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Question 1
Incorrect
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A 14 year-old girl is found to have haemophilia B. What pathological problem does she have?
Your Answer: Deficiency of factor XI
Correct Answer: Deficiency of factor IX
Explanation:Haemophilia B (also known as Christmas disease) is due to a deficiency in factor IX. Haemophilia A is due to a deficiency in factor VIII.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 2
Correct
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This structure divides the space between the lens and the cornea into the anterior and posterior chambers of the eye:
Your Answer: The iris
Explanation:The iris divides the space between the lens and the cornea into an anterior and a posterior chamber. The anterior cavity is filled with watery aqueous fluid, and the posterior cavity with a gel-like vitreous fluid. The anterior chamber of the eye is bounded in front by the posterior surface of the cornea; behind by the front of the iris and the central part of the lens. The posterior chamber is a narrow gap behind the peripheral part of the iris and in front of the suspensory ligament of the lens and the ciliary processes.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 3
Correct
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From which source does the lingual artery originate?
Your Answer: External carotid
Explanation:The lingual artery arises from the external carotid between the superior thyroid artery and facial artery. It can be located easily on the lower surface of the tongue. The terminal branch of the lingual artery is the deep lingual artery. On its course the lingual artery gives off side branches: dorsal lingual branches that supply the dorsum of the tongue till the epiglottis; sublingual artery that supplies the sublingual gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 4
Correct
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Evaluation of a 60-year old gentleman, who has been a coal miner all his life and is suspected to have pulmonary fibrosis reveals the following: FEV1 of 75% (normal > 65%), arterial oxygen saturation 92%, alveolar ventilation 6000 ml/min at a tidal volume of 600 ml and a breathing rate of 12 breaths/min. There are also pathological changes in lung compliance and residual volume. Calculate his anatomical dead space.
Your Answer: 100 ml
Explanation:Dead space refers to inhaled air that does not take part in gas exchange. Because of this dead space, taking deep breaths slowly is more effective for gas exchange than taking quick, shallow breaths where a large proportion is dead space. Use of a snorkel by a diver increases the dead space marginally. Anatomical dead space refers to the gas in conducting areas such as mouth and trachea, and is roughly 150 ml (2.2 ml/kg body weight). This corresponds to a third of the tidal volume (400-500 ml). It can be measured by Fowler’s method, a nitrogen wash-out technique. It is posture-dependent and increases with increase in tidal volume. Physiological dead space is equal to the anatomical dead space plus the alveolar dead space, where alveolar dead space is the area in the alveoli where no effective exchange takes place due to poor blood flow in capillaries. This physiological dead space is very small normally (< 5 ml) but can increase in lung diseases. Physiological dead space can be measured by Bohr’s method. Total ventilation per minute (minute ventilation) is given by the product of tidal volume and the breathing rate. Here, the total ventilation is 600 ml times 12 breaths/min = 7200 ml/min. The problem mentions alveolar ventilation to be 6000 ml/min. Thus, the difference between the alveolar ventilation and total ventilation is 7200 – 6000 ml/min = 1200 ml/min, or 100 ml per breath at 12 breaths per min. This 100 ml is the dead space volume.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 5
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 6
Correct
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When a patient that is less than 21 years of age develops a bone tumour. What is the most common benign bone tumour that would be considered in individuals below 21 years?
Your Answer: Osteochondroma
Explanation:Osteochondroma is a benign new bone growth that protrudes from the outer contour of bones and is capped by growing cartilage. Nearly 80% of these lesions are noted before the age of 21 years.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 7
Incorrect
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Which of the following substances brings about a dilatation of the gastrointestinal resistance vessels?
Your Answer: Vasopressin
Correct Answer: Vasoactive intestinal peptide
Explanation:Gastric vasoconstrictors include catecholamines, angiotensin II and vasopressin. Vasodilators include vasoactive intestinal peptide and the hormones; gastrin, cholecystokinin and glucagon.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 8
Correct
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A patient who following 20 years of working in the asbestos industry develops malignant mesothelioma and is scheduled for pleuropneumonectomy to remove the entire pleura and lung on the affected side. Which layer would provide a natural cleavage plane for surgical separation of the costal pleura from the thoracic wall?
Your Answer: Endothoracic fascia
Explanation:The endothoracic fascia is connective tissue that is between the costal parietal pleura and the inner aspect of the chest wall. Removing this layer of connective tissue would make it easy to separate the costal pleura from the thoracic wall.
Deep fascia: is not found around the lungs. It is a layer of connective tissue that invests a muscle or a group of muscles.
Parietal pleura: part of the pleura that lines the inner surface of the chest/thoracic cavity.
Visceral pleura: is the serous membrane that lines the surface of the lungs.
Transversus thoracis muscle fascia is associated only with the muscle transversus thoracis.
Peritracheal fascia: a layer of connective tissue that invests the trachea. It is not associated with the thoracic wall or the costal pleura.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 9
Incorrect
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A 60-year-old woman has had persistent diarrhoea for a week. A stool test reveals an infection by Clostridium difficile. Which of the following antibiotics could be used to treat the infection?
Your Answer: Ciprofloxacin
Correct Answer: Oral vancomycin
Explanation:Three antibiotics are effective against Clostridium difficile:
Metronidazole 500 mg orally three times daily is the drug of choice, because of superior tolerability, lower price and comparable efficacy.
Oral vancomycin 125 mg four times daily is second-line therapy in particular cases of relapse or where the infection is unresponsive to metronidazole treatment.
Thirdly, the use of linezolid might also be considered.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 10
Correct
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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: 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 11
Correct
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Passing through the lesser sciatic foramen are the:
Your Answer: Pudendal nerve
Explanation:Structures that pass through the lesser sciatic foramen include:
– the pudendal nerve
– the nerve to obturator internus
– internal pudendal artery
– the tendon of obturator internus
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 12
Incorrect
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Which of the following conditions of the breast is most often associated with use of oral contraceptives?
Your Answer: Galactocele
Correct Answer: Cyst formation
Explanation:Breast cysts are common and are smooth, firm, mobile lumps that can sometimes be tender. Cysts can also be bilateral and are known to recur in 10% of cases. They are more common in women in the third and fourth decades and most often disappear after menopause. Cysts are filled with fluid from the breast which occurs due to the normal menstrual cycle of a woman. The end of the menstrual cycle causes breast cells to swell. After the menses, the cells shrink and the released fluid disappears. However, in some cases this fluid forms a cyst. Incidence of cysts was also linked to use of oral contraceptives.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 13
Incorrect
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Which of the following coagulation factors is responsible for the formation of a complex with tissue factor to activate factors IX and X?
Your Answer: Fibrinogen
Correct Answer: Factor VII
Explanation:Factor VII, also known as proconvertin or stable factor, is a vitamin K–dependent protein that plays a central role in haemostasis and coagulation. Tissue factor is a protein that is normally not exposed on the surface of intact blood vessels. Damage to the vascular lumen leads to tissue factor exposure. The exposed tissue factor binds to factor VII. This facilitates the activation of factor VII to factor VIIa.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 14
Correct
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Which of the following muscle divide the posterior triangle of the neck into the occipital and the subclavian triangle?
Your Answer: Inferior belly of the omohyoid
Explanation:The posterior triangle (or lateral cervical region) is a region of the neck bounded in front by the sternocleidomastoid; behind, by the anterior margin of the trapezius; inferiorly by the middle third of the clavicle and superiorly by the occipital bone. The posterior triangle is crossed, about 2.5 cm above the clavicle, by the inferior belly of the omohyoid muscle, which divides the space into two triangles: an upper or occipital triangle and a lower or subclavian triangle (or supraclavicular triangle).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 15
Incorrect
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What are the derivatives of the first brachial arch?
Your Answer: Is innervated by the glossopharyngeal nerve
Correct Answer: Gives rise to the sphenomandibular ligament
Explanation:The first brachial arch (mandibular) gives rise to the mandibular and maxillary processes. Muscles and bones of this process originate within the arch’s mesoderm. The first arch cartilage (Meckel’s) ossifies to form the incus and malleus of the middle ear. Its perichondrium gives rise to he sphenomandibular ligament and through intermembraneous ossification after the mandible forms, the rest of the cartilage disappears. Muscles of the first arch include: mylohyoid, tensor tympany and palati, temporalis, masseter and lateral pterygoids and the anterior belly of the epigastric. This first arch is supplied by the trigeminal nerve.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 16
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 17
Correct
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A 27 year old women works in a dry-cleaning shop. She was exposed to massive amounts of carbon tetrachloride on her skin as well as inhaled. Which of the following organs is most susceptible to damage?
Your Answer: Liver
Explanation:Carbon tetrachloride (CCl4) is a common agent used in the dry cleaning industry and is thought to cause the formation of free radicals. It causes rapid breakdown of the endoplasmic reticulum due to decomposition of lipids and severe liver cell injury. Within less than 30 mins, hepatic protein synthesis declines, lipid export is reduced due to lack of apoprotein and there is an influx of calcium and cell death.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 18
Correct
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Which of the following foramina provides a passage through which the vestibulocochlear nerve, passes?
Your Answer: Internal acoustic meatus
Explanation:The internal auditory meatus is a canal within the petrous part of the temporal bone of the skull between the posterior cranial fossa and the inner ear. It provides a passage through which the vestibulocochlear nerve, the facial nerve, and the labyrinthine artery (an internal auditory branch of the basilar artery) can pass from inside the skull to structures of the inner ear and face.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 19
Correct
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A 24-year old, lactating mother presents to the clinic with a tender, 1.5cm mass just below the right nipple, which shows multiple fissures. What finding is likely associated with her condition?
Your Answer: Staphylococcus aureus infection
Explanation:Breast abscess occur commonly in lactating mothers in the postpartum period due to cracking of the nipple. It is commonly caused due to Staphylococcus aureus infection. Fat necrosis usually results from trauma wherein an ill-defined mass is formed. Ductal carcinomas are malignant masses which are not tender usually, and rare in the young age group. Plasma cell mastitis affect women in an older age group. Sclerosing adenosis is a type of fibrocystic disease which can lead to a tender, cystic mass but no fissuring or cracks are seen in the nipple. Fibroadenoma and lipomas are non-tender, well-defined masses.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 20
Incorrect
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What is the action of the muscle of the orbit that originates on the lesser wing of the sphenoid bone, just above the optic foramen?
Your Answer: Adduction of the eyeball
Correct Answer: Elevation of the upper eyelid
Explanation:The levator palpebrae superioris is the muscle in the orbit that elevates the superior (upper) eyelid. The levator palpebrae superioris originates on the lesser wing of the sphenoid bone, just above the optic foramen and receives somatic motor input from the ipsilateral superior division of the oculomotor nerve.
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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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Macrolides are a group of antibiotics commonly used to treat respiratory tract and soft-tissue infections. Which of the following antibiotics is a macrolide?
Your Answer:
Correct Answer: Erythromycin
Explanation:Erythromycin is a macrolide antibiotic used in the treatment of several bacterial infections, including respiratory tract infections, skin infections, chlamydia infections, pelvic inflammatory disease, and syphilis. It may also be used during pregnancy to prevent Group B streptococcal infection in the new-born.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 22
Incorrect
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During a car accident, the side mirror shattered and a broken piece of glass severed the posterolateral aspect of the driver's neck. A physical examination reveals that the driver is unable to elevate the tip of his shoulder on the side that was injured. Which nerve was injured?
Your Answer:
Correct Answer: Accessory
Explanation:The tip of the shoulder is formed by the acromion of the scapula. This part is moved by the trapezius muscle which is innervated by the accessory nerve. Damage to this nerve therefore will prevent the patient from lifting the tip of the shoulder.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 23
Incorrect
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Which of the following is a landmark to identify the site of the 2nd costal cartilage?
Your Answer:
Correct Answer: Sternal angle
Explanation:The sternal angle is an important part where the second costal cartilage attaches to the sternum. Finding the sternal angle will help in finding the second costal cartilage and intercostal space.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 24
Incorrect
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Which is the site of action of the drug omeprazole?
Your Answer:
Correct Answer: H+/K+ ATPase
Explanation:H+/K+-ATPase or ‘proton pump’ located in the canalicular membrane plays a major role in acid secretion. The ATPase here is magnesium-dependent. Omeprazole is a proton pump inhibitor and blocks H+/K+- ATPase.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 25
Incorrect
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On exploration of an axillary wound, a branch from the third part of the axillary artery was found to be transected. Which of the following arteries would have been likely injured?
Your Answer:
Correct Answer: Anterior circumflex humeral
Explanation:The axillary artery gives off many branches from the first, second, or third parts along its course. The third part of the axillary artery gives off 3 branches: the subscapular, anterior and posterior circumflex humeral arteries.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 26
Incorrect
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Depression of the normal coagulation system and excessive bleeding after surgery can occur in which of the following medical conditions?
Your Answer:
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 27
Incorrect
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A patient admitted for esophagectomy showed low levels of the lightest plasma protein in terms of weight. Which of the following is the lightest plasma protein:
Your Answer:
Correct Answer: Albumin
Explanation:Albumin is the most abundant and the lightest of all the plasma proteins. It maintains osmotic pressure, transports unconjugated bilirubin, thyroid hormones, fatty acids, drugs and acts as a buffer for pH.
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This question is part of the following fields:
- General
- Physiology
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Question 28
Incorrect
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Which of the following statements is true of Colles’ fracture?
Your Answer:
Correct Answer: Is a cause of carpal tunnel syndrome
Explanation:Colles’ fracture is a distal fracture of the radius that is a known cause of carpal tunnel syndrome (compression of the median nerve in the carpal tunnel). It rarely results in ulnar nerve compression. A Colles’ fracture is extra-articular and does not extend into the wrist joint, otherwise this would make it an intra-articular fracture (Barton’s fracture). The distal fragment in a Colles’ fracture is displaced dorsally, unlike in a Smith’s fracture where the distal fragment is displaced volarly (ventrally). Associated fracture of the ulnar styloid process may occur and is a common associated injury.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 29
Incorrect
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A butcher accidentally cut himself on his right index finger. Which of the following substances when in contact with the basement membrane of the injured vasculature will activate the coagulation cascade as well as the kinin system in a first response to this injury?
Your Answer:
Correct Answer: Hageman factor
Explanation:Hageman factor/factor XII in the intrinsic pathway activates prekallikrein and factor XI. Deficiency will not cause excessive bleeding as other coagulation factors will be utilized but the PTT will be greater than 200 seconds.
Thromboxane promotes platelet aggregation and causes vasoconstriction.
Plasmin, which is cleaved from plasminogen acts as an anticoagulant which breaks down thrombi.
Platelet activating factor promotes platelet aggregation and is also chemotactic to neutrophils.
Histamine acts as a vasodilator.
Platelet inhibiting factor acts an anticoagulant.
Renin is a hormone released from the kidney that causes vasoconstriction and water retention.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 30
Incorrect
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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:
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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SESSION STATS - PERFORMANCE PER SPECIALTY
