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Question 1
Correct
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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: 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 2
Incorrect
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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: Posterior belly of the digastric
Correct 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 3
Correct
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After a severe asthma attack, a 26-year-old woman is left in a markedly hypoxic state. In which of the following organs are the arterial beds most likely to be vasoconstricted due to the hypoxia?
Your Answer: Lungs
Explanation:Hypoxic pulmonary vasoconstriction is a local response to hypoxia resulting primarily from constriction of small muscular pulmonary arteries in response to reduced alveolar oxygen tension. This unique response of pulmonary arterioles results in a local adjustment of perfusion to ventilation. This means that if a bronchiole is obstructed, the lack of oxygen causes contraction of the pulmonary vascular smooth muscle in the corresponding area, shunting blood away from the hypoxic region to better-ventilated regions. The purpose of hypoxic pulmonary vasoconstriction is to distribute blood flow regionally to increase the overall efficiency of gas exchange between air and blood.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 4
Correct
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What is the primary function of the Kupffer cells found in the liver?
Your Answer: Recycling of old red blood cells
Explanation:Kupffer cells found in the liver are part of the monocyte-reticular system. They are specialised macrophages and primarily function to recycle old and damaged RBCs. The RBCs are phagocytosed and the haemoglobin is broken down into haem and globin. The haem is further broken down into iron that is recycled and bilirubin that is conjugated with glucuronic acid and excreted in the bile.
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This question is part of the following fields:
- Inflammation & Immunology; Hepatobiliary
- Pathology
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Question 5
Correct
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A 72 year old man suffered a MI. What is the approximate time needed by the scar tissue of the MI to recover and attain full strength?
Your Answer: Several months
Explanation:A week following a MI attack, a little collagen starts to form and deposit. By the end of the 2nd week, neovascularisation of the scar occurs, with some collagen being laid down in a haphazard fashion. By this time the scar attains some strength. During the next 6 months, collagen is constantly being laid down and is rearranged in order to shrink the scar. Most of the blood vessels by this time have regenerated, decreasing vascularity of the scar reaching full maturity.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Cardiovascular
- Pathology
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Question 6
Correct
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The dural venous sinuses are venous channels that drain blood from the brain. This sinuses are located between which structures?
Your Answer: Meningeal and periosteal layers of the dura mater
Explanation:The dural venous sinuses lies between the periosteal and meningeal layer of the dura mater. Dural venous sinuses is unique because it does not run parallel with arteries and allows bidirectional flow of blood intracranially as it is valve-less.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 7
Correct
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Following a fracture in the fibula, an artery contained in a fibrous canal between tibialis posterior and flexor hallucis longus was lacerated. Which of the following arteries was injured?
Your Answer: Peroneal
Explanation:The peroneal artery is deeply seated at the back of the fibular side of the leg, contained in a fibrous canal between the tibialis posterior and the flexor hallucis longus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 8
Correct
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Bile salt reuptake principally occurs where?
Your Answer: In the ileum
Explanation:90 – 95% of the bile salts are absorbed from the small intestine (mostly terminal ileum and then excreted again from the liver. This is known as the enterohepatic circulation. The entire pool recycles twice per meal and approximately 6 to 8 times per day.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 9
Correct
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Which of the following is a fact worth noting about the development of the spleen?
Your Answer: It develops in the dorsal mesogastrium
Explanation:The spleen in the human embryo arises in week 5 of intrauterine life. It appears as a proliferating mesenchyme above the pancreas. The spleen is one the organs that develops in the dorsal mesogastrium. When the stomach changes its position during development, the spleen is made to move behind the stomach and stays in contact with the left kidney. The spleen is found within the peritoneum of the abdominal cavity thus it is an intraperitoneal organ.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 10
Correct
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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: 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 11
Correct
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The muscle that depresses the glenoid fossa directly is the:
Your 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 12
Correct
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What is the innervation of the laryngeal mucosa inferior to the true vocal cord?
Your Answer: Recurrent laryngeal nerve
Explanation:Motor innervation to all other muscles of the larynx and sensory innervation to the subglottis is by the recurrent laryngeal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 13
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 14
Correct
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In which of the following situations will fat necrosis occur?
Your Answer: Trauma to the breast
Explanation:Fat necrosis is necrosis of adipose tissue with subsequent deposition of calcium, giving it a white chalky appearance. It is seen characteristically in trauma to the breast and the pancreas with subsequent involvement of the peripancreatic fat. In the breast it may present as a palpable mass with is usually painless or as an incidental finding on mammogram. Fatty acids are released from the traumatic tissue which combine with calcium in a process known as saponification, this is an example of dystrophic calcification in which calcium binds to dead tissue. The central focus is surrounded by macrophages and neutrophils initially, followed by proliferation of fibroblasts, neovascularization and lymphocytic migration to the site of the insult.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 15
Correct
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If a 55-year old gentleman who has suffered a stroke, develops a tremor in his fingers that worsens on reaching for an object, what part of his brain is likely to be involved?
Your Answer: Cerebellum
Explanation:The cerebellum plays an important role in the integration of sensory perception and motor output. Multiple neural pathways link the cerebellum with the motor cortex and the spinocerebellar tract. The cerebellum uses the constant feedback on body position to fine-tune the movements and integrates these pathways. The patient described here has a characteristic cerebellar tremor that is a slow, broad tremor of the extremities and occurs at the end of a purposeful movement.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 16
Correct
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A 54 year old man fell off his bicycle. He felt a severe pain in his hand and wasn't able to move it. It was found that a carpal bone in the distal row was fractured. Which is the most likely bone?
Your Answer: Trapezium
Explanation:There are eight carpal bones which are arranged in two rows, proximal and distal; scaphoid, lunate, triquetral and pisiform are of proximal row. Trapezium, trapezoid, capitate and hamate are of the distal row.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 17
Correct
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A 25-year old man presented to the clinic with swelling of the penis. His uncircumcised penis was erythematous and oedematous. The foreskin could not be retracted over the glans. Which of the following agents is the likely cause of his condition?
Your Answer: Staphylococcus aureus
Explanation:Inflammation of the glans penis is known as balanitis. Associated involvement of the foreskin is then known as balanoposthitis. More likely to occur in men who have a tight foreskin that is difficult to pull back, or poor hygiene.
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This question is part of the following fields:
- Pathology
- Urology
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Question 18
Correct
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Following a lacerating injury along the anterior border of the trapezius muscle in the neck, a man has the point of his shoulder (scapula) sagging and he has difficulty with full abduction of his arm. Which nerve is most likely injured?
Your Answer: Accessory (cranial nerve XI)
Explanation:Injury to the accessory nerve denervates the trapezius muscle so that the person will no longer be able to raise the acromion of the shoulder. The dorsal scapular nerve supplies the rhomboids i.e. major and minor and the levator scapulae so that injury to this nerve weakens retraction of the scapula. The greater occipital nerve is responsible for sensation of the posterior scalp. The axillary nerve innervates the deltoid muscle which is responsible for abduction of the arm and the suprascapular nerve is responsible for rotating the humerus laterally. Cutaneous nerves supply the skin.
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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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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.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 20
Correct
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Regarding the long head of the biceps femoris, which of the following is correct?
Your Answer: It crosses two joints
Explanation:The long head of the biceps femoris arises from the lower and inner impression on the back of the tuberosity of the ischium. It inserts with the short head in an aponeurosis which becomes a tendon and this tendon is inserted into the lateral side of the head of the fibula and the lateral condyle of the tibia, thus crossing two joints.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 21
Correct
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Which of the following muscles is solely contained in the anterior triangle of the neck and divides the anterior triangle into three smaller triangles?
Your Answer: Digastric
Explanation:The digastric muscle is a small muscle located under the jaw. It lies below the body of the mandible, and extends, in a curved form, from the mastoid process to the symphysis menti. The digastric divides the anterior triangle of the neck into three smaller triangles:
– The submaxillary triangle, bounded above by the lower border of the body of the mandible and a line drawn from its angle to the sternocleidomastoid, below by the posterior belly of the digastric and the stylohyoid and in front by the anterior belly of the digastric
– The carotid triangle, bounded above by the posterior belly of the digastric and stylohyoid, behind by the sternocleidomastoid and below by the omohyoid
– The suprahyoid or submental triangle, bounded laterally by the anterior belly of the digastric, medially by the midline of the neck from the hyoid bone to the symphysis menti and inferiorly by the body of the hyoid bone.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 22
Correct
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Which of the following diseases causes abrupt vertigo, nausea, vomiting, tinnitus, and nystagmus?
Your Answer: Vestibular neuronitis
Explanation:Vestibular neuronitis or labyrinthitis causes a self-limited episode of vertigo, presumably due to inflammation of the vestibular division of cranial nerve VIII. Its causes are unknown, It may be due to a virus, but it can be related to a bacterial infection, head injury, stress, allergy, or as a reaction to medication. Symptoms can last up to 7-10 days.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 23
Correct
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Which of the following mediators of inflammation requires arachidonic acid for synthesis?
Your 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.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 24
Correct
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Loperamide is a drug used to treat diarrhoea. What is the mechanism of action of loperamide?
Your Answer: Opiate agonist
Explanation:Loperamide is an opioid-receptor agonist and acts on the mu opioid receptors in the myenteric plexus of large intestine. It works by decreasing the motility of the circular and longitudinal smooth muscles of the intestinal wall. It is often used for this purpose in gastroenteritis, inflammatory bowel disease, and short bowel syndrome.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 25
Correct
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A 27-year-old HIV patient started on an antifungal agent. Which antifungal agent that inhibits the biosynthesis of fungal ergosterol was given to the patient?
Your Answer: Ketoconazole
Explanation:Ketoconazole is a synthetic imidazole antifungal drug used primarily to treat fungal infections. It inhibits the biosynthesis of ergosterol by blocking demethylation at the C14 site of the ergosterol precursor. Amphotericin B and Nystatin impair permeability of the cell membrane. Flucytosine interferes with DNA synthesis, while the target of griseofulvin is the microtubules
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 26
Correct
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A 50-year-old woman goes to the doctor complaining of myalgia, muscle cramps, and weakness; she is diagnosed with severe hypokalaemia. Which of the following is the most common cause of hypokalaemia?
Your Answer: Prolonged vomiting
Explanation:Potassium is one of the body’s major ions. Nearly 98% of the body’s potassium is intracellular. The ratio of intracellular to extracellular potassium is important in determining the cellular membrane potential. Small changes in the extracellular potassium level can have profound effects on the function of the cardiovascular and neuromuscular systems. Hypokalaemia may result from conditions as varied as renal or gastrointestinal (GI) losses, inadequate diet, transcellular shift (movement of potassium from serum into cells) and medications. The important causes of hypokalaemia are:
Renal losses: renal tubular acidosis, hyperaldosteronism, magnesium depletion, leukaemia (mechanism uncertain).
GI losses: vomiting or nasogastric suctioning, diarrhoea, enemas or laxative use, ileal loop.
Medication effects: diuretics (most common cause), β-adrenergic agonists, steroids, theophylline, aminoglycosides.
Transcellular shift: insulin, alkalosis.
Severe hypokalaemia, with serum potassium concentrations of 2.5–3 meq/l, may cause muscle weakness, myalgia, tremor, muscle cramps and constipation.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 27
Correct
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During pregnancy the uterus enlarges however after delivery it regresses to its original size. Which of the following organelles is responsible for this regression?
Your Answer: Lysosomes
Explanation:Lysosomes are formed by budding of the Golgi apparatus and contain enzymes which digest macromolecules. They are found in both plants and animals and are active in autophagic cell death, digestion after phagocytosis and for the cells own recycling process. They fuse with the molecules and release their content resulting in digestion.
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This question is part of the following fields:
- General
- Physiology
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Question 28
Correct
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The stomach is an organ that is divided into several important anatomical parts. These parts of the stomach have varied arterial blood supply that ensure that the whole organ receive oxygenated blood. Which of the following arteries if ligated, will not render any portion of the stomach ischaemic?
Your Answer: Superior mesenteric
Explanation:The blood supply to the stomach is through the following arteries:
– The superior mesenteric artery supplies blood to the lower part of the duodenum, pancreas and two-thirds of the transverse colon. Thus ligation of the superior mesenteric artery would not affect the stomach.
– The right and the left gastroepiploic arteries supply the greater curvature of the stomach – along its edges.
– The short gastric artery supplies blood to the upper portion of the of the greater curvature and the fundus of the stomach.
– The gastroduodenal artery supplies blood to the distal part of the stomach (the pyloric sphincter) and the proximal end of the duodenum.
– The left gastroepiploic and the short gastric are branches of the splenic artery and therefore ligation of the splenic artery would directly affect the stomach.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 29
Correct
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Which condition presents with a positive urine dipstick test for blood, but no blood cells on urine microscopy?
Your Answer: Myoglobinuria
Explanation:Myoglobinuria, or presence of myoglobulin in the urine is seen due to rhabdomyolysis (muscle destruction). Common causes of rhabdomyolysis include trauma, electrical injuries, burns, venom and drugs. Damaged muscle leads to release of myoglobin in the blood. Ideally, the released myoglobin gets filtered and excreted by the kidneys. However, excess myoglobin can occlude the renal filtration system leading to acute tubular necrosis and acute renal dysfunction.
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This question is part of the following fields:
- Pathology
- Renal
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Question 30
Correct
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A construction worker is brought to the A&E after a fall on site. The patient is conscious but complains of inability to feel his legs. A neurological examination reveals that he has no cutaneous sensation from his umbilicus to his toes. What is the likely level of the spinal cord that is injured?
Your Answer: T10
Explanation:The umbilicus has a relatively consistent position in humans and thus serves as an important land mark. The skin around the waist at the level of the umbilicus is supplied by the tenth thoracic spinal nerve (T10 dermatome).
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This question is part of the following fields:
- Abdomen
- Anatomy
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SESSION STATS - PERFORMANCE PER SPECIALTY
