june 2020 test Flashcards

1
Q
  1. Pathophysiology of lung abscess is not correct (Lower Respiratory Tract Surgery)
    a) Hoarse voice
    b) Immunosuppressive state may be important
    c) Poor dental hygiene may play a role
    d) Gastro oesophageal reflux would be an insignificant finding.
A

d) Gastro oesophageal reflux would be an insignificant finding.

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2
Q
  1. Clinical presentation of lung abscess is not correct (Lower Respiratory Tract Surgery)
    a) history of night sweats
    b) weight loss
    c) presentation clinically different from pneumonia
    d) Sputum may be purulent
A

c) presentation clinically different from pneumonia

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3
Q

3) Statements regarding investigations is not correct (Immunology - slide 9)
a) On x ray it is common to see an air fluid level within the abscess cavity
b) CT scan may show cavitation with the adjacent consolidation
c) Bronchoscopy is helpful to rule out associated endobronchial obstruction
d) Ultrasound is the investigation of choice because of accuracy and non invasiveness and convenience

A

d) Ultrasound is the investigation of choice because of accuracy and non invasiveness and convenience

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4
Q
  1. Not regarded as a principle of management of lung abscess
    a) Causative organisms should be identified ASAP
    b) Adequate drainage into the tracheobronchial tree is desirable
    c) Even though response to medical treatment is generally poor, it should be started to avoid surgery
    d) External drainage is indicated if there is no drainage into the tracheobronchial tree
A

c) Even though response to medical treatment is generally poor, it should be started to avoid surgery

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5
Q
  1. Not correct regarding patient management
    a) Mobilization is contraindicated because it promotes spread of infection to lower lobes
    b) Postural drainage is a key element
    c) Educate pt regarding management
    d) Physio plays a major role
A

a) Mobilization is contraindicated because it promotes spread of infection to lower lobes

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6
Q
  1. Regarding auto immune disease is not correct
    a) Auto immunity is an immune response against a self antigen
    b) Endocrine glands appear to be susceptible
    c) Any organ can be affected
    d) Type 2 diabetes is an example of a generalized non-organ specific form of an auto immunity
A

d) Type 2 diabetes is an example of a generalized non-organ specific form of an auto immunity

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7
Q
  1. Regarding type 1 hypersensitivity is not correct
    a) degranulation of cells and release of chemical mediators
    b) type 1 involves IgM antibody which binds to mast cells
    c) type 1 reaction is immediate
    d) Auto-immune haemolytic anaemia is a good example of type 1
A

b) type 1 involves IgM antibody which binds to mast cells

d) Auto-immune haemolytic anaemia is a good example of type 1

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8
Q
  1. Which of the following conditions is not an example of type IV/cell-mediated hypersensitivity (Autoimmune- Slide 10)
    a) Allergic asthma
    b) Contact dermatitis
    c) rheumatoid arthritis
    d) tuberculosis
A

a) Allergic asthma

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9
Q
  1. Regarding molecular mimicry is not correct (Autoimmune)
    a) RA involves infection and mimicry
    b) with certain infections there is a structural similarity between microbial antigens and self proteins
    c) Rheumatic fever typically involves infection and mimicry
    d) Similarity results in activation of self-reactive lymphocytes
A

c) Rheumatic fever typically involves infection and mimicry

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10
Q
  1. Regarding RA is not correct (Autoimmune)
    a) Pt may have associated anaemia
    b) 20-40 years
    C) Small joints in the hands and feet are affected
A

b) 20-40 years

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11
Q
  1. Regarding radiation is not correct (Radiation & Chemotherapy)
    a) ionizing radiation may be used to treat cancer but may also be used for diagnosis of disease
    B) Ionizing radiation is capable of removing tightly-bound electrons to form ions within tissues of the body
    c) Production of ions requires energy of long wavelength and low frequency
    d) Radiation is the emission of energy in the form of waves or high speed particles
A

c) Production of ions requires energy of long wavelength and low frequency

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12
Q
  1. Regarding radiation-induced cellular injury is not correct (Radiation & Chemotherapy)
    a) Radiation may result in the generation of free radicals which are capable of causing damage
    b) DNA may be damaged but chromosomes are not
    c) Injured cells are eliminated by apoptosis
    d) Radiation may directly injure cellular organelles such as mitochondria
A

b) DNA may be damaged but chromosomes are not

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13
Q
  1. Not a determinant of the biological effects of ionizing radiation (Radiation & Chemotherapy)
    a) The larger the dose of radiation the more the tissue damage
    b) Continuous radiation more damaging than intermittent or periodic treatment that delivers the same total amount
    c) During radiation treatment cell injury may be less in hypoxic tissue or enhanced by hyperbaric oxygen treatment
    d) Slowly-dividing cells are highly susceptible to radiation, allowing more adage to occur to them during the treatment
A

d) Slowly-dividing cells are highly susceptible to radiation, allowing more adage to occur to them during the treatment

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14
Q
  1. Effects of ionizing radiation is not correct (Radiation & Chemotherapy)
    a) serious consequences may arise if bone marrow and the lymphoid system are affected
    b) fibrosis within tissue is a common consequence
    c) every effort should be made to protect the adult brain from injury due to its extreme sensitivity
    d) injury to blood vessels is common
A

c) every effort should be made to protect the adult brain from injury due to its extreme sensitivity

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15
Q
  1. Not a typical respiratory consequence of irradiation
    a) pneumonia
    b) cor pulmonale
    c) productive cough
    d) dyspnea
A

c) productive cough

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16
Q
  1. Acute Coronary Syndrome
    a) Coronary artery dissection
    b) vasculitic syndromes
    c) coronary embolism from a deep vein thrombosis
    d) coronary trauma
A

c) coronary embolism from a deep vein thrombosis

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17
Q
  1. Cardiovascular effects of drugs is not correct
    a) b-adrenergic blockers affect myocardial contractility
    b) nitrates affect afterload
    c) b-adrenergic blockers affect heart rate
    d) nitrates affect myocardial contractility
A

d) nitrates affect myocardial contractility

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18
Q
  1. ECG characteristics is not associated with myocardial infarction
    a) Inverted T wave
    b) Deep Q wave
    C) ST segment elevation
    d) inverted q/p waves
A

d) inverted q/p waves

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19
Q

19) which drug does not increase peripheral vascular resistance
a) dopamine
b) adrenaline
c) phenylephrine
d) propranolol

A

d) propranolol

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20
Q

20) regarding cell injury is not correct (cell injury)
a) damage to endoplasmic reticulum affects protein synthesis
b) cell membranes are damaged
c) cells may become waterlogged
d) energy production is impaired due to damage to the nucleus

A

d) energy production is impaired due to damage to the nucleus

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21
Q
  1. Regarding ischaemia is not correct (ischaemia and infarction)
    a) hypoxia causes irreversible tissue whereas ischaemia does not
    b) clearance of metabolites is compromised
    c) ischaemia involves cellular injury from reduced blood flow to tissues
    d) ischaemia may be due to reduced venous drainage
A

a) hypoxia causes irreversible tissue whereas ischaemia does not

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22
Q
  1. regarding hypoxic cell injury not correct (Cell Injury)
    a) Sodium accumulates within cells
    b) There is failure of aerobic respiration
    c) Failure of the cells energy dependent sodium pump system
    d) Intracellular lactic acid levels and ph increase
A

d) Intracellular lactic acid levels and ph increase

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23
Q
  1. not correct in relation to phase 1 cardiac rehabilitation (Cardiac Rehabilitation)
    a) Activities of daily living are not relevant for this phase of rehab
    b) patient has some knowledge of heart disease
    c) Patient has clear lungs and is able to clear secretions
    d) patient is able to cope with symptoms
A

a) Activities of daily living are not relevant for this phase of rehab

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24
Q
  1. not a contraindication for exercise as part of cardiac rehab (Cardiac Rehabilitation)
    a) Uncontrolled hypertension
    b) Resting heart rate > 100 beats per minute
    c) any drop in blood pressure on standing up
    d) uncontrolled diabetes
A

c) any drop in blood pressure on standing up

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25
Q
  1. Regarding cardiac patients performance and functioning is not correct (Cardiac Rehabilitation)
    a) Participation restrictions imply difficulties a group of similar patients has in performing group activities
    b) disabilities are important determinants of quality of life
    c) activity limitations imply difficulties an individual has in executing a task or action
    d) activity limitations are important determinants of quality of life
A

a) Participation restrictions imply difficulties a group of similar patients has in performing group activities

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26
Q
  1. Regarding stroke is not correct (Stroke Notes)
    a) HIV is an independent risk factor
    b) TIA is a risk factor
    c) If symptoms of TIA disappear within one hour then one should suspect another pathology
    d) Stroke implies an acute neurological deficit resulting from an intracranial obstructive or haemorrhagic lesion
A

c) If symptoms of TIA disappear within one hour then one should suspect another pathology

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27
Q
  1. Regarding ischaemic stroke is not correct (Stroke Notes)
    a) Intravenous plasminogen activator facilitates thrombolysis
    b) Cornerstone of treatment is removal of obstruction and restoration of blood flow
    c) Plasminogen activator is not used for hemorrhagic stroke
    d) Majority of stroke victims reach hospital within 3-4 hour window for administration of intravenous plasminogen activator
A

d) Majority of stroke victims reach hospital within 3-4 hour window for administration of intravenous plasminogen activator

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28
Q
  1. Regarding stroke in SA is not true (Stroke Reading)
    A) Responsible for >250 000 deaths per annum
    B) Black females have highest race/gender/100 000 mortality rate
    C) More than 80% occurs in low/middle income countries
    D) Most common cause of death in people >50
A

A) Responsible for >250 000 deaths per annum

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29
Q
  1. Which morphological feature of cerebral infarct is not correct (Dr. Reena Mohenal Lecture on Stroke)
    a) Oedema around the infarct results in local mass effect
    b) Within the first 12 hours there is a clear evidence of cerebral swelling and loss of definition between grey and white matter
    c) Infarcts may be haemorrhagic if reflow occurs
    d) By the third week the infarcted tissue undergoes colliquative necrosis
A

b) Within the first 12 hours there is a clear evidence of cerebral swelling and loss of definition between grey and white matter

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30
Q
  1. Which is not a feature of malignant hypertension (Dr. Reena Mohenal Lecture on Stroke)
    a) Diastolic BP >120
    b) Intimal proliferation of medium sized renal arteries
    c) Proteinuria and renal failure
    d) Papilloedema
A

b) Intimal proliferation of medium sized renal arteries

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31
Q
  1. Not found in diabetic patients
    a) Glaucoma
    b) Nephrotic syndrome
    c) Neuropathy affecting motor neurons
    d) Autonomic nerve dysfunction affecting the bladder
A

d) Autonomic nerve dysfunction affecting the bladder

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32
Q
  1. Regarding the therapeutic target values in a patient with a metabolic syndrome is not correct
    a) Target post prandial blood sugar <8mmol
    b) Target hba 1c <4%
    c) Target fasting glucose is <6
    d) Target BP is <130 systolic and <80 diastolic
A

b) Target hba 1c <4%

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33
Q
  1. Complications of diabetes is not correct (Endocrine)
    a) Stroke is microvascular complication
    b) retinopathy is a disease of the retinal microvasculature
    c) diabetic ketoacidosis is an acute complication
    d) neuropathy is a microvascular complication
A

a) Stroke is microvascular complication

34
Q
  1. Regarding pancreas is not correct (Endocrine)
    a) Pancreas secretes digestive enzymes
    b) Secretes hormones
    c) Glucagon raises blood sugar levels
    d) Beta cell secretions are catabolic
A

d) Beta cell secretions are catabolic

35
Q
  1. Regarding types of diabetes is not correct (Endocrine)
    a) Beta cell destruction in type 1 has a genetic component
    b) Beta cell destruction may be associated with preceding viral infection
    c) Histology of pancreas in normal in type 2
    d) Type 2 is associated with autoimmunity
A

d) Type 2 is associated with autoimmunity

36
Q
  1. Regarding jackson burn wound model is not correct
    A) The intermediate zone involves damage to microvasculature
    B) Effective resuscitation may play a role in ischaemia
    C) Key feature of the outer zone is vasoconstriction
    D) Inner zone involves coagulation and cell death
A

C) Key feature of the outer zone is vasoconstriction

37
Q
  1. Regarding systemic effects of burns not correct
    a) Immunity may be suppressed exposing patient to infection
    b) Inflammatory mediators such as tumour necrosis factor play a role
    c) Nutrition is compromised because body enters a catabolic state
    d) Systemic effects are seen when the burn injury involves >50% of body surface
A

d) Systemic effects are seen when the burn injury involves >50% of body surface

38
Q
  1. Regarding burn depth is not correct
    a) Third degree is full thickness
    b) Pain directly proportional to depth/thickness
    c) Ultraviolet light may produce a second degree burn
A

b) Pain directly proportional to depth/thickness

39
Q
  1. Would not be a criterion for admission to a burn unit
    A) Inhalation burn
    b) significant pre-existing medical conditions
    c) burn involving the perineum
    d) a patient with the best prognostic age profile – admit young and fit rather than elderly
A

d) a patient with the best prognostic age profile – admit young and fit rather than elderly

40
Q
  1. Regarding scar management is not correct
    A) Pressure to the scar should be avoided as it limits blood flow and delays healing
    b) massage has a role in remodeling underlying adhesions
    c) massage promotes scar pliability
    d) application of silicone promotes scar occlusion and hydration
A

A) Pressure to the scar should be avoided as it limits blood flow and delays healing

41
Q
  1. Not an indication for a hysterectomy (Gen Surg- Hysterectomy)
    a) Malignant or premalignant disease
    b) Pelvic organ prolapse
    c) Irregular menses
    d) excessive uterine bleeding
A

c) Irregular menses

42
Q
  1. Not an alternative to hysterectomy (Gen Surg- Hysterectomy)
    a) embolization for fibroids
    b) chemo and or radiation for malignancy
    c) ring pessary for prolapse
    d) complete myometrial ablation to control excessive bleeding
A

d) complete myometrial ablation to control excessive bleeding

43
Q
  1. regarding removal of ovaries during hysterectomy Is not correct (Gen Surg- Hysterectomy)
    a) Ovarian cancer risk is increased if the patient has a specific high risk gene aberration
    b) patients must be advised that libido may decrease
    c) leaving the ovaries increases the risk of subsequent cardiovascular disease
    d) ovarian pathology is a reason for a simultaneous removal of one or both ovaries
A

c) leaving the ovaries increases the risk of subsequent cardiovascular disease

44
Q
  1. Not a risk factor for post hysterectomy venous thrombosis and pulmonary embolism (Gen Surg- Hysterectomy)
    a) Malignancy as a reason for the procedure
    b) Immobilization
    c) Administration of aspirin for post operative pain relief
    d) Obesity
A

c) Administration of aspirin for post operative pain relief

45
Q
  1. Not a long term consequence of hysterectomy
    a) pelvic prolapse
    b) dyspareunia (painful intercourse)
    c) High risk of ovarian cancer if the ovaries were not removed at the time of the procedure
    d) early menopause
A

c) High risk of ovarian cancer if the ovaries were not removed at the time of the procedure

46
Q
  1. Regarding haemostatic wound healing not correct (Inflammation)
    a) Tissue factors activate the coagulation cascade
    b) Platelets adhere to exposed collagen and release granular contents
    c) matrix forms and serves as a scaffold for repair
    d) vasodilation is a critical component as it allows cells to migrate to the wound site
A

d) vasodilation is a critical component as it allows cells to migrate to the wound site

47
Q
  1. Regarding inflammatory wound healing is not correct
    a) Priority is removal of devitalized tissue
    b) granulocytes are attracted to the wound
    c) phase lasts 1 day
    d) begins immediately after tissue injury
A

c) phase lasts 1 day

48
Q
  1. Regarding factors that affect healing is not correct
    a) admin f steroids favorably assists
    b) ischaemia may affect
    c) tight suturing of the wound and local oedema adversely affects
    d) poor wound cleaning and foreign body remnants adversely affects
A

a) admin f steroids favorably assists

49
Q
  1. Effects of smoking on would healing not correct
    a) nicotine inhibits proliferation of fibroblasts
    b) Increased co2 decreases o2 carrying capacity of haemoglobin
    c) elevated levels of hydrogen cyanide inhibit beneficial enzymes
    d) smoking decreases collagen deposition
A

b) Increased co2 decreases o2 carrying capacity of haemoglobin

50
Q
  1. Effects of diabetes on wound healing not correct
    A) excessive antibiotic coating of bacteria takes place
    b) microvascular injury takes place within the wound
    c) increased blood viscosity interferes with healing
    d) sorbitol leads to nerve damage
A

A) excessive antibiotic coating of bacteria takes place

51
Q
  1. Regarding MND is not correct
    a) The condition involves upper motor neurons
    b) lower motor neurons
    c) progressive muscular atrophy is a variant
    d) MND is characterized by rapidly progressive neuronal degeneration
A

d) MND is characterized by rapidly progressive neuronal degeneration

52
Q
  1. Regarding pathophysiology of MND is not correct
    A) Degeneration in the ventral horns of spinal cord
    b) Affected neurons are innervated by the spino-thalamic tract
    c) there may be Associated brain atrophy in frontal lobes
    d) there is atrophy of the ventral nerve roots
A

b) Affected neurons are innervated by the spino-thalamic tract

53
Q
  1. MND is not correct
    a) Apoptosis may play a role
    b) exogenous factors such as toxins and viruses may play a causative role
    c) there is a family history
    d) onset is between 40-60
A

c) there is a family history

54
Q
  1. Additional signs unlikely
    a) Twitching of tongue
    b) staccato speech
    c) wasting of hand muscles
    d) choking during meals
A

b) staccato speech

55
Q
  1. Not expect to find on neurological exam
    a) Loss of deep tendon reflex
    b) Extensor plantar responses
    c) Sensory losses
    d) Muscle atrophy and fasciculation
A

c) Sensory losses

56
Q
  1. Regarding urinary incontinence Is not correct
    a) Postural incontinence involves involuntary passage of urine with a change in body position
    b) stress incontinence involves involuntary passage of urine eg with physical exertion, coughing or sneezing
    c) Involuntary passage of urine during sleep is a classic example of insensible incontinence
    d) Passage of urine during coitus is recognized form of incontinence
A

c) Involuntary passage of urine during sleep is a classic example of insensible incontinence

57
Q
  1. Physical problems do not fit with the type of incontinence
    a) Overflow incontinence is associated with urethral blockage
    b) Stress incontinence is associated with reduced tone in the pelvic floor and increased intra-abdominal pressure
    c) stress incontinence is associated with reduced tone in the pelvic floor and typically occurs even with low intra-abdominal pressure
    d) urinary tract infection leads to heightened bladder sensitivity and urgency
A

c) stress incontinence is associated with reduced tone in the pelvic floor and typically occurs even with low intra-abdominal pressure

58
Q

58) Does not fit with overactive bladder
a) frequency
b) urinary tract infection
c) urgency
d) nocturia

A

b) urinary tract infection

59
Q
  1. Regarding bladder training is not correct
    a) Improved central modulation of afferent sensory impulses
    b) pelvic floor responsive to training because of smooth muscle
    c) bladder training involves behaviour change through awareness incontinence – causing situations
    d) bladder training improves cortical facilitation over urethral closure during bladder filling
A

b) pelvic floor responsive to training because of smooth muscle

60
Q
  1. Electrostimulation is not correct
    a) Detrusor contraction is stimulated
    b) patient becomes aware
    c) treatment increases the strength of pelvic floor muscle
    d) intensity must be monitored
A

b) patient becomes aware

61
Q
  1. Regarding myelin is not correct
    a) Myelin enhances/speeds the conduction of nerve impulses
    b) provides insulation from nerve impulses
    c) surrounds dendrites in central nervous system
    d) lipid rich membrane ensheathing nerves
A

c) surrounds dendrites in central nervous system

62
Q
  1. Regarding demyelination is not correct
    a) Result of a pathological process that damages myelin
    b) MS is a result of auto-immunity
    c) Non-ionising radiation of the brain may cause demyelination
    d) demyelination may be the result of a pathological process that damages oligodendrocytes
A

c) Non-ionising radiation of the brain may cause demyelination

63
Q
  1. Regarding immune-mediated demyelination is not correct
    a) cytokines are involved
    b) Exogenous anti-oxidants are involved in the process
    c) Macrophages are involved
    d) T-cells are involved
A

a) cytokines are involved

64
Q
  1. Regarding clinical presentation is not correct
    a) Cognitive deficits appear very early in the disease process
    b) may be evidence of cerebellar dysfunction
    c) may be motor deficits
    d) May be sensory symptoms
A

a) Cognitive deficits appear very early in the disease process

65
Q
  1. Following symptoms would one not expect to find as a manifestation of ms
    a) bowel incontinence
    b) bladder incontinence
    c) myopia
    d) diplopia
A

a) bowel incontinence

c) myopia

66
Q
  1. Not a risk for development of breast cancer
    a) family history
    b) previous chest wall irradiation
    c) late menarche
    d) history of chronic use of contraceptives
A

c) late menarche

67
Q
  1. Not a typical presenting factor of breast cancer
    a) skin changes
    b) stabbing pain in the breast
    c) nipple retraction
    d) nipple discharge
A

b) stabbing pain in the breast

68
Q
  1. Regarding prognosis for invasive breast cancer is not true
    a) prognosis depends on response to treatment
    b) poorly-differentiated tumours are less aggressive than well differentiated
    c) age important
    d) tumor biology important
A

b) poorly-differentiated tumours are less aggressive than well differentiated

69
Q
  1. Regarding spread of breast cancer is not correct
    a) Lymphatic spread my involve internal mammary lymph nodes
    b) may spread to underlying muscle
    c) axillary staging is no longer regarded as an important prognostic indicator
    d) spread via bloodstream may involve the brain
A

c) axillary staging is no longer regarded as an important prognostic indicator

70
Q
  1. Regarding oncoplastic breast surgery is not correct
    a) procedure limited by tumor size
    b) Volume resected tissue may be replaced by autologous tissues
    c) approach combines cancer resection with plastic surgery
    d) cosmetic outcome enhanced with OPBS
A

a) procedure limited by tumor size

71
Q
  1. not a cause of acute abdomen
    a) perforated peptic ulcer
    b) sigmoid volvulus
    c) gallstones
    d) strangulated hernia
A

c) gallstones

72
Q
  1. regarding visceral pain is not correct
    a) localizes poorly
    b) intra-abdominal ischaemia is a trigger
    c) nausea is associated
    d) result of stimulation of spinal somatic nerves
A

d) result of stimulation of spinal somatic nerves

73
Q
  1. Regarding post operative fever is not correct
    a) elderly patients become delirious and should receive meds
    b) develop atelectasis
    c) develop venous thrombosis which leads to pulmonary embolus
    d) in catheterized, risk of UTI
A

c) develop venous thrombosis which leads to pulmonary embolus

74
Q
  1. Regarding gallstones is not correct (gen surg abdomen)
    a) By 60, 60% of women would have had
    b) 85 cholesterol and 15 bile
    c) frequency lower In men
    d) association with obesity
A

a) By 60, 60% of women would have had

75
Q
  1. Regarding surgical options for gallstones (gen surg - acute abdomen)
    a) laparoscopic associated with shorter hospital stay
    b) more post operative pain because multiple incisions
    c) open cholecystectomy is indicated if laparoscopy fails
    d) open cholecystectomy required for malignancy of gall bladder
A

b) more post operative pain because multiple incisions

76
Q
  1. Not secreted by kidney
    a. Prostoglandins
    b. Eryhtropoietin
    c. Renin
    d. Parathormone
A

d. Parathormone

77
Q
  1. Regarding acute renal failure not correct
    a) due to toxins that have caused acute tubular necrosis
    b ) Initial oliguria
    c) associated hypokalemia is common
    d) swollen, necrotic cells
A

c) associated hypokalemia is common

78
Q
  1. Regarding aetiology of acute renal failure not correct?
    a. Myocardial infarction would be considered as a cause of pre-renal failure.
    b. Prostatic cancer would typically be considered as a cause of post-renal failure.
    c. Massive haemorrhage would be considered as a cause of pre-renal failure.
    d. Urethral calculi would typically be categorised as a cause of intra-renal failure.
A

d. Urethral calculi would typically be categorised as a cause of intra-renal failure.

79
Q
  1. Regarding chronic renal not correct (renal path)
    a) features of rickets
    b) sodium and water retention
    c) pericarditis may be a feature
    d) metabolic alkalosis is common
A

d) metabolic alkalosis is common

80
Q
  1. Regarding hypersensitive renal disease not correct (anatomical path - renal)
    a) whites are affected mire
    b) females more
    c) present with proteinuria
    d) related to age
A

b) females more