PASTEST RECALL MAY May 2022

1.A 72-year-old man presents two weeks post-endovascular aneurysm repair of an aortic aneurysm.
He iscomplaining of a new, painless swelling in his right groin. On examination, the swelling is 2 x 1
cm, it ispulsatile and there are no signs of infection. It is most likely believed to be a pseudoaneurysm
post-procedure.
Appro management ?

Endovascular aneurysm repair

Surgical repair
Usg compression
Usg thrombin injection
U/s scan and surveillance

2.A 64-year-old man presents to the Emergency Department with an ankle injury following a road
trafficaccident. A plain radiograph shows fractures of the distal fibula and medial malleolus, with
widening of thedistal tibiofibular articulation.
How could this injury be classified?

Garden 2
Gartland 2
Weber A
Weber B
Weber C

3,A 58-year-old man is brought to the Emergency Department with a 3-day history of frequent
urination andmuscle cramps. He is now lethargic and confused as well as clinically dehydrated. He is a
well-controlled diabetic on insulin therapy who has a prior history of renal disease and is now two
years post renalt ransplant.What biochemical abnormality is most likely responsible for his current
presentation?

DKA
Diuretic therapy and hypokalemia.
Hypercalcaemic crisis secondary to tertiary hyperparathyroidism.
Hyponatremia
Cushings syndrome

4. Embryological development of trachea ?

Foregut ectoderm
Foregut mesoderm
Foregut endoderm
Midgut endoderm
Hindgut mesoderm

5. Which one of the following is a function of sympathetic nervous system ?

Miosis
Defecation
Bradycardia
Erection
Sweating

6. A 60-year-old man is brought to the Emergency Department with bleeding from a chest wound and
decreased consciousness. Examination shows a stab wound just above the xiphoid process. A Focused
Assessment with Sonography for Trauma (FAST) scan shows a pericardial effusion.
Which of the following structures is most likely to be injured?

Arch of aorta
Left atrium
Right atrium
Right ventricle
Left ventricle

7. Vit k dependent clotting factors ?

Factor V
Factor VIII
Factor IX
Factor XII
Factor XIII

8. A 78-year-old woman has undergone a wide local excision of what is thought to be a basal cell
carcinoma of her nose. The lesion was on the bridge of her nose and the surgery has left her with a
defect of 3 x 4 cm,down through the cartilaginous layer.
Best option for wound closure ?

Full thickness graft

Primary closure
Secondary closure
Skin flap
Split thickness graft

9.An 82-year-old woman is brought to the Emergency Department after she fell out of the bed at the
frail careunit of an old age home, where she is currently being treated for bronchitis. After a chest X-
ray she is diagnosed with a flail segment with fracture to the sixth, seventh and eighth ribs on the
right.Most appro management ?

Admission to a general surgical ward for analgesia

Admission to high dependency unit
Outpatient analgesia and early mobilisation
Outpt analgesia and incentive spirometey actua

10. You are called to review a 74-year-old man on the orthopedic ward who is complaining of severe
pain in the tip of his penis, following catheterisation for urinary retention after a total hip
replacement. On examination the prepuce is retracted with the glans swollen and oedematous.
What is the most likely diagnosis?

Balanitis
Balanitis xerotica obliterans
Paraphimosis
Phimosis
Traumatic catheterisation

11. A 48-year-old woman with a left nasal alae Basal Cell Carcinoma (BCC) undergoes surgical
resection. A 1cm wound is created and there is nasal cartilage loss during the surgery. The wound
heals well, however there is a residual defect over the left nasal alae.
What is the most appropriate management?
Mohs surgery
Nasolabial flap
Nasolabial flap with ear cartilage graft
Rhinoplasty
Septoplasty
12. A 66-year-old man develops sudden-onset shortness of breath four days' postoperatively after
fixation of a distal tibia fracture. On examination, his Glasgow Coma Scale (GCS) score is 15 and his
lungs are clear to auscultation, with saturations of 91% in room air. An electrocardiogram (ECG) shows
sinus tachycardia, blood tests show elevated C-reactive protein (CRP) and his chest X-ray is
unremarkable.What is the most likely diagnosis?

Atelectasis
Fat embolism
Hospital acquired pneumonia
Myocardial infarction
Pulmonary embolism

13. A 10-year-old boy is diagnosed with a pathological fracture of the femoral shaft following weeks of
severe bone pain. A computed tomography (CT) scan reveals sclerotic lesions in the pelvis and
vertebral bodies. He also reports fevers and worsening shortness of breath over recent weeks.
Most likely cause

Ewings
Neuroblastoma
Osteochondroma
Osteosarcoma
Wilms tumour

14. A 50-year-old man undergoes an uneventful anterior resection for bowel cancer. His care is guided
by the principles of the Enhanced Recovery After Surgery (ERAS) programme.
Which of the following interventions should be used as part of this approach?

Discharge from acute hospital within 24 hrs

An 8 hr preoperative fast is not required
Mobilise on day one post operatively
Remove urinary catheter and drains before pt leaves theatre

15. A 60-year-old woman presents to the Emergency Department with dyspnoea and chest pain. On
examination, her blood pressure is 140/82 mmHg, heart rate is 72 bpm, respiratory rate is 24 breaths
per minute and her oxygen saturation is 98% on room air. Her temperature is 36.7 °C. She has a
computed tomography (CT) pulmonary angiogram, which is positive for an acute pulmonary embolus.
She is already on low-molecular-weight heparin (LMWH) for treatment of previous unprovoked
pulmonary embolisms.Whats the most appropriate next step ?
Apixaban long term
Ivc filter
Remain on current LMWH
Warfarin for 3 mnths
Warfarin for 6 mnths

DOC in PE: DOACs

DOC in PE (pregnancy): LMWH (DOACs should not be used)
DOC in PE in a cancer patient: LMWH (DOACs can be used in active maalignancy but should be
avoided with GI malignancy due to an increased risk of bleeding.)
DOC in PE and Antiphospholipid syndrome: Warfarin (DOAC should not be used)

16. During a superficial parotidectomy, the facial nerve is inadvertently injured.

Which of the following problems might the patient experience?
Dry mouth
Loss of corneal reflex
Loss of taste from anterior two-thirds of tongue
Loss of taste from posterior third of tongue
Numbness of cheek

17. Which one of the following statements is the most applicable to Enhanced recovery programme?
A lumbar epidural for analgesia also minimises the duration of postoperative ileus
Insufflation with warm and humidified carbon dioxide gas has a positive benefit towards pain
control and maintenance of normothermia
Preoperative carbohydrate loading reduces postoperative Insulin resistance
Preoperative carbohydrate loading should be given within 2 hours of surgery
Postoperative early feeding has no effect on nitrogen equilibrium

18. A 25-year-old man presents with severe wrist pain after falling onto an outstretched hand with
wrist hyperextension. The patient also reports pins and needles over the thumb, index and middle
fingers. He has swelling and tenderness over the dorsal aspect of his wrist. A plain radiograph shows a
dorsally displaced capitate and normal radiolunate alignment.
What is the most likely diagnosis?
Colles' fracture
Lunate dislocation
Perilunate dislocation
Scaphoid fracture
Smith's fracture

19. A 6-week-old boy presents with projectile vomiting soon after feeding. His mother is concerned
that he is constipated and reports a small round mass in his upper abdomen.
What is the most likely diagnosis?
Gastro-oesophageal reflux disease (GORD)
Hirschsprung's disease
Idiopathic hypertrophic pyloric stenosis (IHPS)
Intussusception
Midgut volvulus

20. A 35-year-old man presents to the Emergency Department after being bitten on the nose by his
dog. He has lost the tip of his nose and a large bulk of the bridge of his nose is also missing.
What is the best option for the closure of the wound?
Full thickness skin graft
Primary closure
Secondary closure
Skin flap
Split skin graft

With a contaminated and dirty wound such as this, a significant amount of debridement may need to
beperformed depending on tissue damage and whether any infection has set in. This means the
resulting wound may actually be much larger than would be first presumed at presentation. For facial
wounds toolarge for primary closure, skin flaps are the ideal option. This is due to the good vascular
supply of facial skin,
the mobility of facial skin and the skin pigmentation match, which all combine to produce a good
aesthetic
outcome. Various types of skin flap can be used dependent on the size and location of the wound, eg
rotational, transposition and advancement.
With such a large amount of full-thickness tissue loss, leaving this wound to heal by secondary
intention is
not a viable option. Whilst the wound may heal to organised tissue, there will be a very poor aesthetic
appearance.

21. A 10-month-old baby boy is brought to the Outpatient Clinic with failure to thrive, persistent
vomiting at theonset of feeding and recurrent chest infections. He has a history of maternal
polyhydramnios.
What is the most likely diagnosis?

Duodenal atresia
Gastro-oesophageal reflux disease
Hirschsprung's disease
Hypertrophic pyloric stenosis
Tracheo-oesophageal fistula

22. You are assisting in an endoscopy to coagulate a bleeding peptic ulcer using a laser.
What type of laser is most commonly used in this type of procedure?
Argon beam
Co2
Helium neon
Nd YAG
Pulsed ruby laser

23. A 43-vear-old woman injures her lower leg in a twisting mechanism while skiing. A plain
radiograph shows an undisplaced and non-comminuted spiral fracture of the tibial shaft. There is a
moderate degree of shortening and rotation. The fibula is intact.
What is the most appropriate definitive management?
Above-knee cast followed by patella tendon-bearing cast
Backslab
External fixation
Intramedullary nail
Open reduction and internal fixation

24. A 4-year-old girl is diagnosed with a pathological proximal femur fracture with no history of
trauma. Her parents report that she has been generally unwell for a few weeks and has been suffering
abdominal distension, loss of appetite and constipation
What is the most likely diagnosis?

Neuroblastoma
Non-accidental injury
Osteogenesis imperfecta
Perthes' disease
Wilms' tumour

25. A 72-year-old man who is diagnosed with laryngeal cancer is undergoing a tracheostomy as part of
radical
neck dissection. While entering the dissected trachea, a significant amount of bleeding starts
Which of the following is the most likely direct origin of the vessel injured in this patient?

Subclavian artery

The aortic arch

The ascending aorta

The common carotid artery

The descending aorta

26. A 55-year-old chronic smoker with a past history of diabetes mellitus is undergoing cardiac bypass
surgery.
Detailed testing of the patient shows decreased venous drainage from the anterior surface of the
heart.
Which of the following veins is responsible for the venous drainage of the affected area?

Great cardiac vein

Left marginal vein

Middle cardiac vein

Right marginal vein

Small cardiac vein

27. A 66-year-old man is blue-lighted to the Stroke Unit due to new onset of ipsilateral facial palsy,
contralateral hemiparesis and vertigo. An emergency computed tomography (CT) head scan is
performed which shows a new pontine stroke.
Regarding arterial supply to the brainstem, which is the main supply likely to be affected in this
patient?

Basilar artery

Labvrinthine artery

Posterior cerebral artery

Posterior communicating artery

Vertebral artery

28. An 18-year-old man is brought to the Emergency Department after having been stabbed in the
chest during a fight. On examination, he has a wound extending just below the right nipple.
Which of the following structures is most likely to be damaged?

Oesophagus

Pulmonary trunk

Thoracic duct

Thoracic part of the descending aorta

Thymus
29. A 26-year-old man is brought to the Emergency Department in a confused state by his friends,
after drinkingalcohol. His blood pressure is 100/70 mmHg, heart rate is 76 bpm, his temperature is 37
°C and his respiratory rate is 9 breaths per minute. Physical examination shows a diminished
respiratory activity.
Which of the following areas/centres in the brain is responsible for gradually normalising the patient's
respiratory rate?

Apneustic centre

Dorsal respiratory group

Nucleus of tracts solitarius

Pneumatic centre

Ventral respiratory group

apneustic centre is located in the lower pons. It excites the respiratory centre. It causes a slow rise in
therespiratory rate because it causes slow firing of the respiratory muscles. The net result of this
process is an increase in the duration of inspiration. It results in the gradual stimulation of the
inspiratory muscles.

30. A 60-year-old woman is suspected of having a squamous cell carcinoma (SCC) on her cheek, and
surgical excision is planned.
Which of the following histological features would you expect to find when this patient's lesion is
examinedmicroscopically?

Basaloid epithelial tumour arising from the epidermis

Nests of melanocytes are found at the dermo-epidermal junction and within the dermis

Nests of melanocytes confined to the dermis

Nests of squamous epithelial cells arising from the epidermis and extending into the dermis

Pagetoid spread of melanocytes