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  • Question 1 - During an appendicectomy in a 16 year old girl, the registrar initially did...

    Correct

    • During an appendicectomy in a 16 year old girl, the registrar initially did not find the appendix on entering the peritoneal cavity. She, however, remained calm as she knew she could find it by:

      Your Answer: Looking at the confluence of the taenia coli

      Explanation:

      The vermiform appendix arises from the apex of the caecum. Although it has a constant base, it can pass in one of several directions such as upward behind the caecum, to the left behind the ileum and mesentery or downward into the lesser pelvis. It is retained in place by a peritoneal fold, the mesoenteriole derived from the left leaf of the mesentery. Taenia coli meet at the appendix which is the terminal portion of the caecum. The appendix is below the ileocecal valve, not above. It is not near the right colic artery (which supplies the ascending colon). It would not be found by removing a layer of the jejuno-ileum and is not in the pelvic brim.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      13.3
      Seconds
  • Question 2 - A 45-year old farmer was referred to the surgical clinic with complaints of...

    Correct

    • A 45-year old farmer was referred to the surgical clinic with complaints of pain in his right hypochondrium. Investigations confirmed the diagnosis of hepatocellular carcinoma with malignant ascites. According to you, what is the most likely cause of HCC in this patient?

      Your Answer: Aflatoxin

      Explanation:

      Aflatoxins are naturally occurring toxins produced by the Aspergillus fungus (most often, A. flavus and A. parasiticus). These organisms are common and their native habitat is soil, decaying vegetation and grains. They can contaminate the grain before harvest or after storage, more likely in high-humidity (at least 7%) or high temperature environment of after stressful conditions like drought. Aflatoxins are mycotoxins and also carcinogenic. They get metabolized in the liver to an epoxide, aflatoxin M1. High exposure can lead to acute necrosis, cirrhosis or liver carcinoma. These substances can cause haemorrhage, acute liver damage, oedema, and alteration in digestion, absorption and/or metabolism of nutrients. Although humans are susceptible to these toxins like all other animals, they have a high tolerance level and hence, rarely develop acute aflatoxicosis. However, children are particularly susceptible to exposure leading to growth impairment and delayed development. Chronic exposure carries a high risk of hepatic cancer, due to intercalation of its metabolite aflatoxin M1 into the DNA and alkylation of the bases because of its epoxide moiety.

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
      20
      Seconds
  • Question 3 - The optic foramen, superior orbital fissure, foramen ovale, foramen rotundum and foramen sinosum...

    Correct

    • The optic foramen, superior orbital fissure, foramen ovale, foramen rotundum and foramen sinosum are all located on which bone at the base of the skull?

      Your Answer: Sphenoid

      Explanation:

      The sphenoid bone consists of two parts, a central part and two wing-like structures that extend sideways towards each side of the skull. It forms the base of the skull, and floor and sides of the orbit. On its central part lies the optic foramen. The foramen ovale, foramen spinosum and foramen rotundum lie on its great wing while the superior orbital fissure lies on its lesser wing.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      7.9
      Seconds
  • Question 4 - Which of the following mediators of inflammation requires arachidonic acid for synthesis? ...

    Incorrect

    • Which of the following mediators of inflammation requires arachidonic acid for synthesis?

      Your Answer: Interleukin-1

      Correct Answer: Prostaglandins

      Explanation:

      Arachidonic acid is normally present in the phospholipids that make up the cell membrane and is cleaved by phospholipase A2 from the phospholipid. Arachidonic acid is a precursor for the production of eicosanoids which include: 1) prostaglandins, prostacyclins and thromboxane, 2) leukotrienes and 3) anandamides. The production of these products along with their action on the body is called the arachidonic acid cascade.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      11
      Seconds
  • Question 5 - A 49-year-old man, smoker, complains of a persisting and worsening cough over the...

    Correct

    • A 49-year-old man, smoker, complains of a persisting and worsening cough over the past few months. He also has noted blood in his sputum. The patient has no other major health conditions. Which of the following investigative procedures should be done first?

      Your Answer: Sputum cytology

      Explanation:

      Sputum cytology is a diagnostic test used for the examination of sputum under a microscope to determine if abnormal cells are present. It may be used as the first diagnostic procedure to help detect a suspected lung cancer or certain non-cancerous lung conditions.

    • This question is part of the following fields:

      • Pathology
      • Respiratory
      33.3
      Seconds
  • Question 6 - Which of these nerves controls adduction of hand? ...

    Incorrect

    • Which of these nerves controls adduction of hand?

      Your Answer: Median nerve

      Correct Answer: Ulnar nerve

      Explanation:

      The adductors of the fingers are the palmer interossei. They are supplied by the ulnar nerve, which is a branch of the medical cord of the brachial plexus.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      7.7
      Seconds
  • Question 7 - Which of the following bones was most likely fractured following an injury in...

    Incorrect

    • Which of the following bones was most likely fractured following an injury in the medial side of the foot between the navicular behind and base of the first metatarsal in front?

      Your Answer: Cuboid

      Correct Answer: First cuneiform

      Explanation:

      The first cuneiform bone is the largest of the three cuneiforms. It is situated at the medial side of the foot, between the navicular behind and the base of the first metatarsal in front.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      21.1
      Seconds
  • Question 8 - Where is factor VIII predominantly synthesised? ...

    Incorrect

    • Where is factor VIII predominantly synthesised?

      Your Answer: Kupffer cells

      Correct Answer: Vascular endothelium

      Explanation:

      Factor VIII is an important part of the coagulation cascade. Deficiency causes haemophilia A. It is synthesised predominantly by the vascular endothelium and is not affected by liver disease. In the circulation it is bound to von Willebrand factor and it forms a stable complex with it. It is activated by thrombin or factor Xa and acts as a co factor to factor IXa to activate factor X which is a co factor to factor Va. Thrombin cleaves fibrinogen in fibrin and forms a meshwork to trap RBC and platelets to form a clot.

    • This question is part of the following fields:

      • General
      • Physiology
      12.5
      Seconds
  • Question 9 - A surgeon performing a laparoscopic repair of an inguinal hernia visualizes a loop...

    Incorrect

    • A surgeon performing a laparoscopic repair of an inguinal hernia visualizes a loop of bowel protruding through the abdominal wall to form a direct inguinal hernia. When this is viewed from the side of the abdomen with a laparoscope, in which region would the hernial sac be?

      Your Answer: Superficial inguinal ring

      Correct Answer: Medial inguinal fossa

      Explanation:

      In a direct inguinal hernia, visceral contents exit the abdomen through a weak point in the fascia in the medial inguinal fossa i.e. the area between the medial and lateral umbilical folds. Such a hernia doesn’t pass through the deep inguinal ring or the lateral inguinal fossa. Note that direct hernias can go through the superficial inguinal ring, although rarely. The supravesical fossa, between the median and medial umbilical folds, is formed by a peritoneal reflection from the anterior abdominal wall onto the bladder and the retrovesical fossa is the region behind the urinary bladder.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      30.2
      Seconds
  • Question 10 - The blood investigations of a 30-year old man with jaundice revealed the following...

    Correct

    • The blood investigations of a 30-year old man with jaundice revealed the following : total bilirubin 6.5 mg/dl, direct bilirubin 1.1 mg/dl, indirect bilirubin 5.4 mg/dl and haemoglobin 7.3 mg/dl. What is the most likely diagnosis out of the following?

      Your Answer: Haemolysis

      Explanation:

      Hyperbilirubinemia can be caused due to increased bilirubin production, decreased liver uptake or conjugation, or decreased biliary excretion. Normal bilirubin level is less than 1.2 mg/dl (<20 μmol/l), with most of it unconjugated. Elevated unconjugated bilirubin (indirect bilirubin fraction >85%) can occur due to haemolysis (increased bilirubin production) or defective liver uptake/conjugation (Gilbert syndrome). Such increases are less than five-fold usually (<6 mg/dl or <100 μmol/l) unless there is coexistent liver disease.

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
      11.8
      Seconds
  • Question 11 - A young male was diagnosed with hepatitis A, which clinically resolved in 2...

    Correct

    • A young male was diagnosed with hepatitis A, which clinically resolved in 2 weeks. What will his liver biopsy done after 6 months show?

      Your Answer: Normal architecture

      Explanation:

      Hepatitis A is the most common acute viral hepatitis, more common in children and young adults. It is caused by Hepatitis A virus, which is a single-stranded RNA picornavirus. The primary route of spread of Hepatitis A is the faecal-oral route. Consumption of contaminated raw shellfish is also a likely causative factor. The shedding of the virus in faecal matter occurs before the onset of symptoms and continues a few days after. Hepatitis A does not lead to chronic hepatitis or cirrhosis, and there is no known chronic carrier state. Hence, a biopsy performed after recovery will show normal hepatocellular architecture.

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
      4.7
      Seconds
  • Question 12 - A 47 year-old woman was admitted for elective cholecystectomy, with a past...

    Incorrect

    • A 47 year-old woman was admitted for elective cholecystectomy, with a past history of easy bruising and heavy menstrual periods. The patient was also diagnosed with Willebrand's disease. Willebrand's disease is:

      Your Answer: Autosomal recessive

      Correct Answer: Autosomal dominant

      Explanation:

      von Willebrand disease is an autosomal dominant disorder marked by the deficiency of vWF, a large protein synthesized by the endothelial cells and megakaryocytes. It mediates adhesion of platelets to the subendothelium at site of vascular injury. Disease characteristics include impaired platelet adhesion, prolonged bleeding time and a functional deficiency of factor VIII (vWF is its carrier protein).

    • This question is part of the following fields:

      • General
      • Physiology
      14.1
      Seconds
  • Question 13 - A 32-year old gentleman came to the emergency department, complaining of progressively increasing...

    Correct

    • A 32-year old gentleman came to the emergency department, complaining of progressively increasing weakness in his arms and legs over 5 days. On examination, there is symmetrical weakness on both sides of his face, along with weakness of the proximal and distal muscles of all four limbs. No loss of sensation noted. Deep tendon reflexes could not be elicited and plantar responses were downward. On enquiry, it was revealed that he had an upper respiratory tract infection 10 days ago. The likely diagnosis is:

      Your Answer: Guillain–Barré syndrome

      Explanation:

      Guillain–Barré syndrome (GBS) is an acute, autoimmune polyradiculoneuropathy which affects the peripheral nervous system and is usually triggered by an acute infectious process. 75% patients have a history of acute infection within the past 1–4 weeks, usually respiratory or gastrointestinal. immunisations have also been implicated. The most common form is acute inflammatory demyelinating polyneuropathy. It results in an ascending paralysis with complete loss of deep tendon reflexes. Treatment includes immunoglobulins and supportive care. However, the disease may be fatal due to severe pulmonary complications and dysautonomia.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      34.5
      Seconds
  • Question 14 - A 45-year old male patient with a long history of alcoholism developed liver...

    Correct

    • A 45-year old male patient with a long history of alcoholism developed liver cirrhosis that has led to portal hypertension. Which of the following plexuses of veins is most likely dilated in this patient?

      Your Answer: Haemorrhoidal plexus

      Explanation:

      The haemorrhoidal plexus or also known as the rectal plexus is a venous plexus that surrounds the rectum. This venous plexus in males communicates anteriorly with the vesical plexus and uterovaginal plexus in females. This venous plexus forms a site of free communication between the portal and systemic venous systems. In the case of portal hypertension this plexus would most likely dilate due to the increased pressure.

    • This question is part of the following fields:

      • Anatomy
      • Pelvis
      19.8
      Seconds
  • Question 15 - A 60-year old gentleman visited his general practitioner complaining of high grade fever...

    Correct

    • A 60-year old gentleman visited his general practitioner complaining of high grade fever for 7 days and a dull, aching pain in his left lumbar region. On enquiry, he admitted to having a burning sensation while passing urine. His blood results showed an elevated white blood cell count with a left shift. In his condition, which is the most characteristic finding on urine examination?

      Your Answer: White blood cell casts

      Explanation:

      Tubulointerstitial nephritis is the term given to primary injury to renal tubules and the renal interstitium, which ultimately results in a decline in renal function. Acute tubulointerstitial nephritis (acute pyelonephritis) is often seen as a result of infection or drug reactions. The most characteristic feature of this condition on urine analysis is the presence of white blood cell casts.

    • This question is part of the following fields:

      • Pathology
      • Renal
      16
      Seconds
  • Question 16 - Which of these HLA alleles is most likely to be present in ankylosing...

    Correct

    • Which of these HLA alleles is most likely to be present in ankylosing spondylitis?

      Your Answer: HLA-B27

      Explanation:

      Ankylosing spondylitis usually appears between the ages of 20-40 years old and is more frequent in men. It is strongly associated with HLA-B27, along with other spondyloarthropathies, which can be remembered through the mnemonic PAIR (Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, and Reactive arthritis).

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      7.4
      Seconds
  • Question 17 - A 69 Year old lady presented to the emergency department following a massive...

    Correct

    • A 69 Year old lady presented to the emergency department following a massive myocardial infarction. She was found to be in hypotensive shock with focal neurological signs. Unfortunately the patient demised. What would be the expected findings on the brain biopsy?

      Your Answer: Liquefactive necrosis

      Explanation:

      Liquefactive necrosis is often associated with bacterial or fungal infections. However, hypoxic death of cells within the central nervous system can also result in liquefactive necrosis. The focal area is soft with a liquefied centre containing necrotic debris and dead white cells. This may later be enclosed by a cystic wall

    • This question is part of the following fields:

      • Cell Injury & Wound Healing; Neurology
      • Pathology
      17.5
      Seconds
  • Question 18 - A 40-year old gentleman underwent a computed tomographic scan for the abdomen to...

    Correct

    • A 40-year old gentleman underwent a computed tomographic scan for the abdomen to rule out blunt abdominal trauma, after a vehicular accident. The scan revealed no abnormal finding except for a 1 cm-sized cortical mass in the left adrenal gland. The doctor-on-call decided to not intervene for this mass because it was likely to be a:

      Your Answer: Non-functioning adrenal adenoma

      Explanation:

      Adrenal adenomas are common, benign lesions which are asymptomatic and seen in 10% of population. Usually detected incidentally on Computed tomography (‘incidentaloma’), only around 1 in 10,000 are malignant (adenocarcinoma). Adrenal adenomas rarely need to be investigated, especially if they are homogenous and less than 3 cm in diameter. Follow-up imaging can be done after an interval of 3-6 months to assess any change in size. Some adenomas can secrete cortisol (leading to Cushing syndrome), or aldosterone (leads to Conn syndrome) or androgens (leading to hyperandrogenism).

      Haematomas and simple cysts are not usually seen in adrenal gland. Infection due to Histoplasma capsulatum is usually bilateral and leads to multiple granulomas. Adrenal metastasis will usually demonstrate a lung primary and the adrenal lesions will be often multiple and larger than 1 cm.

    • This question is part of the following fields:

      • Endocrine
      • Pathology
      12
      Seconds
  • Question 19 - A TRUE statement regarding abolition of the cephalic phase of pancreatic secretion is...

    Incorrect

    • A TRUE statement regarding abolition of the cephalic phase of pancreatic secretion is that it:

      Your Answer: Will mainly affect HCO3 – secretion

      Correct Answer: Will result after vagotomy

      Explanation:

      Recognition and integration of the sight, smell and taste of food triggers the cephalic phase of pancreatic secretion, causing an increase in pancreatic HCO3- and enzyme secretion. The degree of enzyme secretion in this phase is about 50% of the maximal response seen with exogenous CCK and secretin. The vagus nerve regulates the secretion through the cholinergic fibres innervating the acinar cells of the pancreas, and through peptidergic nerve fibres, which innervate ductal cells.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      16.3
      Seconds
  • Question 20 - An explorative laparotomy is done on a 23 year old following a gunshot...

    Incorrect

    • An explorative laparotomy is done on a 23 year old following a gunshot abdominal injury through the right iliac fossa. It is found that the ileocolic artery is severed and the bullet had perforated the caecum. From which branch does the ileocolic artery originate?

      Your Answer: Inferior mesenteric artery

      Correct Answer: Superior mesenteric artery

      Explanation:

      Ileocolic artery branches off from the superior mesenteric artery. It then divides to give a superior and inferior branch.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      28.1
      Seconds
  • Question 21 - A 58-year-old woman has had a headache, fever, lethargy and nausea for the...

    Correct

    • A 58-year-old woman has had a headache, fever, lethargy and nausea for the last 10 days. He undergoes a CT scan which reveals a lesion in his frontal lobe, which, after a biopsy, is found to be formed by granulation tissue with collagenisation, gliosis and oedema. What's the most likely diagnosis?

      Your Answer: Chronic brain abscess

      Explanation:

      A cerebral abscess can result from direct extension of cranial infections, penetrating head trauma, haematogenous spread, or for unknown causes. An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts. Oedema around the abscess can increase the intracranial pressure. Symptoms result from increased intracranial pressure and mass effects. In a CT scan, an abscess appears as an oedematous mass with ring enhancement.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      40.6
      Seconds
  • Question 22 - In the human body, veins often run a course parallel to the artery...

    Incorrect

    • In the human body, veins often run a course parallel to the artery that has the same name. Which of the following listed veins doesn't run parallel to the artery of the same name?

      Your Answer: Superior epigastric

      Correct Answer: Inferior mesenteric

      Explanation:

      The inferior mesenteric artery and inferior mesenteric vein don’t run in tandem because the vein is part of the portal venous system-draining into the splenic vein which drains into the hepatic portal vein. The inferior mesenteric artery is a branch of the descending aorta at the level of L3. The inferior mesenteric vein and artery, however, drain the same region i.e. the descending and sigmoid colon and rectum.

      Superior epigastric vessels course together and are the continuation of the internal thoracic artery and vein.

      Superficial circumflex iliac vessels course together in the superficial fat of the abdominal wall.

      Superior rectal vessels are the terminal ends of the inferior mesenteric vessels, located on the posterior surface of the rectum.

      The ileocolic artery and vein are branches off the superior mesenteric vessels. Both course in the mesentery, supplying/draining the caecum, appendix, terminal portion of the ileum. The inferior epigastric vessels run together.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      37.3
      Seconds
  • Question 23 - A 34-year-old woman with severe burns, presented to casualty with a blood pressure...

    Correct

    • A 34-year-old woman with severe burns, presented to casualty with a blood pressure of 75/40 mmHg and pulse of 172/minute. Obviously the patient is in shock. Which type of shock is it more likely to be?

      Your Answer: Hypovolaemic shock

      Explanation:

      Shock is a life-threatening condition that occurs when the organs and tissues of the body are not receiving a sufficient flow of blood. Lack of blood flow, oxygen and nutrients results in the inability to function properly and damage to many organs. Shock requires immediate treatment because, if left untreated the impaired tissue perfusion and cellular hypoxia can cause irreversible tissue injury, collapse, coma or even death. There are various types of physiological shock, including: cardiogenic (due to heart damage), hypovolaemic (due to low total volume of blood or plasma), neurogenic (due to nervous system damage), septic (due to infections) and anaphylactic shock (due to allergic reactions). Hypovolaemic shock can be caused by blood loss due to trauma, internal bleeding or other fluid loss due to severe burns, prolonged diarrhoea, vomiting and sweating.

    • This question is part of the following fields:

      • Cardiovascular
      • Pathology
      8.5
      Seconds
  • Question 24 - A 30-year-old woman feels thirsty. This thirst is probably due to: ...

    Correct

    • A 30-year-old woman feels thirsty. This thirst is probably due to:

      Your Answer: Increased level of angiotensin II

      Explanation:

      Thirst is the basic need or instinct to drink. It arises from a lack of fluids and/or an increase in the concentration of certain osmolites such as salt. If the water volume of the body falls below a certain threshold or the osmolite concentration becomes too high, the brain signals thirst. Excessive thirst, known as polydipsia, along with excessive urination, known as polyuria, may be an indication of diabetes. Angiotensin II is a hormone that is a powerful dipsogen (i.e. it stimulates thirst) that acts via the subfornical organ. It increases secretion of ADH in the posterior pituitary and secretion of ACTH in the anterior pituitary.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      7.7
      Seconds
  • Question 25 - Which of the following substances is most likely to cause pulmonary vasodilatation? ...

    Correct

    • Which of the following substances is most likely to cause pulmonary vasodilatation?

      Your Answer: Nitric oxide

      Explanation:

      In the body, nitric oxide is synthesised from arginine and oxygen by various nitric oxide synthase (NOS) enzymes and by sequential reduction of inorganic nitrate. The endothelium of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, so dilating the artery and increasing blood flow. Nitric oxide/oxygen blends are used in critical care to promote capillary and pulmonary dilation to treat primary pulmonary hypertension in neonatal patients post-meconium aspiration and related to birth defects.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      7
      Seconds
  • Question 26 - The blood-brain barrier is a membrane that separates the circulating blood from the...

    Correct

    • The blood-brain barrier is a membrane that separates the circulating blood from the brain extracellular fluid in the central nervous system (CNS). Which of the following statements regarding the blood– brain barrier is CORRECT?

      Your Answer: It breaks down in areas of brain that are infected

      Explanation:

      The blood–brain barrier is a membrane that controls the passage of substances from the blood into the central nervous system. It is a physical barrier between the local blood vessels and most parts of the central nervous system and stops many substances from travelling across it. During meningitis, the blood–brain barrier may be disrupted. This disruption may increase the penetration of various substances (including either toxins or antibiotics) into the brain. A few regions in the brain, including the circumventricular organs, do not have a blood–brain barrier.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      4.3
      Seconds
  • Question 27 - A young lady visited a doctor with complaints of fever and a dull,...

    Correct

    • A young lady visited a doctor with complaints of fever and a dull, continuous pain in the right lumbar region for 6 days. On, enquiry, she recalled passing an increasing number of stools with occasional blood in last few months. Lower gastrointestinal endoscopic biopsy was taken 5 cm proximal to ileocaecal valve which showed transmural inflammation with several granulomas. Tissue section showed the absence of acid-fast bacillus. She denies any history of travel and her stool cultures were negative. What is the likely diagnosis?

      Your Answer: Crohn’s disease

      Explanation:

      Crohn’s disease is a chronic, inflammatory disease that can affect any part of the gastrointestinal tract but is usually seen in the distal ileum and colon. It is transmural and symptoms include chronic diarrhoea, abdominal pain, fever, anorexia and weight loss. On examination, there is usually abdominal tenderness with a palpable mass or fullness seen occasionally. Rectal bleeding is uncommon (except in isolated colonic involvement) which manifests like ulcerative colitis. Differential diagnosis includes acute appendicitis or intestinal obstruction. 25%-33% patients also have perianal disease in the form of fissure or fistulas.

      Extra intestinal manifestations predominate in children, and include: arthritis, pyrexia, anaemia or growth retardation. Histologically, the disease shows crypt inflammation and abscesses initially, which progress to aphthoid ulcers. These eventually develop into longitudinal and transverse ulcers with interspersed mucosal oedema, leading to the characteristic ‘cobblestoned appearance’. Transmural involvement leads to lymphoedema and thickening of bowel wall and mesentery, leading to extension of mesenteric fat on the serosal surface of bowel and enlargement of mesenteric nodes. There can also be hypertrophy of the muscularis mucosae, fibrosis and stricture formation, which can cause bowel obstruction.

      Abscesses are common and the disease can also leas to development of fistulas with various other organs, anterior abdominal wall and adjacent muscles. Pathognomonic non-caseating granulomas are seen in 50% cases and they can occur in nodes, peritoneum, liver, and in all layers of the bowel wall. The clinical course does not depend on the presence of granulomas. There is sharp demarcation between the diseased and the normal bowel (skip areas).

      35% cases show only the ileal involvement, whereas in 45% cases, both the ileum and colon are involved with a predilection for right side of colon. 20% cases show only colonic involvement, often sparing the rectum (unlike ulcerative colitis). In occasional cases, there is jejunoileitis – involvement of the entire small bowel. The stomach, duodenum and oesophagus are rarely involved, although there has been microscopic evidence of disease involving the gastric antrum in younger patients. The affected small bowel segments show increased rick of cancer. Moreover, patients with colonic disease show a long-term risk of cancer similar to that seen in ulcerative colitis.

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
      17.4
      Seconds
  • Question 28 - A 60-year old patient having a history of cholelithiasis that led to recurrent...

    Correct

    • A 60-year old patient having a history of cholelithiasis that led to recurrent pain, bloating, nausea and vomiting, was scheduled for surgery to have the gallbladder removed. During the cholecystectomy, the registrar conducting the procedure accidentally punctured a blood vessel that lies immediately posterior to the omental foramen and blood filled the operating field. Which of the following blood vessels was likely punctured?

      Your Answer: Inferior vena cava

      Explanation:

      The omental foramen is the pathway that connects the greater peritoneal sac and the lesser peritoneal sac. The omental foramen is bordered posteriorly by the inferior vena cava. This is the blood vessel that would most likely be punctured.

      The aorta and its branch, the renal artery, lie postero-lateral to the omental foramen and are deeper than the inferior vena cava hence making them less likely to be injured.

      The hepatic portal vein, the hepatic artery and the superior mesenteric vein borders the omental foramen anteriorly and would not be injured by a jab on the posterior border of the omental foramen.

      Finally, the splenic artery is found in the splenorenal ligament that borders the omental foramen laterally to the left.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      20.7
      Seconds
  • Question 29 - A child defecates a few minutes after being fed by the mother. This...

    Incorrect

    • A child defecates a few minutes after being fed by the mother. This is most likely due to:

      Your Answer: Vasovagal reflex

      Correct Answer: Gastrocolic reflex

      Explanation:

      The gastrocolic reflex is a physiological reflex that involves increase in colonic motility in response to stretch in the stomach and by-products of digestion in the small intestine. It is shown to be uneven in its distribution throughout the colon, with the sigmoid colon affected more than the right side of the colon in terms of a phasic response. Various neuropeptides have been proposed as mediators of this reflex, such as serotonin, neurotensin, cholecystokinin and gastrin.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      7.9
      Seconds
  • Question 30 - The third branch of the maxillary artery lies in which fossa? ...

    Incorrect

    • The third branch of the maxillary artery lies in which fossa?

      Your Answer: Temporal fossa

      Correct Answer: Pterygopalatine fossa

      Explanation:

      The maxillary artery supplies deep structures of the face. It branches from the external carotid artery just deep to the neck of the mandible. It is divided into three portions:

      – The first or mandibular portion (or bony portion) passes horizontally forward, between the neck of the mandible and the sphenomandibular ligament.

      – The second or pterygoid portion (or muscular portion) runs obliquely forward and upward under cover of the ramus of the mandible, on the surface of the lateral pterygoid muscle; it then passes between the two heads of origin of this muscle and enters the fossa.

      – The third portion lies in the pterygopalatine fossa in relation to the pterygopalatine ganglion. This is considered the terminal branch of the maxillary artery. Branches from the third portion includes: the sphenopalatine artery, descending palatine artery, infraorbital artery, posterior superior alveolar artery, artery of pterygoid canal, pharyngeal artery, middle superior alveolar artery and anterior superior alveolar artery.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      15.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Abdomen (2/5) 40%
Anatomy (4/10) 40%
Gastrointestinal; Hepatobiliary (4/4) 100%
Pathology (11/12) 92%
Head & Neck (1/2) 50%
Inflammation & Immunology (0/1) 0%
Respiratory (2/2) 100%
Upper Limb (0/1) 0%
Lower Limb (0/1) 0%
General (0/2) 0%
Physiology (4/8) 50%
Neurology (2/2) 100%
Pelvis (1/1) 100%
Renal (1/1) 100%
Orthopaedics (1/1) 100%
Cell Injury & Wound Healing; Neurology (1/1) 100%
Endocrine (1/1) 100%
Gastroenterology (0/2) 0%
Cardiovascular (1/1) 100%
Fluids & Electrolytes (2/2) 100%
Passmed