USMLE Sugery (germ)

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?

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?

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?

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?

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?

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?

You are assisting a bypass grafting procedure in theatre. Your senior colleague asks you to show him from where the common fem oral artery arises. From the list below, choose the statement that best describes the anatomical landmark and course of the common femoral artery?

A 24-year-old sexually active medical student is diagnosed as having a urinary tract infection by her GP. Which one of the following organisms is most commonly associated with community acquired urinary tract infection?

A 28-year-old student presents with a 2-day history of dysuria and mucopurulent urethral discharge. He reports recently having had unprotected sex while on holiday in the Mediterranean. A urethral discharge smear inoculated into Thayer-Martin medium confirms infection with Neisseria gonorrhoeae and appropriate antibiotics are started. What type of organism is N. gonorrhoeae?

A 22-year-old Caucasian man presents to the ENT clinic complaining that he is unable to hear properly in the right ear. A week earlier, he received a blow to the right ear while playing rugby. Rinne's test is negative on the right (bone conduction greater than air conduction). On Weber's test, sound is heard best on the right side. Which one of the following is the most appropriate, regarding the likely cause?

A 65-year-old Caucasian woman attends the clinic complaining of gradual progressive difficulty hearing in her left ear. She has noticed that she is having to ask her friends and relatives to speak up in public places. This is causing her some social embarrassment. Weber's test localizes to the right ear. Rinne's test is positive bilaterally. Which one of the following is the most appropriate statement regarding the likely cause?

A 65-year-old Caucasian woman attends the clinic complaining of gradual progressive difficulty hearing in her left ear. She has noticed that she has to ask her friends and relatives to speak up in public places. This is causing her some social embarrassment. Weber's test localizes to the right ear. Rinne's test is positive bilaterally, which one of the following is the most likely diagnosis?

A 17-year-old boy is transferred to the emergency resuscitation bay following a serious road traffic accident. He was not wearing a seat belt and 'bulls-eyed' the windscreen on impact with another car. No life-threatening injuries were detected on primary survey. On secondary survey you notice major bruising to the front and right side of his forehead and face. His right eye is also badly bruised. He has multiple superficial cuts and some blood is trickling from the right nostril. Which one of the following statements is the most appropriate regarding facial trauma?

An 18-year-old school student of East African origin presents with a 2-week history of lethargy, myalgia, rigours with hot flushes and intermittent pyrexia. Neither she nor any close contacts have been travelling recently. Examination reveals enlarged anterior and posterior chain lymph nodes in the neck. A blood ftlm reveals the presence of Downey bodies, thrombocytosis and an increase in the lymphocyte count to 50 % of total leucocytes. This girl is likely to have?

A 10-year-old boy is brought to the hospital by his mother with complaints of sudden onset of severe colicky abdominal pain associated with several episodes of vomiting. There is a history of failure to thrive and also of the passage of worms per rectum in the past. On examination, he is pale and underweight for his age. The abdomen is distended with palpable bowel loops. The bowel sounds are exaggerated. His haemoglobin is 10.2 g/dL and 12 o/o eosinophils. What is the diagnosis of this patient?

A 21-year-old male medical student presents with a 14-day history of intermittent fever, rigours, headache, neck stiffness and a single episode of vomiting just prior to attending his appointment. On questioning, he admits to a visit to rural east Africa 2 months ago as part of a university outreach group and is up to date on all vaccinations. Furthermore, he had not had unprotected sexual intercourse over the past several months. On examination, he is noted to be tachycardic with a pulse rate of 100 beats/min and appears slightly dehydrated. Routine blood tests show moderately raised inflammatory markers. The admitting team suspects meningitis and conducts a lumbar puncture. The tap reveals a white cell count of 995/mm3 with a neutrophilia and lymphocytosis, 2.5 g/L of protein and 3.0 mmol/L of glucose. Samples are additionally sent for Gram staining and virological examination and appropriate therapy started pending final confirmation. Which one of the following micro-organisms is most likely causing meningitis in this patient?

You are asked to review a 75-year-old female patient in the emergency department. She describes a 1-week history of severe left-sided earache, which is especially profound at night. She has taken to carrying tissues with her to clean up copious exudate discharging from the ear. Of note her past medical history includes controlled diabetes mellitus. Physical examination reveals granulation tissue in the external auditory canal. The erythrocyte sedimentation rate is elevated. Which one of the following pathogens is most likely to be responsible?

A 40-year-old Caucasian man presents complaining of pain in his left eye. Earlier that day he was working in his house, attempting to put up a shelf with nails. He felt a sensation of 'some material entering his eye'. He does not wear contact lenses. His eye has been extremely watery and he has been unable to open it properly, fluorescein assessment under the blue light slit lamp reveals a discrete green region at the lateral corneal margin. Following clinical assessment and thorough irrigation, the assessing clinician removes all the foreign bodies, which are sent for culture. Which one of the following pathogens is most likely to be responsible for infection?

A 40-year-old Caucasian man presents with visual disturbance in both temporal visual fields. He works as a taxi driver and is finding he cannot notice customers on the street as well as he used to. His appetite is reduced. He has a 2-week history of morning headache. Clinical examination reveals bitemporal hemianopia. Which of the following is the best diagnostic investigation?