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Question 1
Correct
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A teenage Somalian boy presents with a complaint of an enlarged lower jaw. His blood film shows blast cells and macrophages. Which virus is responsible for this?
Your Answer: Epstein–Barr virus
Explanation:Burkitt’s lymphoma is a type of non-Hodgkin’s lymphoma. Histologically it is characterised by a starry sky appearance due to numerous neoplastic macrophages which are required to clear the rapidly dividing tumour cells/blast cells. Burkitt’s lymphoma commonly affects the jaw bone, forming a huge tumour mass. It is associated with translocation of c-myc gene and has three types: 1) endemic/African type, 2)sporadic and 3)immunodeficiency-associated. The first type is strongly associated with EBV.
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This question is part of the following fields:
- General
- Physiology
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Question 2
Incorrect
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An abdominal aortogram shows occlusion of the inferior mesenteric artery. Which of the following segments of bowel is most likely to have preserved arterial supply?
Your Answer: Rectum
Correct Answer: Caecum
Explanation:The inferior mesenteric artery supplies blood to the end of the transverse colon and all distal structures in the gastrointestinal tract i.e. splenic flexure, descending colon, sigmoid colon and rectum would all be deprived of blood if it were occluded. The caecum receives blood from the superior mesenteric artery so it would not be affected.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 3
Correct
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A 60-year old gentleman visited his general practitioner complaining of high grade fever for 7 days and a dull, aching pain in his left lumbar region. On enquiry, he admitted to having a burning sensation while passing urine. His blood results showed an elevated white blood cell count with a left shift. In his condition, which is the most characteristic finding on urine examination?
Your Answer: White blood cell casts
Explanation:Tubulointerstitial nephritis is the term given to primary injury to renal tubules and the renal interstitium, which ultimately results in a decline in renal function. Acute tubulointerstitial nephritis (acute pyelonephritis) is often seen as a result of infection or drug reactions. The most characteristic feature of this condition on urine analysis is the presence of white blood cell casts.
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This question is part of the following fields:
- Pathology
- Renal
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Question 4
Incorrect
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All the following statements are FALSE regarding the ophthalmic division of the trigeminal nerve, except:
Your Answer: It passes through the inferior orbital fissure
Correct Answer: The ophthalmic nerve is the smallest branch of the trigeminal nerve
Explanation:The ophthalmic nerve is the smallest of the three trigeminal divisions. The cutaneous branches of the ophthalmic nerve supply the conjunctiva, the skin over the forehead, the upper eyelid, and much of the external surface of the nose.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 5
Incorrect
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Point of entry of the vagal trunk into the abdomen:
Your Answer: Aortic hiatus
Correct Answer: Oesophageal hiatus
Explanation:The oesophageal hiatus is located in the muscular part of the diaphragm a T10 and is above, in front and a little to the left of the aortic hiatus. It transmits the oesophagus, the vagus nerves and some small oesophageal arteries.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 6
Incorrect
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Choose the most correct answer regarding the common peroneal nerve.
Your Answer: It branches to supply the intrinsic muscles of the foot
Correct Answer: It gives rise to the nerve that supplies the anterior compartment leg muscles
Explanation:The common peroneal nerve divides beneath the peroneus longus muscle and gives off articular and lateral sural cutaneous nerves which supply muscular branches to the muscles of the anterior compartment of the leg which are the tibialis anterior, extensor digitorum, peroneus tertius and extensor hallucis longus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 7
Incorrect
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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: Mannitol
Correct 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).
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This question is part of the following fields:
- Physiology
- Renal
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Question 8
Incorrect
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Prostatectomy carries a risk of loss of penile erection due to injury to the prostatic plexus responsible for an erection. From which nerves do these fibres originate?
Your Answer: Pudendal
Correct Answer: Pelvic splanchnics
Explanation:Erection is a function of the parasympathetic nerves. Of the nerves listed, only the pelvic splanchnic nerves have parasympathetic fibres that innervate the smooth muscles and glands of the pelvic viscera.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 9
Incorrect
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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: Subcostal 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 10
Incorrect
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A 38 year old man is to undergo excision of the base of the prostate for malignant growth, which of the following structures is directly related to the base of the prostate?
Your Answer: Anus
Correct Answer: Urinary bladder
Explanation:The prostate is situated in the pelvic cavity and is also located immediately below the internal urethral orifice at the commencement of the urethra. It is held in position by the puboprostatic ligaments, the superior fascia of the urogenital diaphragm and the anterior portions of the levatores ani. The base of the prostate is directed upward and is attached to the inferior surface of the urinary bladder while the apex is directed downward and is in contact with the superior fascia of the urogenital diaphragm.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 11
Incorrect
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A 50-year old, obese gentleman with a compression fracture of T11 vertebra was admitted in the hospital. Examination revealed a raised blood pressure 165/112 mmHg and blood glucose 8.5 mmol/l. His abdomen had the presence of purplish striae. What condition is he likely to be suffering from?
Your Answer: Multinodular goitre
Correct Answer: Adrenal cortical carcinoma
Explanation:Adrenocortical carcinomas are rare tumours with reported incidence being only two in a million. However, they have a poor prognosis. These are large tumours and range from 4-10 cm in diameter. They arise from the adrenal cortex and 10% cases are bilateral. 50-80% are known to be functional, leading to Cushing syndrome. Even though the tumour affects both sexes equally, functional tumours are slightly commoner in women and non-functional tumours are commoner in men. As compared to women, men also develop this tumour at an older age and seem to have a poorer prognosis.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 12
Incorrect
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The annular ligament in the forearm:
Your Answer: Encircles the styloid process of the radius
Correct Answer: Encircles the head of the radius
Explanation:The annular ligament forms about four-fifths of the osseofibrous ring and is attached to the anterior and posterior margins of the radial notch. It is a strong band of fibres which encircles the head of the radius retaining it in contact with the radial notch of the ulna. When it comes to its upper border, it blends with the anterior and posterior ligament of the elbow.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 13
Incorrect
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During a laparoscopic surgery, the surgeon visualizes the medical umbilical folds on the deep surface of the anterior abdominal wall. What causes the medial umbilical folds?
Your Answer: Round ligaments of the uterus
Correct Answer: Obliterated umbilical arteries
Explanation:The medial umbilical ligament is a structure found on the deep surface of the anterior abdominal wall and is covered by the medial umbilical folds. It is a paired structure that represents the remnants of the fetal umbilical artery. They have no role in humans after birth other than to be used as a landmark for exploring the medial inguinal fossa during laparoscopic inguinal hernia repair.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 14
Correct
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A surgeon performing a Whipple's procedure, that involves mobilizing the head of the pancreases, accidentally injured a structure immediately posterior to the neck of the pancrease which bled out. Which structure is most likely to have been injured?
Your Answer: Superior mesenteric artery
Explanation:The structure immediately posterior to the neck of the pancreas is the superior mesenteric vein. The neck of the pancreas lies anterior to the superior mesenteric vein, which joins with the splenic vein to form the portal vein.
The superior mesenteric artery (SMA) is also located in proximity to the neck of the pancreas. Specifically, the SMA emerges from the abdominal aorta just below the level of the pancreas and passes posterior to the neck of the pancreas before it descends into the mesentery to supply the intestines. Thus, both the superior mesenteric vein and the superior mesenteric artery are key vascular structures related to the posterior aspect of the neck of the pancreas.
Bleeding out would suggest an arterial injury.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 15
Incorrect
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The physician suggested lifestyle modification for his patient because his present condition could increase his risk for the development of adenocarcinoma of the oesophagus. What is the most common predisposing factor for the development of adenocarcinoma of the oesophagus?
Your Answer: Exposure to nitrosamines
Correct Answer: Gastro-oesophageal reflux disease
Explanation:Barret’s oesophagus is attributed primarily to gastro-oesophageal reflux disease. The chronic acidic environment damages the squamous epithelial lining of the oesophagus, and subsequently undifferentiated pluripotent stem cells develop into columnar epithelium, this is then known as Barret’s oesophagitis.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 16
Correct
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A victim of road traffic accident presented to the emergency department with a blood pressure of 120/90 mm Hg, with a drop in systolic pressure to 100 mm Hg on inhalation. This is known as:
Your Answer: Pulsus paradoxus
Explanation:Weakening of pulse with inhalation and strengthening with exhalation is known as pulsus paradoxus. This represents an exaggeration of the normal variation of the pulse in relation to respiration. It indicates conditions such as cardiac tamponade and lung disease. The paradox refers to the auscultation of extra cardiac beats on inspiration, as compared to the pulse. Due to a decrease in blood pressure, the radial pulse becomes impalpable along with an increase in jugular venous pressure height (Kussmaul sign). Normal systolic blood pressure variation (with respiration) is considered to be >10 mmHg. It is >100 mmHg in Pulsus paradoxus. It is also predictive of the severity of cardiac tamponade.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 17
Incorrect
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The Henderson–Hasselbalch equation describes the derivation of pH as a measure of acidity. According to this equation, the buffering capacity of the system is at maximum when the number of free anions compared with undissociated acid is:
Your Answer: Three times more
Correct Answer: Equal
Explanation:In 1908, Lawrence Joseph Henderson wrote an equation describing the use of carbonic acid as a buffer solution. Later, Karl Albert Hasselbalch re-expressed that formula in logarithmic terms, resulting in the Henderson–Hasselbalch equation. The equation is also useful for estimating the pH of a buffer solution and finding the equilibrium pH in acid–base reactions. Two equivalent forms of the equation are: pH = pKa + log10 [A–]/[HA] or pH = pKa + log10 [base]/[acid]. Here, pKa is − log10(Ka) where Ka is the acid dissociation constant, that is: pKa = –log10(Ka) = –log10 ([H3 O+][A–]/[HA]) for the reaction: HA + H2 O ≈ A– + H3 O+ In these equations, A– denotes the ionic form of the relevant acid. Bracketed quantities such as [base] and [acid] denote the molar concentration of the quantity enclosed. Maximum buffering capacity is found when pH = pKa or when the number of free anions to undissociated acid is equal and buffer range is considered to be at a pH = pKa ± 1.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 18
Incorrect
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A suspected recreational drug user was brought to the Emergency department in an unconscious state, and was found to be hypoventilating. Which of the following set of arterial blood gas analysis report is most consistent with hypoventilation as the primary cause? pH, pa(CO2) (mmHg), pa(O2) (mmHg).
Your Answer: 7.45, 25, 71
Correct Answer: 7.28, 55, 81
Explanation:Hypoventilation (or respiratory depression) causes an increase in carbon dioxide (hypercapnia) and respiratory acidosis. It can result due to drugs such as alcohol, benzodiazepines, barbiturates, opiates, mechanical conditions or holding ones breath. Strong opioids such as heroin and fentanyl are commonly implicated and can lead to respiratory arrest. In recreational drug overdose, acute respiratory acidosis occurs with an increase in p(CO2) over 45 mm Hg and acidaemia (pH < 7.35)
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 19
Incorrect
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Which of the following morphological features is most characteristic of hyaline degeneration?
Your Answer: Orphan Annie eye nucleus
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 20
Incorrect
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In a young, sexually active male, what is the most common cause of non-gonococcal urethritis?
Your Answer: Herpes simplex virus
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 21
Correct
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A 7-year-old boys undergoes a testicular biopsy after a tumour is found in his right testis. Elements similar to hair and teeth are found in it. What kind of tumour is this?
Your Answer: Teratoma
Explanation:A teratoma is a tumour containing tissue elements that are similar to normal derivatives of more than one germ layer. They usually contain skin, hair, teeth and bone tissue and are more common in children, behaving as a benign tumour. After puberty, they are regarded as malignant and can metastasise.
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This question is part of the following fields:
- Pathology
- Urology
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Question 22
Incorrect
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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 testicular vein
Correct 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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 23
Incorrect
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Which of the following is a large artery that runs immediately posterior to the stomach?
Your Answer: Left gastroepiploic
Correct Answer: Splenic
Explanation:The splenic artery is the large artery that would be found running off the posterior wall of the stomach. It is a branch of the coeliac trunk and sends off branches to the pancreas before reaching the spleen. The gastroduodenal artery on the other hand is found inferior to the stomach, posterior to the first portion of the duodenum. The left gastroepiploic artery runs from the left to the right of the greater curvature of the stomach. The common hepatic artery runs on the superior aspect of the lesser curvature of the stomach, and is a branch of the coeliac trunk. The superior mesenteric artery arises from the abdominal aorta just below the junction of the coeliac trunk.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 24
Incorrect
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In what form are fats primarily transported in the body?
Your Answer: Cholesterol
Correct Answer: Free fatty acids
Explanation:Fat is mainly transported in the body as free fatty acids. Once out of the adipose cell, the free fatty acids get ionized and combine with albumin.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 25
Correct
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Injury to this nerve will affect the function of the palatoglossus and levator veli palatini muscles:
Your Answer: Cranial nerve X
Explanation:The vagus nerve (cranial nerve X) innervates both the palatoglossus and levator veli palatini muscles.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 26
Incorrect
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The dural venous sinuses are venous channels that drain blood from the brain. This sinuses are located between which structures?
Your Answer: Periosteal and meningeal layers of the arachnoid mater
Correct Answer: Meningeal and periosteal layers of the dura mater
Explanation:The dural venous sinuses lies between the periosteal and meningeal layer of the dura mater. Dural venous sinuses is unique because it does not run parallel with arteries and allows bidirectional flow of blood intracranially as it is valve-less.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 27
Incorrect
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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 28
Incorrect
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Some substances, such as Chromium-51 and Technetium-99, are freely filtered but not secreted or absorbed by the kidney. In these cases, their clearance rate is equal to:
Your Answer: Renal plasma flow
Correct Answer: Glomerular filtration rate
Explanation:If a substance passes through the glomerular membrane with perfect ease, the glomerular filtrate contains virtually the same concentration of the substance as does the plasma and if the substance is neither secreted nor reabsorbed by the tubules, all of the filtered substance continues on into the urine. Glomerular filtration rate (GFR) describes the flow rate of filtered fluid through the kidney.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 29
Incorrect
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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: Iliohypogastric
Correct 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 30
Incorrect
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Hyperplastic arteriosclerosis with fibrinoid necrosis, petechial haemorrhages, microinfarcts in the kidneys and elevated plasma renin are common findings in which of the following patients?
Your Answer:
Correct Answer: A 45-year-old woman with scleroderma
Explanation:Scleroderma, also known as systemic sclerosis, is a chronic disease of the connective tissue. Involvement of the kidneys occurs in patients with diffuse scleroderma, causing rapid onset of high blood pressure with hyperreninemia, thrombotic microangiopathy, and progressive renal failure.
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This question is part of the following fields:
- Pathology
- Renal
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SESSION STATS - PERFORMANCE PER SPECIALTY
