is associated with a much higher surgical morbidity than resection d perianal Crohn’s disease is more commonly associated with Crohn’s jejunitis than colitis e haemorrhoidectomy should be performed as early as necessary because severe symptoms are likely |
a
|
|
Ulcerative colitis:
a is a mucosal disease that affects both the large and small bowel b in contrast to Crohn’s disease, does not have an increased risk of colorectal cancer c surveillance for colon cancer is mandatory, starting at diagnosis d toxic megacolon may be the initial manifestation e salphasalazine is most effective for acute colitis |
d
|
|
Indications for restorative proctocolectomy in ulcerative
colitis include: a toxic megacolon b a 2-cm villous adenoma in the hepatic flexure of the colon c ulcerative proctitis d severe sacroileitis e low-grade dysplasia on rectal biopsy |
b
|
|
Pathological findings in Crohn’s disease of the small
bowel include: a enlarged blood vessels, creeping along the sides of bowel wall towards the mesenteric border b caseating granulomas occurring in the bowel wall and mesenteric lymph nodes c continuous rather than segmental involvement of the small bowel d inflammation confined to the mucosa and submucosa of the bowel e a cobblestone appearance of the bowel arising from fissuring of the mucosa and submucosal oedema |
e
|
|
Radiation enteritis:
a is related to techniques of delivery of radiation therapy b may present acutely with perforation and peritonitis c may present late with recurrent small bowel obstruction d is associated with a high operative morbidity e may benefit from a high-fibre diet |
e
|
|
The following treatments are appropriate for a
high-output enterocutaneous fistula EXCEPT: a a high-fibre diet b total parenteral nutrition c intravenous fluid and electrolyte replacement d sandostatin e skin care by an enterostomal therapist |
a
|
|
An enterocutaneous fistula that occurs 5 days after a
small bowel resection for Crohn’s disease may be associated with the following EXCEPT: a anastomotic breakdown b persistent intestinal obstruction distal to the fistula c the presence of an inadequately drained abscess adjacent to the anastomosis d traumatic enterotomy during adhesion lysis, which has been overlooked e recurrent Crohn’s disease |
e
|
|
Surgery for complete rectal prolapse includes the
following EXCEPT: a abdominal rectopexy b sigmoid colectomy and rectopexy c Hartmann’s procedure d perineal proctosigmoidectomy e D´elorme’s procedure (mucosal sleeve resection) |
c
|
|
Full-thickness rectal prolapse is characterised by:
a faecal incontinence in approximately half the patients b a rare association with uterine prolapse c a peak incidence in elderly males d a high incidence of psychotic disorders e characteristic abnormalities on anorectal manometry |
a
|
|
Complications of ileostomy include the following
EXCEPT: a ileostomy prolapse b skin irritation around stoma site c ileostomy retraction d food bolus obstruction e peptic ulcer |
e
|
|
Which of the following is INCORRECT concerning stoma
management? a pre-operative stoma siting and counselling are important b further measurements for new stoma appliances are performed approximately 4 weeks after surgery c dietary restrictions are necessary d sexual activities are to be avoided because of the stoma e the enterostomal therapist is an integral member of the management team |
d
|
|
The preferred treatment of an ischiorectal abscess is:
a a prolonged course of antibiotics to abort the infection b incision and drainage under general anaesthesia c needle aspiration under local anaesthesia d warm salt baths e fistulotomy |
b
|
|
The aetiology of anal fistula includes:
a anal gland infection b ulcerative colitis c ischaemic colitis d anal syphilis e levator syndrome |
a
|
|
Painful perianal conditions include:
a Bowen’s disease b second-degree haemorrhoids c perianal haematoma d anal warts e ulcerative colitis |
c
|
|
Complications of haemorrhoidectomy include the
following EXCEPT: a severe anal pain b urinary retention c anal stricture d pyelonephritis e rectal bleeding |
d
|
|
Anal fissure is characterised by the following EXCEPT:
a severe anal pain during and immediately after defecation b bleeding on defecation c a sentinel anal skin tag d a relapsing history e a patulous anus |
e
|
|
A 48-year-old woman presents with thick greenish nipple
discharge from both breasts. There is no palpable breast lump, although both nipples are slightly retracted. The patient does not take any medication. Mammogram and ultrasound do not show any evidence of cancer. The most likely diagnosis is: a galactorrhoea b duct papilloma c mammary duct ectasia d fibroadenoma e lobular carcinoma in situ |
c
|
|
A 42-year-old woman presents with a 2-cm breast lump,
detected 2 weeks ago. The lump is discrete but soft. There is no past history of breast disease. The initial management includes: a repeat clinical examination in 4 weeks’ time to detect any changes b bilateral mammogram with or without breast ultrasound c fine needle aspiration cytology of the lump as breast imaging is unnecessary in this age group d excision biopsy e unilateral mammogram and ultrasound of the breast with the lump |
b
|
|
Mammography screening programmes:
a reduce mortality of breast cancer, especially in women aged between 40 and 50 years b detect smaller cancers with a lower incidence of axillary nodal metastases than in the unscreened population c show a higher incidence of lobular but not ductal carcinoma in situ d include quality assurance targets of attendance rates higher than 50% and recall rates lower than 50% e involve radiologists as the primary personnel responsible for diagnosis and management |
b
|
|
A 39-year-old woman has a 5-cm, grade III breast
cancer. Twelve of 16 lymph nodes contain metastases. The oestrogen receptor is negative, although the progesterone receptor is positive. There is no evidence of systemic metastases on chest X-ray and bone scan. Following a total mastectomy and axillary clearance, the MOST likely follow-up management would be: a regular review, with reservation of chemotherapy for recurrent disease b adjuvant tamoxifen c adjuvant chemotherapy d adjuvant radiotherapy e oophorectomy |
c
|
|
Correct statement concerning ductal carcinoma in situ
(DCIS): a it is associated with microcalcification on mammography b DCIS is less commonly found in women undergoing routine mammographic screening c comedo subtype is rarely multicentric d there is a high risk for lymph node metastasis with the papillary subtype e the risk for progression to invasive cancer is smaller than with lobular carcinoma in situ |
a
|
|
Thyroid follicular cells arise primarily from:
a the laryngeal cartilage b the second bronchial arch c the oesophagus d the base of the tongue e the neural crest |
d
|
|
FNAC can reliably diagnose all types of thyroid cancer
except: a follicular thyroid cancer b papillary thyroid cancer c anaplastic thyroid cancer d medullary thyroid cancer e metastases from renal cell cancer |
a
|
|
The type of thyroid cancer with the worst prognosis
(5-year survival <1%) is: a papillary thyroid cancer b follicular thyroid cancer c anaplastic thyroid cancer d medullary thyroid cancer e thyroid lymphoma |
c
|
|
Thyroiditis presenting following a viral infection with an
exquisitely tender, enlarged, firm thyroid gland, and with systemic symptoms of headache and malaise is generally due to: a Hashimoto’s thyroiditis b de Quervain’s (subacute) thyroiditis c Reidels thyroiditis d acute bacterial thyroiditis e non-specific thyroiditis |
b
|
|
Damage to one recurrent laryngeal nerve during
thyroidectomy generally leads to: a the need for a tracheostomy b an inability to sing high notes c inability to project the voice to the back of a hall d a falsetto voice e a hoarse voice |
e
|
|
The parathyroid glands arise from:
a the third and fourth branchial pouches b the base of the tongue c the first branchial pouch d the thyroid parenchyma e a tracheal diverticulum |
a
|
|
Parathyroid hormone (PTH) has a half-life of:
a 7 seconds b 5 minutes c 1 hour d 2 days e 5 weeks |
b
|
|
Primary hyperparathyroidism is due, in 90% of cases,
to: a metastatic cancer b parathyroid cancer c parathyroid hyperplasia d multiple parathyroid tumours e a single parathyroid adenoma |
e
|
|
The diagnosis of primary hyperparathyroidism is usually
confirmed by the following biochemical results: a raised serum calcium, suppressed PTH b raised serum calcium, raised or normal PTH c normal serum calcium, raised PTH d normal serum calcium, suppressed PTH e low serum calcium, raised or normal PTH |
b
|
|
The most common cause of hypoparathyroidism is:
a congenital absence of the parathyroids b autoimmune parathyroid failure c parathyroid cancer d surgical removal of the parathyroids at total thyroidectomy e acute bacterial infection |
d
|
|
Adrenal masses occur in:
a <1% of the population b 3–7% of the population c 10–20% of the population d 40–50% of the population e >66% of the population |
b
|
|
Conn’s syndrome is due to a tumour of the adrenal
cortex secreting excess: a cortisol b adrenaline c noradrenaline d aldosterone e sex steroids |
d
|
|
Paragangliomas arise from:
a the adrenal cortex b the adrenal medulla c the carotid bifurcation d the foregut e parasympathetic tissue arising from the neural crest |
e
|
|
The initial test used to diagnose Cushing’s syndrome is
measurement of: a serum cortisol and 24-hour urinary free cortisol levels b serum ACTH c serum cortisol after a dexamethasone test d plasma renin/aldosterone ratio e serum catecholamines |
a
|
|
Adrenal “incidentalomas” should be removed when they
are: a >25 cm b >10–15 cm c >3–5 cm d >1 cm e any size at all |
c
|
|
The most common form of functioning tumour of the
pancreatic islet cells is: a gastrinoma b insulinoma c somatostatinoma d vipoma e glucagonoma |
b
|
|
The Zollinger–Ellison syndrome can be controlled by
administration of: a omeprazole b folic acid c methotrexate d atenolol e atorvastatin |
a
|
|
The islets of Langerhans contain all these types of cells
except: a alpha cells b beta cells c gamma cells d delta cells e enterochromaffin cells |
d
|
|
The Snellen visual acuity in a patient is noted to be 6/60
in the right eye and 6/18 in the left eye. Which of the following statements is correct? a the Snellen acuity in the right eye is better than the left eye b the denominator expresses the distance acuity in the tested eye c the numerator expresses the near vision in the tested eye d Snellen acuity compares a tested eye to a normally seeing eye |
d
|
|
Which of the following is most likely to be found in a
patient with an orbital blow-out fracture? a proptosis b horizontal diplopia c anosmia d upper gum anaesthesia |
b
|
|
The preferred treatment for an intra-ocular infection is:
a intravenous steroids b intensive antibiotic drops c intensive antibiotic drops combined with intravenous antibiotics d intravenous antibiotics |
b
|
|
Which modality of treatment is most useful for
nasopharyngeal carcinoma? a chemotherapy b radiotherapy c surgery d immunotherapy e hormonal therapy |
b
|
|
Which of the following statement concerning
nasopharyngeal carcinoma is INCORRECT ? a keratinising SCC is most common in developed countries b examination of the nasopharynx is usually positive c in 90% of patients, cervical nodes were involved d there are known aetiological factors e the tumour tends to infiltrate widely |
b
|
|
Which of the following statement concerning parotid
gland tumours is INCORRECT ? a a cystic lesion in the lower pole is likely to be benign b a long-standing tumour that enlarges and becomes painful suggests malignancy c bilateral tumours in elderly men are usually benign d facial nerve palsy suggests malignant disease e needle aspiration cytology of parotid tumours is contraindicated |
e
|
|
The commonest tumour of the head and neck area is:
a pleomorphic tumour of the parotid gland b squamous cell carcinoma of the larynx c squamous cell carcinoma of the skin d basal cell carcinoma of the skin e carcinoma of the thyroid gland |
d
|
|
The most common paediatric soft tissue sarcoma in the
head and neck area is: a angiosarcoma b malignant fibrous histiocytoma c dermatofibrosarcoma protuberans d rhabdomyosarcoma e chondrosarcoma |
d
|
|
The highest propensity for lymph node metastasis occurs
in squamous cell carcinoma of the: a ear b scalp c upper lip d nose e lower lip |
c
|
|
The commonest type of hernia is:
a inguinal b femoral c epigastric d incisional e umbilical |
a
|
|
The most serious and urgent complication of a hernia is:
a pressure on the spermatic cord b irreducibility c obstruction d strangulation e neuralgia |
d
|
|
Indirect inguinal hernias:
a can hardly ever be distinguished from direct inguinal hernias by clinical examination b rarely occur in children c can be treated by herniotomy, herniorraphy and hernioplasty d should not be treated laparoscopically e arise beneath the inguinal ligament |
c
|
|
Femoral hernias:
a may occasionally appear above the inguinal ligament in young children b should always be repaired surgically c can be treated with a surgical truss d are caused by a defect in the cribriform fascia e may compress the femoral artery |
b
|
|
A 70-year-old man presents with a 1-cm painless nodule
on the side of his nose. This has been present for 3 weeks. The centre of the lesion appears to contain a plug of hard skin. What is the most likely diagnosis? a squamous cell carcinoma b basal cell carcinoma c keratoacanthoma d Merkel cell carcinoma e seborrhoiec keratosis |
c
|
|
A 45-year-old motor mechanic presents with a nodule on
the tip of his finger. This has been present for 12 months and it bothers him now when he presses on that finger. He seems to remember injuring that finger at work several years earlier. On examination there is a 0.5-cm nodule and the overlying skin is intact. What is the most likely diagnosis? a dermoid cyst b epidermoid cyst c pyogenic granuloma d dermatofibroma e cylindroma |
b
|
|
The parents of a 4-week-old boy are concerned about a
lump above the infant’s right eye. It has been present since birth and has not changed in size. The skin over the 1-cm lump is intact and the lump appears to be attached to the underlying tissues. What is the most likely diagnosis? a dermoid cyst b epidermoid cyst c cystic hygroma d branchial cyst e osteoma |
a
|
|
A 75-year-old man has what appears to be a 1-cm basal
cell carcinoma on the side of his nose immediately below his left eye. What would be the most appropriate treatment? a radiotherapy b application of 5-fluorouracil cream c injection of vinblastine d excision and split-skin graft e excision and full-thickness graft |
e
|
|
A 17-year-old girl presents with a painless swelling on
the anterior aspect of her right leg. This has been present for about 6 months and does not bother her much, except that it itches occasionally. The lump is pink and firm, and the overlying skin is intact. What is the most likely diagnosis? a basal cell carcinoma b epidermoid cyst c Bowen’s disease d dermatofibroma e malignant melanoma |
d
|
|
Soft tissue sarcomas are commonest in:
a the abdomen and retroperitoneum b the head and neck c the lower limb d the upper limb e the thorax |
c
|
|
The commonest site of metastasis for soft tissue
sarcomas is: a regional lymph nodes b liver c bone d lungs e brain |
d
|
|
Which of the following is an indication for removal of a
lipoma? a a 3-cm lipoma in the tibialis anterior b a 3-cm lipoma in the subcutaneous fat of the anterior abdominal wall c a 3-cm lipoma in the subcutaneous fat of the buttock d a lipoma of many years standing which has not changed in size e a lipoma on CT scanning of homogeneous density |
a
|
|
Desmoid tumours:
a are increasingly commoner in woman as they age b occur in the root of the mesentry in association with the FAP syndrome c cause death by metastasis d tend not to recur locally e metastasise to regional lymph nodes |
b
|
|
Cellulitis:
a is occasionally caused by Gram-negative coliforms b often occurs spontaneously without any apparent cause or organism c is treated with rest, immobilisation and high-dose penicillin d frequently requires surgical drainage e is often complicated by suppuration and skin necrosis |
c
|
|
Fournier’s gangrene:
a is a form of pyomyositis b occurs mainly in debilitated patients and can be life-threatening c is usually due to stapylococcal infection d can be treated by hyperbaric oxygen alone e is seldom managed surgically |
b
|
|
Hidradenitis suppurativa:
a is a complication of cystic fibrosis b rarely occurs in the axillae or groin c may be associated with pilonidal sinus d chronic cases are improved by excisonal surgery e antibiotics have no role in management |
d
|
|
Clostridial infections:
a are common in domestic gardeners b can usually be treated expectantly c are nearly always confined to HIV-positive patients d advanced infections resolve with hyperbaric therapy alone e require urgent surgical debridement |
e
|
|
Which of the following does not predispose to ischaemic
necrosis and wound breakdown? a excessive tension b foreign body c application of vacuum d haematoma e irradiation |
c
|
|
Lesions such as naevi, birthmarks and skin cancers can
be: a removed with elliptical excision b excised perpendicular to Langer’s lines c excised across the line of least tension or maximum laxity d excised using incisions that transgress cavities or flexion creases e closed with a z-plasty following all excisions |
a
|
|
Sutures should:
a be placed horizontally to the wound through the tissues to approximately the full depth of the wound b be the least number to maintain closure c be of the greatest calibre to maintain closure d remain once cross hatching has occurred e sutures should be left in for longer periods in young patients compared to the elderly patients |
b
|
|
A graft shaved at a dermal level, which includes elements
of the epidermis and dermis: a is a full-thickness graft b is used where large areas of skin are required c is sensate immediately after transfer d is limited by the donor defect to be closed e requires 1 week before blood flow is established in it |
b
|
|
The following are critical determinants of patient
outcome following injury, EXCEPT: a time from injury to definitive care b presence of a well-organised regional system of trauma care c protocols and guidelines when clinical experience is limited d early mobilisation of teams led by doctors to most scenes of injury e thrombosis prophylaxis |
d
|
|
Hypovolaemic shock can result from any of the
following, EXCEPT: a pulmonary laceration b extradural haemorrhage c pelvic fracture d femur fracture e laceration to scalp |
b
|
|
A restrained 32-year-old male involved in a head-on
motor vehicle collision presents with chest pain and the following vital signs on arrival in the emergency department: Heart rate – 120/minute; Blood pressure – 86/50; GCS score – 10; and O2 saturations of 92%. Which of the following takes first priority? a urgent CT scan of the head to rule out an extradural haemorrhage with midline shift b rapid resuscitation with 2 large-bore intravenous cannulae and warmed fluids c ECG and an echocardiogram to eliminate cardiac contusion as the cause of his hypotension d obtaining an urgent cross match e elimination of tension pneumothorax as a cause of his symptoms/signs: |
e
|
|
Which of the following is NOT considered an immediate
threat to life? a fracture of T6 with a complete spinal cord transection b splenic injury with ongoing bleeding c open pneumothorax d rapidly rising intra-cranial pressures e aspiration |
a
|
|
The volume of fluid replacement required in the first
24 hours in a 70-kg adult with 30% burns is approximately: a 2,500 mL b 4,000 mL c 7,500 mL d 10 500 mL e 12 500 mL |
c
|
|
Fluid replacement in a 70-kg adult with 30% burns
should maintain a urine flow of: a 35 mL/hour b 70 mL/hour c 105 mL/hour d 140 mL/hour e 175 mL/hour |
b
|
|
Mesh split skin grafts are used in burns because:
a they release haematomas b they cause less pain c they produce a better cosmetic result d the donor site heals more quickly e all of the above |
a
|
|
Which of the following bacteria occur commonly in burn
wound infections? a Klebsiella spp. b Clostridium difficile c Bacteroides fragilis d Staphylococcus epidermidis e Pseudomonas pyocyanea |
e
|
|
Radiologic evidence of an acute fracture includes:
a loss of continuity in cortical bone b osteoporosis c sclerosis of bone d reduced adjacent soft tissue markings e gas in the surrounding muscle |
a
|
|
In assessing the severity of an acute fracture, one must
always: a examine for subcutaneous emphysema b examine for evidence of gangrene c examine the status of the neurovascular system of the fractured part d examine for a temperature and arrhythmia e examine for evidence of a fat embolism |
c
|
|
The cardinal feature of a compartment syndrome are:
a pain b hyperthermia c rubor d punctate ecchymosis e limb hyperactivity |
a
|
|
When a plaster cast is applied for a fractured wrist, care
must be taken to instruct the patient on symptoms of: a pulmonary embolism b fat embolism c air embolism d compartment syndrome e Choong–Baker syndrome |
d
|
|
Dislocation may be missed in the following circumstance:
a posterior dislocation of the hip b posterior dislocation of the shoulder c posterior dislocation of the elbow d posterior dislocation of the sternoclavicular joint e posterior dislocation of the knee |
b
|
|
Degenerative arthritis is a common condition
characterised by: a joint pain, stiffness, contracture and deformity b recurrent haemarthroses, joint swelling and a charcot joint c high temperature, exquisite joint pain and constitutional symptoms d flitting arthralgia, skin rash and sore throat e single joint swelling, conjunctivitis and urethritis |
a
|
|
The radiologic features of degenerative arthritis include:
a syndesmophytes, bamboo spine b joint narrowing, subchondral sclerosis, osteophyte formation, cyst formation c joint debris, density, derangement and destruction d osteoporosis, valgus knee, marked joint synovitis |
b
|
|
Crystal arthropathy may be seen in the following
condition: a hyperurecaemia b chondrodysplasia c haemachromatosis d Osgood–Schlatters disease e osteochondritis dissecans |
a
|
|
Septic arthritis is associated with the following features:
a exquisite pain with attempted joint motion b minimal constitutional symptoms c low incidence in children d low incidence in the elderly e never associated with trauma |
a
|
|
Septic arthritis should be managed urgently with:
a amputation b arthrodesis c arthrocentesis d arthrocutaneous fistula e arthroplasty |
c
|
|
In the treatment of head injury, the following is true:
a steroids are regularly used b patients with a Glasgow Coma Scale score less than 8 are usually intubated and ventilated c antibiotics are routinely used d pyrexia is nearly always due to severe infection e severe fluid restriction is necessary |
b
|
|
The best investigation for patients with severe head
injury is: a CT Scan b skull X-ray c EEG d ultrasound e MRI |
a
|
|
Traumatic intracerebral haematomas following blunt
trauma: a can usually be diagnosed by skull X-ray b are usually associated with severe brain injury c always need to be drained d should be treated with fluid restriction e are always associated with a skull fracture |
b
|
|
An acute subdural haematoma:
a shows a characteristic hyperdense extra-cerebral mass b is often associated with only a minor head injury c virtually never need surgical excision d can always be managed with diuretic therapy e usually causes an ipsilateral hemiparesis |
a
|
|
The following is true:
a meningiomas are the most common adult brain tumours b brain tumours are rare in children c high-grade cerebral gliomas are invariably fatal d metastatic cancer in the brain is uncommon e oligodendroglioma is the most common type of glioma |
c
|
|
Cerebral gliomas in adults:
a do not infiltrate through the brain b are best managed with chemotherapy c rarely cause raised intracranial pressure d are best visualised by MRI e most frequently occurs in the cerebellum |
d
|
|
Brain tumours in children:
a most commonly occur in the posterior fossa b can be cured with surgery c never metastasise d invariably have an excellent prognosis e most frequently present with epilepsy |
a
|
|
Cerebral aneurysms:
a usually occur on the peripheral intracranial vessels b can be definitively diagnosed by a CT scan c are the most common cause of subarachnoid haemorrhage in adults d are virtually always multiple e usually present with focal seizures |
c
|
|
Subarachnoid haemorrhage:
a is most commonly due to ruptured arterial venous malformation in adults b usually presents as an epileptic seizure as the initial symptom c must be evacuated as an emergency d is characterised by the onset of a sudden severe headache e is frequently due to haemorrhage from a tumour |
d
|
|
In considering pituitary tumours, the following is true:
a the tumour is always confined to the sellar b adults frequently present with growth retardation c prolactin-secreting tumours are best treated with surgery d ACTH-secreting tumours cause Cushing’s disease e posterior pituitary function is almost always absent in patients presenting with large tumours |
d
|
|
Carpal tunnel syndrome:
a most frequently occurs in men b is due to the compression of the ulnar nerve at the wrist c usually causes severe weakness in the hand d is especially associated with pregnancy and lactation e causes decreased sensation on the dorsum of the hand |
d
|
|
In considering spinal cord compression, the following is
true: a the most common cause is an intramedullary spinal cord tumour b the management of compression by a malignant metastatic tumour is best undertaken utilizing chemotherapy c the usual treatment for spinal cord compression due to malignant tumours is urgent surgery or radiotherapy d spinal pain is a late feature of spinal cord compression e metastatic tumours are rarely a cause of spinal cord compression |
c
|
|
In considering nerve injuries, the following is true:
a a neurapraxia almost never recovers b neurotmesis is a mild form of injury, likely to be transient c an Erb’s palsy is due to damage of the upper trunk of the brachial plexus d Horner’s syndrome in association with a brachial plexus injury is indicative of an excellent prognosis e injury to the radial nerve in the upper arm causes weakness of finger flexion |
c
|
|
Considering peripheral nerve entrapments, the following
is true: a the ulnar nerve is frequently trapped at the elbow in front of the medial epicondyle b carpal tunnel syndrome is due to entrapment of the radial nerve at the wrist c meralgia paraesthetica is due to entrapment of the lateral cutaneous nerve of the thigh d the principal symptom of meralgia paraesthetica is weakness of the leg e the early features of ulnar nerve entrapment at the elbow is numbness involving the thumb and index finger |
c
|
|
Which of the following is true about a pulsatile mass in
the abdomen? a it must be an aortic aneurysm b an ultrasound would be the best initial investigation c no imaging is needed if the mass is not tender d immediate surgery is indicated e immediate angiography is indicated |
b
|
|
Which of the following suggest that acute arterial
ischaemia is due to embolus in a 70-year-old woman? a she is in atrial fibrillation b her symptoms developed slowly over a month c she has had long-standing intermittent claudication d she smokes e she is an insulin-dependent diabetic |
a
|
|
Which of the following is true about arterial trauma?
a all arterial injury is associated with pulsatile bleeding b the commonest cause in Australia is penetrating injury c the distal pulses will be absent d there is no relationship to major joint dislocations e bleeding is more likely with partial than with complete arterial transection |
e
|
|
Which of the following is true about the diabetic foot
complications? a the neuropathy is only sensory b there is no relation to ongoing smoking c the metatarsal phalangeal joints do not dislocate d the prognosis is worse with arterial disease and ongoing smoking e there is no place for surgical management |
d
|
|
Which of the following is not true about the anatomy of
extracranial arterial disease? a the left subclavian artery arises directly from the aortic arch b the vertebral artery is a branch of the subclavian carotid artery c the vertebral arteries form the basilar artery d there is no communication between the anterior and posterior cerebral circulations e there is a low-resistance flow pattern in the internal carotid artery |
d
|
|
An 80-year-old woman presents with transient right
hemiparesis, lasting 15 minutes and resolving completely. She is otherwise healthy and independent. Her carotid duplex scan shows >80% stenosis of her left internal carotid artery. Despite aspirin therapy, she has a further episode. Which of the following statements is true? a she is best managed on warfarin therapy b left carotid endarterectomy is indicated c carotid stenting is a preferred option to surgery d she is facing a cumulative 5% stroke within the next 3 years e lowering her blood cholesterol level will reduce her immediate risk of stroke |
b
|
|
Which of the following is true about the pathology of
extracranial arterial disease? a atherosclerosis is the commonest cause of internal carotid stenosis b recurrent stenosis occurs in >50% of patients after carotid endarterectomy c carotid body tumours arise from the vertebral arteries d fibromuscular disease is commonest in young men e Takayasu’s disease is commonly known as ‘pulsing disease’ |
a
|
|
Which if the following is true about carotid
endarterectomy? a it is associated with a high (>5%) risk of peri-operative stroke b closure with a patch decreases the risk of recurrent stenosis c there is a plane between the atheromatous plaque and the intima d it is the procedure of choice for fibromuscular disease e it precludes the use of a carotid stent for recurrent stenosis |
b
|
|
A 65-year-old man presents with angina, and a left neck
bruit is heard. Which of the following statements is correct? a the first priority is investigation of the bruit b the bruit may be arising from the aortic valve c a carotid angiogram in indicated d there is no relationship between angina and a carotid bruit e the left internal carotid artery must be occluded |
b
|
|
With regards to varicose veins, which of the following is
incorrect? a varicose veins are dilated, tortuous and visible when the patient is standing b valvular incompetence is an integral component of the pathogenesis of varicose veins c the principal superficial venous systems of the lower limbs are the long and the short saphenous systems d the principal route of venous drainage from the lower limb is via the superficial venous system e the principal driver of venous drainage from the legs in the erect position is the calf pump |
d
|
|
Which of the following is incorrect? Patients with
varicose veins may present to their doctor because of: a calf pain after walking 200 m that is relieved by resting for 5 minutes b a superficial ulcer on the ankle c aching discomfort in the calf after prolonged standing d superficial thrombophlebitis e spontaneous bleeding from a varix |
a
|
|
Which ONE of the following is correct?
a venography is an accurate method for investigating varicose veins b duplex scanning has little to add to the pre-operative investigation of varicose veins c the most frequent cause of recurrent varicose veins is neovascularisation d due to frequent, serious late complications, all patients with varicose veins should be advised to have surgery e patients with varicose veins and who have haemosiderin deposits and liposclerosis at the ankle should be treated |
e
|
|
Which of the following is NOT true in the management
of patients with varicose veins? a below-knee-length elastic stockings may be definitive treatment in the patient in whom surgery is contraindicated because of co-morbidities b injection with a sclerosing agent followed by elastic compression for 4–6 weeks can be beneficial c using a below-knee elastic stocking may help decide if calf symptoms are due to varices d surgical trials have demonstrated that it is not necessary to remove the long saphenous vein in the thigh e endoscopic techniques to divide incompetent perforating veins have been developed |
d
|
|
Primary lymphoedema:
a should be differentiated from oedema due to varicose veins with a duplex scan b should be investigated with lymphoscintography before deciding on treatment c is more common in women d usually responds to nocturnal elevation and elastic compression during the day e the response to therapy is monitored by serial measurement of limb circumference |
b
|
|
Which of the following is not correct with respect to
upper tract urinary calculi? a approximately 80% of upper tract stones pass spontaneously b calcium oxalate is the commonest component of these stones c diuresis at the time of an episode of ureteric colic facilitates spontaneous passage of the stone d urate calculi may be dissolved with alkalinisation of urine e infection stones are most commonly associated with Proteus species of bacteria, which contain urease |
c
|
|
Which of the following is correct with respect to prostate
cancer? a compared with men under the age of 65 years, prostate cancer in the elderly is very rarely an aggressive cancer b most patients diagnosed with prostate cancer present with lower urinary tract symptoms c 80% of men presenting with an elevated serum prostate specific antigen (PSA) have prostate cancer d approximately 95% of prostate cancer patients have a durable response (>36 months) to androgen suppression therapy e the obturator, internal iliac and presacral lymph nodes are commonly involved in prostate cancer metastases |
e
|
|
Which of the following is correct?
a ‘obstructive symptoms’ of hesitancy, a reduced flow and terminal dribbling indicate bladder outflow obstruction (BOO) in more than 90% of men 50 years and over b benign prostatic hyperplasia (BPH) is predominantly a stromal hyperplasia c a residual of more than 100 mL on three consecutive occasions is diagnostic of BOO d the size of the prostate on digital rectal examination (DRE) is a reliable indicator of the presence or absence of BOO e all men with chronic urinary retention benefit clinically from transurethral resection of the prostate |
b
|
|
Which of the following is not correct?
a a mid-stream specimen of urine (m/s/u) submitted for microscopy, culture and sensitivities (m/c/s) remains the standard approach for diagnosing a urinary tract infection b vesico-ureteric reflux of infected urine in infancy causes reflux nephropathy c patients with reflux nephropathy are at risk for developing chronic pyelonephritis, hypertension and renal failure d E. coli is the bacterium responsible for most urinary tract infections e first-line management of a 20-year-old woman with her first episode of lower urinary tract symptoms of acute onset involves obtaining an m/s/u for m/c/s and prescribing a 10-day course of one of the new quinolone drugs (ciprafloxacin or norfloxacin) |
e
|
|
Your recommendation for a 45-year-old man with a
history of suspected haematuria 2 weeks earlier, who is currently asymptomatic, is: a an m/s/u submitted for m/c/s, voided urinary cytology and ultrasound examination of both upper and lower tracts b an m/s/u submitted for m/c/s, voided urinary cytology, intravenous urography and cystourethroscopy c reassurance with advice to return if and when the bleeding recurs for investigation at that time d an m/s/u submitted for m/c/s and voided urinary cytology e an m/s/u submitted for m/c/s, voided urinary cytology and CT scan of the urinary tract |
b
|
|
Penile cancer has the following characteristics except:
a almost exclusively found in the uncircumcised male b commonly associated with the human papilloma virus c usually a squamous cell carcinoma d commonly involves the inguinal lymph nodes e is most commonly treated with radiotherapy |
e
|
|
Which of the following features is true of testicular
cancer? a is most common in elderly men b arises most commonly from germ cells c commonly metastasises to the inguinal nodes d is insensitive to radiation therapy e has a 75% cure rate |
b
|
|
The coronary artery bypass graft conduit with the
highest patency after 5 and 10 years is: a left internal thoracic artery b right internal thoracic artery c left radial artery d right radial artery e left or right long saphenous vein |
a
|
|
Regarding the results of coronary artery bypass
grafting: a an operative mortality of over 10% is common b patients with poor left ventricular function have a higher operative mortality c older patients have less post-operative morbidity d diabetes has no influence on post-operative morbidity e the use of an internal mammary artery improves survival but does not provide long-term freedom from angina |
b
|
|
Regarding cardiac valve prosthesis:
a mechanical valves require no long-term anticoagulation b tissue valves are highly durable c mechanical valves have lower bleeding and thromboembolic rates d tissue valves are generally preferred in the mitral position e structural failure is extremely rare in mechanical valves |
e
|
|
Complications of cardiac valve replacement surgery
include: a anticoagulant (warfarin) related haemorrhage b cerebral thromboembolism c prosthetic valve endocarditis d structural deterioration of tissue valves after 10 to 15 years e all of the above |
e
|
|
Which of the following clinical signs is NOT present in a
patient with a tension pneumothorax? a tachypnoea b hypotension c elevated jugular venous pressure d tracheal deviation towards the side of the pneumothorax e hyper-resonant percussion note on the side of the pneumothorax |
d
|
|
Immediate insertion of a chest tube may be lifesaving in
which condition? a carcinoma of the lung b pulmonary embolism c tension pneumothorax d pleural effusion e lung abscess |
c
|
|
The pathological type of carcinoma of the lung with the
worst prognosis is: a small-cell carcinoma b large-cell carcinoma c adenocarcinoma d squamous cell carcinoma e adenosquamous cell carcinoma |
a
|
|
The greatest chance of long-term survival in a patient
with a localised carcinoma of the lung is provided by: a chemotherapy b radiotherapy c combined chemotherapy and radiotherapy d surgical excision e immunotherapy |
d
|
|
The most common cause of constipation is:
a slow-transit constipation b inadequate dietary fibre and fluids c obstruction from colorectal cancer d hypothyroidism e rectocele |
b
|
|
A 31-year-old lady lawyer has chronic constipation not
responding to laxatives. She has 80% of transit markers retained in the ascending colon 5 days after ingestion. Thyroid function tests, defecating proctogram and anorectal physiologic tests were otherwise normal. The most appropriate management is: a use a combination of laxatives, enemas and rectal washout b right hemicolectomy c total colectomy and ileorectal anastomosis d electro-colonic stimulation e aerobic dancing (high-impact type) |
c
|
|
A 24-year-old female secretary has constipation for
3 weeks after starting a new job. There are no other abdominal symptoms and no family history of colorectal cancer. The most appropriate management is: a try taking enough dietary fibre and fluids b colonoscopy and anorectal physiology tests c anorectal biofeedback therapy d teach self digital extraction of faeces from rectum e repeat thyroid function tests at least 3 times |
a
|
|
A 43-year-old mother of two children complains of
difficulty in initiating rectal evacuation. She feels there is a lump in the perineum which requires vaginal reduction prior to effective evacuation. The most appropriate management is: a teach good hygienic practices b avoid excessive sexual relationships c transit marker studies d defecating proctogram e anorectal biofeedback |
d
|
|
After a previous hysterectomy, a 55-year-old mother of 3
children complains of constipation. Defecating proctogram showed lack of relaxation of the puborectalis paradoxus at defecation. The most appropriate management is: a yoga taught by genuine Indian guru b regular use of St. Mark’s anal dilator prior to defecation c anorectal biofeedback therapy d mandatory use of squatting posture at defecation e avoid laxatives but teach rectal washout instead |
c
|
|
Which of the following is CORRECT with faecal
incontinence? a none of the treatments for faecal incontinence is satisfactory b faecal incontinence should only be managed by a specialist c sphincteroplasty is performed only if there is an intact sphincter d specialised testing with endoanal ultrasond and anorectal physiology could be helpful in managing severe faecal incontinence e specialised treatment such as sacral nerve stimulation is not available in Australia |
d
|
|
Faecal incontinence:
a is more common in men than in women b is more common than urinary incontinence c is often improved by pelvic floor exercises d is usually managed by surgery e is usually due to complications of anorectal surgery |
c
|
|
Most patients presenting with massive rectal bleeding:
a will bleed to death unless they have surgery b usually were found to have colon cancer c usually were found to have rectal cancer d should have a capsule endoscopy performed immediately e should have a proctosigmoidoscopy performed before a colonoscopy |
e
|
|
Patients with massive rectal bleeding:
a should never have surgery until the precise site and cause of rectal bleeding is identified b should have a nasogastric tube inserted before any other investigation to exclude an upper gastrointestinal source of bleeding c should proceed directly to a mesenteric angiogram d should be appropriately resuscitated e should have radionuclide scan performed immediately, regardless of the amount of bleeding |
d
|
|
The INCORRECT statement regarding passage of black,
tarry stools is: a it is usually an indication of bleeding from the upper gastrointestinal tract b it can be mimicked by the ingestion of iron medication c it is commonly a symptom of a cancer of the colon d It can be present without other symptoms e it is often but not universally associated with haematemesis |
c
|
|
The causes of haematemesis and melaena include the
following EXCEPT: a oesophageal varices b gastric ulceration c epistaxis with swallowed blood d beetroot ingestion e gastritis f Mallory–Weiss tear |
d
|
|
The following statements apply to the patient who has
suffered a GI bleed EXCEPT: a be pale and sweaty b be faint and have a bradycardia c be faint and have a tachycardia d require urgent resuscitation with normal saline initially e appear quite well with normal supine blood pressure |
b
|
|
Which of the following is the INCORRECT statement on
the diagnosis of the cause of the bleeding episode? a is the most urgent requirement in patient management b may be suspected from a history of NSAID (non steroidal inflammatory drug) intake c can made by early endoscopy of upper GI tract d can often be combined with treatment at the initial endoscopy e surgical intervention is required for ongoing blood loss |
a
|
|
INCORRECT statement on haematemesis and melaena:
a is a serious condition with a high mortality and morbidity rate? b now occurs in an older age group of patients. c has been eliminated with the advent of Cox2 inhibitor anti-inflammatory drugs. d when associated with oesophageal varices may require repeated interventions for control. e is best managed in a dedicated specialist treatment unit. |
c
|
|
Which of the following conditions may not be a cause of
obstructive jaundice? a choledochal cyst b ulcerative colitis c hydatid disease d scleroderma e chronic pancreatitis |
b
|
|
Drugs which may cause hepatotoxic drug reactions do
not include: a paracetamol b vitamin A c nitrofurantoin d flucloxacillin e oestrogen |
b
|
|
Which of the following clinical features is found in a
patient presenting with acute abdominal pain who has generalised peritonitis? a slow pulse rate b extreme restlessness and writhing around in agony c motionless with pain, worse with movement d normal bowel sounds e deep palpation of most abdominal organs is possible |
c
|
|
Acute epigastric pain is unusual in which of the following
conditions? a acute pancreatitis b acute cholecystitis c perforated peptic ulcer d acute diverticulitis e ruptured abdominal aortic aneurysm |
d
|
|
Immediate laparotomy would not be recommended in a
patient diagnosed as having which of the following conditions? a mesenteric infarction b perforated peptic ulcer with generalised peritonitis c acute pancreatitis d acute cholecystitis e ruptured abdominal aortic aneurysm |
c
|
|
Which of the following parameters is the most practical
for monitoring the progression of the underlying pathological process responsible for acute abdominal pain in a patient being initially managed non-operatively? a erythrocyte sedimentation rate (ESR) b C-reactive protein (CRP) c white cell count d white cell scan e serum phosphate |
c
|
|
Pelvic abscess that occurred 5 days after an anterior
resection of rectum: a is usually due to anastomotic leak b usually requires surgery and a Hartmann’s procedure c will usually settle with intravenous antibiotics d is best detected by MRI e is best detected by endorectal ultrasound |
a
|
|
Common causes of post-surgical pelvic abscess include:
a cholecystectomy b appendicectomy c laparoscopic but not conventional open anterior resection d rectovaginal fistula e use of powdered surgical gloves |
b
|
|
In portal hypertension:
a there is increased portal blood volume b there is a decrease in portal blood pressure c there is increased splanchnic vasoconstriction d there is hypoproteinaemia due to increased renal protein losses e there is reduced splanchnic lymphatic flow |
a
|
|
The following conditions are typically associated with
ascites: a filiariasis b Gilbert’s disease c abdominal tuberculosis d large uterine fibroids e ectopic pregnancy |
c
|
|
In patients with ascites:
a bacterial peritonitis can be prevented by prophylactic antibiotics b leveen shunts may alleviate ascites associated with portal hypertension c pancreatitis may develop d may be relieved by spironolactone e paracentesis gives long periods of relief, often lasting several months |
d
|
|
In jaundiced patients with ascites:
a there is a low risk for hepatorenal syndrome because of splanchnic vasodilatation b coagulation profiles are usually normal c the systemic blood volume is increased d the renal blood flow is increased e there is a poor prognosis when operating for malignant disease |
e
|
|
The following cancers are commonly associated with the
development of ascites: a lymphoma b endometrial c GIST tumours d mucus-secreting villous adenoma e ovarian |
e
|
|
The most common cause of enlargement of the
jugulodigastric lymph node in a child 9 years of age is: a Hodgkin’s disease b glandular fever c tonsillitis d non-Hodgkin’s lymphoma e metastatic Wilm’s tumour |
c
|
|
Metastatic involvement of the posterior triangle nodes in
the neck is most likely to be due to: a nasopharyngeal carcinoma b basal cell carcinoma of the shoulder region c laryngeal carcinoma d squamous cell carcinoma of the posterior scalp e carcinoma of the oesophagus |
d
|
|
The symptoms of dysphagia include the following
EXCEPT: a very common and thus can be ignored in most cases b may be associated with reflux symptoms c may be associated with significant pain d can present acutely with total obstruction of the oesophagus e may be associated with diminished pharyngeal propulsion |
a
|
|
The causes of dysphagia may be the following EXCEPT:
a classified as pharyngo-oesophageal and oesophageal b pharyngo-oesophageal causes are often neurological in origin, e.g. CVA c associated with altered motility of the oesophagus d achalasia is a disease primarily of the oesophageal musculature and is coexistent with gastro-oesophageal reflux e be associated with an adenocarcinoma of the mucosal lining |
d
|
|
The cause of dysphagia can often be identified by the
following EXCEPT: a upper GI endoscopy b barium swallow examination c upper abdominal ultrasound examination d CT examination of the chest e oesophageal manometry |
c
|
|
Patients with dysphagia may complain of the following
EXCEPT: a regurgitation of fluid and food when recumbent at night b difficulty with swallowing fluids more than solid food c difficulty with swallowing solid food more than liquids d may have significant weight loss e may have no weight loss f their partner may complain of snoring |
f
|
|
dysphagia can be caused by the following EXCEPT:
a benign strictures in the oesophagus b squamous carcinoma of the oesophagus c pharyngeal diverticulum d oesophageal spasm e uncomplicated sliding hiatus hernia |
e
|
|
A 65-year-old woman has a chronic leg ulcer. Which of
the following is the least likely case? a squamous cell carcinoma b giant cell arteritis c superficial venous valvular incompetence d deep venous valvular incompetence e trauma |
b
|
|
The most important measure to get a chronic venous
ulcer to heal is: a apply a dressing b stop smoking c apply compression bandaging/stockings d surgery to excise the ulcer e counselling |
c
|
|
Which of the following is true regarding chronic leg
ulcers? a they are generally well managed b 80% are due to superficial venous insufficiency c a biopsy is best done of the ulcer edge d basal cell carcinoma is the commonest malignancy in the leg e arterial and venous ulcers are easily distinguished |
c
|
|
Which of the following is true regarding the calf-muscle
pump? a it plays no part in venous return to the heart b it cannot work if the valves are incompetent c it is the only musculo-venous pump d it depends on good ankle movement e it cannot work if arterial disease is present |
d
|
|
Bilateral leg swelling with pitting oedema may be caused
by the following EXCEPT: a reduced lymphatic removal of exudate b increased capillary permeability c decreased filtration pressure at the arteriolar end d reduced oncotic pressure e excessive fluid intake |
c
|
|
A 75-year-old female underwent a right-sided total hip
replacement. On post-operative day 10, she complained of discomfort and swelling over her right thigh and calf. She has been ambulating satisfactorily. Which of the following statements is true? a bed rest and diuretic therapy should be prescribed b a CT scan of the lower pelvis and right hip should be done c a Doppler study of the lower limb deep venous system should be performed d local complications of surgery is the most likely cause for the swelling e a plain X-ray of the right hip is most informative |
c
|
|
The following statements on acute lymphangitis of the
lower limb are correct EXCEPT: a improperly managed, it may lead to lymphadenitis b lymphangiography is the investigation of choice in the management c rest and elevation of the affected limb is appropriate d cellulitis may be the initiating cause e appropriate antibiotics should include cover for streptococcal infection |
b
|
|
Eight days following a low anterior resection for
carcinoma of the rectum, a 65-year-old man developed unilateral gross swelling of his right lower limb. Select the correct statement: a a diagnosis of deep venous thrombosis can confidently be made on the basis of clinical signs b deep venous thrombosis is unlikely as the patient had received peri-operative prophylactic subcutaneous heparin c a past history of superficial thrombophlebitis in this patient is almost certainly related to deep venous thrombosis d the short saphenous vein is usually the site of origin of deep venous thrombosis e ilio-femoral thrombosis is likely as it commonly follows pelvic surgery |
e
|
|
A 24-year-old female at 32 weeks’ gestation presents
with loin pain and haematuria. The best initial radiologic study is: a IVP b non-contrast CT scan c renal ultrasound d cystourethroscopy e PET scan |
c
|
|
The best evaluation of the lower urinary tract is with:
a bladder ultrasound b cystourethroscopy c voiding cystourethrogram d triple-phase CT scan e MRI |
b
|
|
You are asked to see a 65-year-old man who 3 days
previously underwent a laparotomy for a perforated duodenal ulcer. He has become confused and is causing a disturbance in the ward. You see from the notes that he suffers with chronic obstructive pulmonary disease and normally drinks three glasses of wine a day. The only medication he was taking prior to admission was atenolol. To this stage his post-operative recovery has been uneventful and he has been given morphine regularly. Your first action should be to: a start on an alcohol withdrawal protocol and give diazepam b attach a face mask and administer oxygen c examine his chest and start antibiotics d increase intravenous fluids and give 1 L isotonic saline over 4 hours e substitute pethidine for morphine on the drug chart |
b
|
|
You are called to see a 56-year-old man with dyspoea
and pleuritic chest pain. Five days earlier he underwent a laparotomy and gastric resection. On examination he has a temperature of 37.5◦C, a tachypnoea of 25, a pulse rate of 90 and a blood pressure of 130/95 mm Hg. His heart sounds are normal and there are no added sounds or murmurs. There is good air entry to both bases and the percussion note is resonant in all areas. A chest X-ray and a ventilation-perfusion scan are performed. Which one of the following combinations of test results indicates a high probability of a pulmonary embolus in a particular zone of the lung: chest X-ray ventilation scan perfusion scan a normal normal reduced b normal abnormal normal c consolidation normal reduced d consolidation abnormal normal e normal abnormal reduced |
a
|
|
You are asked to see a 65-year-old woman who feels
unwell and faint. Seven days previously she underwent an elective sigmoid colectomy for carcinoma. The procedure was uncomplicated and until now, she had been making an uneventful recovery. On examination she has a temperature of 39.5◦C, a pulse rate of 100 beats per minute and a blood pressure of 90/60 mm Hg. Her respiratory rate is 15 breaths per minute. She has cool clammy peripheries. Her abdomen is tender in the left iliac fossa, around the wound site. Which of the following is the most reasonable explanation for her current problem? a myocardial infarction b pneumonia c secondary haemorrhage d pulmonary embolus e septic shock |
e
|
|
A 72-year-old diabetic develops a discharge from his
midline abdominal wound 7 days after surgery for perforated diverticular disease. The most likely cause of the discharge is: a a faecal fistula b wound haematoma c wound infection d deep wound dehiscence e small-bowel fistula |
c
|
|
An otherwise fit 57-year-old man spikes a temperature
of 39◦C 5 days after an open appendicectomy for acute appendicitis. There is a tender, reddened and fluctuant swelling at the medial end of the wound. What is the most appropriate initial action to take? a arrange a CT scan of the abdomen b arrange an ultrasound scan of the wound and anterior abdominal wall c start the patient on oral antibiotics d open the wound to allow free drainage e send off blood samples for a white cell count and culture |
d
|
|
The claw hand:
a is sometimes called an intrinsic plus hand b occurs following a median nerve injury c results in loss of power grip of the fingers into the palm d is more obvious in a proximal, ulnar palsy than a distal palsy e includes metacarpophalangeal joint extension of the involved fingers |
e
|
|
From which of the following blood vessels does the
bleeding in a patient with massive haemopytsis usually occur? a pulmonary artery b pulmonary vein c bronchial artery d bronchial vein e thoracic aorta |
c
|
|
Which of the following lung conditions is NOT a
common cause of massive haemoptysis? a carcinoma of the lung b pulmonary arteriovenous malformation c tuberculosis d lung abscess e aspergillosis |
a
|
|
The investigation which will most reliably determine the
site of bleeding in a patient with massive haemoptysis is: a chest X-ray b CT scan of the chest c radionuclide lung scan d bronchoscopy e pulmonary angiogram |
d
|
|
Definitive therapy in a patient with massive haemoptysis
may include: a broad-spectrum antiobiotics b surgical resection of the bleeding source c pulmonary arterial embolisation d radiotherapy e all of the above |
e
|
|
Severe epistaxis in the elderly patient is most likely to be
due to: a cardiac failure b hypertension c nasal tumour d alcoholism e Osler’s Disease |
b
|
|
An L4–5 disc prolapse is most likely to cause:
a pain from the buttock across the thigh, but not beyond the knee b an L4 radiculopathy c weakness of ankle plantar flexion d weakness of extensor hallucis longus e an absent ankle jerk |
d
|
|
A cauda equina syndrome:
a is a benign clinical problem b requires urgent decompression c has no influence on bladder function d can only be present if the patient has severe leg pain e can be managed best with manipulation |
b
|
|
Which of the following features is not true of complete
testicular torison? a most common between puberty and the age of 25 years b is not associated with tenderness of the cord c pain is relieved by elevation of the scrotum d usually shows changes on colour Doppler ultrasound e requires urgent surgical treatment |
c
|
|
Torsion of a testicular appendage:
a occurs most commonly after puberty b involves the head of the epididymis c involves the hydatid of Morgagni d causes severe scrotal pain e requires urgent surgery |
c
|
|
Acute epididymo-orchitis is characterised by the
following features except: a history of urinary tract infection b rapid onset of pain c swollen tender testes d tenderness of the cord e pyrexia and leucocytosis |
b
|
|
A 30-year-old man presents with 1 week of right sciatica
and has numbness on the dorsum of his right foot and weak dorsiflexion at the ankle. Which of the following is true? a he probably has an L4–L5 disc prolapse, with compression of the L4 nerve root b he needs an urgent CT myelogram c he can be managed initially with rest and analgesics d he is likely to require surgery e he should be encouraged to undertake spinal extension exercises |
c
|
|
A 35-year-old woman presents with acute lumbar back
pain, bilateral sciatica, difficulty in voiding and on examination has weakness in the ankles and feet, absent ankle reflexes and decreased sensation in the soles of both feet. Which of the following statements is false? a she has developed an acute cauda equina compression b she has developed an acute spinal cord compression c central disc prolapse at L5–S1 is a likely cause d urgent magnetic resonance imaging is required e urgent surgery will be required |
b
|
|
A 30-year-old diabetic presents with a severe mid and
lower thoracic pain, radiation of the pain to the mid-abdomen, and on examination he is tender in the thoracic spine at the level of T10, has weak lower limbs and finds it difficult to walk. Which of the following statements is false? a CT scan will be helpful as an initial investigation b he should have an FBE and ESR c he may have a dissecting aneursym of the aorta d a needle biopsy is indicated initially e an MRI is indicated and urgent surgery should be considered |
d
|
|
Post-traumatic confusion commonly occurs due to the
following conditions except: a cerebral contusion b intracerebral haematoma c hypoxia d hypernatraemia e venous engorgement |
d
|
|
Post-traumatic confusion may require the following
treatments except: a i.v. sedatives b i.v. codeine c i.v. morphine d physical restraint e oxygen supplementation |
b
|
|
With reference to the actions of the extra-ocular
muscles, which of the following is correct? a in adduction, the superior oblique elevates the eye. b in abduction, the inferior rectus depresses the eye. c in adduction, the inferior oblique muscle intorts the eye. d in abduction, the inferior oblique muscle intorts the eye. |
b
|
|
The muscle most employed in reading is:
a the medial rectus. b the lateral rectus. c the superior oblique. d the inferior oblique. |
c
|
|
When investigating a case of diplopia, a helpful sign is:
a the patient prefers to fixate on a target with the eye with the paretic muscle. b the image from the eye with the paretic muscle is displaced most. c the paralysis of one extra-ocular muscle has no effect on the other muscles. d the patient prefers to fixate on a target with the eye with healthy muscles. |
d
|