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Question 1
Correct
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The primary somatosensory cortex is located in the:
Your Answer: Postcentral gyrus
Explanation:The primary somatic sensory cortex is located in the postcentral gyrus and is the largest cortical receiving area for information from somatosensory receptors. Through corticocortical fibres, it then sends the information to other areas of the neocortex and further analysis takes place in the posterior parietal association cortex.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 2
Correct
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Question 3
Correct
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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.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 4
Correct
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A patient is brought to the accident and emergency department. He is said to have been involved in a mall explosion. Chest imaging reveals metal fragments in his thoracic cavity. He also has a pericardial effusion suggestive of a pericardial tear. An emergency thoracotomy is done which revealed a tear of the pericardium inferiorly. The surgeon began to explore for fragments in the pericardial sac with his hand from below the apex. He slips his fingers upward and to the right within the sac until they were stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart. His finger tips were now in the:
Your Answer: Oblique pericardial sinus
Explanation:Transverse sinus: part of pericardial cavity that is behind the aorta and pulmonary trunk and in front of the superior vena cava separating the outflow vessels from the inflow vessels.
Oblique pericardial sinus: is behind the left atrium where the visceral pericardium reflects onto the pulmonary veins and the inferior vena cava. Sliding a finger under the heart will take you to this sinus.
Coronary sinus: large vein that drains the heart into the right atrium. Located on the surface of the heart.
Coronary sulcus: groove on the heart demarcating the atria from the ventricles.
Costomediastinal recess: part of the pleural sac where the costal pleura transitions to become the mediastinal pleura.
Sulcus terminalis: a groove between the right atrium and the vena cava.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 5
Correct
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An excised lesion is found to be a premalignant during examination by the pathologist. What is the most likely histopathology report of this lesion?
Your Answer: Solar keratosis
Explanation:Premalignant condition is a state of disordered morphology of cells that is associated with an increased risk of cancer. If this condition is left untreated, it may lead to the development of cancer. The following are examples of pre-malignant lesions: actinic keratosis, Barret’s oesophagitis, atrophic gastritis, ductal carcinoma in situ, dyskeratosis congenita, sideropenic dysphagia, lichen planus, oral submucous fibrosis, solar elastosis, cervical dysplasia, leucoplakia and erythroplakia.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 6
Correct
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Which of the following conditions is characterized by generalised oedema due to effusion of fluid into the extracellular space?
Your Answer: Anasarca
Explanation:Anasarca (or ‘generalised oedema’) is a condition characterised by widespread swelling of the skin due to effusion of fluid into the extracellular space. It is usually caused by liver failure (cirrhosis of the liver), renal failure/disease, right-sided heart failure, as well as severe malnutrition/protein deficiency.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 7
Correct
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Which muscle is most likely to be affected following an injury to the thoracodorsal nerve (C6-C8)?
Your Answer: Latissimus dorsi
Explanation:Latissimus dorsi is a triangular, flat muscle that covers the lumbar region and the lower half of the thoracic region. It is supplied by the sixth, seventh and eighth cervical nerves through the thoracodorsal (long subscapular) nerve.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 8
Correct
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The following structures DO NOT lie between the layers of the mesosalpinx except for the?
Your Answer: Fallopian tube
Explanation:Mesosalpinx is the portion of the broad ligament that stretches from the fallopian tube to the ovary and contains the uterine tubes between it’s layers.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 9
Correct
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Which of the following conditions can present with multiple abscesses that may discharge sulphur granules?
Your Answer: Actinomycosis
Explanation:Actinomycosis is primarily caused by any of the several members of the bacterial genus Actinomyces. These bacteria are generally anaerobes. And can cause multiple abscesses that may discharge sulphur granules.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 10
Correct
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One of the following structures is contained in the anterior compartment of the lower leg. Which is it?
Your Answer: Extensor hallucis muscle
Explanation:The lower leg is made up of four fascial compartments separated from one another by septa that contain the muscles of the lower leg. The four compartments are ; anterior, lateral, deep posterior and superficial posterior compartments.
These are the compartments and there contents:
i) Anterior compartment: Tibialis anterior muscle, extensor hallucis longus muscle, extensor digitorum longus muscle, peroneus tertius muscles, deep fibular nerve and anterior tibial blood vessels
ii) Lateral compartment: Fibularis longus muscle, brevis muscles and superficial fibular nerve
iii) Deep posterior compartment: Tibialis posterior m., flexor hallucis longus m., flexor digitorum longus m. ,popliteus m. , tibial nerve, posterior tibial artery and posterior tibial vessels such as the fibular artery.
iv) Superficial posterior compartment: Gastrocnemius m., soleus m., plantaris m., medial sural cutaneous nerve
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 11
Incorrect
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A 65-year-old man with no history of smoking complains of shortness of breath and persistent cough over the past 8 months. He reveals that in the 1960s he worked for several years as a boiler operator. Chest X-ray shows diffuse lung infiltrates. Which of the following is the most probable cause of these findings?
Your Answer: COPD
Correct Answer: Asbestosis
Explanation:Asbestosis is a chronic lung disease which leads to long-term respiratory complications and is caused by the inhalation of asbestos fibres. Symptoms due to long exposure to asbestos usually appear 10 to 40 years after initial exposure and include shortness of breath, cough, weight loss, clubbing of the fingers and chest pain. Typical chest X-ray findings include diffuse lung infiltrates that cause the appearance of shaggy heart borders.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 12
Correct
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What percentage of the cardiac output is delivered to the brain?
Your Answer: 15%
Explanation:Among all body organs, the brain is most susceptible to ischaemia. Comprising of only 2.5% of total body weight, the brain receives 15% of the cardiac output. Oxygen extraction is also higher with venous oxygen levels approximating 13 vol%, and arteriovenous oxygen difference of 7 vol%.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 13
Incorrect
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What is the arterial sequence for an analgesic to reach the latissimus dorsi muscle assuming that your starting point is at the subclavian vein?
Your Answer: Subclavian – costocervical trunk – suprascapular
Correct Answer: Subclavian – axillary – subscapular – thoracodorsal
Explanation:Assuming our starting point is the subclavian artery, the analgesic continues in the same vessel into the axillary artery, as it passes into the axilla. The axillary artery at the lower border of the subscapularis gives rise to the subcapsular artery which is considered the largest branch of the axillary artery. This circumflex scapular branch distributes a serratus branch before entering the substance of the muscle as the thoracodorsal artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 14
Correct
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Which muscle in the neck divides the neck into two large triangles?
Your Answer: Sternocleidomastoid
Explanation:The sternocleidomastoid muscle is an important landmark in the neck as it divides the neck into two; anterior and posterior triangles. These triangles help in the location of the structures of the neck including the carotid artery, head and neck lymph nodes, accessory nerve and the brachial plexus. It originates from the manubrium and medial portion of the clavicle and inserts on the mastoid process of the temporal bone, superior nuchal line. The sternocleidomastoid receives blood supply from the occipital artery and the superior thyroid artery. It is innervated by the accessory nerve (motor) and cervical plexus (sensory).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 15
Incorrect
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Which organ is most vulnerable to haemorrhagic shock?
Your Answer: Skin
Correct Answer: Kidneys
Explanation:At rest, the brain receives 15% cardiac output, muscles 15%, gastrointestinal tract 30% and kidneys receive 20%. However, if normalised by weight, the largest specific blood flow is received by the kidneys at rest (400 ml/min x 100g), making them highly vulnerable in the case of a haemorrhagic shock.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 16
Incorrect
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Out of the given options, which of the following is the most likely diagnosis in a 25-year old gentleman presenting with a testicular germ cell tumour?
Your Answer: Leydig cell tumour
Correct Answer: Embryonal carcinoma
Explanation:Embryonal carcinoma is a non-seminomatous germ cell tumour of the testis, accounting for 25% testicular tumours. Other germ cell tumours include seminoma, teratoma and choriocarcinoma. Embryonal carcinomas are known to occur in men aged 25-35 years, and occasionally in teens. They are rarely seen in ovaries of females. It can spread to the vas deferens and also to the aortic lymph nodes. Embryonal carcinomas are known to have elements of fetal origin such as cartilage. Usually, the main tumour is about 2.5cm long, with an extension of 8-9cm along the testicular cord. Contiguous spread to the testicle is seen in less than 1% cases.
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This question is part of the following fields:
- Pathology
- Urology
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Question 17
Incorrect
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A 45-year-old man with short bowel syndrome requires parenteral nutrition. The solution of choice for parenteral nutrition is:
Your Answer: Darrow’s solution
Correct Answer: Crystalline amino acids
Explanation:Total parenteral nutrition (TPN), is the practice of feeding a person intravenously, circumventing the gut. It is normally used in the following situations: surgery, when feeding by mouth is not possible, when a person’s digestive system cannot absorb nutrients due to chronic disease or if a person’s nutrient requirement cannot be met by enteral feeding and supplementation. A sterile bag of nutrient solution, between 500 ml and 4L, is provided. The pump infuses a small amount (0.1–10 ml/h) continuously to keep the vein open. The nutrient solution consists of water, glucose, salts, amino acids, vitamins and sometimes emulsified fats. Ideally each patient is assessed individually before commencing on parenteral nutrition, and a team consisting of doctors, nurses, clinical pharmacists and dietitians evaluate the patient’s individual data and decide what formula to use and at what rate.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 18
Correct
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Which nerve lies immediately medial to the psoas major muscle?
Your Answer: Obturator
Explanation:The obturator nerve is formed from the ventral divisions of the 2nd, 3rd and 4th lumbar nerves. It courses through the fibres of the psoas major and emerges from the medial border near the pelvic brim.
The iliohypogastric nerve comes from the first lumbar nerve and emerges from the upper part of the lateral border of psoas major.
The ilioinguinal nerve arises with the iliohypogastric nerve from the first lumbar nerve and also emerges from the lateral border of the psoas major muscle.
The lateral femoral cutaneous nerve comes from the posterior division of the 2nd and 3rd lumbar nerves to emerge from the lateral border of the psoas major muscle near its middle.
The femoral nerve also arises from the dorsal divisions, but of the 2nd, 3rd and 4th lumbar nerves and courses through the muscle fibres to emerge at the lower part of the lateral border.
The coccygeal nerve doesn’t arise from the lumbar plexus but from the sacral plexus.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 19
Incorrect
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A 35-year-old woman in her 37th week of pregnancy complains of urinary incontinence. She is most likely to have:
Your Answer: Mixed incontinence
Correct Answer: Stress incontinence
Explanation:Urinary incontinence is the involuntary excretion of urine from one’s body. It is often temporary and it almost always results from an underlying medical condition. Several types include:
– Stress incontinence is the voiding of urine following increased abdominal pressure e.g. laughing, coughing, pregnancy etc. It is the most common form of incontinence in women, most commonly due to pelvic floor muscle weakness, physical changes from pregnancy, childbirth and menopause. In men it is a common problem following a prostatectomy. Most lab results such as urine analysis, cystometry and postvoid residual volume are normal.
– Urge incontinence is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate. The most common cause of urge incontinence are involuntary and inappropriate detrusor muscle contractions.
– Functional incontinence – occurs when a person does not recognise the need to go to the toilet, recognise where the toilet is or get to the toilet in time. The urine loss may be large. Causes of functional incontinence include confusion, dementia, poor eyesight, poor mobility, poor dexterity or unwillingness. t
– Overflow incontinence – sometimes people find that they cannot stop their bladders from constantly dribbling or continuing to dribble for some time after they have passed urine.
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This question is part of the following fields:
- Physiology
- Renal
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Question 20
Incorrect
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The pterion is clinically significant as it marks an area of weakness on the skull. What structure lies beneath it?
Your Answer: Superior sagittal sinus
Correct Answer: Anterior branches of the middle meningeal artery
Explanation:The pterion is the area where four bones, the parietal, frontal, greater wing of sphenoid and the squamous part of the temporal bone meet. It overlies the anterior branch of the middle meningeal artery on the internal aspect of the skull. The pterion is the weakest part of the skull. Slight trauma to this region can cause extradural hematoma.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 21
Incorrect
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Tumours derived from all three germ-cell layers in new-borns usually occur in which of the following sites?
Your Answer: Ovaries
Correct Answer: Sacrococcygeal area
Explanation:A teratoma is a tumour with tissue or organ components resembling normal derivatives of more than one germ layer. It is derived from all three cell layers. The most common location of teratoma in new-born infants is in the sacrococcygeal area.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 22
Incorrect
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Choose the most correct answer regarding the obturator internus muscle.
Your Answer: It emerges from the pelvis through the obturator foramen
Correct Answer: It emerges from the pelvis through the lesser sciatic foramen
Explanation:The obturator internus arises from the inner surface of the anterolateral wall of the pelvis and the pelvic surface of the obturator membrane. The fibres converge rapidly towards the lesser sciatic foramen and end in four or five tendinous bands and leave the pelvis through the lesser sciatic foramen.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 23
Incorrect
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A patient underwent surgical excision of mass in the right carotid triangle. One day after the surgery patient complained of numbness of the skin over the right side of the neck. Injury to the cervical plexus of nerves is suspected. What is the possible nerve affected in this patient?
Your Answer: Medial supraclavicular
Correct Answer: Transverse cervical
Explanation:The transverse cervical nerve (superficial cervical or cutaneous cervical) arises from the second and third spinal nerves, turns around the posterior border of the sternocleidomastoid and, passing obliquely forward beneath the external jugular vein to the anterior border of the muscle, it perforates the deep cervical fascia, and divides beneath the platysma into the ascending and descending branches. It provides cutaneous innervation to this area.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 24
Correct
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Decreased velocity of impulse conduction through the atrioventricular node (AV node) in the heart will lead to:
Your Answer: Increased PR interval
Explanation:AV node damage may lead to an increase in the PR interval to as high as 0.25 – 0.40 s (normal = 0.12 – 0.20 s). In the case of severe impairment, there might be a complete failure of passage of impulses leading to complete block. In this case, the atria and ventricles will beat independently of each other.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 25
Incorrect
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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: Acute pancreatitis
Correct 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 26
Incorrect
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Which of the following is a true statement regarding secretion of gastric acid?
Your Answer: Acetylcholine decreases gastric acid secretion
Correct Answer: Acetylcholine increases gastric acid secretion
Explanation:Gastric acid secretion is increased by acetylcholine, histamine and gastrin, with the help of cAMP as a secondary messenger. They increase H+ and Cl- secretion by increasing the number of H+/K+ ATPase molecules and Cl- channels. In contrast, gastric acid secretion is decreased by somatostatin, epidermal growth factor and prostaglandins.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 27
Incorrect
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QT interval in the electrocardiogram of a healthy individual is normally:
Your Answer: 0.10 s
Correct Answer: 0.40 s
Explanation:QT interval extends from beginning of the QRS complex till the end of he T-wave and normally lasts for 0.40 s. It is important in the diagnosis of long-QT and short-QT syndrome. The QT interval varies on the basis of heart rate and may need to be corrected.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 28
Correct
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A lady presents to the out patient clinic with a painful boil on the skin of her mons pubis. Which nerve supplies the skin of the mons pubis?
Your Answer: Anterior labial
Explanation:Anterior labial branch is the terminal branch of the ilioinguinal nerve that innervates the skin of the mons pubis in women and the skin of the anterior scrotum in men.
The femoral branch of genitofemoral nerve innervates the upper medial thigh.
The iliohypogastric innervates muscles of the abdominal wall.
The subcostal nerve innervates muscles of the abdominal wall and the skin of the lower abdominal wall.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 29
Correct
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Which cells are most commonly seen in a granulomatous lesion that suggests an underlying chronic inflammation?
Your Answer: Lymphocytes
Explanation:Lymphocytes and monocytes are commonly and characteristically recognised in a case of chronic inflammation.
Eosinophils and neutrophils are seen with acute inflammation.
Mast cells release histamine in early inflammation.
Basophils are seen with allergies.
Plasma cells are seen with viral infection.
Platelets are not characteristic of any type of inflammation.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 30
Incorrect
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Which of the following coagulation factors cross-links fibrin?
Your Answer: Factor VII
Correct Answer: Factor XIII
Explanation:Factor XIII, also known as fibrin stabilizing factor, is an enzyme of the coagulation cascade that crosslinks fibrin. Deficiency of FXIII may cause bleeding tendency but paradoxically, it may also predispose to thrombosis.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 31
Incorrect
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A tumour growing in the posterior mediastinum is found in a 40-year-old man who presented to the out patient clinic with chest pain. Such a tumour is likely to compress the following structure:
Your Answer: Pulmonary trunk
Correct Answer: Oesophagus
Explanation:The boundaries of the posterior mediastinum are: the superiorly through the sternal angle and T4/5, inferiorly, the diaphragm, anteriorly, by the middle mediastinal structures and posteriorly by the spinal cord. Structures in the posterior mediastinum include the descending thoracic aorta, the azygos system, oesophagus, thoracic duct and lymph nodes. The great vessels and structures at the root of the lung are part of the middle mediastinum. The oesophagus is the only structure in the posterior mediastinum among the choices.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 32
Incorrect
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An 18 -year-old female is diagnosed with folliculitis in the left axilla. What is the most likely organism that could cause this condition?
Your Answer: Escherichia coli
Correct Answer: Staphylococcus aureus
Explanation:Folliculitis is the inflammation of the hair follicles. It is usually caused by Staphylococcus infection.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 33
Incorrect
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The thoracic duct :
Your Answer: Enters the thorax through the vena caval hiatus of the thoracoabdominal diaphragm
Correct Answer: varies in length from 38 to 45 cm
Explanation:The thoracic duct is the main drainage of lymph in the body. It varies in length from 38 to 45 cm and extends from the second lumbar vertebra to the root of the neck.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 34
Incorrect
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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: Paracortical lymphoid hyperplasia
Correct 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.
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This question is part of the following fields:
- Inflammation & Immunology; Female Health
- Pathology
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Question 35
Incorrect
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A 48-year-old woman has a mass in her right breast and has right axillary node involvement. She underwent radical mastectomy of her right breast. The histopathology report described the tumour to be 4 cm in its maximum diameter with 3 axillary lymph nodes with evidence of tumour. The most likely stage of cancer in this patient is:
Your Answer: IIA
Correct Answer: IIB
Explanation:Stage IIB describes invasive breast cancer in which: the tumour is larger than 2 centimetres but no larger than 5 centimetres; small groups of breast cancer cells — larger than 0.2 millimetre but not larger than 2 millimetres — are found in the lymph nodes OR the tumour is larger than 2 centimetres but no larger than 5 centimetres; cancer has spread to 1 to 3 axillary lymph nodes or to lymph nodes near the breastbone (found during a sentinel node biopsy) OR the tumour is larger than 5 centimetres but has not spread to the axillary lymph nodes.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 36
Correct
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A 7-month-old abandoned baby with congenital non-communicating hydrocephalus is hosted by a clinic at its new-born hostel. A CT scan of the baby's brain reveals what might be a blockage of the ventricular system between the third and the fourth ventricles. Which of the following is the most likely blocked structure?
Your Answer: Cerebral aqueduct
Explanation:The drainage of cerebral spinal fluid from the third ventricle to the fourth ventricle is carried out by the cerebral aqueduct. The cerebral aqueduct is the narrowest passageway in the entire ventricular system and thus forms the most common site of blockage of flow of cerebrospinal fluid. The interventricular foramen allows passage of CSF to the third ventricle. The foramen of Luschka and Magendie are located on the fourth ventricle and allow passage of CSF to the subarachnoid space from the ventricular system. The pontine cistern is a space located on the ventral aspect of the pons. The cisterna magna is an opening on the subarachnoid space between the pia matter and the arachnoid.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 37
Incorrect
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Which of the following brings about a reduction in gastric blood flow?
Your Answer: Vagal stimulation
Correct Answer: Vasopressin
Explanation:Gastric blood flow is increased by vagal stimulation, gastrin, histamine and acetylcholine as they stimulate gastric section and the production of vasodilator metabolites. Acetylcholine and histamine also have a direct action on the gastric arterioles. Similarly, gastric blood flow is reduced by inhibitors of secretion – catecholamines, secretin and vasopressin.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 38
Incorrect
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A 57-year-old male smoker noted a lump on his inner lip. Upon physical examination the lump measured more than 2 cm but less than 4 cm in its greatest dimension. He is diagnosed with squamous cell carcinoma of the lip. What is the stage of the patient's cancer according to the TNM staging for head and neck cancers?
Your Answer: T4
Correct Answer: T2
Explanation:Head and neck cancer is a group of cancers that starts within the mouth, nose, throat, larynx, sinuses, or salivary glands. The TNM staging system used for head and neck cancers is a clinical staging system that allows physicians to compare results across patients, assess prognosis, and design appropriate treatment regimens. The staging is as follows; Primary tumour (T): Tis: pre-invasive cancer (carcinoma in situ), T0: no evidence of primary tumour, T1: tumour 2 cm or less in its greatest dimension, T2: tumour more than 2 cm but not more than 4 cm, T3: tumour larger than 4 cm, T4: tumour with extension to bone, muscle, skin, antrum, neck, etc and TX: minimum requirements to assess primary tumour cannot be met. Regional lymph node involvement (N): N0: no evidence of regional lymph node involvement, N1: evidence of involvement of movable homolateral regional lymph nodes, N2: evidence of involvement of movable contralateral or bilateral regional lymph nodes, N3: evidence of involvement of fixed regional lymph nodes and NX: Minimum requirements to assess the regional nodes cannot be met. Distant metastases (M): M0: no evidence of distant metastases, M1: evidence of distant metastases and MX: minimum requirements to assess the presence of distant metastases cannot be met. Staging: Stage I: T1 N0 M0, Stage II: T2 N0 M0, Stage III: T2NOMO and T3N1MO, Stage IV: T4N1M0, any TN2M0, any TN3M0, any T and any NM1. The depth of infiltration is predictive of the prognosis. With increasing depth of invasion of the primary tumour, the risk of nodal metastasis increases and survival decreases. The patient in this scenario therefore has a T2 tumour.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 39
Correct
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Regarding the posterior compartment of the leg, which is correct?
Your Answer: The muscles plantarflex the foot and are innervated by the tibial nerve
Explanation:The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris. Deep muscles include tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus. The superficial ( calf muscles) which are responsible for plantarflexion of the foot are supplied by the tibial nerve as follows: the gastrocnemius and soleus muscles are supplied by the first and second sacral nerves and the plantaris by the fourth and fifth lumbar and first sacral nerve (the tibial nerve).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 40
Correct
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Which of the following physiological changes will you see in a young man who has been trekking in the Himalayas for 3 years?
Your Answer: Increased renal excretion of HCO3 –
Explanation:The atmospheric pressure is lower at high altitudes as compared with sea level. This leads to a decrease in the partial pressure of oxygen. Once 2100 m (7000 feet) of altitude is reached, there is a drop in saturation of oxyhaemoglobin. The oxygen saturation of haemoglobin determines the oxygen content in the blood. The body physiological tries to adapt to high altitude by acclimatization. Immediate effects include hyperventilation, fluid loss (due to a decreased thirst drive), increase in heart rate and slightly lowered stroke volume. Long term effects include lower lactate production, compensatory alkali loss in urine, decrease in plasma volume, increased erythropoietin release and red cell mass, increased haematocrit, higher concentration of capillaries in striated muscle tissue, increase in myoglobin, increase in mitochondria, increase in aerobic enzyme concentration such as 2,3-DPG and pulmonary vasoconstriction.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 41
Incorrect
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Electrophoresis is used to detect antibodies (immunoglobulins) in a blood sample from the umbilical artery of a new born. Which antibodies have the highest percentage in a new-born?
Your Answer: IgM
Correct Answer: IgG
Explanation:IgG is a monomeric immunoglobulin. It is formed by two heavy chains and two light chains and has two binding sites. Its is the most abundant antibody that is equally distributed in the blood and the tissues. It is the only antibody that can pass through the placenta and thus the only antibody present in the baby after it is born. There are four subclasses: IgG1 (66%), IgG2 (23%), IgG3 (7%) and IgG4 (4%). IgG1, IgG3 and IgG4 cross the placenta easily
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This question is part of the following fields:
- General
- Physiology
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Question 42
Incorrect
-
Lateral medullary syndrome, also known as Wallenberg's syndrome is a neurological condition caused by ischaemia in the lateral part of the medulla oblongata and is commonly associated with numerous neurological symptoms. Which of the following arteries when occluded leads to this condition?
Your Answer: Anterior spinal
Correct Answer: Posterior inferior cerebellar
Explanation:The lateral medullary syndrome or Wallenberg’s disease is also known as posterior inferior cerebellar artery syndrome (PICA). This syndrome is a clinical manifestation of the occlusion of the posterior cerebellar artery that results in symptoms of infarction of the lateral medullary oblongata. Other arteries that contribute to blood flow in to this region such are the vertebral artery, superior middle cerebellar and inferior medullary arteries can also result to this syndrome when occluded.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 43
Correct
-
A textbook of cardiac surgery explains that while doing a left pneumonectomy, a surgeon must be careful to avoid injury to a vital structure that leaves an impression on the mediastinal surface of the left lung. Which structure is it referring to?
Your Answer: Aortic arch
Explanation:Structures that leave an impression on the mediastinal surface of the left lung include: the oesophagus, subclavian artery, brachiocephalic vein, first rib, thymus, the heart, the diaphragm, descending aorta and arch of the aorta. The other structures form an impression on the mediastinal aspect of the right lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 44
Incorrect
-
A patient who has used NSAIDS for many years presents to the A&E with symptoms of acute haemorrhagic shock. An emergency endoscopy is done that shows that a duodenal ulcer has perforated the posterior wall of the first part of the duodenum. Which artery is most likely to be the cause of the haemorrhage?
Your Answer: Left gastric
Correct Answer: Gastroduodenal
Explanation:The gastroduodenal artery is a branch of the hepatic artery and descends near the pylorus between the first part of the duodenum and the neck of the pancreas to divide at the lower border of the duodenum into the right gastroepiploic and pancreaticoduodenal arteries. Before it divides, it gives off a few branches to the pyloric end of the stomach and to the pancreas. The artery that is most likely involved in this situation is the gastroduodenal artery since it is posterior to the first part of the duodenum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 45
Correct
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A 47-year-old male smoker, who had been self-medicating with oral steroids for the last two years due to persistent breathlessness presented to the doctor complaining of a productive cough, fever and chest pain. A chest X-ray revealed bilateral patchy opacities. He was diagnosed with bilateral bronchopneumonia. Which of these organisms is most probably causing these findings?
Your Answer: Nocardia asteroides
Explanation:Nocardia is a Gram-positive aerobic actinomycete. Several species have been identified but the most common human pathogen is Nocardia asteroides. The predominant clinical finding in the majority of patients affected by nocardiosis is pulmonary disease. Predisposing factors for pulmonary nocardiosis include leukaemia, human immunodeficiency virus (HIV) infection, organ transplantation, diabetes and receiving prolonged corticosteroids.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 46
Incorrect
-
A 30-year old lady was admitted to the general surgical ward after a diagnosis of perforation of the first part of the duodenum that resulted from a long standing ulcer. If this perforation led to the expulsion of the gastric content that resulted to the erosion of an artery found in this part of the duodenum (the posterior of the first part of the duodenum). Which of the following arteries is this most likely to be?
Your Answer: Common hepatic
Correct Answer: Gastroduodenal
Explanation:The proximal part of the duodenum is supplied by the gastroduodenal artery. This artery is found descending behind the first part of the duodenum after branching from the hepatic artery. If gastric content was to be expelled in the posterior portion of the first part of the duodenum, then this artery would be most likely to be damaged. The common hepatic artery and the left gastric artery are branches of the coeliac trunk that are found superior to the duodenum. The proper hepatic artery is a branch of the common hepatic artery also found superior to the duodenum. The superior mesenteric artery is found behind the pancreas as a branch of the aorta that is at the bottom of the L1 level. The right gastric artery arises above the pylorus from the proper hepatic artery and supplies the lesser curvature of the stomach. The intestinal arteries supply the ileum and the jejunum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 47
Incorrect
-
Which of the following is NOT true regarding malignant hyperpyrexia
Your Answer: It can be caused by isoflurane
Correct Answer: It can be caused by nitrous oxide
Explanation:Malignant hyerpyrexia occurs in 1 in 150,000. All inhalational anaesthetic agents and suxamethonium, except nitrous oxide can cause malignant hyperpyrexia.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 48
Incorrect
-
upon stroking the plantar surface of a patient's foot, extension of toes was noted. This is likely to be accompanied with:
Your Answer: Atrophy
Correct Answer: Spasticity
Explanation:An upper motor neuron lesion affects the neural pathway above the anterior horn cell or motor nuclei of the cranial nerves, whereas a lower motor neurone lesion affects nerve fibres travelling from the anterior horn of the spinal cord to the relevant muscles. An upper motor neurone lesions results in the following:
– Spasticity in the extensor muscles (lower limbs) or flexor muscles (upper limbs).
– ‘clasp-knife’ response where initial resistance to movement is followed by relaxation
– Weakness in the flexors (lower limbs) or extensors (upper limbs) with no muscle wasting
– Brisk tendon jerk reflexes
– Positive Babinski sign (on stimulation of the sole of the foot, the big toe is raised rather than curled downwards)
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This question is part of the following fields:
- Neurology
- Physiology
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Question 49
Correct
-
Which of these illnesses is most likely to precede Guillain-Barré syndrome?
Your Answer: Viral pneumonia
Explanation:Guillain–Barré syndrome (GBS) is characterized by a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. In about two-thirds of patients, the syndrome begins 5 days to 3 weeks after an infectious disease, surgery or vaccination. Infection is the trigger in over 50% of patients; common pathogens include Campylobacter jejuni, enteric viruses, herpesviruses (including cytomegalovirus and those causing infectious mononucleosis) and Mycoplasma species. The underlying mechanism involves an autoimmune disorder in which the body’s immune system mistakenly attacks the peripheral nerves and damages their myelin insulation, although the cause for this is still unknown.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 50
Incorrect
-
Loperamide is a drug used to treat diarrhoea. What is the mechanism of action of loperamide?
Your Answer: Lowers the surface tension of the stool, facilitating penetration of water and fats
Correct 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 51
Incorrect
-
A 20-year old involved in a brawl was stabbed in the anterior chest in a structure that is in close proximity to where the first rib articulates with the sternum. What is the structure that was most likely injured?
Your Answer: Sternal angle
Correct Answer: Sternoclavicular joint
Explanation:The first rib articulates with the sternum right below the sternoclavicular joint.
The sternal angle articulates with the costal cartilage of the second rib.
The nipple is found between the fourth and the fifth ribs, in the fourth intercostal space.
The xiphoid process is located right below the point of articulation of the costal cartilage of rib 7 with the sternum.
The root of the lung is the part of the lung where neurovascular structures enter and leave the lung.
Acromioclavicular joint is the point of articulation between the acromion process and the clavicle, near the shoulder.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 52
Incorrect
-
A 34-year-old woman with pelvic inflammatory disease is administered ceftriaxone. The subclass of antibiotics that ceftriaxone belongs to is:
Your Answer: Macrolides
Correct Answer: Third-generation cephalosporins
Explanation:Ceftriaxone is a third-generation cephalosporin antibiotic. It has a broad spectrum of activity against Gram-positive and Gram-negative bacteria. Its indications include middle ear infections, endocarditis, meningitis, pneumonia, bone and joint infections, intra-abdominal infections, skin infections, urinary tract infections, gonorrhoea, and pelvic inflammatory disease.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 53
Incorrect
-
The otic ganglion receives its preganglionic sympathetic fibres from which of the following nerves?
Your Answer: Trigeminal nerve
Correct Answer: Glossopharyngeal nerve
Explanation:The otic ganglion is a small (2–3 mm), oval shaped, flattened parasympathetic ganglion of a reddish-grey colour, located immediately below the foramen ovale in the infratemporal fossa and on the medial surface of the mandibular nerve. The preganglionic parasympathetic fibres originate in the inferior salivatory nucleus of the glossopharyngeal nerve. They leave the glossopharyngeal nerve by its tympanic branch and then pass via the tympanic plexus and the lesser petrosal nerve to the otic ganglion. Here, the fibres synapse, and the postganglionic fibres pass by communicating branches to the auriculotemporal nerve, which conveys them to the parotid gland. They produce vasodilator and secretomotor effects.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 54
Incorrect
-
A 60-year-old male who was admitted due to cerebrovascular disease on his 5th hospital stay developed pneumonia. The most likely organism that causes hospital acquired pneumonia is pseudomonas aeruginosa. What is the most likely mechanism for the pathogenesis on pseudomonas infection?
Your Answer: Activation of EF-2
Correct Answer: Exotoxin
Explanation:Pseudomonas aeruginosa is a common Gram-negative, rod-shaped bacterium that can cause disease in plants and animals, including humans. It is citrate, catalase, and oxidase positive. P. aeruginosa uses the virulence factor exotoxin A to inactivate eukaryotic elongation factor 2 via ADP-ribosylation in the host cell, much the same as the diphtheria toxin does. Without elongation factor 2, eukaryotic cells cannot synthesize proteins and necrotise. The release of intracellular contents induces an immunologic response in immunocompetent patients.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 55
Incorrect
-
A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and oliguria. She is diagnosed with chronic renal failure. Dipstick testing shows no protein, glucose, nitrite or ketones but a semi-quantitative sulphosalicylic acid test for urine protein is positive. Which of the following is the most probable cause of chronic renal failure in this patient.
Your Answer: Systemic lupus erythematosus
Correct Answer: Multiple myeloma
Explanation:Dipstick results are negative because the proteins found in the urine of this patient are not albumin but Bence Jones proteins. A Bence Jones protein is a monoclonal globulin protein commonly detected in patients affected by multiple myeloma. Multiple myeloma is a malignancy of plasma cells characterised by the production of monoclonal immunoglobulin. Symptoms include bone pain, bone fractures, bleeding, neurologic symptoms, fatigue, frequent infections and weight loss.
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This question is part of the following fields:
- Pathology
- Renal
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Question 56
Incorrect
-
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: Acute cholecystitis
Correct 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..
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 57
Correct
-
A 26-year old man is brought to the A&E with a stab wound to the chest. The wound is in a part of the left lung that might partially fill the costomediastinal recess in full respiration. Where did the weapon strike this man?
Your Answer: Lingula
Explanation:During full inspiration, the lingual-of the left lung partially fills the costomediastinal recess. If the apex of the lung is fully filled with air, it would occupy the copula (the part of the pleura that extends above the first rib). The hilum is part of the lung where the neurovascular structures that form the root of the lung enter and leave the lung and doesn’t expand on inspiration. The middle lobe can expand to fill the costomediastinal recess, however, the middle lobe is on the right lung. The inferior lobe, during full inspiration, might fill the costodiaphragmatic recess.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 58
Incorrect
-
What is the role of ICAM-1 and VCAM-1 in the inflammatory process?
Your Answer: Chemotaxis
Correct Answer: Leukocyte adhesion
Explanation:Steps involved in leukocyte arrival and function include:
1. margination: cells migrate from the centre to the periphery of the vessel.
2. rolling: selectins are upregulated on the vessel walls.
3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes. Interaction of these results in adhesion.
4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product.
5. phagocytosis: engulfing the offending substance/cell.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 59
Correct
-
The ability of the bacteria to cause disease or its virulence is related to :
Your Answer: Toxin and enzyme production
Explanation:The pathogenicity of an organism or its ability to cause disease is determined by its virulence factors. Many bacteria produce virulence factors that inhibit the host’s immune system. The virulence factors of bacteria are typically proteins or other molecules that are synthesized by enzymes. These proteins are coded for by genes in chromosomal DNA, bacteriophage DNA or plasmids. The proteins made by the bacteria can poison the host cells and cause tissue damage.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 60
Correct
-
Which statement is true about the inferior sagittal sinus?
Your Answer: Is formed between two layers of meningeal dura
Explanation:The inferior sagittal sinus is also known as the inferior longitudinal sinus. It courses along the inferior border of the falx cerebri, superior to the corpus callosum. It is cylindrical in shape and increases in size as it passes backward ending in the straight sinus. It receives blood from the deep and medial aspects of the cerebral hemispheres and drains into the straight sinus.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 61
Incorrect
-
Which of the following is the most common germ cell tumour of the testis affecting an adult male?
Your Answer: Teratoma
Correct Answer: Seminoma
Explanation:Germ cell tumours represent 90% of primary tumours arising in the testis. They are broadly divided into seminomas and non-seminomas. Seminomas are the most common testicular germ cell tumour seen in 40% cases. The other non-seminomatous histological subtypes include embryonal (25%), teratocarcinoma (25%), teratoma (5%) and pure choriocarcinoma (1%).
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This question is part of the following fields:
- Pathology
- Urology
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Question 62
Correct
-
An amateur body-builder complains of increasing pain in his right shoulder after a few days of intense training. A surgeon aspirates clear fluid from his subdeltoid region. What's the most likely diagnosis?
Your Answer: Bursitis
Explanation:Bursae are potential cavities that contain synovial fluid, found in areas where friction occurs. Their function is to minimise friction and facilitate movement. Bursitis is the inflammation of one or more bursae, and they can occur in the shoulder, elbow, knee, ischium, amongst other joints. Acute bursitis can appear after strenuous exercise or activity, and chronic bursitis can develop following previous bursitis or trauma. Acute bursitis causes pain, tenderness, and swelling.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 63
Incorrect
-
Risk factors for hepatocellular carcinoma do NOT include:
Your Answer: Aflatoxin
Correct Answer: Heptitis E
Explanation:Risk factors for hepatocellular carcinoma include hepatitis B and C, aflatoxin, anabolic steroids, alcohol cirrhosis and primary liver disease.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 64
Incorrect
-
Which type of thyroid tumour represents 75 - 80% of thyroid cancer cases? This type is predominant in children and in patients who have had a previous history of head or neck radiation.
Your Answer: Follicular carcinoma
Correct Answer: Papillary carcinoma
Explanation:Papillary thyroid carcinoma is the most common thyroid cancer. This cancer has a high cure rate with 10-year survival rates for all patients with papillary thyroid cancer estimated at 80% to 90%.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 65
Incorrect
-
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: Hepatoduodenal ligament
Correct 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 66
Incorrect
-
A 25 year old primi gravida lady was scheduled for a regular antenatal check up. During the vaginal exam of this lady, the registrar discovered a malignant growth on the anterior wall of her vagina. Which of the following structures, adjacent to the vagina, is likely to be involved as well?
Your Answer: Uterine tube
Correct Answer: Fundus of the bladder
Explanation:The fundus of the bladder is related anatomically to the anterior surface of the vagina and the urethra as well. If there was a malignant growth in the anterior surface of the vagina, then most likely the fundus of the bladder would be involved as well aspotentially the urethra.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 67
Incorrect
-
C5a (a complement component) is a potent?
Your Answer: Opsonin
Correct Answer: Anaphylotoxin
Explanation:C5a is a strong chemoattractant as well as an anaphylotoxin and is involved in the recruitment of inflammatory cells such as neutrophils, eosinophils, monocytes, and T lymphocytes. It is also involved in activation of phagocytic cells, release of granule-based enzymes and generation of oxidants. All of which contribute to innate immune functions.
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This question is part of the following fields:
- General
- Physiology
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Question 68
Incorrect
-
Depression of the normal coagulation system and excessive bleeding after surgery can occur in which of the following medical conditions?
Your Answer: Heart disease
Correct Answer: Liver disease
Explanation:As most of the coagulation factors are synthesized in the liver, liver diseases like hepatitis or cirrhosis will depress the coagulation system. Vitamin K deficiency can also decrease the production of vitamin K dependent coagulation factors VII, XI, X and prothrombin.
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This question is part of the following fields:
- General
- Physiology
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Question 69
Incorrect
-
In relation to the muscles of facial expression, It is true to say:
Your Answer: The mandibular nerve, a branch of the trigeminal nerve innervates some of the facial muscles
Correct Answer: They are in the same subcutaneous plane as the platysma muscle
Explanation:The facial muscles generally originate from the facial bones and attach to the skin, in the same plane as the platysma muscle. They are all innervated by cranial nerve VII (the facial nerve). The occipitofrontalis muscle consists of two parts: The occipital belly, near the occipital bone, and the frontal belly, near the frontal bone.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 70
Incorrect
-
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: Transversalis fascia
Correct 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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 71
Incorrect
-
A CT-scan report of a patient with gastric carcinoma shows that the lymph nodes around the coeliac trunk are enlarged. The coeliac trunk:
Your Answer: Is accompanied by the coeliac vein
Correct Answer: Gives rise to the splenic, left gastric and common hepatic arteries
Explanation:The coeliac trunk is a branch of the aorta arising just below the aortic hiatus of the diaphragm to pass nearly horizontally forward to divide into 3 large branches i.e. the left gastric, the hepatic and the splenic arteries. Occasionally it may give off one of the inferior phrenic arteries. It is covered by the lesser omentum and on the right side bordered by the right coeliac ganglion and the cardiac end of the stomach. Inferiorly it is bordered by the upper border of the pancreas and splenic vein. The embryonic midgut is supplied by the superior mesenteric artery.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 72
Incorrect
-
Injury to this nerve may result in loss of sensation of the mandibular teeth and bone:
Your Answer: Greater palatine nerve
Correct Answer: Inferior alveolar nerve
Explanation:The inferior alveolar nerve (sometimes called the inferior dental nerve) is a branch of the mandibular nerve, which is itself the third branch of the trigeminal nerve. The inferior alveolar nerves supply sensation to the lower teeth of the mandible.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 73
Incorrect
-
A 45-year old gentleman presented to the emergency department at 5.00 AM with pain in his left flank. The pain began suddenly and presented in waves throughout the night. Urine examination was normal except for presence of blood and few white blood cells. The pH and specific gravity of the urine were also found to be within normal range. What is the likely diagnosis?
Your Answer: Transitional cell carcinoma of bladder
Correct Answer: Ureteric calculus
Explanation:A calculus in the ureter, if less than 5mm in diameter is likely to pass spontaneously. However, a larger calculus irritates the ureter and may become lodged, leading to hydroureter and/or hydronephrosis. Likely sites where the calculus might get lodged, include pelviureteric junction, distal ureter at the level of iliac vessels and the vesicoureteric junction. An obstruction can result in reduced glomerular filtration. There can be deterioration in renal function due to hydronephrosis and a raised glomerular pressure, leading to poor renal blood flow. Permanent renal dysfunction usually takes about 4 weeks to occur. Secondary infection can also occur in chronic obstruction.
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This question is part of the following fields:
- Pathology
- Renal
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Question 74
Correct
-
Which statement is correct regarding secretions from the adrenal glands?
Your Answer: Aldosterone is producd by the zona glomerulosa
Explanation:The secretions of the adrenal glands by zone are:
Zona glomerulosa – aldosterone
Zona fasciculata – cortisol and testosterone
Zona reticularis – oestradiol and progesterone
Adrenal medulia – adrenaline, noradrenaline and dopamine.
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This question is part of the following fields:
- Physiology
- Renal
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Question 75
Incorrect
-
What is the name of the cutaneous branch of the posterior primary ramus of C2?
Your Answer: Lesser occipital nerve
Correct Answer: Greater occipital nerve
Explanation:The dorsal primary ramus of the spinal nerve C2 is the greater occipital nerve which provides cutaneous innervation to the skin of the back of the head. The ventral primary ramus gives off the great auricular nerve, the lesser occipital nerve and the ansa cervicalis.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 76
Incorrect
-
A 46-year old female patient experienced a stroke that affected her glossopharyngeal nerve. Damage to the glossopharyngeal nerve would most likely:
Your Answer: Affect the parasympathetic innervation to the submandibular gland
Correct Answer: Result in general sensory deficit to the pharynx
Explanation:The glossopharyngeal nerve (CN IX) has many functions which include:
– Contributes to the pharyngeal plexus
– Receiving general somatic sensory fibres from the tonsils, pharynx, the middle ear and the posterior third of the tongue.
– supplies motor fibres to only one muscle; the stylopharyngeus muscle.
– provides parasympathetic fibres to the parotid gland via the otic ganglion.
– Receives visceral sensory fibres from the carotid bodies & carotid sinus.
– Receives special visceral sensory fibres from the posterior third of the tongue.
The above functions will directly be affected by the damage of the glossopharyngeal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 77
Incorrect
-
Which of the following muscles are involved in abduction of the wrist?
Your Answer: Pronator teres and brachioradialis
Correct Answer: Extensor carpi radialis brevis and flexor carpi radialis
Explanation:The muscle of the wrist that cause abduction of the wrist otherwise also know as radial flexion of the wrist are the following:
-Abductor Pollicis Longus
-Flexor Carpi Radialis
-Extensor Carpi Radialis Longus
-Extensor Carpi Radialis Brevis
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 78
Incorrect
-
Hepatomegaly with greatly increased serum alpha-fetoprotein is seen in which of the following conditions?
Your Answer: Cholangiocarcinoma
Correct Answer: Hepatocellular carcinoma
Explanation:Hepatocellular carcinoma or hepatoma affects people with pre-existing cirrhosis and is more common in areas with higher prevalence of hepatitis B and C. Diagnosis include raise alpha-fetoprotein levels, imaging and liver biopsy if needed. Patients at high-risk for developing this disease can undergo screening by periodic AFP measurement and abdominal ultrasonography. The malignancy carries poor prognosis (see also Answer to 10.4).
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 79
Incorrect
-
A 6 year-old boy is brought to you coughing. He is suspected to have aspirated a Lego piece which he was seen playing with. Where would you expect the piece to be?
Your Answer: Left main bronchus
Correct Answer: Right main bronchus
Explanation:Inhaled objects are more likely to enter the right lung for several reasons. First the right bronchus is shorter, wider and more vertical than the left bronchus. Also, the carina (a ridge-like structure at the point of tracheal bifurcation) is set a little towards the left. The terminal bronchiole is a very small space and impossible for the seed to lodge here.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 80
Incorrect
-
During a radical mastectomy for advanced breast cancer, the surgeon injured the long thoracic nerve. Which among the following muscles is likely to be affected?
Your Answer: Anterior scalene
Correct Answer: Serratus anterior
Explanation:The long thoracic nerve innervates the serratus anterior muscle which holds the scapula forward and balances the rhomboids and the trapezius muscles which retract the scapula. Injury to this nerve results in a ‘winged scapula’ with a posterior protrusion.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 81
Incorrect
-
When a patient is standing erect, pleural fluid would tend to accumulate in which part of the pleural space?
Your Answer: Cupola
Correct Answer: Costodiaphragmatic recess
Explanation:The costo-diaphragmatic recess is the lowest extent of the pleural cavity or sac. Any fluid in the pleura will by gravity accumulate here when a patient is standing erect.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 82
Incorrect
-
A 32-year-old man presented with a metabolic acidosis and increased anion gap. What is the most likely cause of the changes of the anion gap in this patient?
Your Answer: Bromide intoxication
Correct Answer: Lactic acidosis
Explanation:High anion gap in metabolic acidosis is caused generally by the elevation of the levels of acids like ketones, lactate, sulphates in the body, which consume the bicarbonate ions. Other causes of a high anion gap include overdosing on salicylates, uraemia, rhabdomyolysis, hypocalcaemia, hypomagnesaemia, or ingestion of toxins such as ethylene glycol, methanol, propyl alcohol, cyanide and iron.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 83
Incorrect
-
A 25 year old man presented with a history of headache and peripheral cyanosis. He had been living in the Himalayas for 6 months prior to this. What is the reason for his condition?
Your Answer: Hypoxic injury
Correct Answer: Physiological polycythaemia
Explanation:Polycythaemia is a condition that results in an increase in the total number of red blood cells (RBCs) in the blood. It can be due to myeloproliferative syndrome or due to chronically low oxygen levels or rarely malignancy. In primary polycythaemia/polycythaemia vera the increase is due to an abnormality in the bone marrow, resulting in increases RBCs, white blood cells (WBCs) and platelets. In secondary polycythaemia the increase occurs due to high levels of erythropoietin either artificially or naturally. The increase is about 6-8 million/cm3 of blood. A type of secondary polycythaemia is physiological polycythaemia where people living in high altitudes who are exposed to hypoxic conditions produce more erythropoietin as a compensatory mechanism for thin oxygen and low oxygen partial pressure.
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This question is part of the following fields:
- General
- Physiology
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Question 84
Incorrect
-
A 34-year-old woman is diagnosed with cerebral oedema after suffering a severe head trauma. Which of the following conditions is not likely to be associated with the extracellular oedema?
Your Answer: Increased capillary permeability
Correct Answer: Increased plasma colloid osmotic pressure
Explanation:Cerebral oedema is extracellular fluid accumulation in the brain. Increased capillary permeability, increased capillary pressure, increased interstitial fluid colloid osmotic pressure and lymphatic blockage would increase fluid movement into the interstitial spaces. Increased plasma colloid osmotic pressure, however, would oppose fluid movement from the capillaries into the interstitial compartment.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 85
Incorrect
-
A 40-year-old woman is suspected to have an ovarian cancer. Which tumour marker should be requested to confirm the diagnosis?
Your Answer: CEA
Correct Answer: CA-125
Explanation:CA-125 is a protein that is used as a tumour marker. This substance is found in high concentration in patients with ovarian cancer. It is the only tumour marker recommended for clinical use in the diagnosis and management of ovarian cancer.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 86
Incorrect
-
An experiment was conducted in which the skeletal muscle protein (not smooth muscle) involved in contraction was selectively inhibited. Which protein was inhibited?
Your Answer: Actin
Correct Answer: Troponin
Explanation:The mechanism of contraction of smooth muscles is different from that of skeletal muscles in which the contractile protein is troponin whilst in smooth muscle contraction is a protein called calmodulin. Calmodulin reacts with calcium ions and stimulates the formation of myosin crossbridges.
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This question is part of the following fields:
- General
- Physiology
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Question 87
Incorrect
-
Arterial blood gas analysis of a man admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD) showed the following: pH = 7.28, p(CO2) = 65.5 mmHg, p(O2)= 60 mmHg and standard bicarbonate = 30.5 mmol/l. This patient had:
Your Answer: Metabolic alkalosis
Correct Answer: Respiratory acidosis
Explanation:Acidosis with high p(CO2) and normal standard bicarbonate indicates respiratory acidosis, commonly seen in acute worsening of COPD patients. Respiratory acidosis occurs due to alveolar hypoventilation which leads to increased arterial carbon dioxide concentration (p(CO2)). This in turn decreases the HCO3 –/p(CO2) and decreases pH. In acute respiratory acidosis, the p(CO2) is raised above the upper limit of normal (over 45 mm Hg) with a low pH. However, in chronic cases, the raised p(CO2) is accompanied with a normal or near-normal pH due to renal compensation and an increased serum bicarbonate (HCO3 – > 30 mmHg).
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 88
Incorrect
-
A 15 year old girl presented to the emergency with a history of chronic cough, fever and weight loss. Her chest X-ray showed multiple nodules 1-4 cm in size and some of them with cavitation especially in the upper lobe. A sputum sample was positive for acid fast bacilli. Which of the following cells played a part in the development of the lung lesions?
Your Answer: Neutrophil
Correct Answer: Macrophage
Explanation:The characteristic cells in granulomatous inflammation are giant cells, formed from merging macrophages and epithelioid cells elongated with granular eosinophilic cytoplasm. Granulomatous reactions are seen in patients with tuberculosis. A tuberculous/caseating granuloma is characterised by a zone of central necrosis lined with giant multinucleated giant cells (Langhans cells) and surrounded by epithelioid cells, lymphocytes and fibroblasts. The caseous zone is present due to the damaged and dead giant cells and epithelioid cells.
Mast cells are only few in number and fibroblasts lay down collagen.
Basophils are not present.
The giant cell made up of macrophages are the most abundant cells in this inflammatory process.
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This question is part of the following fields:
- Inflammation & Immunology; Respiratory
- Pathology
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Question 89
Incorrect
-
Which of the following is responsible for the maximum increase in total peripheral resistance on sympathetic stimulation?
Your Answer: Veins
Correct Answer: Arterioles
Explanation:Arterioles are also known as the resistance vessels as they are responsible for approximately half the resistance of the entire systemic circulation. They are richly innervated by the autonomic nervous system and hence, will bring about the maximum increase in peripheral resistance on sympathetic stimulation.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 90
Incorrect
-
What is the reason for a deranged thrombin clotting time?
Your Answer: Thrombocytopaenia
Correct Answer: Heparin therapy
Explanation:Thrombic clotting time is also known as thrombin time. It is clinically performed to determine the therapeutic levels of heparin. After plasma is isolated from the blood, bovine thrombin is added to it and the time it takes from the addition to clot is recorded. The reference interval is usually <21s. deranged results are indicative of heparin therapy, hypofibrinogenemia, hyperfibrinogenaemia or lupus anticoagulant.
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This question is part of the following fields:
- General
- Physiology
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Question 91
Incorrect
-
The cranial nerves of the brain provide motor and sensory innervation to the structures of the head and neck. Which of the following cranial nerves provide only motor innervation?
Your Answer: Vestibulocochlear
Correct Answer: Abducens
Explanation:The cranial nerves emerge directly from the brain and the brain stem. They provide sensory, motor or both motor and sensory innervation. Here is a summary of the cranial nerves and their function:
Olfactory – Purely sensory
Optic – Sensory
Oculomotor – Mainly motor
Trochlear – Motor
Trigeminal – Both sensory and motor
Abducens – Mainly motor
Facial – Both sensory and motor
Vestibulocochlear – Mostly sensory
Glossopharyngeal – Both sensory and motor
Vagus – Both sensory and motor
Accessory – Mainly motor
Hypoglossal – Mainly motor
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 92
Correct
-
The chest X-ray of a 72 year old patient reveals the presence of a round lesion containing an air-fluid level in the left lung. These findings are most probably suggestive of:
Your Answer: Lung abscess
Explanation:Lung abscesses are collections of pus within the lung that arise most commonly as a complication of aspiration pneumonia caused by oral anaerobes. Older patients are more at risk due to poor oral hygiene, gingivitis an inability to handle their oral secretions due to other diseases. Chest X-ray most commonly reveals the appearance of an irregularly shaped cavity with an air-fluid level.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 93
Correct
-
A young man in a motor vehicle accident sustained a spinal injury at C8 level. What would likely be seen in this patient?
Your Answer: The hypothenar muscles would be completely paralysed
Explanation:The eighth cervical nerve is one of the contributors of the ulnar nerve. The ulnar nerve supplies the hypothenar muscles which include the opponens digiti minimi, abductor digiti minimi, flexor digiti minimi brevis, and palmaris brevis.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 94
Incorrect
-
An 8 year old boy presents with a history of repeated bacterial/pyogenic infections. He had a normal recovery from chickenpox and measles and shows normal antibody response. A decrease in which of the cell types can best explain this history of repeated pyogenic infections?
Your Answer: Eosinophils
Correct Answer: Neutrophils
Explanation:A decrease in the number of granulocytes, particularly neutrophils is known as agranulocytosis and it increases the susceptibility of an individual towards recurrent infections. Neutropenia can be either due to decreased production or increased elimination of neutrophils.
Ineffective agranulopoiesis is seen in: 1. myeloid stem cell suppression, 2. disease conditions associated with granulopoiesis such as megaloblastic anaemia and myelodysplastic syndromes, 3. rare genetic diseases, 4. splenic sequestration and 5. increased peripheral utilization.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 95
Incorrect
-
A 30 year old female suffered from mismatched transfusion induced haemolysis. Which substance will be raised in the plasma of this patient?
Your Answer: Hemosiderin
Correct Answer: Bilirubin
Explanation:Bilirubin is a yellow pigment that is formed due to the break down of RBCs. Haemolysis results in haemoglobin that is broken down into a haem portion and globin which is converted into amino acids and used again. Haem is converted into unconjugated bilirubin in the macrophages and shunted to the liver. In the liver it is conjugated with glucuronic acid making it water soluble and thus excreted in the urine. Its normal levels are from 0.2-1 mg/dl. Increased bilirubin causes jaundice and yellowish discoloration of the skin.
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This question is part of the following fields:
- General
- Physiology
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Question 96
Incorrect
-
Which of the following arteries, if ligated, will most likely affect blood supply to the pancreas?
Your Answer: Common hepatic
Correct Answer: Superior mesenteric
Explanation:The pancreas is a glandular organ in the body that produces important hormones such as insulin and glucagon. Its blood supply is from branches of the coeliac artery, superior mesenteric artery and the splenic artery. These are the arteries that if ligated, would affect blood supply to the pancreas.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 97
Incorrect
-
A 24-year old patient diagnosed with a direct inguinal hernia was scheduled for surgery to have the hernia repaired. The hernia was discovered to be protruding through the Hesselbach's triangle (inguinal triangle). Which of the following blood vessels that is a branch of the external iliac artery forms the lateral border of this triangle?
Your Answer: Uterine artery
Correct Answer: Inferior epigastric
Explanation:The inguinal triangle is formed by the following structures; inguinal ligament at the base; inferior epigastric vessels laterally and the lateral border of the rectus sheath medially. This triangle (also known as Hesselebach’s triangle) is where direct inguinal hernias protrude. The inferior epigastric artery is this the branch of the external iliac artery being referred to. All the other blood vessels are branches of the internal iliac artery.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 98
Incorrect
-
Calculate the pulmonary vascular resistance in an adult male with the following parameters:
Heart rate 70 beats/min
Arterial [O2] 0.24 ml O2/min
Venous [O2] 0.16 ml O2/mi
Whole body O2 consumption 500 ml/min
Pulmonary diastolic pressure 15 mmHg
Pulmonary systolic pressure 25 mmHg
Wedge pressure 5 mmHg.Your Answer: 1.5 resistance units (mmHg/l per min)
Correct Answer: 2.0 resistance units (mmHg/l per min)
Explanation:Pulmonary vascular resistance (PVR) = (Mean pulmonary artery pressure – Pulmonary capillary wedge pressure) divided by Cardiac output. To get cardiac output, Fick’s principle needs to be applied which states that VO2 = (CO × CAO2) – (CO × CVO2) where VO2 = oxygen consumption, CO = cardiac output, CA = oxygen concentration of arterial blood and CVO2 = oxygen concentration of venous blood. Thus, CO = VO2/CAO2– CVO2, CO = 500/0.24–0.16, CO = 500/0.8, CO = 6.25 l/min. To calculate mean pulmonary artery pressure, we use the formula: Mean pulmonary artery pressure = Diastolic pressure + 1/3(Systolic pressure – Diastolic pressure). Thus, Mean pulmonary artery pressure = 15 + 1/3(25 – 15) = 15 + 3. 33 = 18.33. Substituting these values in the first formula, PVR = 18.3–5/6.25 = 13.5/5.25 = 2.0 resistance units (mmHg/l per min) approximately.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 99
Incorrect
-
Which of the following is a fact worth noting about the development of the spleen?
Your Answer: It becomes retroperitoneal during its development
Correct 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 100
Incorrect
-
The pattern of drainage of the lymphatic and venous systems of the anterior abdominal wall is arranged around a horizontal plane above which drainage is in a cranial direction and below which drainage is in a caudal direction. Which horizontal plane is being referred to?
Your Answer: Transtubercular line
Correct Answer: Level of the umbilicus
Explanation:The umbilicus is a key landmark for the lymphatic and venous drainage of the abdominal wall. Above it, lymphatics drain into the axillary lymph nodes and the venous blood drains into the superior epigastric vein, into the internal thoracic vein. Below it, lymphatics drain into the superficial inguinal lymph nodes while venous blood drains into the inferior epigastric vein and the external iliac vein.
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This question is part of the following fields:
- Abdomen
- Anatomy
-
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Question 101
Incorrect
-
Which of the following morphological features is most characteristic of hyaline degeneration?
Your Answer: Accumulation of lipofuscin
Correct Answer: Homogeneous, ground-glass, pink-staining appearance of cells
Explanation:The characteristic morphological features of hyaline degeneration is ground-glass, pinking staining cytoplasm with an intact cell membrane. The accumulation of lipids, calcium salts, lipofuscin and an amorphous cytoplasm with an intact cell membrane are all characteristically found in different situations.
Pyknotic nucleus and orphan Annie eye nucleus are not seen in hyaline degeneration.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 102
Correct
-
A patient is suspected to have a chromosomal abnormality. Which tumour and chromosomal association is correct?
Your Answer: Neuroblastoma – chromosome 1
Explanation:Neuroblastoma is associated with a deletion on chromosome 1 and inactivation of a suppressor gene. Neurofibromas and osteogenic sarcoma are associated with an abnormality on chromosome 17. Retinoblastoma (Rb) is associated with an abnormality on chromosome 13. Wilms’ tumours of the kidney are associated with an abnormality on chromosome 11.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 103
Incorrect
-
A 30 year old male has a painless and transilluminant swelling at the upper pole of his left testi. There is a negative cough test. Which of the following is the likely diagnosis?
Your Answer: Varicocele
Correct Answer: Spermatocoele
Explanation:Spermatocele, also known as a spermatic cyst is a cystic mass usually occurring at the upper pole of the testis. Differential diagnosis included hydrocele as both are cystic, painless and transilluminant. Ultrasound is a useful modality. If symptomatic or large, surgical excision can be done.
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This question is part of the following fields:
- Pathology
- Urology
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Question 104
Correct
-
A 65-year old gentleman presents to the clinic with chronic back pain and weight loss. His blood count shows a white blood cell count of 10 × 109/l, with a differential count of 66 polymorphonuclear leukocytes, 7 bands, 3 metamyelocytes, 3 myelocytes, 14 lymphocytes, 7 monocytes, and 5 nucleated red blood cells. The haemoglobin is 13 g/dl with a haematocrit of 38.1%, a mean corpuscular volume of 82 fl, and a platelet count of 126 × 109/l. What is the likely diagnosis?
Your Answer: Metastatic carcinoma
Explanation:The peripheral blood findings suggest a leucoerythroblastic picture, the common causes of which in a 65-year old gentleman includes prostatic or lung malignancy.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 105
Incorrect
-
A 20-year-old woman had profuse watery diarrhoea for 2 days. She felt dizzy and weak, and thus decided to seek medical attention. At the emergency room her BP was 80/60 mmHg with a pulse of 118/min. What is the most appropriate intravenous treatment that should be given?
Your Answer: Verapamil
Correct Answer: Isotonic saline
Explanation:Normal saline is typically the first fluid used when hypovolemia is severe enough to threaten the adequacy of blood circulation. It is isotonic and has long been believed to be the safest fluid to give quickly in large volumes.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 106
Incorrect
-
A patients sciatic nerve has been severed following a stab injury. What would be affected?
Your Answer: The sartorius and gracilis muscles would not be able to contract
Correct Answer: There would still be cutaneous sensation over the anteromedial surface of the thigh
Explanation:The sciatic nerve supplies nearly all of the sensation of the skin of the leg and the muscles of the back of the thigh, leg and foot. A transection of the sciatic nerve at its exit from the pelvis will affect all the above-mentioned functions except cutaneous sensation over the anteromedial surface of the thigh, which comes from the femoral nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 107
Incorrect
-
A 65 year old man with a history of diabetes and hypertension presented with a stroke a few months ago severely affecting his speech and movement in the right arm and leg. A cerebral angiogram revealed a middle cerebral artery occlusion. A recent CT scan was done which revealed a 5 cm cystic space in his left parietal lobe. This lesion is a result of which of the following forms of resolution?
Your Answer: Coagulative necrosis
Correct Answer: Liquefactive necrosis
Explanation:Characteristically, the brain will undergo liquefactive necrosis following ischaemic injury. This leaves a cystic space in that region which would show up on a CT scan. Atrophy would result in a generalized decrease in the brain size. Coagulative necrosis typically occurs in parenchymal organs e.g. the spleen or kidney which have a lower lipid content. Caseous necrosis is typical in granulomatous tuberculosis infection. Apoptosis will not form a cystic area as it is programmed cell death involving a individual cells. Gangrenous necrosis is characteristic of ischaemic injury of the lower limb and GI tract. Fibrinous necrosis results from necrotic damage to the blood vessels with the leaking of proteins into the vessel, appearing bright pink on H & E staining.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Neurology
- Pathology
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Question 108
Incorrect
-
For which of the following is NOT screened for in blood for transfusion?
Your Answer: Hepatitis B
Correct Answer: EBV
Explanation:Blood for transfusion is routinely screened for hepatitis B and C, HIV, CMV and syphilis.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 109
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.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 110
Incorrect
-
During an inguinal hernia repair, an incision is made parallel to and 5cm above the inguinal ligament. The registrar is warned to look out for the inferior epigastric vessels to avoid damage. Between which layers of the abdominal wall is the registrar likely to find these vessels?
Your Answer: Skin and deep fascia of the abdominal wall
Correct Answer: Transversus abdominis muscle and peritoneum
Explanation:The inferior epigastric vessels lie on the inner surface of the transversus abdominis muscle covered by the parietal peritoneum. This layer of peritoneum lies over the inferior epigastric vessels to make the lateral umbilical fold. Camper’s and Scarpa’s fascia are two layers of the superficial fascia, the fatty layer and the membranous layer respectively.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 111
Incorrect
-
A man in his sixties underwent surgery to remove a lump from his axilla. During removal, a nerve originating from the lateral cord of the brachial plexus was damaged. Which nerve is this referring to?
Your Answer: Medial pectoral
Correct Answer: Lateral pectoral
Explanation:The only branch of the lateral cord of brachial plexus in the options given, is the lateral pectoral nerve. It supplies the pectoralis major muscle and sends a branch to join the medial pectoral nerve forming a loop in front of the first part of the axillary artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 112
Incorrect
-
In a study, breast lumps were analysed to determine the characteristic of malignant neoplasm on biopsy. What microscopic findings are suggestive of malignancy?
Your Answer: Anaplasia
Correct Answer: Invasion
Explanation:Invasion is suggestive of malignancy and an even better option would have been metastasis. Pleomorphism is found in both benign and malignant neoplasms along with atypia and anaplasia. A height nuclear/cytoplasmic ratio is suggestive of malignancy but not the best indicator. Malignant tumours are aggressive and growth rapidly. Necrosis can be seen in benign tumours if they deplete their blood supply.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 113
Incorrect
-
Which of the following veins is prostate cancer most likely to metastasize through?
Your Answer: Cephalic vein
Correct Answer: Internal vertebral venous plexus
Explanation:The internal vertebral veins are the most likely route of metastasis as they are valveless. They serve an important clinical role as they are the route of free travel for cancerous cells to other body structures. The other veins on the list have valves and would be the least likely routes for metastasis.
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This question is part of the following fields:
- Anatomy
- Neurology
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Question 114
Correct
-
A 46-year old lady presents with chief complaints of a large mass in the left breast. Histopathology of the mass revealed a stromal component with an epithelial component. What is the likely lesion?
Your Answer: Phyllodes tumour
Explanation:Phyllodes tumours are large, quickly growing tumours which arise from the periductal stroma of the breast. These are fibroepithelial tumours and account for less than 1% of breast cancers. These tumours can be benign, borderline or malignant based on the histology. The tumour usually affects adult women, mostly between the age of 40 to 50 years. It can be confused with fibroadenoma, which however affects much younger patients.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 115
Incorrect
-
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: Dorsalis pedis
Correct 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 116
Incorrect
-
A 63-year-old woman complains of a new, persisting headache. She is diagnosed with vasculitis and the histopathological sample revealed giant-cell arteritis. What is the most probable diagnose?
Your Answer: Wegener’s granulomatosis
Correct Answer: Temporal arteritis
Explanation:Giant cell arteritis (GCA), also known as temporal arteritis, is the most common systemic inflammatory vasculitis that occurs in adults. It is of unknown aetiology and affects arteries large to small however the involvement of the superficial temporal arteries is almost always present. Other commonly affected arteries include the ophthalmic, occipital and vertebral arteries, therefore GCA can result in systemic, neurologic, and ophthalmologic complications. GCA usually is found in patients older than 50 years of age and should always be considered in the differential diagnosis of a new-onset headache accompanied by an elevated erythrocyte sedimentation rate. Diagnosis depends on the results of artery biopsy.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 117
Incorrect
-
The midgut loop, also called the primary intestinal loop in a developing embryo, is formed when the midgut bends around which of the following arteries?
Your Answer: Coeliac trunk
Correct Answer: Superior mesenteric
Explanation:In a developing foetus, the midgut develops to form most of the intestines. During this development process, the midgut usually bends around the superior mesenteric artery and forms what is referred to as the midgut loop.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 118
Correct
-
A 62-year-old man presented with a persistent cough and weight loss. Chest x-ray demonstrated widespread nodular opacities. After a bronchoalveolar lavage, atypical cells were detected. Which is the most probable diagnosis?
Your Answer: Bronchioalveolar carcinoma
Explanation:Bronchioloalveolar carcinoma (BAC) is a term used to define a particular subtype of adenocarcinoma which develops in cells near the alveoli, in the outer regions of the lungs. On a chest X-ray it can appear as a single peripheral spot or as scattered spots throughout the lungs. Symptoms include cough, haemoptysis, chest pain, dyspnoea and loss of weight.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 119
Incorrect
-
Which structure holds the duodenojejunal flexure in place?
Your Answer: Greater omentum
Correct Answer: Suspensory ligament (of Treitz)
Explanation:The duodenum is connected to the diaphragm by the suspensory ligament called the ligament of Treitz. It is a slip of skeletal muscle from the right crus of the diaphragm and a fibromuscular band of smooth muscle from the 3rd and 4th parts of the duodenum. It is an important landmark, used to divide the gastrointestinal tract into the upper and lower parts. Contraction of this ‘ligament’ leads to opening of the duodenojejunal flexure allowing the flow of chyme.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 120
Correct
-
A 30-year-old woman feels thirsty. This thirst is probably due to:
Your Answer: Increased level of angiotensin II
Explanation:Thirst is the basic need or instinct to drink. It arises from a lack of fluids and/or an increase in the concentration of certain osmolites such as salt. If the water volume of the body falls below a certain threshold or the osmolite concentration becomes too high, the brain signals thirst. Excessive thirst, known as polydipsia, along with excessive urination, known as polyuria, may be an indication of diabetes. Angiotensin II is a hormone that is a powerful dipsogen (i.e. it stimulates thirst) that acts via the subfornical organ. It increases secretion of ADH in the posterior pituitary and secretion of ACTH in the anterior pituitary.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 121
Incorrect
-
In which of the following compartments of the femoral sheath is the femoral artery located?
Your Answer: Intermediate compartment
Correct Answer: Lateral compartment
Explanation:The femoral sheath also known as the crural sheath is made up of three compartments; lateral, intermediate and the medial. The femoral artery is contained in the lateral compartment of the femoral sheath while the femoral vein is in the intermediate compartment.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 122
Incorrect
-
Which of the following is involved in vitamin B12 absorption?
Your Answer: Ca2+
Correct Answer: Intrinsic factor
Explanation:Absorption of vitamin B12 is by an active transport process and occurs in the ileum. Most cobalamins are bound to proteins and are released in the stomach due to low pH and pepsin. The cobalamins then bind to R proteins, i.e. haptocorrin (HC) secreted from salivary glands and gastric juice. Another cobalamin binding protein is Intrinsic factor (IF) secreted from the gastric parietal cells. The cobalamin-HC complex is digested by pancreatic proteases in the intestinal lumen, and the free cobalamin then binds to IF. The complex then reaches a transmembrane receptor in the ileum and undergoes endocytosis. Cobalamin is then released intracellularly and binds to transcobalamin II (TC II). The newly formed complex then exits the ileal cell and enters the blood circulation.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 123
Incorrect
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A 45-year old gentleman presents with diarrhoea for two weeks. He has no history of fever and the diarrhoea stops on fasting. Which is the most likely type of diarrhoea that he is suffering from?
Your Answer: Motility related
Correct Answer: Osmotic
Explanation:The different types of diarrhoea are:
1. Secretory diarrhoea – Due to increased secretion or decreased absorption. There is minimal to no structural damage in this type. The most common cause is cholera toxin which stimulates secretion of anions (especially chloride), with sodium and water.
2. Osmotic diarrhoea – Due to increased osmotic load, there is water loss. This occurs in cases of maldigestion syndromes, such as coeliac or pancreatic disease.
3. Motility-related diarrhoea – Occurs in cases of abnormal gastrointestinal motility. Due to increased motility, there is poor absorption and this leads to diarrhoea. This is seen post-vagotomy or in diabetic neuropathy.
4. Inflammatory diarrhoea – Due to damage to the mucosa or brush border, there is a loss of protein-rich fluids and poor absorption. Features of all the above three types can be seen in this type. Aetiology includes bacterial, viral, parasitic infections or autoimmune problems including inflammatory bowel disease.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 124
Incorrect
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Which is the CORRECT statement regarding the small intestine:
Your Answer: The mesentery of the distal ileum has less fat that that of the proximal jejunum
Correct Answer: The superior mesenteric artery courses between the body and uncinate process of the pancreas before the artery supplies the jejunum and ileum
Explanation:The small intestine extends from the pylorus to the ileocecal valve where It ends in the large intestine. It is surrounded on the sides and above by the large intestine. It is related anteriorly with the greater omentum and abdominal wall. Is connected to the vertebral column by a fold of peritoneum or otherwise known as the mesentery. Is divided into three portions: the duodenum, jejunum and ileum. The jejunum and ileum are supplied by the superior mesenteric artery that courses between the body and uncinate process of the pancreas before it gives off intestinal branches.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 125
Incorrect
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A 15-year-old girl was diagnosed with bacterial meningitis. Gram staining of the spinal fluid shows numerous polymorphonuclear neutrophils and Gram-positive cocci. Which is the empiric drug of choice to be given to the patient until the antibiotic sensitivity report is available?
Your Answer: Methicillin
Correct Answer: Ceftriaxone
Explanation:Acute meningitis is a medical emergency. All suspects should receive their first dose of antibiotics immediately and be transferred to hospital as soon as possible. If facilities for blood culture and/or lumbar puncture (LP) are immediately available, they should be performed before administration
of the first dose of antibiotics (see contraindications to LP below). Neither procedure should lead to a significant delay in antibiotic administration.
Administer ceftriaxone 80-100 mg/kg (maximum 2 g, 12 hourly) intravenously. The intramuscular or intraosseous route can be used if there is no vascular access. Penicillin allergy is not a contraindication to ceftriaxone in acute meningitis (C-1). Omit ceftriaxone only if there has been documented ceftriaxone anaphylaxis. Give chloramphenicol 25 mg/kg (maximum 500 mg) intravenously instead, if available. Administer adequate analgesia and transfer the patient immediately to hospital, detailing all administered
medication in the referral letter. -
This question is part of the following fields:
- Microbiology
- Pathology
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Question 126
Incorrect
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A 13 year old girl presented with signs of shortness of breath, chest pain, non-productive cough, oedema of the lower extremities and cyanosis of the fingertips. She has a history of a ventricular septal defect not surgically corrected. The most probable cause of these symptoms is:
Your Answer: Endocardial fibroelastosis
Correct Answer: Shunt reversal
Explanation:A ventricular septal defect (VSD) is a common form of congenital heart defects and is characterised by the presence of a hole in the wall that separates the right from the left ventricle. Medium or large defects can cause many complications. One of these complication is Eisenmenger syndrome, characterised by reversal of the shunt (from left-to-right shunt into a right-to-left) ,cyanosis and pulmonary hypertension.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 127
Incorrect
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Which of the following arteries branch from the deep femoral artery and course between the pectineus and iliopsoas muscles?
Your Answer: Lateral ascending femoral circumflex
Correct Answer: Medial femoral circumflex
Explanation:The medial femoral circumflex artery is an artery in the upper thigh that supplies blood to the head and neck of the femur. It arises from the deep femoral artery and winds around the medial side of the femur. It passes first between pectineus and psoas major, and then between obturator externus and adductor brevis.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 128
Incorrect
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The passage of leukocytes through the wall of the blood vessels is best described by which of the following terms?
Your Answer: Chemotaxis
Correct Answer: Diapedesis
Explanation:The steps involved in leukocyte arrival and function are:
1. margination: cells migrate from the centre to the periphery of the vessel
2. rolling: selectins are upregulated on the vessel walls
3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes, interaction of these results in adhesion
4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product
5. phagocytosis: engulfing the offending substance/cell.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 129
Incorrect
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A 31-year-old woman is diagnosed with adrenal hyperplasia, and laboratory samples are taken to measure serum aldosterone and another substance. Which is most likely to be the other test that was prescribed to this patient?
Your Answer: Plasma adrenocorticotrophic hormone (ACTH)
Correct Answer: Plasma renin
Explanation:The evaluation of a patient in whom hyperaldosteronism is first to determine that hyperaldosteronism is present (serum aldosterone) and, if it is present, to differentiate primary from secondary causes of hyperaldosteronism. The aldosterone-to-renin ratio (ARR) is the most sensitive means of differentiating primary from secondary causes of hyperaldosteronism as it is abnormally increased in primary hyperaldosteronism, and decreased or normal but with high renin levels in secondary hyperaldosteronism.
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This question is part of the following fields:
- Physiology
- Renal
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Question 130
Correct
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A 45-year-old man presents to the emergency department with an irregular pulse and shortness of breath. Electrocardiography findings show no P waves, normal QRS complexes and an irregularly irregular rhythm. The patient most probably has:
Your Answer: Atrial fibrillation
Explanation:Atrial fibrillation is one of the most common arrhythmias, characterised by an irregular and rapid heart rate. Due to the decreased cardiac output, atrial fibrillation increases the risk of heart failure. It can also lead to thrombus formation which may lead to thromboembolic events. Clinical findings include palpitations, shortness of breath, fatigue, chest pain and confusion. The diagnosis is made by electrocardiographic findings which include absent P wave, fibrillatory (f) waves between QRS complexes and irregularly irregular R-R intervals.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 131
Incorrect
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In a young, sexually active male, what is the most common cause of non-gonococcal urethritis?
Your Answer: Trichomonas vaginalis
Correct Answer: Chlamydia
Explanation:Non-gonococcal urethritis is most commonly caused by Chlamydia trachomatis (50% cases). Less common organisms include Mycoplasma genitalium, Urea urealyticum and Trichomonas vaginalis. Chlamydia is also the commonest cause of non-gonococcal cervicitis in women and proctitis in both sexes.
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This question is part of the following fields:
- Pathology
- Renal
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Question 132
Incorrect
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A brain tumour causing blockage of the hypophyseal portal system is likely to result in an increased secretion of which of the following hormones?
Your Answer: Growth hormone
Correct Answer: Prolactin
Explanation:The hypophyseal portal system links the hypothalamus and the anterior pituitary. With the help of this system, the anterior pituitary receives releasing and inhibitory hormones from the hypothalamus and regulates the action of other endocrine glands. One of the inhibitory hormones carried by this system is the prolactin-inhibitory hormone. In the absence of this hormone which might occur in case of a blockage of the system, prolactin secretion increases to about three times normal levels.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 133
Incorrect
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A patient is diagnosed with a tumour of the parotid gland. During surgical removal of the gland, which artery is vulnerable to injury?
Your Answer: Greater petrosal nerve
Correct Answer: External carotid artery
Explanation:The external carotid artery is a major artery of the head and neck. It arises from the common carotid artery when it splits into the external and internal carotid artery. It supplies blood to the face and neck. The external carotid artery begins opposite the upper border of the thyroid cartilage and, taking a slightly curved course, passes upward and forward and then inclines backward to the space behind the neck of the mandible, where it divides into the superficial temporal and internal maxillary arteries. It rapidly diminishes in size in its course up the neck, owing to the number and large size of the branches given off from it. At its origin, this artery is more superficial and placed nearer the midline than the internal carotid and is contained within the carotid triangle. The external carotid artery is covered by the skin, superficial fascia, platysma, deep fascia and anterior margin of the sternocleidomastoid. It is crossed by the hypoglossal nerve, by the lingual, ranine, common facial and superior thyroid veins; and by the digastric and stylohyoid; higher up it passes deeply into the substance of the parotid gland, where it lies deep to the facial nerve and the junction of the temporal and internal maxillary veins. It is here that it is in danger during surgery of the parotid gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 134
Incorrect
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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 masseter 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.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 135
Incorrect
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A 50-year old gentleman who was admitted for elective surgery was found to have haemoglobin 9.5 g/dl, white blood cell count of 1.4 × 109/l and a mean corpuscular volume (MCV) of 134 fl. Which of the following is the likely finding on his peripheral blood smear?
Your Answer: Nucleated red blood cells
Correct Answer: Hypersegmented neutrophils
Explanation:The likely diagnosis is megaloblastic anaemia, which also shows the presence of hypersegmented neutrophils.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 136
Incorrect
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The Brunner glands secrete an alkaline product that helps maintain an optimal pH for pancreatic enzyme activity. Where are these glands located?
Your Answer: Submucosa of the jejunum
Correct Answer: Submucosa of the duodeneum
Explanation:The Brunner glands are located in the submucosa of the duodenum. These glands are connected to the interstitial lumen by ducts that open into certain crypts. They secrete an alkaline product that protects the duodenal mucosa from the acidic chyme and helps achieve an optimal pH for the enzymes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 137
Incorrect
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A 30-year-old woman is diagnosed with Hodgkin's lymphoma. Which of the following chemotherapy regimens would be used in this case?
Your Answer: BEP
Correct Answer: ABVD
Explanation:ABVD is a chemotherapy regimen used in the first-line treatment of Hodgkin’s lymphoma. It consists of concurrent treatment with the chemotherapy drugs, adriamycin, bleomycin, vinblastine and dacarbazine. It supplanted the older MOPP protocol.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 138
Correct
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A 5 year-old-child with fever complains of sore throat . She was brought to her paediatrician for consult because she has also developed a rash and has swollen lymph nodes. Upon physical examination she cried when her liver was palpated and the tip of her spleen is slightly palpable. Full blood count shows haemoglobin 13 g/dL, Haematocrit 40%, white blood cell count 13x109/L with a WBC differential count of 45 neutrophils, 4 bands, 26 lymphocytes, 15 atypical lymphocytesm, 10 monocytes and 1 eosinophil. Whick is the most likely infectious agent that is responsible for the patient's condition?
Your Answer: Epstein–Barr virus
Explanation:Epstein-Barr virus (EBV), also known as human herpes virus 4,is a member of the herpes virus family. EBV spreads most commonly through bodily fluids, primarily saliva. EBV can cause infectious mononucleosis. Symptoms of EBV can include fatigue, fever, inflamed throat, swollen lymph nodes in the neck, enlarged spleen, swollen liver and rash.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 139
Incorrect
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Question 140
Incorrect
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Which organ is responsible for the secretion of enzymes that aid in digestion of complex starches?
Your Answer: Salivary glands
Correct Answer: Pancreas
Explanation:α-amylase is secreted by the pancreas, which is responsible for hydrolysis of starch, glycogen and other carbohydrates into simpler compounds.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 141
Incorrect
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Which condition presents with a positive urine dipstick test for blood, but no blood cells on urine microscopy?
Your Answer: Renal papillary necrosis
Correct 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 142
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 143
Incorrect
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A lad involved in a road traffic accident is rushed to casualty where physical examination reveals that he has limited extension of his right humerus. Which of the following nerves is most likely to have been injured?
Your Answer: Upper subscapular nerve
Correct Answer: Thoracodorsal nerve
Explanation:Extension of the humerus is a function of the latissimus dorsi. This muscle is supplied by the thoracodorsal nerve which is a branch of the posterior cord of the plexus whose fibres are derived from cranial nerves V, VI and VII.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 144
Incorrect
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Which of the following muscles attach to the hyoid bone?
Your Answer: Trapezius
Correct Answer: Middle pharyngeal constrictor
Explanation:The hyoid bone is a horseshoe-shaped bone situated in the anterior midline of the neck between the chin and the thyroid cartilage. A large number of muscles attach to the hyoid: Superiorly – the middle pharyngeal constrictor muscle, hyoglossus muscle, genioglossus, intrinsic muscles of the tongue and suprahyoid muscles. Inferiorly – the thyrohyoid muscle, omohyoid muscle and sternohyoid muscle.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 145
Correct
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A 76-year-old man with a urinary tract obstruction due to prostatic hyperplasia develops acute renal failure. Which of the following physiological abnormalities of acute renal failure will be most life threatening for this patient?
Your Answer: Acidosis
Explanation:Acute renal failure (ARF) is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. This accumulation may be accompanied by metabolic disturbances, such as metabolic acidosis and hyperkalaemia, changes in body fluid balance and effects on many other organ systems. Metabolic acidosis and hyperkalaemia are the two most serious biochemical manifestations of acute renal failure and may require medical treatment with sodium bicarbonate administration and antihyperkalaemic measures. If not appropriately treated these can be life-threatening. ARF is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient amounts of urine.
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This question is part of the following fields:
- Physiology
- Renal
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Question 146
Incorrect
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Which of the cranial nerves is responsible for touch sensation on the skin over the maxilla region and the mandible?
Your Answer:
Correct Answer: Trigeminal
Explanation:The sensation of the face is provided by the trigeminal nerve which is cranial nerve V. It is also responsible for other motor functions such as biting and chewing. The trigeminal nerve has three branches; the ophthalmic nerve (V1), the maxillary nerve((V2) and the mandibular nerve (V3). These three branches exit the skull through separate foramina, namely; the superior orbital fissure, the foramen rotundum and the foramen ovale respectively. The mnemonic for this is ‘Standing room only’. The sensory fibres of the maxillary nerve are distributed to the lower eyelid and cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa, the palate and roof of the pharynx, the maxillary, ethmoid and sphenoid sinuses, and parts of the meninges. The sensory fibres of the mandibular nerve are distributed to the lower lip, the lower teeth and gums, the floor of the mouth, the anterior two-thirds of the tongue, the chin and jaw (except the angle of the jaw, which is supplied by C2–C3), parts of the external ear, and parts of the meninges. The mandibular nerve carries touch/ position and pain/temperature sensation from the mouth. The sensory fibres of the ophthalmic nerve are distributed to the scalp and forehead, the upper eyelid, the conjunctiva and cornea of the eye, the nose (including the tip of the nose), the nasal mucosa, the frontal sinuses and parts of the meninges (the dura and blood vessels). The sensory fibres of the maxillary nerve are distributed to the lower eyelid and cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa, the palate and roof of the pharynx, the maxillary, ethmoid and sphenoid sinuses, and parts of the meninges.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 147
Incorrect
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The muscle that stabilizes the stapes is innervated by which of the following nerves?
Your Answer:
Correct Answer: Facial nerve
Explanation:The stapedius is the smallest skeletal muscle in the human body. At just over one millimetre in length, its purpose is to stabilize the smallest bone in the body, the stapes and is innervated by a branch of the facial nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 148
Incorrect
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Which of the following can lead to haemolytic anaemia?
Your Answer:
Correct Answer: Presence of haemoglobin S
Explanation:Haemoglobin S is an abnormal type of haemoglobin seen in sickle cell anaemia. This allows for the haemoglobin to crystalize within the RBC upon exposure to low partial pressures of oxygen. This results in rupture of the RBCs as they pass through microcirculation, especially in the spleen. This can cause blockage of the vessel down stream and ischaemic death of tissues, accompanied by severe pain.
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This question is part of the following fields:
- General
- Physiology
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Question 149
Incorrect
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There are several mechanisms involved in the transport of sodium ions from blood to interstitial fluid of the muscle cells. Which of the following mechanisms best describes this phenomenon?
Your Answer:
Correct Answer: Diffusion through channels between endothelial cells
Explanation:Capillaries are the smallest of the body’s blood vessels, measuring 5–10 μm and they help to enable the exchange of water, oxygen, carbon dioxide, and many other nutrients and waste substances between the blood and the tissues surrounding them. The walls of capillaries are composed of only a single layer of cells, the endothelium. Ion channels are pore-forming proteins that help to establish and control the small voltage gradient that exists across the plasma membrane of all living cells by allowing the flow of ions down their electrochemical gradient. An ion channel is an integral membrane protein or more typically an assembly of several proteins. The archetypal channel pore is just one or two atoms wide at its narrowest point. It conducts a specific ion such as sodium or potassium and conveys them through the membrane in single file.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 150
Incorrect
SESSION STATS - PERFORMANCE PER SPECIALTY
