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Question 1
Incorrect
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Different substances have different renal clearance rates. Which of the following substances should have the lowest renal clearance rate in a healthy patient?
Your Answer: Creatinine
Correct Answer: Glucose
Explanation:Under normal conditions the renal clearance of glucose is zero, since glucose is completely reabsorbed in the renal tubules and not excreted. Glycosuria – the excretion of glucose into the urine- is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 2
Incorrect
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A 70-year-old male who has smoked since his teens complains of progressive shortness of breath and a persistent cough. He is diagnosed with COPD. Which of the following abnormalities is most likely to be present in his pulmonary function tests?
Your Answer: Increased FEV1/FVC
Correct Answer: Increased residual volume
Explanation:Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by long-term poor airflow. The main symptoms include shortness of breath and cough with sputum production. The best diagnostic test for evaluating patients with suspected chronic obstructive pulmonary disease (COPD) is lung function measured with spirometry. Key spirometrical measures may be obtained with a portable office spirometer and should include forced vital capacity (FVC) and the normal forced expiratory volume in the first second of expiration (FEV1). The ratio of FEV1 to forced vital capacity (FEV1/FVC) normally exceeds 0.75. Patients with COPD typically present with obstructive airflow. Complete pulmonary function testing may show increased total lung capacity, functional residual capacity and residual volume. A substantial loss of lung surface area available for effective oxygen exchange causes diminished carbon monoxide diffusion in the lung (DLco) in patients with emphysema. Tobacco smoking is the most common cause of COPD, with factors such as air pollution and genetics playing a smaller role.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 3
Incorrect
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The muscle that depresses the glenoid fossa directly is the:
Your Answer: Pectoralis major
Correct Answer: Pectoralis minor
Explanation:Situated at the upper part of the thorax beneath the pectoralis major, is a thin pectoralis minor, triangular muscle. It originates from the third, fourth and fifth ribs, near the cartilage and from the aponeurosis which covers the intercostals. These fibres move upwards and laterally to join and form a flat tendon. This is inserted into the medial border and upper surface of the coracoid process of the scapula. Through this medial anterior thoracic nerve, fibres from the pectoralis minor are received from the eighth cervical and first thoracic nerves. This pectoralis minor pushes down on the point of the shoulder (glenoid fossa), drawing the scapula downward and medially towards the thorax which throws the inferior angle backwards.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 4
Correct
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The principal motor and sensory nerve of the perineum is the?
Your Answer: Pudendal
Explanation:The pudendal nerve is formed by S1,2,4 anterior branches. It gives off the inferior haemorrhoid nerve before dividing terminally into the perineal nerve and the dorsal nerve of the clitoris or the penis. Thus, it is the principal motor and sensory nerve of the perineum.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 5
Incorrect
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Which nerve mediates the sensation to itch from the skin that is just over the base of the spine of your scapula?
Your Answer: Ventral root of T1
Correct Answer: Dorsal primary ramus of C7
Explanation:The first branches off spinal nerves are called the dorsal and ventral rami. The dorsal rami mediate sensation of the skin over the back and motor supply to the true muscles of the back whilst the ventral rami gives sensation to the skin over the limbs and the skin that is over the ventral side of the trunk. It also gives motor supply to the skeletal muscles of the neck, the trunk and extremities. Hence, itchiness of the part of the skin that is over the spine of the scapula would be mediated by the primary ramus of C7. Accessory nerve doesn’t have any sensory innervation.
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This question is part of the following fields:
- Anatomy
- Neurology
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Question 6
Incorrect
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Which of the following statements regarding the femoral artery is CORRECT?
Your Answer: It lies outside the femoral sheath
Correct Answer: It has the femoral nerve lying lateral to it
Explanation:The femoral artery begins immediately behind the inguinal ligament, midway between the anterior superior spine of the ilium and the symphysis pubis. The first 4 cm of the vessel is enclosed, together with the femoral vein, in a fibrous sheath (the femoral sheath). The femoral nerve lies lateral to this.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 7
Correct
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Following nerve injury, paralysis of the quadriceps femoris muscle occurs. Which of the following movements will be affected?
Your Answer: Extension of the leg
Explanation:The quadriceps muscle is a great extensor of the thigh. Therefore, following nerve injury or cutting nerve supply to the quadriceps will affect extension of the thigh
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 8
Incorrect
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A tumour on the floor of the fourth ventricle is most likely to compress which of the following cranial nerve nuclei?
Your Answer: Oculomotor
Correct Answer: Abducent
Explanation:The fourth ventricle, is a cavity of the brains ventricular system in which the cerebrospinal fluid is formed. This cavity is located behind the pons and upper half of the medulla oblongata. It extends from the cerebral aqueduct, to its connection to the third ventricle, and to the obex- which is the caudal tip of the fourth ventricle. The floor of the fourth ventricle consists of three parts – superior, intermediate and inferior. This inferior aspect of the floor of the fourth ventricle has the nucleus of the abducens nerve, CN VI which is looped over by the facial nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 9
Correct
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Linezolid is an antibiotic used for the treatment of infections caused by bacteria that are resistant to other antibiotics. Which of the following organisms is most likely to be effectively treated by linezolid?
Your Answer: Methicillin-resistant Staphylococcus aureus
Explanation:Linezolid is a synthetic antibiotic used for the treatment of infections caused by multiresistant bacteria, including streptococci and methicillin-resistant Staphylococcus aureus (MRSA). Linezolid is effective against Gram-positive pathogens, notably Enterococcus faecium, S. aureus, Streptococcus agalactiae, Streptococcus pneumoniae and Streptococcus pyogenes. It has almost no effect on Gram-negative bacteria and is only bacteriostatic against most enterococci.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 10
Incorrect
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Coagulation in the body (in vivo) is a process in which several proteins known as coagulation factors are activated in a cascade effect to stop bleeding. Which of the following initiates this cascade effect?
Your Answer: Fibrinogen
Correct Answer: Tissue factor
Explanation:Tissue factor (TF), also known as ‘factor III’ or ‘thromboplastin’, is an anti-coagulation protein that initiates the extrinsic coagulation. TF acts as a transmembrane receptor for Factor VII/VIIa . It is expressed by endothelial cells but also certain tissues, such as the heart and brain.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 11
Correct
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An anatomy instructor is giving a demonstration of the right lung. Which of the statements about the right lung made by the demonstrator is correct?
Your Answer: Its upper lobar bronchus lies behind and above the right pulmonary artery
Explanation:The root of the lungs on both sides are similar in that the pulmonary veins are anterior and inferior while the bronchus is posterior. However, on the right side, the pulmonary arteries are anterior to the bronchus while on the left side the pulmonary arteries are superior to the bronchus. The lingual is only found on the left lung. The mediastinum is the space in the thorax between the two pleural sacs and does not contain any lung. The right lung, having three lobes, is slightly larger than the left lung. On both sides, the phrenic nerves passes in front of the root of the lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 12
Incorrect
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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: Stromal hypertrophy
Correct 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 13
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 14
Correct
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Which of the following chemotherapy regimens is most likely to be used in colorectal cancer?
Your Answer: FOLFOX
Explanation:Chemotherapy regimens are often identified by acronyms, identifying the agents used in the drug combination. However, the letters used are not consistent across regimens. FOLFOX is a chemotherapy regimen used for the treatment of colorectal cancer, made up of the following drugs: • FOL: fluorouracil (5-fluorouracil or 5-FU) • F: folinic acid (leucovorin) • OX: oxaliplatin (Eloxatin®).
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 15
Incorrect
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A 30-year-old man is brought to the emergency department suffering from extreme dehydration, and subsequent hypotension and tachycardia. Which part of the kidney will compensate for this loss?
Your Answer: Proximal convoluted tubule
Correct Answer: Collecting ducts
Explanation:The collecting duct system of the kidney consists of a series of tubules and ducts that physically connect nephrons to a minor calyx or directly to the renal pelvis. The collecting duct system is the last component of the kidney to influence the body’s electrolyte and fluid balance. In humans, the system accounts for 4–5% of the kidney’s reabsorption of sodium and 5% of the kidney’s reabsorption of water. At times of extreme dehydration, over 24% of the filtered water may be reabsorbed in the collecting duct system.
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This question is part of the following fields:
- Physiology
- Renal
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Question 16
Correct
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When the pitch of a sound increases, what is the physiological response seen in the listener?
Your Answer: The location of maximal basilar membrane displacement moves toward the base of the cochlea
Explanation:An increase in the frequency of sound waves results in a change in the position of maximal displacement of the basilar membrane in the cochlea. Low pitch sound produces maximal displacement towards the cochlear apex and greatest activation of hair cells there. With an increasing pitch, the site of greatest displacement moves towards the cochlear base. However, increased amplitude of displacement, increase in the number of activated hair cells, increased frequency of discharge of units in the auditory nerve and increase in the range of frequencies to which such units respond, are all seen in increases in the intensity or a sound stimulus.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 17
Incorrect
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When a patient that is less than 21 years of age develops a bone tumour. What is the most common benign bone tumour that would be considered in individuals below 21 years?
Your Answer: Osteogenic sarcoma
Correct Answer: Osteochondroma
Explanation:Osteochondroma is a benign new bone growth that protrudes from the outer contour of bones and is capped by growing cartilage. Nearly 80% of these lesions are noted before the age of 21 years.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 18
Correct
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The superior ulnar collateral artery is a direct branch of this artery:
Your Answer: Brachial
Explanation:The brachial artery gives rise to a small branch at the middle of the arm, which is the superior collateral artery. It descends accompanied by the ulnar nerve and anastomoses with the posterior ulnar recurrent and inferior ulnar collateral.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
Correct
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What class of drugs does buspirone belong to?
Your Answer: Anxiolytic
Explanation:Buspirone is an anxiolytic agent and a serotonin-receptor agonist that belongs to the azaspirodecanedione class of compounds. It shows no potential for addiction compared with other drugs commonly prescribed for anxiety, especially the benzodiazepines. The development of tolerance has not been noted. It is primarily used to treat generalized anxiety disorders. It is also commonly used to augment antidepressants in the treatment of major depressive disorder.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 20
Correct
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Which is a feature of the action of insulin?
Your Answer: Promotes protein synthesis
Explanation:Insulin is produced by the beta-cells of the islets of Langerhans in the pancreas. Its actions include:
– promoting uptake of glucose into cells
– glycogen synthesis (glycogenesis)
– protein synthesis
– stimulation of lipogenesis (fat formation).
– driving potassium into cells – used to treat hyperkaelamia.
Parathyroid hormone and activated vitamin D are the principal hormones involved in calcium/phosphate metabolism, rather than insulin.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 21
Correct
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Which nodes are most likely to be enlarged in a patient complaining of a boil located on the labia majora?
Your Answer: Superficial inguinal
Explanation:The perineum, external genitalia, the labia majora and scrotum drain to the superficial inguinal lymph nodes. In a man, the testes do not drain to the superficial inguinal lymph nodes but rather travel in the spermatic cord and drain into the lumbar nodes. The lumbar nodes drain the internal pelvic organs. The sacral nodes drain the prostrate gland, uterus, vagina, rectum and posterior pelvic wall and the external iliac nodes in turn drain the lower limb. The internal iliac nodes drain the pelvis and gluteal region.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 22
Correct
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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: 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 23
Correct
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Which of the following factors will not affect the wound healing process in a young women who suffered serious burns to her chest and hands?
Your Answer: Vitamin A deficiency
Explanation:Healing can be sped-up or slowed down due to various reasons: 1. blood supply, 2. infection, 3. denervation, 4. collection of blood/hematoma, 5. mechanical stress, 6. foreign body, 7. techniques used during surgery and 8. dressing of the wound. Other systemic factors include 1. nutrition e.g. deficiency of zinc, vitamin C, protein deficiency, 2. metabolic status, 3. circulatory status and 4. hormonal influence
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 24
Correct
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A 40-year old woman presents with tightening of the skin over her fingers which makes movement of her fingers difficult.. She also gives a history of her fingers turning blue on exposure to low temperatures. She admits to gradual weight loss. Investigations reveal negative rheumatoid factor, negative antinuclear antibody and a positive anticentromere body. Which of the following conditions is she likely to have?
Your Answer: Oesophageal stricture
Explanation:Scleroderma is a connective tissue disorder that ranges in severity and progression. The disease could show generalised skin thickening with rapid, fatal, visceral involvement; or only cutaneous involvement (typically fingers and face). The slow progressive form is also known as ‘limited cutaneous scleroderma’ or CREST syndrome (calcinosis cutis, Raynaud’s phenomenon, (o)oesophageal dysmotility, sclerodactyly, and telangiectasia).
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 25
Correct
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What is the percentage of bone calcium that is freely exchangeable with the extracellular fluid that is available for buffering changes in the calcium ion balance?
Your Answer: 1%
Explanation:Around 1% of calcium in the body is available for buffering changes in calcium ion balance. These are mainly derived from the bone that are freely exchangeable with extracellular fluid.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 26
Correct
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A 40 year old woman, who is under anaesthesia for an elective procedure, received an antibiotic injection. She immediately developed a rash and her airway constricted raising the airway pressure. Which mechanism is responsible for this reaction?
Your Answer: Type I hypersensitivity
Explanation:Type I hypersensitivity reaction is an immediate reaction that occurs due to binding of the antigen with antibodies attached to mast cells in a previously sensitized person. It has an immediate phase, which is characterised by vasodilation, leakage of plasma, smooth muscle spasm, or glandular secretions. This manifests in about 5-30 min and usually resolves within 60 mins. The delayed phase follows after 24 hours and can persist up to several days. It is due to infiltration of eosinophils, neutrophils, basophils and CD4+ cells and leads to tissue destruction. The nature of the reaction varies according to the site. It can take the form of skin allergy, hives, allergic rhinitis, conjunctivitis, bronchial asthma or food allergy.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 27
Incorrect
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A 35-year old lady presents to her GP with vague abdominal symptoms. Examination reveals a normal size spleen. Which of the following is the likely diagnosis?
Your Answer:
Correct Answer: Idiopathic thrombocytopenic purpura
Explanation:Idiopathic thrombocytopenic purpura (ITP) is a disease caused due to development of an antibody against a platelet antigen (autoantibody). In childhood disease, the autoantibody gets triggered by binding of viral antigen to the megakaryocytes. Presentation includes unexplained thrombocytopenia, petechiae and bleeding from mucosal surfaces. The spleen usually does not enlarge in size. However, splenomegaly can occur due to coexisting viral infection. Marrow examination reveals normal or increased number of megakaryocytes. Diagnosis is by exclusion of other thrombocytopenic disorders.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 28
Incorrect
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A 62-year-old male smoker, presented with shortness of breath, chronic cough and haemoptysis over the last three months. He has developed a fat pad in the base of his neck, rounded face, acne and osteoporosis. Which of the following is the most likely pulmonary disease that is causing these symptoms and findings?
Your Answer:
Correct Answer: Small-cell anaplastic carcinoma
Explanation:Small cell lung cancer is a highly aggressive form of lung cancer. It is thought to originate from neuroendocrine cells in the bronchus called Feyrter cells and is often associated to ectopic production of hormones like ADH and ACTH that result in paraneoplastic syndromes and Cushing’s syndrome.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 29
Incorrect
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A 33-year old lady presented to the gynaecology clinic with amenorrhoea for 6 months and a recent-onset of milk discharge from her breasts. She was not pregnant or on any medication. On enquiry, she admitted to having frequent headaches the last 4 months. Which of the following findings would you expect to see in her condition?
Your Answer:
Correct Answer: Hyperprolactinaemia
Explanation:Excessively high levels of prolactin in the blood is called hyperprolactinaemia. Normally, prolactin levels are less than 580 mIU/l in females and less than 450 mIU/l in men. The biologically inactive macroprolactin can lead to a false high reading. However, the patient remains asymptomatic. Dopamine down-regulates prolactin whereas oestrogen upregulates it. Hyperprolactinaemia can be caused due to lack of inhibition (compression of pituitary stalk or low dopamine levels), or increased production due to a pituitary adenoma (prolactinoma). Either of these causes can lead to a prolactin level of 1000-5000 mIU/l. However, levels more than 5000mIU/l are usually associated due to an adenoma and >100,000 mIU/l are seen in macroadenomas (tumours < 1cm in diameter). Increased prolactin causes increased dopamine release from the arcuate nucleus of hypothalamus. This increased dopamine in turn, inhibits the GnRH (Gonadotrophin Releasing Hormone) thus blocking gonadal steroidogenesis resulting in the symptoms of hyperprolactinaemia. In women, it includes hypoestrogenism, anovulatory infertility, decreased or irregular menstruation or complete amenorrhoea. It can even cause production of breast milk, loss of libido, vaginal dryness and osteoporosis. In men, the symptoms include impotence, decreased libido, erectile dysfunction and infertility. In men, treatment can be delayed due to late diagnosis as they have no reliable indicator such as menstruation that might indicate a problem. Most of the male patients seek help only when headaches and visual defects start to surface.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 30
Incorrect
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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:
Correct 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.
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This question is part of the following fields:
- Anatomy
- Pelvis
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SESSION STATS - PERFORMANCE PER SPECIALTY
