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Question 1
Incorrect
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A 27 year-old male patient was admitted to the hospital due to recurrent fever for the past 2 weeks. The patient claimed that he is an intravenous drug user. Following work up, the patient was diagnosed with infective endocarditis. Which is the most likely organism responsible for this diagnosis?
Your Answer: Enterococcus
Correct Answer: Staphylococcus aureus
Explanation:Acute bacterial endocarditis is a fulminant illness lasting over days to weeks (<2weeks). It is most likely due to Staphylococcus aureus especially in intravenous drug abusers.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 2
Correct
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What is the arterial sequence for an analgesic to reach the latissimus dorsi muscle assuming that your starting point is at the subclavian vein?
Your Answer: Subclavian – axillary – subscapular – thoracodorsal
Explanation:Assuming our starting point is the subclavian artery, the analgesic continues in the same vessel into the axillary artery, as it passes into the axilla. The axillary artery at the lower border of the subscapularis gives rise to the subcapsular artery which is considered the largest branch of the axillary artery. This circumflex scapular branch distributes a serratus branch before entering the substance of the muscle as the thoracodorsal artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 3
Incorrect
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During work up for a 29 year-old lady who complained of chest pain, a computed tomography showed a large mass in the posterior mediastinum. Which among the following structures could be involved?
Your Answer: Inferior vena cava
Correct Answer: Lymph nodes
Explanation:Boundaries of the posterior mediastinum include:
Superior: a plane through the sternal angle and T4/5
Inferior: the diaphragm
Anterior: the middle mediastinal structures
Posterior the spinal cord.
Structures in the posterior mediastinum include the descending thoracic aorta, the azygos system, oesophagus, thoracic duct and lymph nodes. The great vessels and structures at the root of the lung are part of the middle mediastinum. In this case, the lymph nodes is the correct answer.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 4
Correct
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A 45 -year-old female is recently diagnosed with breast cancer. She has a 8-cm-diameter mass in her left breast, with enlarged left axillary node. What is the most likely stage of her disease?
Your Answer: IIIA
Explanation:Stage IIIA breast cancer is T0–2 N2 M0 or T3 N1-2 M0 disease. It describes invasive breast cancer in which either: the tumour is smaller than 5 cm in diameter and has spread to 4 to 9 axillary lymph nodes; or it is found through imaging studies or clinical exam to have spread to internal mammary nodes (near the breastbone found during imaging tests or a physical exam); or the tumour is larger than 5 cm and has spread to 1 to 9 axillary nodes, or to internal mammary nodes. In this stage, the cancer has not metastasized (spread to distant sites).
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 5
Correct
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The petrous part of the internal carotid artery is located inside of which cranial bone?
Your Answer: Temporal
Explanation:The petrous segment, or C2, of the internal carotid is that which is inside the petrous part of the temporal bone. This segment extends until the foramen lacerum. The petrous portion classically has three sections: an ascending, or vertical portion; the genu, or bend; and the horizontal portion.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 6
Incorrect
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What are the derivatives of the first brachial arch?
Your Answer: Gives rise to the styloid process and hyoid bone
Correct Answer: Gives rise to the sphenomandibular ligament
Explanation:The first brachial arch (mandibular) gives rise to the mandibular and maxillary processes. Muscles and bones of this process originate within the arch’s mesoderm. The first arch cartilage (Meckel’s) ossifies to form the incus and malleus of the middle ear. Its perichondrium gives rise to he sphenomandibular ligament and through intermembraneous ossification after the mandible forms, the rest of the cartilage disappears. Muscles of the first arch include: mylohyoid, tensor tympany and palati, temporalis, masseter and lateral pterygoids and the anterior belly of the epigastric. This first arch is supplied by the trigeminal nerve.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 7
Incorrect
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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: Progressive multifocal leukoencephalopathy
Correct 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.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 8
Correct
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The pattern of drainage of the lymphatic and venous systems of the anterior abdominal wall is arranged around a horizontal plane above which drainage is in a cranial direction and below which drainage is in a caudal direction. Which horizontal plane is being referred to?
Your Answer: Level of the umbilicus
Explanation:The umbilicus is a key landmark for the lymphatic and venous drainage of the abdominal wall. Above it, lymphatics drain into the axillary lymph nodes and the venous blood drains into the superior epigastric vein, into the internal thoracic vein. Below it, lymphatics drain into the superficial inguinal lymph nodes while venous blood drains into the inferior epigastric vein and the external iliac vein.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 9
Incorrect
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A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for the last 5 days. A CT scan reveals an oedematous mass with ring enhancement in the left temporal region. It is biopsied, revealing glial cells, necrosis, neutrophils and lymphocytes. What is the most likely diagnosis?
Your Answer: Herpes simplex type 2 encephalitis
Correct Answer: Cerebral 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. It is most frequent in the third decade of life, and when it occurs in children, it is usually associated with congenital heart disease.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 10
Correct
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The middle meningeal artery is the largest among the arteries that supplies that dura mater of the brain. The middle meningeal artery is a branch of the?
Your Answer: Maxillary artery
Explanation:The middle meningeal artery is the largest of the three (paired) arteries that supply the meninges.
The middle meningeal artery is a large arterial branch of the maxillary artery which is a terminal branch of the external carotid artery. Upon originating, the middle meningeal artery passes through the foramen spinosum. In the skull, it courses in the middle cranial fossa where it provides several branches.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 11
Incorrect
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A victim of assault in a domestic violence is stabbed in the left chest. The tip of the pen knife entered the pleural space just above the cardiac notch. Luckily the lung was spared as it would only occupy this space during deep inspiration. Which of these structures was pierced by the knife?
Your Answer: Costodiaphragmatic recess
Correct Answer: Costomediastinal recess
Explanation:The costomediastinal recess is located immediately next to the cardiac notch. The medial aspect of the superior lobe of the left lung, when fully inflated expands to this place. The lung wouldn’t enter the anterior or the posterior mediastinum which are found between the two pleural cavities.
The costodiaphragmatic recess is the lowest extent of the pleural cavity where the inferior lobes of the lungs would expand into in deep inhalation.
The cupola, is the part of the pleural cavity that extends above the first rib into the root of the neck. The superior most part of the superior lobe of the lung might extend into this part.
Pulmonary ligament: pleural fold that is located below the root of the lung where the visceral pleura and the mediastinal pleura are in continuity.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 12
Correct
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A 55-year-old man underwent CT scan of the whole abdomen. The result showed renal cell carcinoma with a tumour size of 7cm and extension into the regional lymph. What is the clinical stage of his renal cell cancer?
Your Answer: Stage III
Explanation:Renal cell carcinoma is a kidney cancer that originates in the lining of the proximal convoluted tubule. It is the most common type of kidney cancer in adults, responsible for approximately 90–95% of cases. Renal cell carcinomas can be staged by using the American Joint Committee on Cancer (AJCC) TNM (tumour-node-metastasis) classification, as follows: Stage I: tumours that are 7 cm or smaller and confined to the kidney, Stage II: tumours that are larger than 7 cm but still confined to the kidney, Stage III: tumours extending into the renal vein or vena cava, involving the ipsilateral adrenal gland and/or perinephric fat, or which have spread to one local lymph node and Stage IV: tumours extending beyond Gerota’s fascia, to more than one local node, or with distant metastases Recent literature has questioned whether the cut-off in size between stage I and stage II tumours should be 5 cm instead of 7 cm. The patient’s cancer in this case is stage III.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 13
Incorrect
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The superior rectal artery is a continuation of the:
Your Answer: Sigmoid artery
Correct Answer: Inferior mesenteric artery
Explanation:The superior rectal artery or superior haemorrhoidal artery is the continuation of the inferior mesenteric artery. It descends into the pelvis between the layers of the mesentery of the sigmoid colon, crossing the left common iliac artery and vein.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 14
Correct
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A 17-year-old female was given an antibiotic for a urinary tract infection. After taking the medication the patient developed Steven-Johnson syndrome. Which particular antibiotic usually causes Steven-Johnson syndrome?
Your Answer: Sulphonamides
Explanation:Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulphonamide antibiotics, and nevirapine.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 15
Correct
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Which muscle would be affected most following injury to the transverse cervical artery?
Your Answer: Trapezius
Explanation:The latissimus dorsi receives blood from the thoracodorsal artery, the supraspinatus receives its blood from the suprascapular artery, the levator scapulae and the rhomboids are supplied by the dorsal scapular artery and the transverse cervical artery supplies blood to the trapezius.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 16
Correct
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In a neurological exam on a robbery with violence victim, it was discovered that the victim had lost sense of touch to the skin over her cheek and chin (maxilla and mandible region). Where are the cell bodies of the nerve that is responsible for touch sensations of this region located?
Your Answer: Cranial nerve V ganglion
Explanation:The skin over the cheek and the maxilla are innervated by the trigeminal nerve (CN V). The trigeminal nerve has three major branches and it is the largest cranial nerve. The three branches of the trigeminal nerve are; the ophthalmic nerve, the maxillary nerve and the mandibular nerve. The trigeminal nerves ganglion is a sensory nerve ganglion know as the trigeminal ganglion (also referred to as the Gasser’s ganglion or the semilunar ganglion). It is contained in the dura matter in a cavity known as the Meckel’s cave, which covers the trigeminal impression near the apex of the petrous part of the temporal bone.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 17
Incorrect
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The transmembrane proteins responsible for resting membrane potential of vascular smooth muscle cells was blocked by a drug. Which of the following transmembrane proteins were blocked by this drug?
Your Answer: Ca2+ channels
Correct Answer: K+ channels
Explanation:The resting membrane potential is due to selective permeability of the membrane to potassium ions. The Na/K pump is responsible for the generation of a gradient across the membrane and it is due to the inherent ability of the K channels to allow diffusion back into the nerve at rest which charges the cells. In reality, the resting membrane potential is more positive because of small contributions by Na+ channels, Cl− channels and non-selective cation channels.
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This question is part of the following fields:
- General
- Physiology
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Question 18
Correct
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A 5 year-old-child with fever complains of sore throat . She was brought to her paediatrician for consult because she has also developed a rash and has swollen lymph nodes. Upon physical examination she cried when her liver was palpated and the tip of her spleen is slightly palpable. Full blood count shows haemoglobin 13 g/dL, Haematocrit 40%, white blood cell count 13x109/L with a WBC differential count of 45 neutrophils, 4 bands, 26 lymphocytes, 15 atypical lymphocytesm, 10 monocytes and 1 eosinophil. Whick is the most likely infectious agent that is responsible for the patient's condition?
Your Answer: Epstein–Barr virus
Explanation:Epstein-Barr virus (EBV), also known as human herpes virus 4,is a member of the herpes virus family. EBV spreads most commonly through bodily fluids, primarily saliva. EBV can cause infectious mononucleosis. Symptoms of EBV can include fatigue, fever, inflamed throat, swollen lymph nodes in the neck, enlarged spleen, swollen liver and rash.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 19
Incorrect
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The wound healing process is documented in patients undergoing laparoscopic procedures. The port incisions are sutured closed and the wounds observed every few weeks for re-epithelialisation and tensile strength. Which substance is mostly likely to be found at a cellular level involved in wound healing?
Your Answer: Collagen
Correct Answer: Tyrosine kinase
Explanation:Cell surface growth factor receptors require intercellular proteins such as tyrosine kinase which are necessary to initiate a series of events that eventually lead to cell division and growth. Tyrosine kinase is an enzyme that transfers a phosphate group to the tyrosine residue in a protein. This phosphorylation will lead to an up regulation of the enzyme activity.
Fibronectin acts in the extracellular matrix to bind macromolecules (such as proteoglycans) via integrin receptors to aid attachment and migration of cells.
Laminin is an extracellular matrix component that is abundant in basement membranes.
Hyaluronic acid is one of the proteoglycans in the extracellular matrix.
Collagen fibres are part of the extracellular matrix that gives strength and stability to connective tissues.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 20
Correct
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A 24 year old mother is breastfeeding her first child. Which of the following cellular adaptations occurred in her breast tissue to allow her to do this?
Your Answer: Lobular hyperplasia
Explanation:Under the influence of oestrogen in pregnancy, there is an increase in the number of lobules which will facilitate lactation.
Steatocytes occur due to loss of weight and nutritional deficit.
Metaplasia is a normal physiological process which is due to a change in normal epithelium with another type.
Lobular atrophy will result in a decreased capacity to provide milk.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Female Health
- Pathology
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Question 21
Correct
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A young girl who presented with a clinical picture of type I hypersensitivity reaction with eosinophilia is most likely to have?
Your Answer: Liver flukes
Explanation:Usually a parasitic infection will be associated with a type I hypersensitivity reaction.
Amyloid deposition will not cause an immune reaction.
Organic dust will lead to a type III hypersensitivity reaction.
Cell mediated as well as humoral immune mechanism play a part in syphilis, but they are do not specifically cause a type I reaction.
Malaria is cause by plasmodium and is not cause of a hypersensitivity reaction.
Atopic dermatitis will not be accompanied by eosinophilia.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 22
Correct
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Which tumour site is more commonly involved in adults than in children?
Your Answer: Lung
Explanation:In adults, the most common primary site of tumour is in the lungs, compared to children wherein the most common primary site is the blood.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 23
Incorrect
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A 50 year old man was admitted to the surgical ICU following a hemicolectomy for carcinoma of the caecum. A full blood count revealed: haematocrit = 30%, erythrocytes = 4 × 106/μ, haemoglobin level = 8 g/dl. To determine the likely cause of his anaemia, red blood cell indices were calculated. Which RBC indices are correct?
Your Answer: MCHC = haemoglobin concentration × 10/erythrocyte number
Correct Answer: MCHC = haemoglobin concentration/haematocrit
Explanation:Mean corpuscular haemoglobin concentration (MCHC) is calculated simply by dividing the haemoglobin concentration (8 g/dl) by the haematocrit (0.3). The normal range is 31–36 g/dl. This patient has a hypochromic anaemia (MCHC = 8/0.3 = 26.7 g/dl). Dividing the haemoglobin concentration × 10 by erythrocyte number yields mean corpuscular haemoglobin (MCH). Normal range is 25.4–34.6 pg/cell and this patient has a significantly reduced cellular haemoglobin content (MCH = 8 × 10/4 = 20 pg/cell). Mean corpuscular volume (MCV) is calculated by dividing haematocrit × 1000 by erythrocyte number (4 × 106/μl). Normal range is 80–100 fl and this patient has a microcytic anaemia (MCV = 0.3 × 1000/4 = 75 fl). Microcytic, hypochromic anaemia is characteristic for iron-deficiency.
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This question is part of the following fields:
- General
- Physiology
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Question 24
Correct
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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.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 25
Correct
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The line which divides the perineum into two triangles is connected to the?
Your Answer: Ischial tuberosities
Explanation:The perineum has it’s deep boundaries in front of the pubic arch and the arcuate ligament of the pubis, behind the tip of the coccyx and on either side of the inferior rami of the pubis and ischium and the sacrotuberous ligament. It also corresponds to the outlet of the pelvis. A line drawn transversely across, in front of the ischial tuberosities divides the space into two portions, the posterior contains the termination of the anal canal and the anterior, contains the external urogenital organs.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 26
Correct
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Which of the following is NOT a nutritional factor involved in wound healing:
Your Answer: Vitamin B3
Explanation:Vitamin B6 is required for collagen cross-links.
Vitamin A is required for epithelial cell proliferation.
Zinc is required for RNA and DNA synthesis.
Copper is required for cross-linking of collagen.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Physiology
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Question 27
Correct
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The neurotransmitters adrenaline, noradrenaline and dopamine are derived from which amino acid?
Your Answer: Tyrosine
Explanation:Tyrosine is the precursor to adrenaline, noradrenaline and dopamine. Tyrosine hydroxylase converts tyrosine to DOPA, which is in turn converted to dopamine, then to noradrenaline and finally adrenaline.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 28
Correct
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Signals pass through neuromuscular junctions via the neurotransmitter acetylcholine. After release from the skeletal neuromuscular junction, acetylcholine:
Your Answer: Causes postsynaptic depolarisation
Explanation:Acetylcholine is released from the presynaptic membrane into the cleft where it binds to the ion gated channels on the post synaptic membrane, causing them to open. This results in sodium entering into the fibre and further depolarizing it, creating an action potential.
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This question is part of the following fields:
- General
- Physiology
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Question 29
Correct
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The Brunner glands secrete an alkaline product that helps maintain an optimal pH for pancreatic enzyme activity. Where are these glands located?
Your Answer: Submucosa of the duodeneum
Explanation:The Brunner glands are located in the submucosa of the duodenum. These glands are connected to the interstitial lumen by ducts that open into certain crypts. They secrete an alkaline product that protects the duodenal mucosa from the acidic chyme and helps achieve an optimal pH for the enzymes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 30
Incorrect
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For calculation of cardiac output by Fick's principle, which of the following vessels is the best source of venous blood to determine the arterial-to-venous oxygen tension difference?
Your Answer: Pulmonary vein
Correct Answer: Pulmonary artery
Explanation:Fick’s principle states that the total uptake (or release) of a substance by peripheral tissues is equal to the product of the blood flow to the peripheral tissues and the arterial– venous concentration difference (gradient) of the substance. It is used to measure the cardiac output, and the formula is Cardiac output = oxygen consumption divided by arteriovenous oxygen difference. Assuming there are no shunts across the pulmonary system, the pulmonary blood flow equals the systemic blood flow. The arterial and venous blood oxygen content is measured by sampling from the pulmonary artery (low oxygen content) and pulmonary vein (high oxygen content). Peripheral arterial blood is used as a surrogate for the pulmonary vein.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 31
Correct
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Which foramen contains the vertebral artery?
Your Answer: Foramen magnum
Explanation:The foramen magnum is found in the most inferior part of the posterior cranial fossa. It is traversed by vital structures including the medulla oblongata. Its contents include the following: medulla oblongata, meninges, spinal root of the accessory nerve, vertebral arteries, anterior and posterior spinal arteries, tectorial membrane and alar ligaments.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 32
Correct
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A chef, whilst preparing food, cut her thumb with a knife. She transected the arteria princeps pollicis. This artery is a branch of the?
Your Answer: Radial artery
Explanation:The radial artery branches into the arteria princeps pollicis as it turns medially into the deep part of the hand. The arteria princeps pollicis is distributed to the skin and subcutaneous tissue of the thumb.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 33
Correct
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An experiment was conducted in which the skeletal muscle protein (not smooth muscle) involved in contraction was selectively inhibited. Which protein was inhibited?
Your Answer: Troponin
Explanation:The mechanism of contraction of smooth muscles is different from that of skeletal muscles in which the contractile protein is troponin whilst in smooth muscle contraction is a protein called calmodulin. Calmodulin reacts with calcium ions and stimulates the formation of myosin crossbridges.
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This question is part of the following fields:
- General
- Physiology
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Question 34
Correct
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Which of the following diseases can cause paraesthesia along the distribution of the median nerve of the hand, especially after activities which require flexion and extension of the wrist?
Your Answer: Carpal tunnel syndrome
Explanation:Carpal tunnel syndrome tends to occur in women between the ages of 30-50. There are many risk factors, including diabetes, hypothyroidism, obesity, pregnancy, and repetitive wrist work. Symptoms include pain in the hand and wrist, tingling, and numbness distributed along the median nerve (the palmar side of the thumb, the index and middle fingers, and the radial half of the ring finger), which worsens at night.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 35
Incorrect
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A 46-year old lady presents with chief complaints of a large mass in the left breast. Histopathology of the mass revealed a stromal component with an epithelial component. What is the likely lesion?
Your Answer: Fibroadenoma
Correct Answer: Phyllodes tumour
Explanation:Phyllodes tumours are large, quickly growing tumours which arise from the periductal stroma of the breast. These are fibroepithelial tumours and account for less than 1% of breast cancers. These tumours can be benign, borderline or malignant based on the histology. The tumour usually affects adult women, mostly between the age of 40 to 50 years. It can be confused with fibroadenoma, which however affects much younger patients.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 36
Correct
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A 55-year-old woman died 3 years after a cardiac transplant due to worsening congestive heart failure. Autopsy revealed diffuse hyperplasia of the vascular intima involving the entire length of the coronary arteries. The most probable cause of deterioration of the cardiac function is:
Your Answer: Coronary atherosclerosis
Explanation:Allograft coronary artery disease (CAD) can begin right after the transplant and is the major cause of later death in cardiac transplant recipients. This form of atherosclerosis progresses quickly resulting in allograft failure. Due to lack of premonitory symptoms CAD may lead to sudden death.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 37
Correct
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An amateur body-builder complains of increasing pain in his right shoulder after a few days of intense training. A surgeon aspirates clear fluid from his subdeltoid region. What's the most likely diagnosis?
Your Answer: Bursitis
Explanation:Bursae are potential cavities that contain synovial fluid, found in areas where friction occurs. Their function is to minimise friction and facilitate movement. Bursitis is the inflammation of one or more bursae, and they can occur in the shoulder, elbow, knee, ischium, amongst other joints. Acute bursitis can appear after strenuous exercise or activity, and chronic bursitis can develop following previous bursitis or trauma. Acute bursitis causes pain, tenderness, and swelling.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 38
Correct
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Depression of the normal coagulation system and excessive bleeding after surgery can occur in which of the following medical conditions?
Your Answer: Liver disease
Explanation:As most of the coagulation factors are synthesized in the liver, liver diseases like hepatitis or cirrhosis will depress the coagulation system. Vitamin K deficiency can also decrease the production of vitamin K dependent coagulation factors VII, XI, X and prothrombin.
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This question is part of the following fields:
- General
- Physiology
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Question 39
Correct
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Which of the deep fasciae located in the anterolateral abdominal wall form the inguinal ligament?
Your Answer: External abdominal oblique aponeurosis
Explanation:The inguinal ligament is the inferior border of the aponeurosis of the external oblique abdominis and extends from the anterior superior iliac spine to the pubic tubercle from whence it is reflected backward and laterally to attach to the pectineal line and form the lacunar ligament.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 40
Correct
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During a car accident, the side mirror shattered and a broken piece of glass severed the posterolateral aspect of the driver's neck. A physical examination reveals that the driver is unable to elevate the tip of his shoulder on the side that was injured. Which nerve was injured?
Your Answer: Accessory
Explanation:The tip of the shoulder is formed by the acromion of the scapula. This part is moved by the trapezius muscle which is innervated by the accessory nerve. Damage to this nerve therefore will prevent the patient from lifting the tip of the shoulder.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 41
Correct
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A tumour growing in the posterior mediastinum is found in a 40-year-old man who presented to the out patient clinic with chest pain. Such a tumour is likely to compress the following structure:
Your Answer: Oesophagus
Explanation:The boundaries of the posterior mediastinum are: the superiorly through the sternal angle and T4/5, inferiorly, the diaphragm, anteriorly, by the middle mediastinal structures and posteriorly by the spinal cord. Structures in the posterior mediastinum include the descending thoracic aorta, the azygos system, oesophagus, thoracic duct and lymph nodes. The great vessels and structures at the root of the lung are part of the middle mediastinum. The oesophagus is the only structure in the posterior mediastinum among the choices.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 42
Correct
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A 50 year-old man, who sustained a head injury experienced sudden onset of horizontal double vision. He is diagnosed with lateral rectus palsy. Which of the following nerves is affected in this condition?
Your Answer: Abducent
Explanation:The lateral rectus muscle is one of the 6 extra-ocular muscles that control eye movements. It is responsible for abduction and is the only muscle that is innervated by the abducens nerve (CN VI).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 43
Correct
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During an operation for a sigmoid colectomy the surgeon ligates the sigmoid arteries. From which artery do the sigmoid arteries branch?
Your Answer: Inferior mesenteric artery
Explanation:Sigmoid arteries are branches of the inferior mesenteric artery (IMA). Sigmoid artery gives off branches that supply the lower descending colon, the iliac colon and the sigmoid colon.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 44
Correct
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A lady presents to the out patient clinic with a painful boil on the skin of her mons pubis. Which nerve supplies the skin of the mons pubis?
Your Answer: Anterior labial
Explanation:Anterior labial branch is the terminal branch of the ilioinguinal nerve that innervates the skin of the mons pubis in women and the skin of the anterior scrotum in men.
The femoral branch of genitofemoral nerve innervates the upper medial thigh.
The iliohypogastric innervates muscles of the abdominal wall.
The subcostal nerve innervates muscles of the abdominal wall and the skin of the lower abdominal wall.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 45
Incorrect
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A 30-year-old woman is diagnosed with Hodgkin's lymphoma. Which of the following chemotherapy regimens would be used in this case?
Your Answer: CHOP
Correct Answer: ABVD
Explanation:ABVD is a chemotherapy regimen used in the first-line treatment of Hodgkin’s lymphoma. It consists of concurrent treatment with the chemotherapy drugs, adriamycin, bleomycin, vinblastine and dacarbazine. It supplanted the older MOPP protocol.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 46
Correct
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A 15-day old male baby was brought to the emergency department with sweating and his lips turning blue while feeding. He was born full term. On examination, his temperature was 37.9°C, blood pressure 75/45 mmHg, pulse was 175/min, and respiratory rate was 42/min. A harsh systolic ejection murmur could be heard at the left upper sternal border. X-ray chest showed small, boot-shaped heart with decreased pulmonary vascular markings. He most likely has:
Your Answer: Tetralogy of Fallot
Explanation:The most common congenital cyanotic heart disease and the most common cause of blue baby syndrome, Tetralogy of Fallot shows four cardiac malformations occurring together. These are ventricular septal defect (VSD), pulmonary stenosis (right ventricular outflow obstruction), overriding aorta (degree of which is variable), and right ventricular hypertrophy. The primary determinant of severity of disease is the degree of pulmonary stenosis. Tetralogy of Fallot is seen in 3-6 per 10,000 births and is responsible for 5-7% congenital heart defects, with slightly higher incidence in males. It has also been associated with chromosome 22 deletions and DiGeorge syndrome. It gives rise to right-to-left shunt leading to poor oxygenation of blood. Primary symptom is low oxygen saturation in the blood with or without cyanosis at birth of within first year of life. Affected children ay develop acute severe cyanosis or ‘tet spells’ (sudden, marked increase in cyanosis, with syncope, and may result in hypoxic brain injury and death). Other symptoms include heart murmur, failure to gain weight, poor development, clubbing, dyspnoea on exertion and polycythaemia. Chest X-ray reveals characteristic coeur-en-sabot (boot-shaped) appearance of the heart. Treatment consists of immediate care for cyanotic spells and Blalock–Taussig shunt (BT shunt) followed by corrective surgery.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 47
Correct
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Which of the following cytokines produced by the T cell induce MHC-II proteins?
Your Answer: γ-Interferon
Explanation:Interferons elicit a non-specific antiviral activity by inducing specific RNA synthesis and expression of proteins in neighbouring cells. Common interferon inducers are viruses, double-stranded RNA and micro-organisms. INF-γ is produced mainly by CD4+, CD8+ T cells and less commonly by B cells and natural killer cells. INF-γ has antiviral and antiparasitic activity but its main biological activity appears to be immunomodulatory. Among its many functions are activation of macrophages and enhanced expression of MHC-II proteins or macrophages.
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This question is part of the following fields:
- General
- Physiology
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Question 48
Incorrect
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Which of the following is true about myasthenia gravis?
Your Answer: A large dose of physostigmine is likely to improve the symptoms
Correct Answer: Response of skeletal muscle to nerve stimulation is weakened
Explanation:An autoimmune disorder, myasthenia gravis leads to progressive muscle weakness. It occurs due to formation of antibodies against the nicotinic acetylcholine (ACh) receptor of the motor endplate, which leads to impaired neuromuscular transmission. Thus, nerve stimulation will lead to a weakened muscle response, but direct electrical stimulation will bring about a normal response. Diagnostic test includes improvement of muscle weakness by small doses of acetylcholinesterase inhibitors (physostigmine or edrophonium). However, a large dose of physostigmine worsens the weakness due to desensitisation of the endplate to persistent Ach. One of the investigative tools includes radiolabelled snake venom α-bungarotoxin. It is an in vitro study performed on muscle biopsy specimens and used to quantify the number of ACh receptors at the motor endplate.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 49
Correct
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A 13-year-old girl has complained of pain in her left arm for 4 months. An X-ray reveals a mass along with erosion of the affected humerus. Histologically, the tumour is found to be formed by small, round, blue cells. What is the most likely diagnosis?
Your Answer: Ewing’s sarcoma
Explanation:Ewing’s sarcoma is formed by small, round, blue cells, and is common in children. The usually develop in limbs, and clinical findings include pain and inflammation, with lytic destruction showing up on X-rays.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 50
Incorrect
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A 45-year-old-female is suspected to have a pulmonary mass. Supposing that she has a neoplasm, which of the following are most commonly found to involve the lung:
Your Answer: Small-cell anaplastic carcinomas in smokers
Correct Answer: Pulmonary metastases
Explanation:Lung metastases occur when a cancer started in another part of the body (primary site) spreads to the lungs. The lungs are among the most common site where cancer can spread due to its rich systemic venous drainage, almost every type of cancer can spread to the lung. The most common types of cancer that spread to the lung are breast, colorectal, kidney, testicular, bladder, prostate, head and neck cancers.
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This question is part of the following fields:
- Pathology
- Respiratory
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