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Question 1
Correct
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A 27-year-old woman has chronic low serum calcium levels. Which of the following conditions may be responsible for the hypocalcaemia in this patient?
Your Answer: Hypoparathyroidism
Explanation:Chronic hypocalcaemia is mostly seen in patients with hypoparathyroidism as a result of accidental removal or damage to parathyroid glands during thyroidectomy.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 2
Incorrect
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A 12-year old girl was brought to the hospital with recurrent headaches for 6 months. Her physical examination revealed no abnormality. A CT scan of the head revealed a suprasellar mass with calcifications, eroding the surrounding sella turcica. The lesion is likely to represent:
Your Answer: Prolactinoma
Correct Answer: Craniopharyngioma
Explanation:Craniopharyngiomas (also known as Rathke pouch tumours, adamantinomas or hypophyseal duct tumours) affect children mainly between the age of 5 and 10 years. It constitutes 9% of brain tumours affecting the paediatric population. These are slow-growing tumours which can also be cystic, and arise from the pituitary stalk, specifically the nests of epithelium derived from Rathke’s pouch. Histologically, this tumour shows nests of squamous epithelium which is lined on the outside by radially arranged cells. Calcium deposition is often seen with a papillary type of architecture.
ACTH-secreting pituitary adenomas are rare and mostly microadenomas. Paediatric astrocytoma’s usually occur in the posterior fossa. Although null cell adenomas can cause mass effect and give rise to the described symptoms, they are not suprasellar. Prolactinomas can also show symptoms of headache and disturbances in the visual field, however they are known to be small and slow-growing.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 3
Correct
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A 45 year old man who complains of chronic post prandial, burning epigastric pain undergoes a gastrointestinal endoscopy. There is no apparent mass or haemorrhage and a biopsy is taken from the lower oesophageal mucosa just above the gastro-oesophageal junction. The results reveal the presence of columnar cells interspersed with goblet cells. Which change best explains the above mentioned histology?
Your Answer: Metaplasia
Explanation:Metaplasia is the transformation of one type of epithelium into another as a means to better cope with external stress on that epithelium. In this case metaplasia occurs due to the inflammation resulting from gastro-oesophageal reflux disease. Dysplasia is disordered cellular growth. Hyperplasia is an increase in cell number but not cell type i.e. transformation. Carcinoma is characterized by cellular atypia. Ischaemia would result in necrosis with ulceration. Carcinoma insitu involves dysplastic atypical cells with the basement membrane intact and atrophy would mean a decrease in number of cells.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Gastrointestinal
- Pathology
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Question 4
Correct
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In a splenectomy procedure, special care is emphasized on the preservation of the tail of the pancreas that is closely associated with the spleen to avoid post operative pancreatic fistula. As a general surgeon conducting a splenectomy where are you most likely to find the tail of the pancreas in the abdominal cavity?
Your Answer: Splenorenal ligament
Explanation:The tail of the pancreas is the only intraperitoneal part of the pancreas and is found contained in the splenorenal ligament of the peritoneal cavity. The splenorenal ligament is derived from the peritoneum where the wall of the general peritoneal cavity connects to the omental bursa between the spleen and the left kidney. This ligament contains the splenic vessels and the tail of the pancreas.
The gastrocolic ligament stretches from the greater curvature of the stomach to the transverse colon, connecting the two.
The gastrosplenic ligament is derived from the greater omentum and is the structure that connects the stomach to the hilum of the spleen. The gastrosplenic ligament continues from the splenic flexure of the colon to the diaphragm and acts as a support to the spleen.
The transverse colon is connected to the abdominal wall by the mesocolon ligament.
The falciform ligament on the other hand, attaches the liver to the ventral wall of the abdomen.
The hepatoduodenal ligament connects the porta hepatis of the liver to the superior part of the duodenum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 5
Correct
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An ultrasound report of a 35-year old female patient revealed that she had cancer of the pancreas and presented with subsequent severe obstructive jaundice. In which part of this was woman's pancreas was the tumour most likely located?
Your Answer: Head
Explanation:The pancreas is divided into five parts; the head, body, neck, tail, and the uncinate process. Of the five parts, tumours located at the head of the pancreas in most instances cause obstruction of the common bile duct more often than tumours in the other parts of the pancreas. This is because the common bile duct passes through the head of the pancreas from the gallbladder and the liver (it is formed where the cystic and the hepatic bile duct join) to empty bile into the duodenum. This biliary obstruction leads to accumulation of bile in the liver and a consequent bilirubinaemia (raised levels of blood bilirubin). This results in jaundice. The pancreas is not divided into lobes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 6
Correct
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Macrolides are a group of antibiotics commonly used to treat respiratory tract and soft-tissue infections. Which of the following antibiotics is a macrolide?
Your Answer: Erythromycin
Explanation:Erythromycin is a macrolide antibiotic used in the treatment of several bacterial infections, including respiratory tract infections, skin infections, chlamydia infections, pelvic inflammatory disease, and syphilis. It may also be used during pregnancy to prevent Group B streptococcal infection in the new-born.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 7
Correct
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Which of the following muscle divide the posterior triangle of the neck into the occipital and the subclavian triangle?
Your Answer: Inferior belly of the omohyoid
Explanation:The posterior triangle (or lateral cervical region) is a region of the neck bounded in front by the sternocleidomastoid; behind, by the anterior margin of the trapezius; inferiorly by the middle third of the clavicle and superiorly by the occipital bone. The posterior triangle is crossed, about 2.5 cm above the clavicle, by the inferior belly of the omohyoid muscle, which divides the space into two triangles: an upper or occipital triangle and a lower or subclavian triangle (or supraclavicular triangle).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 8
Correct
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A 45-year-old pregnant woman develops high blood pressure at 20 weeks. She complains of headaches and swollen feet, and a test reveals proteinuria (350 mg/day). Which of the following is the most likely diagnosis?
Your Answer: Pre-eclampsia
Explanation:Pre-eclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure (two separate readings taken at least 6 h apart of 140/90 or more) and often a significant amount of protein in the urine (>300 mg of protein in a 24-h urine sample). While blood pressure elevation is the most visible sign of the disease, it involves generalised damage to the maternal endothelium of the kidneys and liver, with the release of vasopressive factors only secondary to the original damage. Pre-eclampsia may develop at varying times within pregnancy and its progress differs among patients; most cases present pre-term. It has no known cure apart from ending the pregnancy (induction of labour or abortion). It may also present up to 6 weeks post partum. Risk factors for pre-eclampsia include obesity, prior hypertension, older age, and diabetes mellitus.
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This question is part of the following fields:
- Physiology
- Renal
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Question 9
Incorrect
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Painful erections along with deviation of the penis to one side when erect are seen in which of the following conditions?
Your Answer: Priapism
Correct Answer: Peyronie’s disease
Explanation:Peyronie’s disease leads to development of fibrous plaques in the penile soft tissue and occurs in 1% of men, most commonly affecting white males above 40 years age. It is a connective tissue disorder named after a French surgeon, François de la Peyronie who first described it. Symptoms include pain, hard lesions on the penis, abnormal curvature of erect penis, narrowing/shortening, painful sexual intercourse and in later stages, erectile dysfunction. 30% cases report fibrosis in other elastic tissues such as Dupuytren’s contractures of the hand. There is likely a genetic predisposition as increased incidence is noted among the male relatives of an affected individual.
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This question is part of the following fields:
- Pathology
- Urology
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Question 10
Correct
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Whilst snorkelling, a 30-year old gentleman has the respiratory rate of 10/min, tidal volume of 550 ml and an effective anatomical dead space of 250 ml. What is his alveolar ventilation?
Your Answer: 3000 ml/min
Explanation:Alveolar ventilation is the amount of air reaching the alveoli per minute. Alveolar ventilation = respiratory rate × (tidal volume – anatomical dead space volume). Thus, alveolar ventilation = 10 × (550 − 250) = 3000 ml/min.
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This question is part of the following fields:
- Physiology
- Respiratory
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SESSION STATS - PERFORMANCE PER SPECIALTY
