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  • Question 1 - A 50-year old gentleman who was admitted for elective surgery was found to...

    Correct

    • 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: Hypersegmented neutrophils

      Explanation:

      The likely diagnosis is megaloblastic anaemia, which also shows the presence of hypersegmented neutrophils.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      83
      Seconds
  • Question 2 - A 40 year old man sustained a fracture to the surgical neck of...

    Correct

    • A 40 year old man sustained a fracture to the surgical neck of his left humerus. Which of the following arteries is suspected to be injured in this case?

      Your Answer: Posterior humeral circumflex

      Explanation:

      The posterior humeral circumflex artery arises from the axillary artery and runs with the axillary nerve through the quadrangular space which is bounded laterally by the surgical neck of the humerus. After winding around the surgical neck of the humerus, it is distributed to the deltoid muscle and the shoulder joint. Thus fractures in the surgical neck of the humerus could result in an injury to this artery.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      9.4
      Seconds
  • Question 3 - Which of the following is the source of blood supply to the artery...

    Correct

    • Which of the following is the source of blood supply to the artery of the round ligament at the head of the femur?

      Your Answer: Obturator artery

      Explanation:

      The posterior branch of the obturator artery provides an articular branch to the head of the femur.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      8.2
      Seconds
  • Question 4 - A 20-year old involved in a brawl was stabbed in the anterior chest...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      5.2
      Seconds
  • Question 5 - The lateral thoracic artery: ...

    Correct

    • The lateral thoracic artery:

      Your Answer: Accompanies the long thoracic nerve to the serratus anterior muscle

      Explanation:

      The thoracic nerve, along with the lateral thoracic artery, follow the pectoralis minor to the side of the chest which supplies the serratus anterior and the pectoralis. It then sends branches across the axilla to the axillary glands and subscapularis. The pectoral branch of the thoraco-acromial anastomoses with the internal mammary, subscapular and intercostal arteries, which in women, supply an external mammary branch.

    • This question is part of the following fields:

      • Anatomy
      • Breast
      20
      Seconds
  • Question 6 - What percentage of cardiac output is delivered to the skin? ...

    Correct

    • What percentage of cardiac output is delivered to the skin?

      Your Answer: 2%

      Explanation:

      Making up 4-5% of total body weight, the skin receives approximately 2% of cardiac output.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      1.6
      Seconds
  • Question 7 - Which of the following will show decreased hearing when tested by air conduction...

    Correct

    • Which of the following will show decreased hearing when tested by air conduction but normal hearing when tested by bone conduction?

      Your Answer: Fibrosis causing fixation of the ossicles

      Explanation:

      As the cochlea is embedded into bone, the vibrations from the bone are transmitted directly to the fluid in the cochlea. Hence, any damage to the ossicles or tympanic membrane will not show an abnormal result on bone conduction test.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      5
      Seconds
  • Question 8 - A biopsy taken from the respiratory passage of a 37 year old male,...

    Correct

    • A biopsy taken from the respiratory passage of a 37 year old male, chronic smoker will mostly likely show which cellular adaptation?

      Your Answer: Stratified squamous metaplasia

      Explanation:

      Metaplasia is a change in the cell type caused in part due to an extrinsic stress on the organ. It involves a change in the surface epithelium from one cell type to the another, most commonly squamous to columnar. This is a reversible process, and removal of the stress should theoretically reverse the surface epithelium back to normal morphology. Respiratory tract metaplasia is a classic example, in which the normal pseudostratified columnar epithelium is replaced by stratified squamous epithelium to better cope with the stress. Under continuous stress metaplasia can progress to dysplasia which is a disordered growth of cells eventually leading to the development of carcinoma.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing; Respiratory
      • Pathology
      3.3
      Seconds
  • Question 9 - Which of the following conditions is likely to result in splenomegaly, hypochromic anaemia...

    Correct

    • Which of the following conditions is likely to result in splenomegaly, hypochromic anaemia and hemochromatosis in a young male?

      Your Answer: β-Thalassaemia

      Explanation:

      Beta-thalassaemia is due to decreased production of β-polypeptide chains, with an autosomal inheritance pattern. Carrier patients (heterozygotes) are asymptomatic and have mild to moderate microcytic anaemia. This is known as thalassaemia minor. Homozygotes (β-thalassaemia major, or Cooley’s anaemia) develop severe anaemia and marrow hyperactivity. The disease presents at 1-2 years of age with severe anaemia and transfusional and absorptive iron overload. Patients also present with jaundice, leg ulcers, massive splenomegaly and cholelithiasis. The disease can also lead to splenic sequestration leading to faster destruction of transfused red blood cells. Increased marrow activity causes thickening of cranial bones. Involvement of long bones is also seen, which can cause pathological fractures and growth impairment. There is iron deposition in various organs, which can lead to heart failure or hepatic failure (leading to cirrhosis). Thalassaemias are suspected in presence of family history, or signs suggesting microcytic haemolytic anaemia. Further test and quantitative haemoglobin studies are useful. In beta-thalassaemia, there is an increase in serum bilirubin, iron and ferritin levels. There is severe anaemia, often with haemoglobin < 6 g/dl. There is an elevated red blood cell count, which are microcytic. Peripheral blood smear is diagnostic with nucleated erythroblasts, target cells, small pale red blood cells, and punctate basophilia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      3.9
      Seconds
  • Question 10 - Which of the following is an anion? ...

    Correct

    • Which of the following is an anion?

      Your Answer: Phosphate

      Explanation:

      Cations: sodium, magnesium, calcium and potassium

      Anions: chloride, phosphate, bicarbonate, lactate, sulphate and albumin

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      1.9
      Seconds
  • Question 11 - A 39-year old female patient was diagnosed with a tumour of the left...

    Correct

    • A 39-year old female patient was diagnosed with a tumour of the left adrenal gland. The tumour, which is metastasizing to the adjacent tissues, has already extended to the left suprarenal vein. If the tumour is still spreading, which of the following veins will most likely be affected after the involvement of the left suprarenal vein?

      Your Answer: Left renal vein

      Explanation:

      The suprarenal veins or also known as the veins of Warshaw, are the veins that receive blood from the suprarenal glands. These veins receive blood from the medullary venous plexus and the cortex of the adrenal glands (suprarenal glands). They are two in number – the left and the right suprarenal veins. The right suprarenal vein drains into the inferior vena cava while the left suprarenal vein drains into the left renal vein. This therefore means that in the case of a metastasizing tumour involving the left suprarenal vein, the tumour will most likely extend from the left suprarenal vein to the left renal vein into which it drains.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      6.3
      Seconds
  • Question 12 - What is the 5-year survival rate of carcinoma of the pancreas? ...

    Correct

    • What is the 5-year survival rate of carcinoma of the pancreas?

      Your Answer: 30 per cent

      Explanation:

      Pancreatic cancer typically has a poor prognosis, partly because the cancer usually initially remains symptomless, leading to locally advanced or metastatic disease at the time of diagnosis. Median survival from diagnosis is around 3–6 months. Even in those suitable for resectional surgery, 5-year survival rates are still only 30 per cent.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      2.2
      Seconds
  • Question 13 - In which situation is a stretch reflex such as knee jerk likely to...

    Correct

    • In which situation is a stretch reflex such as knee jerk likely to be exaggerated?

      Your Answer: In upper motor neuron lesion

      Explanation:

      A stretch reflex is a monosynaptic reflex that causes muscle contraction in response to stretching within that muscle. The sensory apparatus in a muscle that are sensitive to stretch are the muscle spindles. The patellar (knee jerk) reflex is an example. In upper motor neuron lesions, the stretch reflexes tend to be brisk due to loss of inhibitory signals on gamma neurons through the lateral reticulospinal tract.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      2.7
      Seconds
  • Question 14 - A 20-year old boy presented with low grade fever, night sweats and weakness...

    Correct

    • A 20-year old boy presented with low grade fever, night sweats and weakness over two months. On examination, he had multiple, non-tender, cervical, supraclavicular and axillary adenopathy. Microscopy of lymph node biopsy showed the presence of Reed-Sternberg cells. He is likely suffering from:

      Your Answer: Hodgkin’s lymphoma

      Explanation:

      Hodgkin’s lymphoma is a disease characterized by malignant proliferation of cells of the lymphoreticular system. It can be localized or disseminated, and can involve the nodes, spleen, liver and marrow. Symptoms of the disease include non-tender lymphadenopathy, fever, night sweats, weight loss, itching and hepatosplenomegaly. Histologically, the involved nodes show the presence of Reed-Sternberg cells, which are large, binucleated cells, in a heterogenous cellular infiltrate of histiocytes, lymphocytes, monocytes, plasma cells and eosinophils.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      7.9
      Seconds
  • Question 15 - Post-total gastrectomy, there will be a decreased production of which of the following...

    Correct

    • Post-total gastrectomy, there will be a decreased production of which of the following enzymes?

      Your Answer: Pepsin

      Explanation:

      Pepsin is a protease that is released from the gastric chief cells and acts to degrade proteins into peptides. Released as pepsinogen, it is activated by hydrochloric acid and into pepsin itself. Gastrin and the vagus nerve trigger the release of pepsinogen and HCl when a meal is ingested. Pepsin functions optimally in an acidic environment, especially at a pH of 2.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      4.3
      Seconds
  • Question 16 - What will the destruction of endoplasmic reticulum stop? ...

    Correct

    • What will the destruction of endoplasmic reticulum stop?

      Your Answer: Synthesis of proteins

      Explanation:

      The rough endoplasmic reticulum is the factory for the manufacturing of proteins. It contains ribosomes attached to it and transports proteins that are destined for membranes and secretions. The rough ER is connected to the nuclear envelope and to the cisternae of the Golgi apparatus by vesicles that shuttle between the two compartments.

    • This question is part of the following fields:

      • General
      • Physiology
      2.9
      Seconds
  • Question 17 - A 38 year-old man falls on an outstretched hand. X-rays indicate an anterior...

    Correct

    • A 38 year-old man falls on an outstretched hand. X-rays indicate an anterior dislocation of one of the carpal bones. Which carpal bone is most commonly dislocated?

      Your Answer: Lunate

      Explanation:

      The scaphoid bone is the most commonly fractured carpal bone and has an increased risk of avascular necrosis.

      The lunate is the most commonly dislocated carpal bone. The displaced bone may compress the median nerve in the carpal tunnel.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      3.9
      Seconds
  • Question 18 - When exposing the right saphenofemoral junction for flush-ligation of the saphenous vein, which...

    Correct

    • When exposing the right saphenofemoral junction for flush-ligation of the saphenous vein, which of the following is the most likely to be seen passing through this opening?

      Your Answer: Superficial external pudendal artery

      Explanation:

      The saphenous opening is an oval opening in the fascia lata. It is covered by the cribriform fascia and It is so called because it is perforated by the great saphenous vein and by numerous blood and lymphatic vessels and the superficial external pudendal artery pierces it.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      5.3
      Seconds
  • Question 19 - Which of these conditions causes haematuria, hypertension and proteinuria in children, usually after...

    Correct

    • Which of these conditions causes haematuria, hypertension and proteinuria in children, usually after a streptococcal infection?

      Your Answer: Acute nephritic syndrome

      Explanation:

      Nephritic syndrome (or acute nephritic syndrome) is a syndrome comprising of signs of nephritis. Children between 2 and 12 are most commonly affected, but it may occur at any age. Predisposing factors/causes include:

      Infections with group A streptococcal bacteria (acute post-streptococcal glomerulonephritis).

      Primary renal diseases: immunoglobulin A nephropathy, membranoproliferative glomerulonephritis, idiopathic rapidly progressive crescentic glomerulonephritis.

      Secondary renal diseases: subacute bacterial endocarditis, infected ventriculo–peritoneal shunt, glomerulonephritis with visceral abscess, glomerulonephritis with bacterial, viral or parasitic infections.

      Multisystem diseases.

      By contrast, nephrotic syndrome is characterized by only proteins moving into the urine.

    • This question is part of the following fields:

      • Physiology
      • Renal
      5.3
      Seconds
  • Question 20 - Which of the following is likely to result in hematocolpos in a 12-year...

    Correct

    • Which of the following is likely to result in hematocolpos in a 12-year old girl?

      Your Answer: Imperforate hymen

      Explanation:

      Hematocolpos means accumulation of blood in vagina and hematometra is accumulation of blood in the uterus. These are most likely seen with an imperforate hymen; which is seen I 1 in 2000 females. If spontaneous resolution does not occur, treatment involves making a hole in the hymen to allow discharge of menstrual blood.

    • This question is part of the following fields:

      • Pathology
      • Women's Health
      2.9
      Seconds
  • Question 21 - During a surgical operation, whilst dissecting the mediastinal lymph nodes for a bronchogenic...

    Correct

    • During a surgical operation, whilst dissecting the mediastinal lymph nodes for a bronchogenic carcinoma of the right upper lobe bronchus, a patient's right sympathetic trunk is accidentally severed above the level of spinal nerve T1. Which function would be left intact in the affected region?

      Your Answer: Voluntary muscle activity

      Explanation:

      The sympathetic nervous system regulates vascular tone, dilation of pupils, arrector pili muscles, sweat production and visceral reflexes. Neurones that supply the voluntary muscles originate from the ventral horn of the spinal cord. If these nerves were thus damaged, these functions would be impaired. The sympathetic nervous system is not responsible for voluntary muscle activity.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      7.6
      Seconds
  • Question 22 - Which of the following changes in the histology of the cell is most...

    Correct

    • Which of the following changes in the histology of the cell is most likely to be accompanied by disruption of the cell membrane following an injury?

      Your Answer: Coagulative necrosis

      Explanation:

      The process of necrosis ends with the rupture of the cell membrane and the consequent release of the cellular components into the surrounding tissue. Apoptosis, pyknosis and karyorrhexis are not reversible events but the cell membrane remains intact. Cloudy swelling and hydropic changes are also reversible but again the cell membrane remains intact and they are therefore different and distinct from necrosis.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing
      • Pathology
      3.8
      Seconds
  • Question 23 - A 59-year-old woman with hyperaldosteronism is prescribed a diuretic. Which of the following...

    Correct

    • A 59-year-old woman with hyperaldosteronism is prescribed a diuretic. Which of the following diuretics promotes diuresis by opposing the action of aldosterone?

      Your Answer: Potassium-sparing diuretic

      Explanation:

      The term potassium-sparing refers to an effect rather than a mechanism or location. Potassium-sparing diuretics act by either antagonising the action of aldosterone (spironolactone) or inhibiting Na+ reabsorption in the distal tubules (amiloride). This group of drugs is often used as adjunctive therapy, in combination with other drugs, for the management of chronic heart failure. Spironolactone, the first member of the class, is also used in the management of hyperaldosteronism (including Conn’s syndrome) and female hirsutism (due to additional antiandrogen actions).

    • This question is part of the following fields:

      • Physiology
      • Renal
      4
      Seconds
  • Question 24 - A 47 -year-old male was admitted due to a bleeding peptic ulcer. On...

    Correct

    • A 47 -year-old male was admitted due to a bleeding peptic ulcer. On his 3rd hospital day, he developed a cardiac arrhythmia. His serum potassium was markedly elevated. What is the most likely cause of hyperkalaemia in this patient?

      Your Answer: Multiple blood transfusions

      Explanation:

      Patients with gastrointestinal bleeding often require blood transfusion. Among the various side effects of blood transfusions, is the increase of potassium levels. The use of stored blood for transfusions is followed by an increase of serum potassium levels. Potassium level increases are more pronounced in patients who receive blood stored for more than 12 d. Furthermore, the lysis and destruction of red blood cells, especially in the transfusion of older PRBCs, can further increase potassium levels. Excessive use of a PPi has been associated with hyperkaelemia however would be less likely in this acute setting.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Pathology
      6.9
      Seconds
  • Question 25 - Intracellular shifting of hydrogen ions can generate a metabolic alkalosis. In which of...

    Correct

    • Intracellular shifting of hydrogen ions can generate a metabolic alkalosis. In which of the following conditions is metabolic alkalosis caused by this mechanism ?

      Your Answer: Hypokalaemia

      Explanation:

      Metabolic alkalosis is characterized by a primary increase in the concentration of serum bicarbonate ions. This may occur as a consequence of a loss of hydrogen ions or a gain in bicarbonate. Hydrogen ions may be lost through the kidneys or the GI tract, as for example during vomiting, nasogastric suction or use of diuretics. Intracellular shifting of hydrogen ions develops mainly during hypokalaemia to maintain neutrality. Gain in bicarbonate ions may develop during administration of sodium bicarbonate in high amounts or in amounts that exceed the capacity of excretion of the kidneys, as seen in renal failure. Fluid losses may be another cause of metabolic alkalosis, causing the reduction of extracellular fluid volume.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Pathology
      8.6
      Seconds
  • Question 26 - Which of the deep fasciae located in the anterolateral abdominal wall form the...

    Correct

    • Which of the deep fasciae located in the anterolateral abdominal wall form the inguinal ligament?

      Your Answer: External abdominal oblique aponeurosis

      Explanation:

      The inguinal ligament is the inferior border of the aponeurosis of the external oblique abdominis and extends from the anterior superior iliac spine to the pubic tubercle from whence it is reflected backward and laterally to attach to the pectineal line and form the lacunar ligament.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      3.5
      Seconds
  • Question 27 - A 34-year-old woman is diagnosed with cerebral oedema after suffering a severe head...

    Correct

    • 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 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.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      5.8
      Seconds
  • Question 28 - The likely cause of a tender and swollen breast in a lactating mother...

    Correct

    • The likely cause of a tender and swollen breast in a lactating mother is:

      Your Answer: Acute mastitis

      Explanation:

      Acute mastitis results due to bacterial infection of the breast and results in signs of inflammation. It commonly occurs 2-3 weeks postpartum and common causative microorganisms are Staphylococcus aureus, Streptococcus species, and Escherichia coli. Complications like an abscess can be avoided by prompt treatment, which includes antibiotics and rest along with continued lactation.

    • This question is part of the following fields:

      • Pathology
      • Women's Health
      3.1
      Seconds
  • Question 29 - Skin infiltration by neoplastic T lymphocytes is seen in: ...

    Correct

    • Skin infiltration by neoplastic T lymphocytes is seen in:

      Your Answer: Mycosis fungoides

      Explanation:

      Mycosis fungoides is a chronic T-cell lymphoma that involves the skin and less commonly, the internal organs such as nodes, liver, spleen and lungs. It is usually diagnosed in patients above 50 years and the average life expectancy is 7-10 years. It is insidious in onset and presents as a chronic, itchy rash, eventually spreading to involve most of the skin. Lesions are commonly plaque-like, but can be nodular or ulcerated. Symptoms include fever, night sweats and weight loss. Skin biopsy is diagnostic. However, early cases may pose a challenge due to fewer lymphoma cells. The malignant cells are mature T cells (T4+, T11+, T12+). The epidermis shows presence of characteristic Pautrier’s micro abscesses are present in the epidermis.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      7.3
      Seconds
  • Question 30 - Injury to the supraspinatus muscle will affect: ...

    Correct

    • Injury to the supraspinatus muscle will affect:

      Your Answer: Initiation of abduction of the humerus

      Explanation:

      This muscle arises from the medial two-thirds of the supraspinatus fossa and from the supraspinatus fascia. It is inserted into the highest impression on the greater tubercle of the humerus after passing over the upper part of the shoulder joint. It works with the deltoid to raise the arm from the side of the trunk and initiate abduction. It also assists in fixation of the head of the humerus in the glenoid cavity.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      2.6
      Seconds
  • Question 31 - An explorative laparotomy is done on a 23 year old following a gunshot...

    Correct

    • An explorative laparotomy is done on a 23 year old following a gunshot abdominal injury through the right iliac fossa. It is found that the ileocolic artery is severed and the bullet had perforated the caecum. From which branch does the ileocolic artery originate?

      Your Answer: Superior mesenteric artery

      Explanation:

      Ileocolic artery branches off from the superior mesenteric artery. It then divides to give a superior and inferior branch.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      5.5
      Seconds
  • Question 32 - During clinic, a medical student conducts a physical examination on a teenage boy...

    Correct

    • During clinic, a medical student conducts a physical examination on a teenage boy with a lump in the inguinal region. The lump is protruding from the superficial inguinal ring. The student correctly concluded that it was:

      Your Answer: Either a direct or an indirect inguinal hernia

      Explanation:

      It is not possible to tell if an inguinal hernia is direct or indirect just by palpating it. Despite the fact that indirect inguinal hernias commonly come out of the superficial inguinal ring to enter the scrotum, direct inguinal hernia might still do this.

      Femoral hernia goes through the femoral ring into the femoral canal (has nothing to do with the superficial inguinal ring).

      Superficial inguinal lymph nodes lie in the superficial fascia parallel to the inguinal ligament; it would therefore feel more superficial and would not be mistaken for a hernia protruding through the inguinal ring.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      6.5
      Seconds
  • Question 33 - After a total colectomy and ileotomy, a 50-year old diabetic man who was...

    Correct

    • After a total colectomy and ileotomy, a 50-year old diabetic man who was a known case of diabetic nephropathy had persistent metabolic acidosis. The patient appeared well perfused, with normal vital signs and normal fluid balance. Investigations revealed:

      Sodium = 132 mmol/l

      Potassium = 6.6 mmol/l

      Creatinine = 185 μmol/l (2.16 mg/dl)

      Chloride = 109 μmol/l

      8am cortisol = 500 nmol/l (18 μg/dl)

      pH = 7.29, p(CO2) = 27 mmHg

      p(O2) = 107 mmHg

      standard bicarbonate = 12 mmol/l.

      What is the likely causes of his acidosis?

      Your Answer: Renal tubular acidosis

      Explanation:

      Acidosis here is due to low bicarbonate. The low p(CO2) is seen in compensation. The anion gap is normal, ruling out intra-abdominal ischaemia (which leads to metabolic acidosis). If it was a gastrointestinal aetiology, low potassium would be seen. The history of diabetic nephropathy predisposes to renal tubular acidosis. Type 4 (hyporeninaemic hypoaldosteronism) is associated with high potassium and is found in diabetic and hypertensive renal disease.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      44.5
      Seconds
  • Question 34 - A urologist makes a transverse suprapubic incision to retrieve a stone from the...

    Correct

    • A urologist makes a transverse suprapubic incision to retrieve a stone from the urinary bladder. Which of the following abdominal wall layers will the surgeon NOT traverse?

      Your Answer: Posterior rectus sheath

      Explanation:

      Pfannenstiel incision (a transverse suprapubic incision) is made below the arcuate line. Thus, there is no posterior layer of the rectus sheath here, only the transversalis fascia lines the inner layer of the rectus abdominis. The layers traversed include: skin, superficial fascia (fatty and membranous), deep fascia, anterior rectus sheath, rectus abdominis muscle, transversalis fascia, extraperitoneal connective tissue and peritoneum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      5.2
      Seconds
  • Question 35 - A patient is suspected to have a chromosomal abnormality. Which tumour and chromosomal...

    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.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      4.6
      Seconds
  • Question 36 - A retroperitoneal structure is: ...

    Correct

    • A retroperitoneal structure is:

      Your Answer: Pancreas

      Explanation:

      Retroperitoneal structures are those that are found behind the peritoneum. They include: kidneys, suprarenal glands, bladder, ureter, inferior vena cava, rectum, oesophagus (part of it), part of the pancreas, 2nd, 3rd and 4th parts of the duodenum and ascending and descending parts of the colon.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      2
      Seconds
  • Question 37 - A surgeon trainee is assisting in an operation to ligate the ductus arteriosus....

    Correct

    • A surgeon trainee is assisting in an operation to ligate the ductus arteriosus. The consultant supervising explains that caution is required when placing a clamp on the ductus to avoid injury to an important structure immediately dorsal to it. To which structure is the consultant referring?

      Your Answer: Left recurrent laryngeal nerve

      Explanation:

      The left recurrent laryngeal nerve branches off the vagus and wraps around the aorta, posterior to the ductus arteriosus/ligamentum arteriosum from whence it courses superiorly to innervate the laryngeal muscles.

      Accessory Hemiazygous vein is on the left side of the body draining the posterolateral chest wall and emptying blood into the azygos vein.

      The left internal thoracic artery is branch of the left subclavian artery supplying blood to the anterior wall of the thorax.

      Left phrenic nerve is lateral to the vagus nerve.

      Thoracic duct: is behind the oesophagus, coursing between the aorta and the azygos vein in the posterior chest.

      Right recurrent laryngeal nerve: loops around the right subclavian artery and is not in danger in this procedure.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      9.4
      Seconds
  • Question 38 - A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and...

    Correct

    • 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: 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.

    • This question is part of the following fields:

      • Pathology
      • Renal
      9.3
      Seconds
  • Question 39 - Due to a plantarflexion–inversion ankle sprain, which is the first ligament to rupture?...

    Correct

    • Due to a plantarflexion–inversion ankle sprain, which is the first ligament to rupture?

      Your Answer: Anterior talofibular ligament

      Explanation:

      The anterior talofibular ligament passes from the anterior margin of the fibular malleolus. It is the most commonly injured ligament, as part of the lateral ligament of the ankle.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      6.7
      Seconds
  • Question 40 - Regarding the venous drainage of the heart which of these is correct? ...

    Correct

    • Regarding the venous drainage of the heart which of these is correct?

      Your Answer: The great cardiac vein is the largest tributary of the coronary sinus and this vein starts at the apex of the heart and ascends with the anterior ventricular branch of the left coronary artery

      Explanation:

      Most of the veins of the heart open into the coronary sinus. This is a wide venous channel, about 2.25 cm in length, situated in the posterior part of the coronary sulcus and covered by muscular fibres from the left atrium. Its tributaries are the great, small and middle cardiac veins, the posterior vein of the left ventricle and the oblique vein of the left atrium. The great cardiac vein is the largest tributary of the coronary sinus.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      6.8
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Haematology (4/4) 100%
Pathology (13/13) 100%
Anatomy (17/17) 100%
Upper Limb (3/3) 100%
Lower Limb (3/3) 100%
Thorax (4/4) 100%
Breast (1/1) 100%
Cardiovascular (1/1) 100%
Physiology (10/10) 100%
Neurology (2/2) 100%
Cell Injury & Wound Healing; Respiratory (1/1) 100%
Fluids & Electrolytes (4/4) 100%
Abdomen (6/6) 100%
Neoplasia (2/2) 100%
Gastroenterology (1/1) 100%
General (1/1) 100%
Renal (3/3) 100%
Women's Health (2/2) 100%
Cell Injury & Wound Healing (1/1) 100%
Respiratory (1/1) 100%
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