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  • Question 1 - A 40-year old gentleman, who is a known with ulcerative colitis, complains of...

    Correct

    • A 40-year old gentleman, who is a known with ulcerative colitis, complains of recent-onset of itching and fatigue. On examination, his serum alkaline phosphatase level was found to be high. Barium radiography of the biliary tract showed a 'beaded' appearance. What is the likely diagnosis?

      Your Answer: Sclerosing cholangitis

      Explanation:

      Primary sclerosing cholangitis is characterised by patchy inflammation, fibrosis and strictures in intra- and extra-hepatic bile ducts. It is a chronic cholestatic condition with 80% patients having associated inflammatory bowel disease (likely to be ulcerative colitis). Symptoms include pruritus and fatigue. ERCP (endoscopic retrograde cholangiopancreatography) or MRCP (magnetic resonance cholangiopancreatography) are diagnostic. Disease can lead to complete obliteration of ducts, which can result in liver failure. Cholangiocarcinoma is also a recognised complication..

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
      108
      Seconds

  • Question 2 - Identify which of the following muscles acts on two joints? ...

    Correct

    • Identify which of the following muscles acts on two joints?

      Your Answer: Sartorius

      Explanation:

      The sartorius muscle, the longest muscle in the body, is one of the two jointed or biarticular muscles. It originates from the anterior superior iliac spine and part of the notch between the anterior superior iliac spine and anterior inferior iliac spine and crosses both the hip joint and the knee joint. At the hip joint the sartorius flexes and rotates the thigh at the hip joint and flexes the leg at the knee joint.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      53.2
      Seconds

  • Question 3 - An ECG of a 30 year old woman revealed low voltage QRS complexes....

    Correct

    • An ECG of a 30 year old woman revealed low voltage QRS complexes. This patient is most probably suffering from?

      Your Answer: Pericardial effusion

      Explanation:

      The QRS complex is associated with current that results in the contraction of both the ventricles. As ventricles have more muscle mass than the atria, they result in a greater deflection on the ECG. The normal duration of a QRS complex is 10s. A wide and deep Q wave depicts myocardial infarction. Abnormalities in the QRS complex maybe indicative of a bundle block, ventricular tachycardia or hypertrophy of the ventricles. Low voltage QRS complexes are characteristic of pericarditis or a pericardial effusion.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      48.7
      Seconds

  • Question 4 - A patient sustained an injury to the facial nerve after it emerges from...

    Correct

    • A patient sustained an injury to the facial nerve after it emerges from the stylomastoid foramen. What is the clinical impact of this injury?

      Your Answer: Facial expression

      Explanation:

      The facial nerve is the seventh of the twelve paired cranial nerves. It emerges from the brainstem between the pons and the medulla. It controls the muscles of facial expression and supplies taste fibres to the anterior two-thirds of the tongue. It also supplies preganglionic parasympathetic fibres to several head and neck ganglia. Its branches and distribution are as follows:

      Inside the facial canal (proximal to the stylomastoid foramen):

      – Greater petrosal nerve – provides parasympathetic innervation to the lacrimal gland, as well as special taste sensory fibres to the palate via the nerve of pterygoid canal

      – Nerve to stapedius – provides motor innervation for the stapedius muscle in the middle ear

      – Chord tympani – provides parasympathetic innervation to the submandibular and sublingual glands and special sensory taste fibres for the anterior two-thirds of the tongue

      Outside the skull (distal to the stylomastoid foramen):

      – Posterior auricular nerve – controls the movements of some of the scalp muscles around the ear

      – Five major facial branches (in the parotid gland), from top to bottom: temporal branch, zygomatic branch, buccal branch, marginal mandibular branch and cervical branch. From the description given above it is obvious that injury to the facial nerve distal to the stylomastoid foramen will affect facial expression.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      70
      Seconds

  • Question 5 - Which of the following is found to be elevated in a case of...

    Correct

    • Which of the following is found to be elevated in a case of hepatocellular carcinoma?

      Your Answer: AFP

      Explanation:

      Alpha-fetoprotein (AFP) is a glycoprotein that is normally produced by the yolk sac of the embryo, and then the fetal liver. It is elevated in the new-born and thus, also in the pregnant women. Eventually, it decreases in the first year of life to reach the adult normal value of < 20 ng/ml by 1 year of age. Markedly elevated levels (>500 ng/ml) in a high-risk patient is considered diagnostic for primary hepatocellular carcinoma (HCC). Moreover, due to smaller tumours secreting less quantities of AFP, rising levels can be a better indication. However, not all hepatocellular carcinomas produce AFP. Also, the level of AFP is not a prognostic factor. Populations where hepatitis B and HCC are common (e.g.: sub-Saharan Africans, ethnic Chinese) can see AFP levels as high as 100,000 ng/ml, whereas levels are low (about 3000 ng/ml) in regions with lesser incidences of HCC.

      AFP can also be elevated up to 500 ng/ml in conditions like embryonic teratocarcinomas, hepatoblastomas, fulminant hepatitis, hepatic metastases from gastrointestinal tract cancers, some cholangiocarcinomas). Lesser values are seen in acute and chronic hepatitis.

      Overall, the sensitivity of AFP value ≥20 ng/ml is 39-64% and the specificity is 76%–91%. Value of 500 ng/ml is considered as the diagnostic cut-off level for HCC.

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
      74.6
      Seconds

  • Question 6 - In a cardiac cycle, what event does the opening of the atrioventricular (AV)...

    Correct

    • In a cardiac cycle, what event does the opening of the atrioventricular (AV) valves coincide with?

      Your Answer: Beginning of diastole

      Explanation:

      Cardiac diastole refers to the time period when the heart is relaxed after contraction and is preparing to refill with blood. Both ventricular and atrial diastole are together known as complete cardiac diastole. At its beginning, the ventricles relax, causing a drop in the ventricular pressure. As soon as the left ventricular pressure drops below that in left atrium, the mitral valve opens and there is ventricular filling of blood. Similarly, the tricuspid valve opens filling the right atrium.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      103
      Seconds

  • Question 7 - A 62-year-old male smoker, presented with shortness of breath, chronic cough and haemoptysis...

    Correct

    • 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.

    • This question is part of the following fields:

      • Pathology
      • Respiratory
      105.1
      Seconds

  • Question 8 - Whilst snorkelling, a 30-year old gentleman has the respiratory rate of 10/min, tidal...

    Incorrect

    • 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. Which of the following will bring about a maximum increase in his alveolar ventilation?

      Your Answer: A 4x increase in tidal volume

      Correct Answer: A 2x increase in tidal volume and a shorter snorkel

      Explanation:

      Alveolar ventilation = respiratory rate × (tidal volume − anatomical dead space volume). Increase in respiratory rate simply causes movement of air in the anatomical dead space, with no contribution to the alveolar ventilation. By use of a shorter snorkel, the effective anatomical dead space will decrease and will cause a maximum rise in alveolar ventilation along with doubling of tidal volume.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      84.7
      Seconds

  • Question 9 - Which of the following is the most abundant WBC seen in a smear...

    Correct

    • Which of the following is the most abundant WBC seen in a smear from a healthy person.

      Your Answer: Neutrophils

      Explanation:

      neutrophils are the most abundant cell type of the WBC. These phagocytes are found normally in the blood and increase in number are seen during an acute inflammation. These the percentages of WBC in blood Neutrophils: 40 to 60%

      Lymphocytes: 20 to 40%

      Monocytes: 2 to 8%

      Eosinophils: 1 to 4%

      Basophils: 0.5 to 1%

      Band (young neutrophil): 0 to 3%. eosinophils, basophils, neutrophils are known as granulocytes and monocytes and lymphocytes as agranulocytes.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      27.8
      Seconds

  • Question 10 - A 41 year old women presents with a history of carcinoma involving the...

    Correct

    • A 41 year old women presents with a history of carcinoma involving the right breast with enlarged axillary nodes on the same side. She underwent mastectomy and axillary node clearance. These were sent for histopathological examination. They showed no signs of metastasis. What could be cause of this enlargement in the lymph nodes?

      Your Answer: Sinus histiocytosis

      Explanation:

      Sinus histiocytosis also referred to as reticular hyperplasia, refers to the enlargement, distention and prominence of the sinusoids of the lymph nodes. This is a non-specific form of hyperplasia characteristically seen in lymph nodes that drain tumours. The endothelial lining of the lymph node becomes markedly hypertrophied, along with an increase in the number of macrophages which results in the distortion, distention and enlargement of the sinus. In this scenario there is no evidence that an infection or another malignancy could account for the enlargement. Paracortical lymphoid hyperplasia is caused by an immune response.

    • This question is part of the following fields:

      • Inflammation & Immunology; Female Health
      • Pathology
      111
      Seconds

  • Question 11 - A 50 year old male point was diagnosed with tennis elbow that became...

    Correct

    • A 50 year old male point was diagnosed with tennis elbow that became worse after he started playing basket ball over the last three months. He was admitted to the orthopaedic ward to have elbow braces fitted. What type of synovial joint is the elbow joint?

      Your Answer: Hinge

      Explanation:

      The elbow joint is one of the many synovial joints in the body. This joint is an example of the hinge joint as the humerus is received into the semilunar notch of the ulna and the capitulum of the humerus articulates with the fovea on the head of the radius, together acting as a hinge in one plane.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      512.7
      Seconds

  • Question 12 - The rotator cuff surrounds the shoulder joint and consists of the supraspinatus, infraspinatus,...

    Correct

    • The rotator cuff surrounds the shoulder joint and consists of the supraspinatus, infraspinatus, subscapularis and which one other muscle?

      Your Answer: Teres minor

      Explanation:

      The correct answer is the teres minor muscle. These group of muscles play an important role in protecting the shoulder joint and keeping the head of the humerus in the glenoid fossa of the scapula. This fossa is somehow shallow and needs support to allow for the full mobility that the shoulder joint has.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      64.6
      Seconds

  • Question 13 - Cyclophosphamide is used as a chemotherapy and immunosuppressant agent and is indicated in...

    Correct

    • Cyclophosphamide is used as a chemotherapy and immunosuppressant agent and is indicated in various diseases. One of the most severe complications of its use is cancer of the:

      Your Answer: Urinary bladder

      Explanation:

      Cyclophosphamide is used to treat various types of cancer and autoimmune disorders. The main use of cyclophosphamide is in combination with other chemotherapy agents in the treatment of lymphomas, some forms of leukaemia and some solid tumours. Side-effects include nausea and vomiting, bone marrow suppression, stomach ache, diarrhoea, darkening of the skin/nails, alopecia, lethargy, and haemorrhagic cystitis. Cyclophosphamide is itself carcinogenic, potentially causing transitional cell carcinoma of the bladder as a long-term complication.

    • This question is part of the following fields:

      • Pathology
      • Pharmacology
      111.3
      Seconds

  • Question 14 - The most likely cause of prominent U waves on the electrocardiogram (ECG) of...

    Correct

    • The most likely cause of prominent U waves on the electrocardiogram (ECG) of a patient is:

      Your Answer: Hypokalaemia

      Explanation:

      The U-wave, not always visible in ECGs, is thought to represent repolarisation of papillary muscles or Purkinje fibres. When seen, it is very small and occurs after the T-wave. Inverted U-waves indicate myocardial ischaemia or left ventricular volume overload. Prominent U-waves are most commonly seen in hypokalaemia. Other causes include hypercalcaemia, thyrotoxicosis, digitalis exposure, adrenaline and class 1A and 3 anti-arrhythmic agents. It can also be seen in congenital long-QT syndrome and in intracranial haemorrhage.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      38.8
      Seconds

  • Question 15 - A teacher had varicosities in the region of the small saphenous vein. Which...

    Correct

    • A teacher had varicosities in the region of the small saphenous vein. Which of the following is true about that vein?

      Your Answer: Has nine to twelve valves

      Explanation:

      It is known that the small saphenous vein has nine to twelve valves along its course. This vein begins as a direct continuation of the lateral marginal vein posterior to the lateral malleolus. It is superficially situated but closer to its termination, perforates the deep fascia in the lower part of the popliteal fossa to end in the popliteal vein.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      69.5
      Seconds

  • Question 16 - A 24-year old, lactating mother presents to the clinic with a tender, 1.5cm...

    Correct

    • A 24-year old, lactating mother presents to the clinic with a tender, 1.5cm mass just below the right nipple, which shows multiple fissures. What finding is likely associated with her condition?

      Your Answer: Staphylococcus aureus infection

      Explanation:

      Breast abscess occur commonly in lactating mothers in the postpartum period due to cracking of the nipple. It is commonly caused due to Staphylococcus aureus infection. Fat necrosis usually results from trauma wherein an ill-defined mass is formed. Ductal carcinomas are malignant masses which are not tender usually, and rare in the young age group. Plasma cell mastitis affect women in an older age group. Sclerosing adenosis is a type of fibrocystic disease which can lead to a tender, cystic mass but no fissuring or cracks are seen in the nipple. Fibroadenoma and lipomas are non-tender, well-defined masses.

    • This question is part of the following fields:

      • Pathology
      • Women's Health
      62.1
      Seconds

  • Question 17 - During an operation for a sigmoid colectomy the surgeon ligates the sigmoid arteries....

    Correct

    • 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.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      42
      Seconds

  • Question 18 - A growing tumour is impinging on the lingual artery in the floor of...

    Incorrect

    • A growing tumour is impinging on the lingual artery in the floor of the mouth. Which structure will experience decreased blood flow?

      Your Answer: The genioglossus muscle

      Correct Answer: The sublingual gland

      Explanation:

      The paired sublingual glands are major salivary glands in the mouth. They are the smallest, most diffuse, and the only unencapsulated major salivary glands. They provide only 3-5% of the total salivary volume. The gland receives its blood supply from the sublingual and submental arteries. The sublingual artery is a branch of the lingual artery, thus damage to the lingual artery will decrease the blood flow to the sublingual gland.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      42.2
      Seconds

  • Question 19 - What is the basic chemical reaction that takes place in the breakdown of...

    Correct

    • What is the basic chemical reaction that takes place in the breakdown of complex foodstuffs?

      Your Answer: Hydrolysis

      Explanation:

      Breakdown of complex food into simpler compounds is achieved by hydrolysis, with the help of different enzymes specific for different compounds.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      37.9
      Seconds

  • Question 20 - Which of the following will be affected by a lesion in the posterior...

    Correct

    • Which of the following will be affected by a lesion in the posterior column-medial lemniscus system?

      Your Answer: Fine touch

      Explanation:

      The posterior column–medial lemniscus (PCML) pathway is a sensory pathway that transmits fine touch and conscious proprioceptive information from the body to the brain. As the posterior columns are also known as dorsal columns, the pathway is also called the dorsal column–medial lemniscus system or DCML.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      42.4
      Seconds

  • Question 21 - Cancer of the testis most likely metastases to which set of lymph nodes?...

    Correct

    • Cancer of the testis most likely metastases to which set of lymph nodes?

      Your Answer: Aortic

      Explanation:

      The lymphatic drainage of an organ is related to its blood supply. The lymphatic drainage of the testis drains along the testicular artery to reach the lymph nodes along the aorta.

    • This question is part of the following fields:

      • Endocrine
      • Pathology
      55.8
      Seconds

  • Question 22 - Where would you insert the needle when drawing blood from a patient's median...

    Correct

    • Where would you insert the needle when drawing blood from a patient's median cubital vein?

      Your Answer: Anterior aspect of the elbow

      Explanation:

      The correct answer is to insert it into the anterior aspect of the elbow. If you look at the venous drainage of the upper limb, you will find that there are two main veins, the basilic and the cephalic vein; the connecting branch between these two veins is the median cubital vein. and this vein passes via the cubital fossa which is on the anterior aspect of the forearm.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      64.7
      Seconds

  • Question 23 - Anthrax is an infection caused by the bacterium Bacillus anthracis. Anthrax spores have been used...

    Correct

    • Anthrax is an infection caused by the bacterium Bacillus anthracis. Anthrax spores have been used as a biological warfare weapon. What is the drug of choice in treating anthrax infection?

      Your Answer: Ciprofloxacin

      Explanation:

      Early antibiotic treatment of anthrax is essential. A delay may significantly lessen the chances for survival of the patient. Treatment for anthrax infection include large doses of intravenous and oral antibiotics, such as fluoroquinolones (ciprofloxacin), doxycycline, erythromycin, vancomycin, or penicillin.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      69.1
      Seconds

  • Question 24 - Which of the following over-the-counter drugs can cause a prolonged bleeding time? ...

    Correct

    • Which of the following over-the-counter drugs can cause a prolonged bleeding time?

      Your Answer: Acetylsalicylic acid

      Explanation:

      Acetylsalicylic acid, or aspirin, is a nonsteroidal anti-inflammatory drug that is widely used as an analgesic and antipyretic. Aspirin is as a cyclo-oxygenase inhibitor that leads to decreased prostaglandin production. Decreased platelet aggregation is another effect of this drug, achieved by long-lasting use of aspirin.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      29.9
      Seconds

  • Question 25 - The gynaecologist suspects that her patient has a cervical cancer. What particular test...

    Correct

    • The gynaecologist suspects that her patient has a cervical cancer. What particular test should be done on this patient to screen for cervical cancer?

      Your Answer: Pap smear

      Explanation:

      Worldwide, approximately 500,000 new cases of cervical cancer and 274,000 deaths are attributable to cervical cancer yearly. This makes cervical cancer the second most common cause of death from cancer in women. The mainstay of cervical cancer screening has been the Papanicolaou test (Pap smear).

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      80.1
      Seconds

  • Question 26 - Which of the following mediators of inflammation requires arachidonic acid for synthesis? ...

    Correct

    • 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.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      52.2
      Seconds

  • Question 27 - During an operation to repair an indirect inguinal hernia, it is noticed that...

    Correct

    • During an operation to repair an indirect inguinal hernia, it is noticed that the hernial sac is protruding out of the superficial inguinal ring. The superficial inguinal ring is an opening in which structure?

      Your Answer: External abdominal oblique aponeurosis

      Explanation:

      The superficial inguinal ring is an opening in the aponeurosis of the external oblique just above and lateral to the pubic crest. The opening is oblique and corresponds to the fibres of the aponeurosis. It is bound inferiorly by the pubic crest, on either side by the margins of the opening in the aponeurosis and superiorly by the curved intercrural fibres.

      The inferior crus is formed by the portion of the inguinal ligament that is inserted into the pubic tubercle.

      The falx inguinalis is made of arching fibres of the transversalis fascia and the internal abdominal oblique muscle. It forms the posterior wall of the inguinal canal.

      The internal abdominal oblique forms the root of the inguinal canal.

      Scarpa’s and Camper’s fascia are the membranous and fatty layers, respectively of subcutaneous fascia.

      Transversalis fascia covers the posterior surface of the rectus abdominis muscle inferior to the arcuate line.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      51
      Seconds

  • Question 28 - After having donated a unit of blood. The blood bank will prefer to...

    Correct

    • After having donated a unit of blood. The blood bank will prefer to use which of the following anticoagulants to store the blood?

      Your Answer: Citrate

      Explanation:

      Calcium is necessary for coagulation to occur. Citrate being a chelator and combining with calcium ions to form un-ionised compound will prevent coagulation. Following transfusion the citrate is removed by the liver with in a few minutes. Oxalate also works on the same principle but it is toxic to the body.

    • This question is part of the following fields:

      • General
      • Physiology
      1809.3
      Seconds

  • Question 29 - Vincristine is a chemotherapy agent used to treat a number of types of...

    Correct

    • Vincristine is a chemotherapy agent used to treat a number of types of cancer. Which of the following is a recognised major side-effect of vincristine?

      Your Answer: Peripheral neuropathy

      Explanation:

      Vincristine is an alkaloid chemotherapeutic agent. It is used to treat a number of types of cancer including acute lymphocytic leukaemia, acute myeloid leukaemia, Hodgkin’s disease, neuroblastoma, and small cell lung cancer among others. The main side-effects of vincristine are peripheral neuropathy and constipation.

    • This question is part of the following fields:

      • Pathology
      • Pharmacology
      67.4
      Seconds

  • Question 30 - A 27 year old women works in a dry-cleaning shop. She was exposed...

    Incorrect

    • A 27 year old women works in a dry-cleaning shop. She was exposed to massive amounts of carbon tetrachloride on her skin as well as inhaled. Which of the following organs is most susceptible to damage?

      Your Answer:

      Correct Answer: Liver

      Explanation:

      Carbon tetrachloride (CCl4) is a common agent used in the dry cleaning industry and is thought to cause the formation of free radicals. It causes rapid breakdown of the endoplasmic reticulum due to decomposition of lipids and severe liver cell injury. Within less than 30 mins, hepatic protein synthesis declines, lipid export is reduced due to lack of apoprotein and there is an influx of calcium and cell death.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing
      • Pathology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gastrointestinal; Hepatobiliary (2/2) 100%
Pathology (13/13) 100%
Anatomy (8/9) 89%
Lower Limb (2/2) 100%
Cardiovascular (3/3) 100%
Physiology (6/7) 86%
Head & Neck (1/2) 50%
Respiratory (1/2) 50%
Inflammation & Immunology (2/2) 100%
Inflammation & Immunology; Female Health (1/1) 100%
Upper Limb (3/3) 100%
Pharmacology (2/2) 100%
Women's Health (1/1) 100%
Abdomen (2/2) 100%
Gastroenterology (1/1) 100%
Neurology (1/1) 100%
Endocrine (1/1) 100%
Microbiology (1/1) 100%
Haematology (1/1) 100%
Neoplasia (1/1) 100%
General (1/1) 100%
Passmed
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