USMLE 2018/Surgery/Basic all 92 MCQs

A 25-year-old lady, weighing 65 Kg, is having a sebaceous cyst excised from her mid back. You are asked to infiltrate local anaesthetic around the area before the sebaceous cyst can be removed. Which of the following is the maximum safe dose of lidocaine that can be used before it reaches toxic levels? Select one: 🔘 195 mg 🔘 120 mg 🔘 160 mg 🔘 250 mg 🔘 200 mg

🔘 195 mg

You are observing a 45-year-old female being prepared for induction of anaesthesia for a laparoscopic cholecystectomy. You discuss the stages of anaesthesia with the Consultant anaesthetist. From the list below, select the answer corresponding to the correct number of stages of anaesthesia? Select one: 🔘 2 🔘 5 🔘 3 🔘 1 🔘 4

🔘 4

You see a 60-year-old female presenting with haematemesis. An upper gastrointestinal endoscopy reveals bleeding oesophageal varices. From the list below, select the answer that corresponds to the correct number of areas of portosystemic anastomoses present in the abdomen? Select one: 🔘 5 🔘 2 🔘 3 🔘 1 🔘 4

🔘 5

A patient is being prepared for treatment of a fistula in the operating theatre. The consultant asks you to examine the patient and from your findings predict the course the tract is likely to have taken. You note a sinus in the 8 o'clock position with the patient in the lithotomy position. Where is the most likely point at which you may find the corresponding internal opening within the anal canal? Select one: 🔘 Along the transverse line bisecting the anal canal 🔘 It is not possible to predict 🔘 12 o'clock 🔘 6 o'clock 🔘 8 o'clock

🔘 6 o'clock

You see a 48-year-old man in the theatre admission lounge that is due for an open abdominal incisional hernia repair. The anaesthetist tells you that a high dependency unit bed has been booked for the patient owing to his co-morbidities and will therefore require close monitoring following surgery. The anaesthetist tells you that the patient falls under ASA 3. From the list below, choose the definition that best describes an ASA grading of 3? Select one: 🔘 A moribund patient who is not expected to survive without an operation 🔘 A patient with severe systemic disease 🔘 A normal healthy patient 🔘 A patient with mild systemic disease 🔘 A patient with severe systemic disease that is a constant threat to life

🔘 A patient with severe systemic disease

You are asked to review a 45-year-old man who has been admitted following acute onset of epigastric pain. His initial observations reveal a pulse of 108 beats per minute, a blood pressure of 95/80 mmHg, a respiratory rate of 32 breaths per minute and a body temperature of 38.5 °C. You are asked to take a set of blood cultures. Which of the following is correct concerning blood cultures? Select one: 🔘 Aerobic and anaerobic blood cultures will only be positive in approximately 20% of patients with sepsis 🔘 None of the above 🔘 Results from blood cultures can be obtained is less than an hour from time of analysis 🔘 Blood cultures should not be taken through in-dwelling central venous catheters 🔘 Antibiotic therapy should commence prior to taking blood cultures

🔘 Aerobic and anaerobic blood cultures will only be positive in approximately 20% of patients with sepsis

A 55-year-old Afro-Caribbean man comes to your clinic because of a red right eye. His vision is blurred and he asks you to 'turn down the bright light' as it is causing him pain. The symptoms have been getting progressively worse over the last 3 days. He was diagnosed with sarcoidosis a month ago. He denies fever or night sweats. Respiratory examination reveals bilateral wheeze. Chest radiograph shows hilar lymphadenopathy. Examination of his right eye reveals photophobia and conjunctival erythema. What is the most common eye disorder associated with sarcoidosis? Select one: 🔘 Maculopathy 🔘 Vitreous hemorrhage 🔘 Conjunctivitis 🔘 Acute glaucoma 🔘 Anterior uveitis

🔘 Anterior uveitis

During a radiological meeting at your local hospital, the Consultant Radiologist is commenting on the intra-abdominal structures found at the level of the transpyloric plane of Addison on a CT scan. At what vertebral level does this plane pass through? Select one: 🔘 None of the above 🔘 At the level of the third lumbar vertebra (L3) 🔘 At the level of the first lumbar vertebra (L1) 🔘 At the level of the second lumbar vertebra (L2) 🔘 At the level of the fourth lumbar vertebra (L4)

🔘 At the level of the first lumbar vertebra (L1)

A 41-year-old man presents to the emergency department with a severe headache that started suddenly following a weight-training session. He is treated appropriately and further examination some days later reveals a palpable lump in the left loin. An ultrasound scan confirms multiple kidney cysts and hepatomegaly, suggestive of adult polycystic kidney disease. On further questioning, he reports that his father died of a brain haemorrhage at the age of 35. Adult polycystic kidney disease is most commonly inherited by which one of the following modalities? Select one: 🔘 Autosomal dominant gene chromosome 8 🔘 Autosomal dominant gene chromosome 16 🔘 Autosomal recessive gene chromosome 16 🔘 Autosomal dominant gene chromosome 4 🔘 Autosomal recessive gene chromosome 4

🔘 Autosomal dominant gene chromosome 16

Of the following, which is not a risk factor for gastric cancer? Select one: 🔘 Helicobacter pylori 🔘 Pernicious anaemia 🔘 Partial gastrectomy 🔘 Blood group O 🔘 Dried fish

🔘 Blood group O

An 18-year-old Caucasian man presents with a 2-day history of a unilateral sore, red, right eye. He describes 'gum sticking the eyelids together'. He also describes dysuria and a painful right knee. His visual acuity is normal and examination reveals a diffusely injected conjunctiva. What is the pathogen most likely to be causing this man's symptoms? Select one: 🔘 Staphylococcus 🔘 Chlamydia 🔘 Streptococcus 🔘 Escherichia coli 🔘 Proteus

🔘 Chlamydia

A 19-year-old girl presents with a recent history of stumbling gait associated with frequent falls and increasing difficulty with her vision, requiring frequent prescription changes. She reports that her grandfather was approximately 40 years old when he died of heart failure, but she and the remainder of her family are otherwise well. Examination reveals bilateral clubbed feet, upward going plantar reflexes, scoliosis and a prominent fourth heart sound. A genetic test is performed, which shows that she is suffering from Friedrich's ataxia. This condition is the result of a defective gene on which chromosome? Select one: 🔘 Chromosome 10 🔘 Chromosome 4 🔘 Chromosome 3 🔘 X chromosome 🔘 Chromosome 9

🔘 Chromosome 9

A slim 60-year-old woman presents to the outpatient clinic with a small (2.5 cm × 1.5 cm), longstanding lump in the right groin, which is only present on standing and walking and usually disappears on lying flat. However, in recent weeks she found that she must reduce it herself when lying down. On examination, the lump is easily reduced with its origin lying below and lateral to the pubic tubercle. Which one of the following structures does not form the femoral canal? Select one: 🔘 Lacunar ligament 🔘 Pectineal ligament 🔘 Cloquet's node 🔘 Inguinal ligament 🔘 Femoral vein

🔘 Cloquet's node

You are reviewing a contrast CT of the thoracic aorta of a 65-year-old patient who has suspected aortic dissection. The radiologist asks you to name the branches of the thoracic aorta. Which of the following is not a branch of the thoracic aorta? Select one: 🔘 Coeliac trunk 🔘 Oesophageal artery 🔘 Pericardial artery 🔘 Bronchial artery 🔘 Subcostal artery

🔘 Coeliac trunk

The following are the treatment options available for the management of the patient with severe head injury. Which of the following does not have an effect on reducing intracranial pressure? Select one: 🔘 Mannitol 🔘 Barbiturates 🔘 Corticosteroids 🔘 Hyperventilation 🔘 Furosemide

🔘 Corticosteroids

A patient is sent for emergency laparoscopic cholecystectomy after being diagnosed with acute cholecystitis, which failed to resolve after 48 hours. One step of this procedure entails clamping and dividing the arterial blood supply to the gallbladder to facilitate its resection. From the list of answers below, select the artery that supplies the gallbladder? Select one: 🔘 Cystic artery 🔘 Common hepatic artery 🔘 Right hepatic artery 🔘 Gastroduodenal artery 🔘 Left hepatic artery

🔘 Cystic artery

A patient presents with symptoms suggestive of adhesive capsulitis (frozen shoulder). Which of the following systemic conditions is most commonly associated with this? Select one: 🔘 Osteoarthritis 🔘 Diabetes 🔘 Fibrotic lung disease 🔘 Systemic lupus erythematosus 🔘 Sjögren's syndrome

🔘 Diabetes

Rheumatoid arthritis is a multisystem connective tissue disease. Which of the following is not a pulmonary complication of rheumatoid arthritis? Select one: 🔘 Cavitation 🔘 Restrictive lung disease 🔘 Effusion 🔘 Obstructive lung disease 🔘 Emphysema

🔘 Emphysema

CREST syndrome is an autoimmune condition which is associated with atrophy and fibrosis of the oesophageal musculature resulting in dysphagia and reflux-type symptoms. Which of the following is not a feature of CREST syndrome? Select one: 🔘 Sclerodactyly 🔘 Erythematous malar rash 🔘 Raynaud's phenomenon 🔘 Soft tissue calcification 🔘 Telangiectasia

🔘 Erythematous malar rash

A 12-year-old boy is suspected to have a right-sided testicular torsion and is taken urgently to theatre for a scrotal exploration. Which of the following structures is not encountered during a scrotal exploration? Select one: 🔘 Tunica vaginalis 🔘 Dartos muscle 🔘 Cremaster fascia and muscle 🔘 External oblique muscle 🔘 External spermatic fascia

🔘 External oblique muscle

Which of the following is not encountered when making Kocher's (right subcostal) incision during an open cholecystectomy? Select one: 🔘 Superior epigastric vessels 🔘 Falciform ligament 🔘 Anterior rectus sheath 🔘 External oblique 🔘 Eighth intercostal nerve

🔘 Falciform ligament

During a ward round you are told to list the structures found in the adductor (Hunter's) canal. From the list below, select the statement that best describes the structures found in the adductor (Hunter's) canal? Select one: 🔘 Femoral vein, anterior tibial artery and saphenous nerve 🔘 Femoral artery, femoral vein, saphenous nerve and the nerve to the vastus medialis 🔘 Anterior tibial artery, posterior tibial artery and common peroneal nerve 🔘 Posterior tibial artery, femoral vein, saphenous nerve 🔘 Femoral artery, femoral vein, saphenous nerve and peroneal nerve

🔘 Femoral artery, femoral vein, saphenous nerve and the nerve to the vastus medialis

A 24-year-old man falls heavily on his right wrist when diving and complains of pain over the anatomical snuffbox. Scaphoid radiographs are initially normal. Subsequent MRI reveals an undisplaced fracture of the waist of the scaphoid. What is the most likely cause? Select one: 🔘 Rugby 🔘 Marathon runners 🔘 Tennis 🔘 Ballet 🔘 Football

🔘 Football

A 61-year-old teacher presents with a 3-month history of intermittent, rightsided facial pain affecting the area between his chin and lower eyelid. He reports that it occurs at any time of the day and has frequently disrupted his teaching sessions and daily activities such as brushing his teeth or having a meal. On examination, there is no obvious abnormality demonstrated. The admitting physician suspects trigeminal neuralgia in the distribution of the maxillary and mandibular branches. A specialist review is requested and appropriate treatment started. Through which of the following basal skull foramina does the mandibular branch of the trigeminal nerve (cranial nerve V3) pass? Select one: 🔘 Foramen spinosum 🔘 Foramen lacerum 🔘 Foramen ovale 🔘 Foramen rotundum 🔘 Superior orbital fissure

🔘 Foramen ovale

A 16-year-old male suffers a head injury and subsequent loss of consciousness while playing rugby. The site of impact was the right temporoparietal region and a CT scan of the head reveals a right-sided extradural haematoma with minimal midline shift. The Radiologist suspects that a branch of the middle meningeal artery is the cause of the extradural haematoma. The patient is taken urgently to theatre to evacuate the haemorrhage. From the list below, select the skull foramina through which the middle meningeal artery passes? Select one: 🔘 Foramen lacerum 🔘 Foramen ovale 🔘 Foramen spinosum 🔘 Jugular foramen 🔘 Carotid canal

🔘 Foramen spinosum

The epiploic foramen of Winslow is an important anatomical landmark as it is the only communication between the greater and the lesser sac. Of the five structures listed below, which one is not a border of the epiploic foramen of Winslow? Select one: 🔘 Caudate lobe of the liver 🔘 First part of the duodenum 🔘 Gallbladder 🔘 Hepatoduodenal ligament 🔘 Inferior vena cava

🔘 Gallbladder

During a ward round, you are asked by your senior registrar to name the most common causative factor that is responsible for the development of acute pancreatitis. Which option from the list below would you choose as your answer? Select one: 🔘 Steroids 🔘 Drugs 🔘 Ethanol 🔘 Trauma 🔘 Gallstones

🔘 Gallstones

A patient is admitted from the emergency department following a large-volume haematemesis. Oesophagogastroduodenoscopy is performed, which identifies a posteriorly positioned duodenal ulcer that is actively bleeding. The vessel responsible is? Select one: 🔘 Abdominal aorta 🔘 Right gastric artery 🔘 Gastroduodenal artery 🔘 Left gastric artery 🔘 Right gastroepiploic artery

🔘 Gastroduodenal artery

During a repair of a primary inguinal hernia, you are asked to name the nerve that is located within the spermatic cord. Which of the following is the nerve that is found within the spermatic cord? Select one: 🔘 Ilioinguinal nerve 🔘 Lateral femoral cutaneous nerve 🔘 Genital branch of the genitofemoral nerve 🔘 Genitofemoral nerve 🔘 Iliohypogastric nerve

🔘 Genital branch of the genitofemoral nerve

During a ward round you are asked about the conditions that must be met in order to qualify a patient for elective abdominal aortic aneurysm repair. From the list below, select the most likely abdominal aortic aneurysm size that warrants elective repair providing the patient is fit for surgery? Select one: 🔘 Greater than 5.0 cm 🔘 Greater than 4.5 cm 🔘 Less than 5.5 cm 🔘 Less than 5.0 cm 🔘 Greater than 5.5 cm

🔘 Greater than 5.5 cm

As part of the peripheral vascular examination, you are asked to record the ankle-brachial pressure index of the patient. Which one of the following values reflects a normal ankle-brachial pressure index? Select one: 🔘 Between 0.6 and 0.3 🔘 Less than or equal to 0.3 🔘 Between 0.9 and 0.6 🔘 Greater than or equal to 1.0 🔘 Greater than 1.3

🔘 Greater than or equal to 1.0

A 45-year-old man undergoes emergency laparotomy for suspected intraabdominal trauma. A large liver laceration is detected during laparotomy and the bleeding is difficult to control. The Consultant locates the free edge of the lesser omentum and performs Pringle's manoeuvre to control the haemorrhage. From the list below, which structures are found within the free edge of the lesser omentum? Select one: 🔘 Hepatic portal vein, hepatic artery and common bile duct 🔘 Hepatic artery and common bile duct 🔘 Hepatic artery and inferior vena cava 🔘 Common hepatic artery, cystic duct and hepatic vein 🔘 Hepatic portal vein, cystic duct and hepatic artery

🔘 Hepatic portal vein, hepatic artery and common bile duct

A 45-year-old railway worker is admitted following a crush injury to his left leg. He is talking in full sentences and complaining of pain in his leg. Further examination reveals a blood pressure of 90/58 mmHg, pulse of 99beats/min, and a swollen and bruised left leg. Intravenous access is gained, routine blood samples are taken and fluid resuscitation is commenced. In addition, the patient is catheterized for monitoring purposes but passes only a small volume of redbrown urine, which, on microscopy, is confirmed to contain myoglobin. The admitting physician makes a working diagnosis of rhabdomyolysis. Which one of the following metabolic abnormalities is not associated with this condition? Select one: 🔘 Hypernatraemia 🔘 Hyperuricaemia 🔘 Hyperphosphataemia 🔘 Hypocalcaemia 🔘 Hyperkalaemia

🔘 Hypernatraemia

A 56-year-old lady is having a total thyroidectomy for Graves' disease. During the operation she develops thyroid storm and the anaesthetist informs you that the patient has developed a tachycardia. From the list below, please choose a feature not likely to be associated with thyroid storm? Select one: 🔘 Cardiac arrhythmias 🔘 Cardiac failure 🔘 Hypothermia 🔘 Coma 🔘 Pyrexia

🔘 Hypothermia

An otherwise well 57-year-old male is 45 minutes post transurethral resection of the prostate gland for benign prostatic hyperplasia. The procedure was performed under general anaesthesia and lasted one and a half hours. You are asked to see the patient due to the fact that he has become acutely confused and drowsy. Initial observation showed an oxygen saturation of 98% on 2 litres of oxygen per minute, respiratory rate of 18 breaths per minute, pulse rate of 40 beats per minute, blood pressure of 90/70 mmHg and temperature of 37.30C. From the list below, choose the most likely cause for this patient's deterioration? Select one: 🔘 Hyperthermia 🔘 Microcytic anaemia 🔘 Hypovolaemia 🔘 Hypervolaemia 🔘 Sepsis

🔘 Hypovolaemia

While assisting in the repair of an inguinal hernia, you are asked to define the boundaries of the Hesselbach's triangle. This anatomical region is defined by? Select one: 🔘 Inguinal ligament, adductor longus muscle, sartorius muscle 🔘 Inguinal ligament, inferior epigastric vessels, sartorius muscle 🔘 Inguinal ligament, inferior epigastric vessels, rectus abdominis muscle 🔘 Inguinal ligament, inferior epigastric vessels, external oblique muscle 🔘 Transversalis fascia, inferior epigastric vessels, rectus abdominis muscle

🔘 Inguinal ligament, inferior epigastric vessels, rectus abdominis muscle

A 49-year-old male is undergoing an elective low anterior resection for a rectal adenocarcinoma. Having studied the blood supply to the large bowel, you are asked about the arterial supply to the rectum. From the list below, choose the artery that contributes to the vascular supply to the rectum? Select one: 🔘 Left gastric artery 🔘 Superior mesenteric artery 🔘 Gastroduodenal artery 🔘 Internal pudendal artery 🔘 Splenic artery

🔘 Internal pudendal artery

A 40-year-old woman presents complaining that her right eye hurts and that she cannot tolerate the bright light in the room. She is protecting her right eye with her hand. There is no history of trauma or foreign body. Visual acuity is reduced in the right eye. Examination reveals redness at the junction between the cornea and sclera of the right eye. The right pupil appears small. Slit lamp examination reveals a collection of cells in the anterior chamber of the eye. What is the most likely cause of this woman's symptoms? Select one: 🔘 Conjunctivitis 🔘 Acute closed angle glaucoma 🔘 Iritis 🔘 Corneal ulceration 🔘 Trauma

🔘 Iritis

Your senior colleague asks you to see a patient in clinic who has Fontaine's classification stage 3 peripheral vascular diseases. Which one of the following options best describes the symptoms associated with stage 3 of Fontaine's classification of peripheral vascular disease? Select one: 🔘 Intermittent claudication 🔘 Ischaemic rest pain 🔘 None of the above 🔘 Asymptomatic 🔘 Ulceration with or without gangrene

🔘 Ischaemic rest pain

A 55-year-old solicitor presents to the urology outpatients department with a 6-month history of abnormal angulated penis on erection. This has made sexual intercourse particularly difficult and painful and has been affecting his relationship with his wife. After further questioning, a diagnosis of Peyronie's disease is offered. All of the following statements regarding Peyronie's disease are true, except? Select one: 🔘 It is a connective tissue disorder of unknown origin 🔘 It is the result of a gene mutation on chromosome 5 🔘 Surgical treatment is considered only 1 year after initial presentation 🔘 Around 1% of men are affected 🔘 There is an association with Dupuytren's contracture

🔘 It is the result of a gene mutation on chromosome 5

An 18-year-old woman presents with a gradual worsening pain over the proximal forearm, with pain on resisted supination with 4+/5 weakness on extension of the metacarpals. What is the most likely cause? Select one: 🔘 Golf 🔘 Kayaking 🔘 Swimming 🔘 Javelin Throwers 🔘 Marathon runners

🔘 Kayaking

Which of the following techniques does not provide a definitive airway? Select one: 🔘 Laryngeal mask airway 🔘 Cricothyroidotomy 🔘 Endotracheal tube 🔘 Tracheostomy 🔘 Nasotracheal tube

🔘 Laryngeal mask airway

The gastro-oesophageal sphincter is not a true sphincter in that it does not rely on a ring of contractile muscle to maintain patency. It therefore relies on several other mechanisms to prevent reflux. Which of the following does not contribute to gastro-oesophageal sphincter function? Select one: 🔘 Smooth muscle of the lower oesophageal sphincter 🔘 Left crus of diaphragm 🔘 Angle of His 🔘 Intra-abdominal pressure 🔘 Right crus of diaphragm

🔘 Left crus of diaphragm

During an open repair of an abdominal aortic aneurysm, the consultant asks you to discuss the openings in the diaphragm. You discuss the structures that pass through the three main openings as well as the several smaller ones. Which of the following structures does not pass through one of the three main diaphragmatic openings? Select one: 🔘 Aorta 🔘 Oesophagus 🔘 Left phrenic nerve 🔘 Inferior vena cava 🔘 Left gastric artery

🔘 Left phrenic nerve

You examine a 35-year-old female patient who presents with a right parotid swelling. Which of the following structures does not lie within the parotid gland? Select one: 🔘 Marginal mandibular nerve 🔘 Facial nerve 🔘 External carotid artery 🔘 Retromandibular vein 🔘 Mandibular nerve

🔘 Mandibular nerve

In which one of the following scenarios is the complication of lymphedema of the arm more likely to occur after resection of a breast tumour and axillary clearance? Select one: 🔘 Mastectomy + postoperative radiotherapy 🔘 Mastectomy + axillary clearance + postoperative radiotherapy to the chest wall 🔘 Mastectomy + axillary clearance + postoperative radiotherapy to the axilla 🔘 Mastectomy + axillary clearance + systemic chemotherapy 🔘 Mastectomy + axillary clearance

🔘 Mastectomy + axillary clearance + postoperative radiotherapy to the axilla

A 7-year-old child is admitted with a supracondylar fracture. His hand is cold and pulseless; however perfusion is restored following fracture reduction. The integrity of which structure is of major concern? Select one: 🔘 Radial artery 🔘 Radial nerve 🔘 Musculocutaneous nerve 🔘 Median nerve 🔘 Ulnar artery

🔘 Median nerve

A 35-year-old housewife presents to her GP with a week-long history of dysuria, frequency and extremely strong smelling urine. A urine dipstick test confirms the presence of leucocytes and nitrites. She has previously suffered from multiple urinary tract infections, which have resolved with a short course of antibiotics. To rule out further complications of the urinary tract, an ultrasound scan is performed, which suggests the presence of a large calculus within the left pelvicalyceal system. Which one of the following microorganisms is not associated with the formation of such stones? Select one: 🔘 Proteus 🔘 Mycoplasma 🔘 Mycobacteria 🔘 Klebsiella 🔘 Pseudomonas

🔘 Mycobacteria

You are reviewing the blood culture results of a patient who was admitted to the Intensive Care Unit after developing septic shock post laparotomy for a diverticular perforation. The blood results reveal the presence of Gram negative bacteria. Which of the following is a Gram negative bacteria? Select one: 🔘 Streptococcus pneumonia 🔘 Streptococcus viridans 🔘 Staphylococcus aureus 🔘 Neisseria meningitides 🔘 Clostridium botulinum

🔘 Neisseria meningitides

A 25-year-old male sustains a right tibia and fibula fracture. He is unable to dorsiflex his right foot and has lost sensation to the dorsum of his right foot. From the list below, select the nerve that is likely to have been damaged? Select one: 🔘 Lateral plantar nerve 🔘 Tibial nerve 🔘 Sciatic nerve 🔘 Medial plantar nerve 🔘 None of the above

🔘 None of the above

During a ward round, you are asked to review a chest radiograph of a 45-yearold female who experienced difficulty breathing 1 day post laparoscopic cholecystectomy. You are quizzed about the contents of the mediastinum. From the list below, which structure does not form part of the contents of the mediastinum? Select one: 🔘 Thoracic duct 🔘 None of the above 🔘 Thymus 🔘 Trachea 🔘 Great vessels

🔘 None of the above

A worried 59-year-old city worker arrives at your clinic with a 1-month history of having noticed a non-itchy, persistent, burning rash in the region of her right breast. On examination, you find the right nipple and the skin overlying the areola to be red and eczematous. The most likely cause is? Select one: 🔘 Malignant phyllodes tumour 🔘 Basal cell carcinoma 🔘 Paget's disease of the nipple 🔘 Breast abscess 🔘 Mastitis

🔘 Paget's disease of the nipple

A 36-year-old carpenter is diagnosed with a seminoma. To which lymph nodes do a seminoma most commonly spread first? Select one: 🔘 Posterior cervical chain 🔘 Superficial inguinal lymph nodes 🔘 Para-aortic lymph nodes 🔘 Deep inguinal lymph nodes 🔘 Anterior cervical chain

🔘 Para-aortic lymph nodes

You are assisting with a primary open right inguinal hernia repair in a 27-year-old male. During the operation, the lead surgeon asks you to define the boundaries of the inguinal canal. Which of the following does not form part of the boundaries of the inguinal canal? Select one: 🔘 Inguinal ligament 🔘 Transversalis fascia and the conjoint tendon 🔘 Aponeuroses of the external and internal oblique fibres 🔘 Pectineal ligament 🔘 Arching fibres of the internal oblique and transversus abdominis muscles

🔘 Pectineal ligament

You are observing an open carpal tunnel decompression in theatre. Which of the following structures is not at risk during this procedure? Select one: 🔘 Median nerve 🔘 Posterior interosseous nerve 🔘 Superficial palmar arch 🔘 Recurrent branch of the median nerve 🔘 Palmar cutaneous branch of the median nerve

🔘 Posterior interosseous nerve

A 27-year-old primary school teacher presents with increasing weakness over the past 3 months. She has been well at the start of each day but feels weaker as the day progresses, with her voice becoming more difficult to understand after several minutes of conversation and an inability to see things clearly at the end of each day. Although the symptoms seem to subside after several hours of sleep they have become worse after a recent bout of flu. On examination, her upper arms are noted to have a reduced bulk and the eyelids appear to droop a few seconds after she is asked to look up or laterally. Her arm reflexes are initially brisk but seem to diminish after repeated testing. An autoimmune disease is suspected as the cause of her symptoms. Against which receptor is she likely to be producing antibodies? Select one: 🔘 β2-adrenergic receptor 🔘 Presynaptic acetylcholine receptor 🔘 H2 histamine receptor 🔘 Postsynaptic γ-aminobutyric acid receptor 🔘 Postsynaptic acetylcholine receptor

🔘 Postsynaptic acetylcholine receptor

Of the following options, which is not a risk factor for subdural haematoma? Select one: 🔘 Alcoholism 🔘 Pregnancy 🔘 Dementia 🔘 Schizophrenia 🔘 Old age

🔘 Pregnancy

A 62-year-old African man presents to his general practitioner in the well-man clinic for a routine check-up. His past medical history includes type 2 diabetes mellitus (diagnosed 20 years ago), hypercholesterolaemia and hypertension. He takes metformin 850 mg per day, but does not record his blood sugar regularly. He is additionally taking simvastatin and enalapril. Examination reveals no cardiovascular or respiratory abnormalities and a normal urine dipstick test. Fundoscopy reveals dot retinal haemorrhages, cotton wool spots and neovascularization. His visual acuity is not significantly impaired. Which one of the following best describes this patient's eye disease? Select one: 🔘 Pre-proliferative retinopathy 🔘 No retinopathy 🔘 Proliferative retinopathy 🔘 Background retinopathy 🔘 Diabetic maculopathy

🔘 Proliferative retinopathy

You are told that a 40-year-old woman, who has had a 4-month history of left upper limb muscular fatigue, dizziness and vertigo, has been diagnosed with subclavian steal syndrome. The most common cause of subclavian steal syndrome is? Select one: 🔘 Proximal occlusion of the left radial artery 🔘 Distal occlusion of the left subclavian artery 🔘 Proximal occlusion of the left subclavian artery 🔘 Distal occlusion of the left brachial artery 🔘 Proximal occlusion of the left brachial artery

🔘 Proximal occlusion of the left subclavian artery

An initial primary survey of the chest is intended to quickly identify the following causes of cardiorespiratory compromise, except? Select one: 🔘 Haemothorax 🔘 Tension pneumothorax 🔘 Pulmonary contusion 🔘 Cardiac tamponade 🔘 Flail chest

🔘 Pulmonary contusion

You perform an arterial blood gas investigation on the patient in Question 20. The results show a pH of 7.31, pO2 11.5, pCO2 4.1 kPa, bicarbonate 24 mmol/L and lactate 6.0. Which of the following is not a cause of lactic acidosis? Select one: 🔘 Pancreatitis 🔘 Septic shock 🔘 Pyloric stenosis 🔘 Biguanides 🔘 Excessive exercise

🔘 Pyloric stenosis

During a total thyroidectomy, the lead surgeon tells you that he must first identify and then preserve a nerve that is situated near the thyroid gland. He also tells you that this nerve is at risk of injury during thyroidectomy procedures. Which of the following nerves is he referring to? Select one: 🔘 External laryngeal nerve 🔘 Vagus nerve 🔘 Phrenic nerve 🔘 None of the above 🔘 Recurrent laryngeal nerve

🔘 Recurrent laryngeal nerve

A 45-year-old male who sustained haemorrhagic shock secondary to polytrauma is being fluid resuscitated. A central venous catheter is being inserted. From the list below, choose the answer which correctly describes where the central venous pressure is being measured from? Select one: 🔘 Left atrium 🔘 Right atrium 🔘 Left ventricle 🔘 Pulmonary veins 🔘 Aortic arch

🔘 Right atrium

A 73-year-old man attends as an outpatient 4 weeks after undergoing a right inguinal hernia repair. He reports good function and the surgical site has healed well. However, he volunteers that since the procedure, he has had a feeling of numbness over the right hemi-scrotum but no such change on the left side. Which one of the following nerves is most likely to be affected? Select one: 🔘 Femoral nerve 🔘 Genital branch of genito-femoral nerve 🔘 Sympathetic nerves 🔘 Left ilio-inguinal nerve 🔘 Right ilio-inguinal nerve

🔘 Right ilio-inguinal nerve

A 21-year-old man presents acutely with pain and tenderness over volar aspect of the distal interphalangeal joint (DIPJ) of the ring finger. On examination the ring finger has no active flexion of the DIPJ. Radiographs of the finger are normal. What is the most likely cause? Select one: 🔘 Rugby 🔘 Ballet 🔘 Tennis 🔘 Swimming 🔘 Football

🔘 Rugby

A 35-year-old female has suffered a road traffic accident while coming off her motorbike at 25 mph during a head-on collision with a car. On arrival to the emergency department, she is found to have a pneumothorax following review of her trauma series imaging. You assist the Surgical Registrar in siting a chest drain. Which of the following structures does not form part of the layers encountered when inserting a chest drain? Select one: 🔘 External intercostal muscle 🔘 Innermost intercostal muscle 🔘 Scarpa's fascia 🔘 Endothoracic fascia 🔘 Serratus anterior

🔘 Scarpa's fascia

You are in the endoscopy unit observing an endoscopic retrograde cholangio pancreatogram for a patient with deranged liver function tests also presenting with jaundice. The Consultant explains to you that he must get to the part of the duodenum where the duodenal papilla is located. From the list of answers below, which part of the duodenum is the Consultant referring to? Select one: 🔘 Second part (D2) 🔘 Fifth part (D5) 🔘 Third party (D3) 🔘 First part (D1) 🔘 Fourth part (D4)

🔘 Second part (D2)

The severity of acute pancreatitis can be assessed using the Glasgow criteria. Which of the following is not used in the calculation? Select one: 🔘 Serum amylase 🔘 Alanine aminotransferase 🔘 Serum urea 🔘 Serum calcium 🔘 White cell count

🔘 Serum amylase

You are asked to give your opinion on an abdominal plain film radiograph of a patient with bowel obstruction. The film shows distended loops of large bowel which form a 'U' shape, giving the appearance of a big coffee bean. Select the most likely reason for the large bowel obstruction? Select one: 🔘 Sigmoid volvulus 🔘 Faecal impaction 🔘 Foreign body 🔘 None of the above 🔘 Obstructing carcinoma

🔘 Sigmoid volvulus

You are observing an elective right hip replacement. The lead surgeon is accessing the hip joint via the posterior approach. From the list below, choose the correct order (from superficial to deep) and correct structures that are cut through during the posterior approach to the hip? Select one: 🔘 Skin, subcutaneous fat, short external rotator muscles, gluteal fascia, gluteus maximus and the hip joint capsule 🔘 Skin, gluteus maximus, subcutaneous fat, gluteal fascia, short external rotator muscles and the hip joint capsule 🔘 Skin, subcutaneous fat, gluteal fascia, short external rotator muscles, gluteus maximus and the hip joint capsule 🔘 Skin, subcutaneous fat, gluteal fascia, gluteus maximus, short external rotator muscles and the hip joint capsule 🔘 Skin, gluteal fascia, subcutaneous fat, short external rotator muscles, gluteus maximus and the hip joint capsule

🔘 Skin, subcutaneous fat, gluteal fascia, gluteus maximus, short external rotator muscles and the hip joint capsule

You are reviewing the blood test results of a 50-year-old man who has been admitted following a crush injury to his right leg. His serum potassium is found to be low at 2.9mmol/L following earlier correction of hyperkalaemia. You request an ECG for this patient. Which one of the following ECG changes is not characteristic of hypokalaemia? Select one: 🔘 Small and inverted T-waves 🔘 S-T segment depression 🔘 Prolonged P-R interval 🔘 Small P-waves 🔘 Presence of U-waves

🔘 Small P-waves

You are observing a tracheostomy being sited in theatre for a patient who has suffered extensive facial trauma. Which of the following structures is not encountered and traversed during insertion of a tracheostomy? Select one: 🔘 Strap muscles 🔘 Platysma muscle 🔘 Investing layer of deep cervical fascia 🔘 Thyroid isthmus 🔘 Sternocleidomastoid muscle

🔘 Sternocleidomastoid muscle

Which of the following options is not a clinical feature common in osteoarthritis and rheumatoid arthritis of the knee? Select one: 🔘 Raised C-reactive protein 🔘 Baker's cyst 🔘 Subcutaneous nodules 🔘 Muscle wasting 🔘 Joint effusion

🔘 Subcutaneous nodules

On assessment of a patient in the outpatients department you identify that they are Trendelenburg's test positive. This indicates a possible palsy of which nerve? Select one: 🔘 Sciatic 🔘 Superior gluteal 🔘 Inferior gluteal 🔘 Femoral 🔘 Obturator

🔘 Superior gluteal

A patient undergoes a laparotomy for large-bowel obstruction secondary to an obstructing sigmoid colonic lesion confirmed on a CT scan. The Surgical Registrar asks you about the formation of the marginal artery of Drummond. Which two vessels from the list below anastomose to form the marginal artery of Drummond? Select one: 🔘 Inferior mesenteric artery and the splenic artery 🔘 Inferior mesenteric artery and middle rectal artery 🔘 Superior mesenteric artery and the splenic artery 🔘 Superior mesenteric artery and inferior mesenteric artery 🔘 Inferior mesenteric artery with superior rectal artery

🔘 Superior mesenteric artery and inferior mesenteric artery

As the external carotid artery courses infero-superiorly from the common carotid bifurcation, it gives off the first of seven arterial branches just below the greater cornu of the hyoid bone. From the list below, select the name of the first branch of the external carotid artery? Select one: 🔘 Lingual artery 🔘 Facial artery 🔘 Ascending pharyngeal artery 🔘 Maxillary artery 🔘 Superior thyroid artery

🔘 Superior thyroid artery

You are assisting with a total thyroidectomy for a patient who has a goiter and is experiencing compressive symptoms. The Surgical Registrar asks you to name the artery supplying the thyroid gland, which originates from the external carotid artery. From the list below, choose the most likely answer? Select one: 🔘 Thyroid ima artery 🔘 Inferior thyroid artery 🔘 Lingual artery 🔘 Superior thyroid artery 🔘 Ascending pharyngeal artery

🔘 Superior thyroid artery

You are shadowing the Breast Surgery Consultant during a clinical consultation. He begins to explain that he has a patient who is due for a right-sided axillary lymph node clearance the following day. He tells you that he will perform a Level 3 axillary lymph node clearance. From the list below, please select the answer that best describes the location of Level 3 axillary lymph nodes? Select one: 🔘 Superomedial to pectoralis minor 🔘 Lateral to pectoralis minor 🔘 Posterior to pectoralis major 🔘 Posterior to pectoralis minor 🔘 Anterior to pectoralis major

🔘 Superomedial to pectoralis minor

A patient with longstanding osteoarthritis presents with pain on movement of his shoulder. You perform a full shoulder exam. You note that you can re-create the pain by asking the patient to abduct his shoulder against resistance. You conclude that there is impingement of which one of the following structures? Select one: 🔘 Supraspinatus 🔘 Teres minor 🔘 Infraspinatus 🔘 Subacromial bursa 🔘 Subscapularis

🔘 Supraspinatus

While explaining the procedure of a lumbar puncture to a junior colleague, you are asked about the layers through which the lumbar puncture needle must pass before reaching the area containing cerebrospinal fluid. After piercing the skin and subcutaneous tissues, which anatomical structure would be traversed next during a tap? Select one: 🔘 Interspinous ligament 🔘 Ligamentum flavum 🔘 Supraspinous ligament 🔘 Epidural space 🔘 Dura mater

🔘 Supraspinous ligament

Dupuytren's contracture is caused by a thickening of the palmar fascia. It is associated with the following conditions, except? Select one: 🔘 Alcoholic cirrhosis 🔘 Acquired immune deficiency syndrome 🔘 Peyronie's disease 🔘 Epilepsy 🔘 Syphilis

🔘 Syphilis

You are examining a patient and looking for the second intercostal place by finding the manubriosternal junction (also known as the 'angle of Louis'). From the list below, choose the vertebral level that corresponds to the manubriosternal junction? Select one: 🔘 T1 🔘 T4 🔘 T2 🔘 T3 🔘 T5

🔘 T4

A 38-year-old woman presents with pain over the lateral aspect of her right elbow. The pain is reproduced when her wrist is extended against resistance. What is the most likely cause? Select one: 🔘 Marathon runners 🔘 Ballet 🔘 Football 🔘 Tennis 🔘 Rugby

🔘 Tennis

A 67-year-old female is taken to theatre for suspected bowel perforation. The oncall anaesthetist is inserting a central venous catheter through the subclavian vein. From the list below which structure is at less risk of damage during this procedure? Select one: 🔘 Thoracic aorta 🔘 Thoracic duct on the left side 🔘 Subclavian artery 🔘 Apex of the lung 🔘 Phrenic nerve

🔘 Thoracic aorta

An 80-year-old man presents to his GP with a 6-month history of increasing urinary frequency. He passes urine approximately eight times during the day and six times each night, but feels that he has not completely voided. In addition, he reports that his stream is very slow and finds it hard to stop, with micturition prolonged due to terminal dribbling. He is otherwise fit and healthy with no other symptoms reported. On rectal examination, the prostate is found to be smoothly enlarged with no other significant findings on systemic examination. Which of the following layers of the prostate gland is likely to be enlarged in this man? Select one: 🔘 Anterior fibromuscular stroma 🔘 Central zone 🔘 All of the above 🔘 Peripheral zone 🔘 Transition zone

🔘 Transition zone

A 34-year-old father of five children attends the family planning clinic for advice on birth control. After discussing the various options available, he requests a vasectomy. Which of the following structures lies most proximal to the vas deferens (ductus deferens)? Select one: 🔘 Internal spermatic fascia 🔘 External spermatic fascia 🔘 Preperitoneal fat 🔘 Superficial scrotal fascia (Dartos fascia) 🔘 Tunica vaginalis

🔘 Tunica vaginalis

A patient presents to the outpatient clinic with weakness in their hand. You perform a detailed neurological examination and find the following: generalized wasting sparing the thenar and hypothenar eminence, with normal sensation over the palmar aspect of the fifth finger and the medial aspect of the fourth finger. Sensation to the medial aspect of the palm is spared. The hand is clawed and you elicit a positive Froment's test. The level of the ulnar nerve lesion is therefore? Select one: 🔘 Medial epicondyle of the humerus 🔘 Wrist 🔘 Ulnar tunnel 🔘 Brachial plexus 🔘 Compression between the heads of flexor carpi ulnaris

🔘 Ulnar tunnel

A female patient is admitted following a domestic assault during which she sustained an isolated head injury. On admission she had a Glasgow Coma Scale score of 13/15 but remained confused. She was therefore admitted overnight for observations. You are called to see her by the high-dependency unit nurses who have noticed a drop in her Glasgow Coma Scale score to 8/15. On examination you note her left pupil is now fixed and dilated. The most likely cause of this is? Select one: 🔘 Isolated III nerve palsy 🔘 Uncal herniation 🔘 Basal skull fracture 🔘 Transient ischaemic attack/cerebrovascular accident 🔘 Previously undocumented eye trauma

🔘 Uncal herniation

A patient is admitted following a road traffic accident. He has a suspected liver laceration and is taken to theatre for a laparotomy. The surgeon performing the procedure asks you to name the other intraperitoneal organs within the abdomen. Which of the following abdominal organs is not classified as intraperitoneal? Select one: 🔘 Gallbladder 🔘 Transverse colon 🔘 Ureters 🔘 Caecum 🔘 Stomach

🔘 Ureters

A 64-year-old Caucasian man presents with a 1-week history of an erythematous vesicular rash on the right side of his face and forehead. He also complains of a painful red right eye. His visual acuity is reduced on the right. Slit lamp assessment with fluorescein stain reveals a discrete green patch under blue light. What is the most likely cause for the acute red eye in this patient? Select one: 🔘 Acute closed angle glaucoma 🔘 Varicella zoster corneal ulcer 🔘 Conjunctivitis 🔘 Iridiocyclitis 🔘 Herpes simplex corneal ulcer

🔘 Varicella zoster corneal ulcer

You are assessing the nutritional status of a patient in the Intensive Care Unit who has been admitted with polytrauma. The Consultant has advised the team that this patient will require a period of total parenteral nutrition (TPN). You are discussing the essential elements which the TPN feed should contain. Which of the following is referred to as a fat-soluble vitamin involved in cell membrane stabilisation and retinal function? Select one: 🔘 Vitamin A 🔘 Vitamin C 🔘 Vitamin B1 🔘 Vitamin K 🔘 Vitamin D

🔘 Vitamin A

A 45-year-old woman is diagnosed with a submandibular calculus, having presented with a tender lump below the jaw on eating. Which structure is likely to be obstructed? Select one: 🔘 Stensen's duct 🔘 Facial nerve 🔘 Biliary duct 🔘 Warthin's duct 🔘 Lingual nerve

🔘 Warthin's duct