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Question 1
Incorrect
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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: Scaphoid
Correct 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.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 2
Incorrect
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Which of the following is true about myasthenia gravis?
Your Answer: A small dose of physostigmine is likely to worsen the symptoms
Correct Answer: Response of skeletal muscle to nerve stimulation is weakened
Explanation:An autoimmune disorder, myasthenia gravis leads to progressive muscle weakness. It occurs due to formation of antibodies against the nicotinic acetylcholine (ACh) receptor of the motor endplate, which leads to impaired neuromuscular transmission. Thus, nerve stimulation will lead to a weakened muscle response, but direct electrical stimulation will bring about a normal response. Diagnostic test includes improvement of muscle weakness by small doses of acetylcholinesterase inhibitors (physostigmine or edrophonium). However, a large dose of physostigmine worsens the weakness due to desensitisation of the endplate to persistent Ach. One of the investigative tools includes radiolabelled snake venom α-bungarotoxin. It is an in vitro study performed on muscle biopsy specimens and used to quantify the number of ACh receptors at the motor endplate.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 3
Correct
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A 53 year old women with a history of atrial fibrillation developed an acute abdomen. On laparoscopic examination her bowels appeared to be dusky to red-purple in colour and her mesenteric veins appeared to be patent. Which of the following is most likely to occur in this situation?
Your Answer: Wet gangrene
Explanation:Infarction of the small bowel following a sudden and complete occlusion of the mesenteric artery can involve any portion of the bowel, whether small or a large. The splenic flexure is at most risk for infarction as it is the watershed area between the superior and inferior mesenteric vessels. Regardless of whether the arterial or the venous blood vessels are occluded, because of the blood reflow into the damaged portion, it will appear haemorrhagic. The bowel appearing congested at first and then becoming oedematous. If the artery is occluded then there will be a clear cut demarcation and in venous occlusion the dusky colour fades with the rest of the normal bowel. Wet gangrene is characteristic of ischaemic injury to the gut.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Gastrointestinal
- Pathology
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Question 4
Correct
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During a procedure in the mediastinum, the surgeon accidentally injured a key structure that lies immediately anterior to the thoracic duct. Which structure is likely to be injured?
Your Answer: Oesophagus
Explanation:In the mid-thorax, the azygos vein, thoracic duct and aorta (in this order from right to the left) are all located posterior to the oesophagus. The superior vena cava, left internal jugular vein and trachea are not found in the mid thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 5
Incorrect
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A 27-yeaar-old woman is diagnosed with candidiasis and prescribed fluconazole. What is the mechanism of action of fluconazole?
Your Answer: Inhibits phospholipase C
Correct Answer: Inhibits cytochrome P450
Explanation:Fluconazole is a triazole antifungal drug used in the treatment and prevention of superficial and systemic fungal infections. Like other imidazole- and triazole-class antifungals, fluconazole inhibits the fungal cytochrome P450 enzyme, 14-demethylase. It is used to treat candidiasis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, dermatophytosis, and pityriasis versicolor.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 6
Incorrect
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Dicloxacillin is an antibiotic; the subclass that dicloxacillin belongs to is:
Your Answer: Quinolone
Correct Answer: Penicillin
Explanation:Dicloxacillin is a narrow-spectrum beta-lactam antibiotic. It is used to treat infections caused by susceptible Gram-positive bacteria and most effective against beta-lactamase-producing organisms such as Staphylococcus aureus. To decrease the development of resistance, dicloxacillin is recommended to treat infections that are suspected or proven to be caused by beta-lactamase-producing bacteria.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 7
Correct
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The Carpal tunnel does NOT contain:
Your Answer: Flexor carpi ulnaris
Explanation:The contents of the carpal tunnel include:
– Median nerve
– Flexor digitorum supervicialis
– Flexor digitorum profundus
– Flexor policis longus
– Flexor carpi radialis
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 8
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 9
Correct
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A 17-year-old female was given an antibiotic for a urinary tract infection. After taking the medication the patient developed Steven-Johnson syndrome. Which particular antibiotic usually causes Steven-Johnson syndrome?
Your Answer: Sulphonamides
Explanation:Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulphonamide antibiotics, and nevirapine.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 10
Incorrect
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A CT-scan of the lung shows a tumour crossing the minor (horizontal) fissure. This fissure separates:
Your Answer: The lower lobe from both the middle and upper lobes
Correct Answer: The middle lobe from the upper lobe
Explanation:The horizontal fissure separates the upper lobe from the middle lobe. The oblique fissure on the other hand separates the lower lobe from both the middle and upper lobes. The lingula is found only on the left lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 11
Correct
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Congenital anomalies of genitourinary tract are more common than any other system. Which of the following anomalies carries the greatest risk of morbidity?
Your Answer: Bladder exstrophy
Explanation:Bladder exstrophy is the condition where the urinary bladder opens from the anterior aspect suprapubically. The mucosa of the bladder is continuous with the abdominal skin and there is separation of the pubic bones. The function of the upper urinary tract remains normal usually. Treatment consists of surgical reconstruction of the bladder and returning it to the pelvis. There can be a need for continent urinary diversion along with reconstruction of the genitals.
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This question is part of the following fields:
- Pathology
- Renal
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Question 12
Incorrect
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The periphery of a haematoma is infiltrated by fibroblasts, collagen and new vasculature. This process is best described as?
Your Answer: Recanalization
Correct Answer: Organisation of the haematoma
Explanation:Formation of granulation tissue at the periphery of the hematoma is a normal process leading to resolution. This granulation tissue is composed of new capillaries, fibroblasts and collagen. Lysis of a blood clot can occur, but the actual process of this response is known as organization, wherein the scar tissue will become part of the vessels. This is followed by recanalization and embolization which can lead to eventual complications. Proliferation of a clot will occur due to an imbalance in the clotting and lysing systems. Thrombosis has nothing to do with the process described above.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 13
Correct
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The accumulation of eosinophils within tissues is mostly regulated by which of the following cytokines?
Your Answer: Interleukin-5
Explanation:IL-5 is produced by TH2 helper cells and by mast cells. They stimulate increased secretion of immunoglobulins and stimulate B cell growth. They are the major regulators in eosinophil activation and control. They are also released from eosinophils and mast cells in asthmatic patients and are associate with a many other allergic conditions.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 14
Correct
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A 30 year old man suffered severe blood loss, approx. 20-30% of his blood volume. What changes are most likely seen in the pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) respectively following this decrease in cardiac output?
Your Answer: Increase Decrease
Explanation:Hypovolemia will result in the activation of the sympathetic adrenal discharge resulting is a decrease pulmonary artery pressure and an elevated pulmonary vascular resistance.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 15
Correct
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The gynaecologist suspects that her patient has a cervical cancer. What particular test should be done on this patient to screen for cervical cancer?
Your Answer: Pap smear
Explanation:Worldwide, approximately 500,000 new cases of cervical cancer and 274,000 deaths are attributable to cervical cancer yearly. This makes cervical cancer the second most common cause of death from cancer in women. The mainstay of cervical cancer screening has been the Papanicolaou test (Pap smear).
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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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The dural venous sinuses are venous channels that drain blood from the brain. This sinuses are located between which structures?
Your 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 17
Correct
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The rotator cuff surrounds the shoulder joint and consists of the supraspinatus, infraspinatus, subscapularis and which one other muscle?
Your Answer: Teres minor
Explanation:The correct answer is the teres minor muscle. These group of muscles play an important role in protecting the shoulder joint and keeping the head of the humerus in the glenoid fossa of the scapula. This fossa is somehow shallow and needs support to allow for the full mobility that the shoulder joint has.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 18
Correct
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Which is the site of action of the drug omeprazole?
Your 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 19
Correct
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A 34-year-old woman with severe burns, presented to casualty with a blood pressure of 75/40 mmHg and pulse of 172/minute. Obviously the patient is in shock. Which type of shock is it more likely to be?
Your Answer: Hypovolaemic shock
Explanation:Shock is a life-threatening condition that occurs when the organs and tissues of the body are not receiving a sufficient flow of blood. Lack of blood flow, oxygen and nutrients results in the inability to function properly and damage to many organs. Shock requires immediate treatment because, if left untreated the impaired tissue perfusion and cellular hypoxia can cause irreversible tissue injury, collapse, coma or even death. There are various types of physiological shock, including: cardiogenic (due to heart damage), hypovolaemic (due to low total volume of blood or plasma), neurogenic (due to nervous system damage), septic (due to infections) and anaphylactic shock (due to allergic reactions). Hypovolaemic shock can be caused by blood loss due to trauma, internal bleeding or other fluid loss due to severe burns, prolonged diarrhoea, vomiting and sweating.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 20
Correct
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what is the cause of a prolonged PT(prothrombin time)?
Your Answer: Liver disease
Explanation:PT measure the intrinsic pathway of coagulation. It determines the measure of the warfarin dose regime, liver disease and vit K deficiency status along with the clotting tendency of blood. PT measured factors are II,V,VII,X and fibrinogen. It is used along with aPTT which measure the intrinsic pathway.
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This question is part of the following fields:
- General
- Physiology
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Question 21
Incorrect
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The blood-brain barrier is a membrane that separates the circulating blood from the brain extracellular fluid in the central nervous system (CNS). Which of the following statements regarding the blood– brain barrier is CORRECT?
Your Answer: It permits carbon dioxide to pass via facilitated diffusion
Correct Answer: It breaks down in areas of brain that are infected
Explanation:The blood–brain barrier is a membrane that controls the passage of substances from the blood into the central nervous system. It is a physical barrier between the local blood vessels and most parts of the central nervous system and stops many substances from travelling across it. During meningitis, the blood–brain barrier may be disrupted. This disruption may increase the penetration of various substances (including either toxins or antibiotics) into the brain. A few regions in the brain, including the circumventricular organs, do not have a blood–brain barrier.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 22
Incorrect
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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: B lymphocytes
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 23
Correct
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Which of the following organs is an ectoderm derivative?
Your Answer: Adrenal medulla
Explanation:Ectoderm derivatives include the adrenal medulla, posterior pituitary, the epidermis of the skin, nails, hair, sweat glands, mammary glands, sebaceous glands, the central nervous system, the peripheral nervous system, the retina and lens of eye, the pupillary muscle of the iris, melanocytes, Schwann cells and odontoblasts.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 24
Correct
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A 43-year-old diabetic man complains of headaches, palpitations, anxiety, abdominal pain and weakness. He is administered sodium bicarbonate used to treat:
Your Answer: Metabolic acidosis
Explanation:Sodium bicarbonate is indicated in the management of metabolic acidosis, which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis. Bicarbonate is given at 50-100 mmol at a time under scrupulous monitoring of the arterial blood gas readings. This intervention, however, has some serious complications including lactic acidosis, and in those cases, should be used with great care.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 25
Incorrect
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The gradual depolarization in-between action potentials in pacemaker tissue is a result of?
Your Answer: A gradual increase in inward Na+ (INa) channels current through fast Na+ channels
Correct Answer: A combination of gradual inactivation outward IK along with the presence of an inward ‘funny’ current (If) due to opening of channels permeable to both Na+ and K+ ions
Explanation:One of the characteristic features of the pacemaker cell is the generation of a gradual diastolic depolarization also called the pacemaker potential. In phase 0, the upstroke of the action potential caused by an increase in the Ca2+ conductance, an influx of calcium occurs and a positive membrane potential is generated. The next is phase 3 which is repolarization caused by increased K+ conductance as a result of outwards K+ current. Phase 4 is a slow depolarization which accounts for the pacemaker activity, caused by increased conductance of Na+, inwards Na+ current called IF. it is turned on by repolarization.
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This question is part of the following fields:
- General
- Physiology
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Question 26
Incorrect
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A 55-year-old male chronic smoker is diagnosed with non-small-cell cancer. His right lung underwent complete atelectasis and he has a 7cm tumour involving the chest wall. What is the stage of the lung cancer of this patient?
Your Answer: T4
Correct Answer: T3
Explanation:Non-small-cell lung cancer is staged through TNM classification. The stage of this patient is T3 because based on the TNM classification the tumour is staged T3 if > 7 cm or one that directly invades any of the following: Chest wall (including superior sulcus tumours), diaphragm, phrenic nerve, mediastinal pleura, or parietal pericardium; or the tumour is in the main bronchus < 2 cm distal to the carina but without involvement of the carina, Or it is associated with atelectasis/obstructive pneumonitis of the entire lung or separate tumour nodule(s) in the same lobe.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 27
Correct
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A previously healthy 40-year-old housewife suddenly complains of a headache and loses consciousness. A CT scan reveals subarachnoid haemorrhage. Which of the following is the most probable cause?
Your Answer: Ruptured berry aneurysm
Explanation:Saccular aneurysms, also known as berry aneurysms, appear as a round outpouching and are the most common form of cerebral aneurysm. They are a congenital intracranial defect, and haemorrhage can occur at any age, but is most common between the ages of 40-65 years. A second rupture (rebleeding) sometimes occurs, most often within about 7 days of the first bleed.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 28
Correct
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A 55-year-old woman complains of pain in the proximal and distal interphalangeal joins, and back pain which has increased over the last 4 years and worsens after activity. X-rays reveal Heberden’s and Bouchard’s nodes in her interphalangeal joints and the presence of osteophytes in her spine. What is the most likely diagnosis?
Your Answer: Osteoarthritis
Explanation:Osteoarthritis is most common in older adults, predominating in women between the ages of 40 and 70; after this age, men and women are affected equally. It affects an entire joint, with disruption and potential loss of joint cartilage, along with other joint changes, including bone hypertrophy (osteophyte formation). The pain is usually gradual and is worse after activity, with occasional joint swelling. X-ray findings include marginal osteophytes, narrowing of the joint space, increased density of the subchondral bone, subchondral cyst formation, bony remodelling and joint effusions.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 29
Correct
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Which of the following structures is affected or damaged when the 'anterior drawer test' is positive?
Your Answer: Anterior cruciate ligament
Explanation:The anterior drawer test is an important orthopaedic test that is used to test weakness of the anterior cruciate ligament. The test is done by having the patient sit in a supine position with his/her knees flexed at 90 degrees. An examiner stabilises the patients feet and softly pulls or pushes on the proximal tibia. The test is positive if there is translational movement of the tibia in relation to the femur, indicating a weakened anterior cruciate ligament. The anterior cruciate ligament prevents the tibia from sliding out in front of the femur.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 30
Incorrect
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A 26-year-old female patient had the following blood report: RBC count = 4. 0 × 106/μl, haematocrit = 27% and haemoglobin = 11 g/dl, mean corpuscular volume (MCV) = 80–100 fl, mean corpuscular haemoglobin concentration (MCHC) = 31–37 g/dl. Which of the following is correct regarding this patient’s erythrocytes:
Your Answer: Increased cell diameter
Correct Answer: Normal MCV
Explanation:MCV is the mean corpuscular volume and it is calculated from the haematocrit and the RBC count. It is normally 90 fl. Mean corpuscular haemoglobin concentration (MCHC) [g/dl] = haemoglobin [g/dl]/haematocrit = 11/0.27 = 41 g/dl and is higher than normal range (32 to 36 g/dL).
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This question is part of the following fields:
- General
- Physiology
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Question 31
Correct
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Which muscle would be affected most following injury to the transverse cervical artery?
Your Answer: Trapezius
Explanation:The latissimus dorsi receives blood from the thoracodorsal artery, the supraspinatus receives its blood from the suprascapular artery, the levator scapulae and the rhomboids are supplied by the dorsal scapular artery and the transverse cervical artery supplies blood to the trapezius.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 32
Correct
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The most likely cause of prominent U waves on the electrocardiogram (ECG) of a patient is:
Your Answer: Hypokalaemia
Explanation:The U-wave, not always visible in ECGs, is thought to represent repolarisation of papillary muscles or Purkinje fibres. When seen, it is very small and occurs after the T-wave. Inverted U-waves indicate myocardial ischaemia or left ventricular volume overload. Prominent U-waves are most commonly seen in hypokalaemia. Other causes include hypercalcaemia, thyrotoxicosis, digitalis exposure, adrenaline and class 1A and 3 anti-arrhythmic agents. It can also be seen in congenital long-QT syndrome and in intracranial haemorrhage.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 33
Correct
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A 59-year-old man was brought to the emergency department by his family after complaining of sudden, severe upper back pain and a ripping sensation, that radiated to his neck. On arrival, his pulse was weak in one arm compared with the other however his ECG result was normal. Which of the following is most probably the cause of these findings and symptoms?
Your Answer: Acute aortic dissection
Explanation:Acute aortic dissection is a serious condition in which the inner layer of the aorta tears and the blood flows in between the inner and middle layers of the aorta causing their separation (dissection). Aortic dissection can lead to rupture or decreased blood flow to organs. Clinical manifestations most often include the sudden onset of severe, tearing or ripping chest pain that can radiate to the shoulder, back or neck; syncope; altered mental status; dyspnoea; pale skin; stroke symptoms etc. The diagnosis of acute aortic dissection is based on clinical findings, imaging studies, electrocardiography and laboratory analysis.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 34
Correct
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A medical officer was shown an X ray with barium contrast and was asked to distinguish the small from the large bowel. Which of the following features listed is CORRECT?
Your Answer: Circular folds of the mucosa
Explanation:Distinguishing features include:
1. Three strips of longitudinal muscle-taenia coli- on the wall instead of a continuous surrounding longitudinal muscle that is seen in the small intestine
2. The colon has bulges called haustra that are not on the small bowel.
3. The surface of the colon is covered with fatty omental appendages. Both the colon and the small intestine have similar circular smooth muscle layer, serosa. Peyer’s patches are lymphoid tissues that are not visible on X ray with barium contrast.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 35
Correct
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A 72-year-old male presents with dysuria and chronic haematuria. He was diagnosed with bladder cancer and tumour invasion of the perivesical fat. What is the stage of the patient's bladder cancer?
Your Answer: T3
Explanation:Bladder cancer is the growth of abnormal or cancerous cells on the inner lining of the bladder wall. The staging is as follows; stage 0is (Tis, N0, M0): Cancerous cells in the inner lining tissue of the bladder only, stage I (T1, N0, M0): tumour has spread onto the bladder wall, stage II (T2, N0, M0): tumour has penetrated the inner wall and is present in muscle of the bladder wall, stage III (T3, N0, M0): tumour has spread through the bladder to fat around the bladder and stage IV: (T4, N0, M0): tumour has grown through the bladder wall and into the pelvic or abdominal wall. The stage of cancer in the case presented is T3 because of the invasion of perivesical fat.
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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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Out of the following options, which malignancy has the highest potential for multicentricity?
Your Answer: Transitional cell carcinoma
Explanation:Transitional cell carcinomas can arise anywhere in the urothelium lining the urinary tract; and hence are known to be multicentric and recur commonly. Prostatic adenocarcinoma most commonly involves the posterior lobe of the prostate gland. Although renal cell carcinomas occasionally show multicentricity, it is not common. Penile carcinomas are usually locally infiltrative lesions. Wilm’s tumours are usually solitary, but can be bilateral or multicentric in 10% cases. Small cell carcinoma of lung and teratomas are usually solitary.
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This question is part of the following fields:
- Pathology
- Renal
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Question 37
Correct
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Which of the following structures carry part of the right bundle branch of the AV bundle?
Your Answer: Moderator band (septomarginal trabecula)
Explanation:The moderator band extends from the base of the anterior papillary muscle to the ventricular septum. It is the structure which carries part of the right AV bundle. Its role it to prevent overdistention of the ventricle.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 38
Correct
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A young 16 year old boy presented to the ENT clinic with a history of sore throat for the past 1 day. On examination there was a pharyngeal purulent discharge. Which of the following types of inflammation is seen in this boy?
Your Answer: Acute inflammation
Explanation:A 1 day history suggests the purulent discharge is due to acute inflammation. Acute inflammation has 3 features:
1) the affected area is occupied by a purulent discharge composed of proteins, fluids and cells from local blood vessels
2) the infective agent i.e. bacteria is present in the affected area
3) the damaged tissue can be liquified and the debris removed from the site.
If the inflammation lasts over weeks or months, then it is termed as chronic inflammation.
Granulomatous inflammation is characterised by the presence and formation of granulomas.
Exudate is not a feature of resolution or a complication of inflammation.
Abscess formation takes more than 1 day to form and is usually within a capsule/cavity.
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This question is part of the following fields:
- Inflammation & Immunology; Respiratory
- Pathology
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Question 39
Correct
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A 25 year old male patient who had sustained a stab wound in the middle of the posterior aspect of the left thigh, was discharged from hospital after dressing and antibiotic prophylaxis. Later on the patient developed bleeding through the wound and upon review, the source was discovered to be an artery that is the direct source of the medial and lateral circumflex arteries. Which is this artery that was injured?
Your Answer: Profunda femoris artery
Explanation:The medial and lateral circumflex arteries are direct branches of the Profunda femoris artery otherwise also known as the deep artery of the thigh. The Profunda femoris artery arises from the femoral artery just below the inguinal ligament (approximately 2-5cm below it).
The following are the branches of the deep artery of the thigh:
Lateral circumflex femoral artery
Medial circumflex femoral artery
Perforating arteries
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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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A 40-year old lady presented to the hospital with fever and mental confusion for 1 week. On examination, she was found to have multiple petechiae all over her skin and mucosal surfaces. Blood investigations revealed low platelet count and raised urea and creatinine. A platelet transfusion was carried out, following which she succumbed to death. Autopsy revealed pink hyaline thrombi in myocardial arteries. What is the likely diagnosis?
Your Answer: Thrombotic thrombocytopenic purpura
Explanation:Hyaline thrombi are typically associated with thrombotic thrombocytopenic purpura (TTP), which is caused by non-immunological destruction of platelets. Platelet transfusion is contraindicated in TTP. Platelets and red blood cells also get damaged by loose strands of fibrin deposited in small vessels. Multiple organs start developing platelet-fibrin thrombi (bland thrombi with no vasculitis) typically at arteriocapillary junctions. This is known as ‘thrombotic microangiopathy’. Treatment consists of plasma exchange.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 41
Correct
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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: 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 42
Correct
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Risk factors for hepatocellular carcinoma do NOT include:
Your 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 43
Correct
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A patient is diagnosed with lung cancer. His physician told him that his lung cancer type is aggressive. It can grow rapidly and may undergo early metastasis, however it is very sensitive to chemotherapy and radiotherapy. Which lung cancer type is most likely present
Your Answer: Small-cell carcinoma
Explanation:Small-cell lung carcinoma (SCLC) is a type of highly malignant cancer that most commonly arises within the lung. SCLC usually metastasizes widely very early on in the natural history of the tumour, and in nearly all cases responds dramatically to chemotherapy and/or radiotherapy. Surgery has no role in the treatment of this disease.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 44
Incorrect
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A blood sample from a patient with polycythaemia vera will show which of the following abnormalities?
Your Answer: Decreased MCV
Correct Answer: High platelet count
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 a myeloproliferative syndrome, 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 increased 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 45
Correct
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A medical student is asked to calculate the net pressure difference in a capillary wall, considering: Interstitial fluid hydrostatic pressure = –3 mmHg, Plasma colloid osmotic pressure = 28 mmHg, Capillary hydrostatic pressure = 17 mmHg, Interstitial fluid colloid osmotic pressure = 8 mmHg, and Filtration coefficient = 1. Which is the correct answer?
Your Answer: 0 mmHg
Explanation:The rate of filtration at any point along a capillary depends on a balance of forces sometimes called Starling’s forces after the physiologist who first described their operation in detail. The Starling principle of fluid exchange is key to understanding how plasma fluid (solvent) within the bloodstream (intravascular fluid) moves to the space outside the bloodstream (extravascular space). Fluid movement = k[(pc– pi)–(Πc– Πi)] where k = capillary filtration coefficient, pc = capillary hydrostatic pressure, pi= interstitial hydrostatic pressure, Πc = capillary colloid osmotic pressure, Πi = interstitial colloid osmotic pressure. Therefore: 1 × [capillary hydrostatic pressure (17) – interstitial fluid hydrostatic pressure (–3)] – [plasma colloid osmotic pressure (28) – interstitial fluid colloid osmotic pressure (8)] = 0 mmHg
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 46
Correct
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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.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 47
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: Rectum
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 48
Correct
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Which structure holds the duodenojejunal flexure in place?
Your 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 49
Correct
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A 50 year old male point was diagnosed with tennis elbow that became worse after he started playing basket ball over the last three months. He was admitted to the orthopaedic ward to have elbow braces fitted. What type of synovial joint is the elbow joint?
Your Answer: Hinge
Explanation:The elbow joint is one of the many synovial joints in the body. This joint is an example of the hinge joint as the humerus is received into the semilunar notch of the ulna and the capitulum of the humerus articulates with the fovea on the head of the radius, together acting as a hinge in one plane.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 50
Incorrect
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A 45 year-old male, with behavioural changes developed euvolemic hyponatraemia. Which of the following conditions most likely predisposed the patient to develop euvolemic hyponatraemia?
Your Answer: Salt-losing nephropathy
Correct Answer: Psychosis
Explanation:In euvolemic hyponatraemia, there is volume expansion in the body, there is no oedema, but hyponatremia occurs. Causes include: state of severe pain or nausea, psychosis, brain trauma, SIADH, hypothyroidism and glucocorticoid deficiency.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 51
Incorrect
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What best describes the muscles of the posterior compartment of the leg?
Your Answer: All pass deep to the extensor retinaculum
Correct Answer: One of the posterior compartment leg muscles laterally rotates the femur
Explanation:The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris and are the chief extensors of the foot at the ankle joint. Deep muscles include the tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 52
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 53
Incorrect
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A 25-year-old female had a painful abdomen and several episodes of vomiting. She was severely dehydrated when she was brought to the hospital. Her ABG showed a pH 7.7, p(O2) 75 mmHg, p(CO2) 46 mmHg and bicarbonate 48 mmol/l. The most likely interpretation of this ABG report would be:
Your Answer: Respiratory alkalosis
Correct Answer: Metabolic alkalosis
Explanation:Metabolic alkalosis is a primary increase in bicarbonate (HCO3−) with or without compensatory increase in carbon dioxide partial pressure (Pco2); pH may be high or nearly normal. Metabolic alkalosis occurs as a consequence of a loss of H+ from the body or a gain in HCO3 -. In its pure form, it manifests as alkalemia (pH >7.40). As a compensatory mechanism, metabolic alkalosis leads to alveolar hypoventilation with a rise in arterial carbon dioxide tension p(CO2), which diminishes the change in pH that would otherwise occur. Normally, arterial p(CO2) increases by 0.5–0.7 mmHg for every 1 mmol/l increase in plasma bicarbonate concentration, a compensatory response that occurs very rapidly. If the change in p(CO2) is not within this range, then a mixed acid–base disturbance occurs. Likewise, if the increase in p(CO2) is less than the expected change, then a primary respiratory alkalosis is also present. However an elevated serum bicarbonate concentration can also occur due to a compensatory response to primary respiratory acidosis. A bicarbonate concentration greater than 35 mmol/l is almost always caused by metabolic alkalosis (as is the case in this clinical scenario). Calculation of the serum anion gap can also help to differentiate between primary metabolic alkalosis and the metabolic compensation for respiratory acidosis. The anion gap is frequently elevated to a modest degree in metabolic alkalosis because of the increase in the negative charge of albumin and the enhanced production of lactate. However, the only definitive way to diagnose metabolic alkalosis is by performing a simultaneous blood gases analysis, which reveals elevation of both pH and arterial p(CO2) and increased calculated bicarbonate.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 54
Correct
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A new-born was found to have an undeveloped spiral septum in the heart. This is characteristic of which of the following?
Your Answer: Persistent truncus arteriosus
Explanation:Persistent truncus arteriosus is a congenital heart disease that occurs when the primitive truncus does not divide into the pulmonary artery and aorta, resulting in a single arterial trunk. The spiral septum is created by fusion of a truncal septum and the aorticopulmonary spiral septum. Incomplete development of these septa results in incomplete separation of the common tube of the truncus arteriosus and the aorticopulmonary trunk.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 55
Incorrect
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What is the linea aspera:
Your Answer: Is found on the inferior pubic ramus
Correct Answer: Serves as an attachment for adductors of the thigh
Explanation:The linea aspera is a prominent longitudinal ridge or crest on the middle third of the femur. It has a medial and a lateral lip and a narrow, rough, intermediate line. The vastus medialis arises from the medial lip of the linea aspera and has superior and inferior prolongations. The vastus lateralis takes origin from the lateral lip . The adductor magnus is inserted into the linea aspera. Two muscles are attached between the vastus lateralis and the adductor magnus: the gluteus maximus is inserted above and the short head of the biceps femoris arises below. Four muscles are inserted between the adductor magnus and the vastus medialis: the iliacus and pectineus superiorly, and the adductor brevis and adductor longus inferiorly.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 56
Incorrect
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During an operation to repair an aortic coarctation in a neonate, a surgeon accidentally cuts the first aortic intercostal arteries as he mobilised the descending aorta. Which one of the following structure might be deprived of its primary source of blood supply following this injury?
Your Answer: First anterior intercostal space
Correct Answer: Right bronchus
Explanation:The right bronchus is supplied by one right bronchial artery that may branch from one of the left bronchial arteries or from the right 3rd posterior intercostal artery (this is the first intercostal artery that arises from the aorta). Damage to this artery might stop blood supply to the main bronchus. Intercostal arteries that go to the first and the second interspaces originate from the highest intercostal artery such that blood supply to either of these spaces would not be interfered with.
The left bronchus receives blood from 2 left bronchial arteries which are direct branches from the descending aorta.
Fibrous pericardium is the sac that contains the heart. Its blood supply is not a major concern.
Visceral pericardium receives its blood supply from the coronary vessels.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 57
Incorrect
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A 20-year old college student was diagnosed with meningitis that had developed due to an acute cavernous sinus thrombosis from an ear infection. Which of the following superficial venous routes is the usual path that an infected blood clot takes to reach the cavernous sinus?
Your Answer: Lingual vein
Correct Answer: Facial vein
Explanation:The facial vein is the usual communication between the cavernous sinus and the pterygoid sinus. It is through this vein that an infected clot can travel to the cavernous sinus and cause infection. The pterygoid plexus is a venous plexus that is situated between the temporalis muscle and lateral pterygoid muscle, and partly between the two pterygoid muscles. The pterygoid plexus is connected to the facial vein by the deep facial vein. This connection is what makes this area where this sinus and the facial vein are located a danger zone. The danger zone or triangle of the face is the area from the corners of the mouth to the nose bridge. The sinus connection in this area makes it possible for infection to reach the cavernous sinus and at times cause meningitis.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 58
Incorrect
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A young women following a road traffic accident suffered heavy blood loss and developed subsequent anaemia. Which of the following is a consequence of this?
Your Answer: High blood pressure
Correct Answer: A high reticulocyte count
Explanation:Anaemia refers to a decrease in the circulating levels of haemoglobin in the blood resulting in a reduced ability of the body to transport oxygen effectively. Anaemia from blood loss results in the body further compensating by releasing stored RBCs and immature RBCs from the bone marrow. Thus resulting in a high reticulocyte count.
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This question is part of the following fields:
- General
- Physiology
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Question 59
Incorrect
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Which of the following will be a likely sequelae of complete ileal resection?
Your Answer: Decreased calcium absorption
Correct Answer: Vitamin B12 deficiency
Explanation:The ileum is a part of the small intestine and has a pH of around 7-8 (neutral or slightly alkaline). Its main function is absorption of products of digestion. The ileal wall has multiple villi, which in turn have numerous microvilli. This increases the surface area available for absorption significantly. The cells lining the ileum contain multiple enzymes such as protease and carbohydrase, which aid in the final stages of digestion. Villi contain lacteals which absorb the products of fat digestion, fatty acids and glycerol. Thus, ileal resection will lead to their decreased absorption and increased fat content in the stool. The ileum is also responsible for absorption of vitamin B12.
Maximum water absorption occurs in the colon followed by the jejunum. Hence, ileal resection is less likely to lead to fluid volume deficiency. Also, most minerals (like calcium, iron etc.) are absorbed in the duodenum, and thus will not be affected by ileal resection.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 60
Incorrect
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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: Trigeminal
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 61
Correct
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An organ transplant patient may be at risk of developing which type of cancer?
Your Answer: Skin cancer
Explanation:The most common malignancies encountered in the post–solid organ transplant setting are non-melanoma skin cancers, post-transplant lymphoproliferative disorders and Kaposi’s sarcoma (KS). The pathogenesis of these tumours is likely related to the immunosuppressive drugs used post-transplantation and subsequent viral infection.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 62
Correct
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A 45 year-old female presents with a drooping eyelid. During examination, the same pupil of the patient is found to be dilated. Which nerve could be involve in this case?
Your Answer: Oculomotor nerve
Explanation:The oculomotor nerve controls most of the eye muscles. It also controls the constriction of the pupils and thickening of the lens of the eye. This can be tested in two main ways. By moving a finger toward a person’s face to induce accommodation, their pupils should constrict or shining a light into one eye should result in equal constriction of the other eye. The neurons in the optic nerve decussate in the optic chiasm with some crossing to the contralateral optic nerve tract. This is the basis of the swinging-flashlight test. Loss of accommodation and continued pupillary dilation can indicate the presence of a lesion of the oculomotor nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 63
Correct
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A 32-year-old man presents to the doctor complaining of pain in his left calf whilst walking. He says that the pain goes away after a short period of rest but starts again during exercise or walking. The man reveals he has been a smoker for the last 15 years. His blood pressure, blood sugar and cholesterol level are normal. Artery biopsy shows intraluminal thrombosis and vasculitis. What's is the most likely cause of these findings?
Your Answer: Buerger's disease
Explanation:Thromboangiitis obliterans, also known as Buerger’s disease, is a rare type of occlusive peripheral arterial disease, usually seen in smokers, most commonly in men aged 20 to 40. Symptoms most often include intermittent claudication, skin changes, painful ulcers on extremities, pain in the extremities during rest and gangrene. Diagnosis is based on clinical findings, arteriography, echocardiography, and computed tomography angiography. A difference in blood pressure between arms, or between the arms and legs is a common finding. Electrocardiographic findings include nonspecific abnormality or normal results.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 64
Incorrect
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A patient with this type of tumour is advised to follow up regularly for monitoring of tumour size as there is a strong correlation with malignant potential and tumour size. Which of the following is the most likely tumour in this patient?
Your Answer: Prostate adenocarcinoma
Correct Answer: Renal adenocarcinoma
Explanation:The distinction between a benign renal adenoma and renal adenocarcinoma is commonly made on the basis of size. Tumours less than 2 cm in size rarely become malignant as opposed to those greater than 3 cm.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 65
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 66
Incorrect
-
A young male was diagnosed with hepatitis A, which clinically resolved in 2 weeks. What will his liver biopsy done after 6 months show?
Your Answer: Central necrosis
Correct Answer: Normal architecture
Explanation:Hepatitis A is the most common acute viral hepatitis, more common in children and young adults. It is caused by Hepatitis A virus, which is a single-stranded RNA picornavirus. The primary route of spread of Hepatitis A is the faecal-oral route. Consumption of contaminated raw shellfish is also a likely causative factor. The shedding of the virus in faecal matter occurs before the onset of symptoms and continues a few days after. Hepatitis A does not lead to chronic hepatitis or cirrhosis, and there is no known chronic carrier state. Hence, a biopsy performed after recovery will show normal hepatocellular architecture.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 67
Incorrect
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During a clinical rotation in the ENT clinic, you observe a flexible bronchoscopy. As the scope is passed down the trachea, you see a cartilaginous structure that resembles a ship's keel and separates the right and the left main stem bronchi. This structure is the:
Your Answer: Cricoid cartilage
Correct Answer: Carina
Explanation:The carina (a keel-like cartilage) is found at the bifurcation of the trachea separating the right from the left main stem bronchi. It is a little more to the left than to the right.
The cricoid cartilage is the inferior and posterior cartilage of the larynx.
The costal cartilage on the other hand elongates the ribs anteriorly and contribute to the elasticity of the thoracic cage.
The pulmonary ligament is a fold of pleura located below the root of the lung.
Tracheal rings are rings of cartilage that support the trachea.
Peritracheal fascia is a layer of connective tissue that invests the trachea from the outside and is not visible on bronchoscopy.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 68
Incorrect
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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: Transversus thoracis muscle fascia
Correct 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 69
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 70
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: Whole blood
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 71
Incorrect
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Which of the following is the most abundant WBC seen in a smear from a healthy person.
Your Answer: Lymphocytes
Correct Answer: Neutrophils
Explanation:neutrophils are the most abundant cell type of the WBC. These phagocytes are found normally in the blood and increase in number are seen during an acute inflammation. These the percentages of WBC in blood Neutrophils: 40 to 60%
Lymphocytes: 20 to 40%
Monocytes: 2 to 8%
Eosinophils: 1 to 4%
Basophils: 0.5 to 1%
Band (young neutrophil): 0 to 3%. eosinophils, basophils, neutrophils are known as granulocytes and monocytes and lymphocytes as agranulocytes.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 72
Correct
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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.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 73
Incorrect
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The pleural cavity is the space between the two pulmonary pleurae which cover the lungs. What is the normal amount of pleural fluid?
Your Answer: 600 ml
Correct Answer: 10 ml
Explanation:Pleural fluid is a serous fluid produced by the serous membrane covering normal pleurae. Most fluid is produced by the parietal circulation (intercostal arteries) via bulk flow and reabsorbed by the lymphatic system. The total volume of fluid present in the intrapleural space is estimated to be only 2–10 ml. A small amount of protein is present in intrapleural fluid. Normally, the rate of reabsorption increases as a physiological response to accumulating fluid.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 74
Correct
-
If a tumour is found in both lobes of the prostate, without nodal involvement or metastases, a histological grade of G2 and elevated PSA, what is the overall prostatic cancer stage?
Your Answer: Stage II
Explanation:The AJCC uses the TNM, Gleason score and PSA levels to determine the overall stage of prostatic cancer. This staging is as follows:
Stage I: T1, N0, M0, Gleason score 6 or less, PSA less than 10; or T2a, N0, M0, Gleason score 6 or less, PSA less than 10
Stage IIa: T1, N0, M0, Gleason score of 7, PSA less than 20; or T1, N0, M0, Gleason score of 6 or less, PSA at least 10 but less than 20; or T2a or T2b, N0, M0, Gleason score of 7 or less, PSA less than 20
Stage IIb: T2c, N0, M0, any Gleason score, any PSA; or T1 or T2, N0, M0, any Gleason score PSA of 20 or more; or T1 or T2, N0, M0, Gleason score of 8 or higher, any PSA
Stage III: T3, N0, M0, any Gleason score, any PSA Stage IV: T4, N0, M0,any Gleason score, any PSA; or any T, N1, M0,any Gleason score, any PSA; or Any T, any N, M1, any Gleason score, any PSA.
The patient in this case has a T2 N0 M0 G2 tumour, meaning it belongs in stage II
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This question is part of the following fields:
- Pathology
- Urology
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Question 75
Incorrect
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Which of the following arteries is the posterior branch of the external carotid artery?
Your Answer: Occipital
Correct Answer: Superficial temporal
Explanation:The external carotid artery is a branch of the common carotid artery that supplies parts of the neck, head and face. It branches off from the common carotid artery at the level of the thyroid cartilage. The external carotid, at the level of the mandible divides into the maxillary artery and the superficial temporal. The superficial temporal artery is the posterior branch of these two arteries. It starts off, somewhat, as a continuation of the external carotid artery at the substance of the parotid gland. Anterior cerebral and middle cerebral arteries are branches of the internal carotid artery.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 76
Incorrect
-
What is the most likely cause of bilateral gynaecomastia in a 55-year old male?
Your Answer: Increased testosterone levels
Correct Answer: Hepatic failure
Explanation:Hypertrophy of breast tissue in males is known as gynaecomastia. It is normally due to proliferation of stroma and not of mammary ducts. Physiological gynaecomastia can occur during puberty and is often transient, bilateral, symmetrical and possibly tender. Gynaecomastia can occur during old age too, but is usually unilateral. Other causes include hepatic or renal failure, endocrinological disorders, drugs (anabolic steroids, antineoplastic drugs, calcium channel blockers, cimetidine, digitalis, oestrogens, isoniazid, ketoconazole, methadone, metronidazole, reserpine, spironolactone, theophylline), and marijuana. It should not be confused with malignancy which is often hard, asymmetric and fixed to the dermis or fascia. Treatment if indicated, includes withdrawal of the causative factor or treatment of the underlying disorder.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 77
Correct
-
A 12-year old girl was brought to the hospital with recurrent headaches for 6 months. Her physical examination revealed no abnormality. A CT scan of the head revealed a suprasellar mass with calcifications, eroding the surrounding sella turcica. The lesion is likely to represent:
Your Answer: Craniopharyngioma
Explanation:Craniopharyngiomas (also known as Rathke pouch tumours, adamantinomas or hypophyseal duct tumours) affect children mainly between the age of 5 and 10 years. It constitutes 9% of brain tumours affecting the paediatric population. These are slow-growing tumours which can also be cystic, and arise from the pituitary stalk, specifically the nests of epithelium derived from Rathke’s pouch. Histologically, this tumour shows nests of squamous epithelium which is lined on the outside by radially arranged cells. Calcium deposition is often seen with a papillary type of architecture.
ACTH-secreting pituitary adenomas are rare and mostly microadenomas. Paediatric astrocytoma’s usually occur in the posterior fossa. Although null cell adenomas can cause mass effect and give rise to the described symptoms, they are not suprasellar. Prolactinomas can also show symptoms of headache and disturbances in the visual field, however they are known to be small and slow-growing.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 78
Incorrect
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Regarding the coagulation cascade, Factor VII:
Your Answer: Is mainly synthesised by the vascular endothelium
Correct Answer: Is a serine protease
Explanation:Factor VII (FVII) is a zymogen for a vitamin K-dependent serine protease essential for the initiation of blood coagulation. It is synthesized primarily in the liver and circulates in plasma. Within the liver, hepatocytes are involved in the synthesis of most blood coagulation factors, such as fibrinogen, prothrombin, factor V, VII, IX, X, XI, XII, as well as protein C and S, and antithrombin, whereas liver sinusoidal endothelial cells produce factor VIII and von Willebrand factor.
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This question is part of the following fields:
- General
- Physiology
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Question 79
Incorrect
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What principal artery that supplies the meninges is susceptible to rupture following trauma to the side of the head over the temporal region:
Your Answer: Basilar artery
Correct Answer: Middle meningeal artery
Explanation:The middle meningeal artery normally arises from the first or mandibular segment of the maxillary artery. The artery runs in a groove on the inside of the cranium, this can clearly be seen on a lateral skull X-ray. An injured middle meningeal artery is the most common cause of an epidural hematoma.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 80
Incorrect
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Which of these is secreted by both macrophages and muscle cells?
Your Answer: Interleukin-5
Correct Answer: Interleukin-6
Explanation:IL-6 is secreted by the T cells and macrophages and is a pro inflammatory cytokine. It is secreted in response to trauma e.g. burns and tissue damage that leads to inflammation. Apart from this its is also a myokine and is elevated due to muscle contraction. Other functions include: stimulate osteoclast formation when secreted by osteoblasts, mediate fever in acute phase response and are responsible for energy metabolism in muscle and fatty tissues. Inhibitors of IL-6 e.g. oestrogen are used as a treatment for postmenopausal osteoporosis.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 81
Correct
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During an exploratory laparotomy of an acute abdomen, the surgeon identified an inflamed Meckel's diverticulum. This is:
Your Answer: Is a site of ectopic pancreatic tissue
Explanation:Meckel’s diverticulum is an outpouching of the small intestine. It usually occurs about 0.6 m (2 feet) before the junction with the caecum. It can be lined with the mucosa of the stomach and may ulcerate. It may also be lined by ectopic pancreatic tissue. It represents the remains of the vitelline duct in early fetal life.
An abnormal persistence of the urachus is called a urachal fistula.
Failure of the midgut loop to return to the abdominal cavity is called an omphalocele.
Polyhydramnios is often caused by anencephaly or oesophageal fistula.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 82
Incorrect
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A 25 year-old female medical student presents with fever, lack of appetite, rashes, sore throat and lymphadenopathy. Peripheral smear shows atypical lymphocytes. Which is the most likely organism responsible for this patient's condition?
Your Answer: Candida albicans
Correct Answer: Epstein–Barr virus
Explanation:Epstein-Barr virus is in the herpes family of viruses and most people will become infected with EBV sometime during their lives. EBV commonly causes infectious mononucleosis, or mono, a contagious viral illness that initially attacks the lymph nodes in the neck and throat. When these tissues become less effective in fighting infection, sore throats, swelling of the nodes and fever may result.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 83
Incorrect
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Decreased velocity of impulse conduction through the atrioventricular node (AV node) in the heart will lead to:
Your Answer: Atrial fibrillation
Correct 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 84
Incorrect
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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: Middle 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 85
Incorrect
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Which of the following is NOT true regarding malignant hyperpyrexia
Your Answer: It occurs in 1 in 150,000
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 86
Incorrect
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The patient who is diagnosed with bladder cancer asked his physician, what could have been the contributing factor in the development of his bladder cancer?
Your Answer: Radon
Correct Answer: Smoking
Explanation:Tobacco smoking is the main known contributor to urinary bladder cancer. In most populations, smoking is associated with over half of bladder cancer cases in men and one-third of cases among women.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 87
Correct
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What class of drugs does buspirone belong to?
Your Answer: Anxiolytic
Explanation:Buspirone is an anxiolytic agent and a serotonin-receptor agonist that belongs to the azaspirodecanedione class of compounds. It shows no potential for addiction compared with other drugs commonly prescribed for anxiety, especially the benzodiazepines. The development of tolerance has not been noted. It is primarily used to treat generalized anxiety disorders. It is also commonly used to augment antidepressants in the treatment of major depressive disorder.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 88
Incorrect
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A 40-year old gentleman, known with a history of peptic ulcer disease, was brought to the clinic in a dehydrated state with persistent vomiting. His blood investigations revealed:
- sodium = 142 mmol/l
- potassium = 2.6 mmol/l
- chloride = 85 mmol/l
- pH = 7.55
- p(CO2) = 50 mmHg
- p(O2) = 107 mmHg
- standard bicarbonate = 40 mmol/l
Your Answer: Respiratory acidosis
Correct Answer: Metabolic alkalosis
Explanation:High pH with high standard bicarbonate indicates metabolic alkalosis. The pa(CO2) was appropriately low in compensation. This is hypokalaemic hypochloraemic metabolic acidosis due to prolonged vomiting. Treatment includes treating the cause and intravenous sodium chloride with potassium.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 89
Correct
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A 40 year old patient with an history of obesity has been diagnosed with meralgia parasthetica. The condition was discovered to be caused by the pinching of the lateral femoral cutaneous nerve. Injuries at what spinal levels usually affect this nerve?
Your Answer: L2, L3
Explanation:The lateral femoral cutaneous nerve of the thigh arises from the dorsal division of the lumbar plexus of the second and the third lumbar nerves (L2 – L3). Spinal injuries at this level are likely to affect the lateral femoral cutaneous nerve. The lateral femoral cutaneous nerve innervates the skin on the lateral aspect of the thigh.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 90
Correct
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A 56-year-old woman complains of back pain, muscle spasms, weakness, and a burning sensation that radiates from her left hip to her toes. What's the most likely diagnosis?
Your Answer: Herniated nucleus pulposus
Explanation:A herniated disk will produce sensory disturbances, causing pain that radiates along the course of the sciatic nerve which is typically burning or stabbing, with or without back pain. The herniation is usually caused by age-related degeneration although trauma, injuries, or straining may also trigger it.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 91
Incorrect
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Which of the following diseases affects young adults, causing pain in any bone -particularly long bones- which worsens at night, and is typically relieved by common analgesics, such as aspirin?
Your Answer: Giant-cell tumour of bone
Correct Answer: Osteoid osteoma
Explanation:Osteoid osteoma, which tends to affect young adults, can occur in any bone but is most common in long bones. It can cause pain (usually worse at night) that is typically relieved by mild analgesics, such as non-steroidal anti-inflammatory drugs. X-ray findings include a small radiolucent zone surrounded by a larger sclerotic zone.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 92
Correct
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In the adult heart, the sinus venosus gives rise to the:
Your Answer: Coronary sinus
Explanation:The sinus venosus is a large quadrangular cavity which precedes the atrium on the venous side of the chordate heart. It exists distinctly only in the embryonic heart (where it is found between the two venae cavae); however, the sinus venosus persists in the adult. In the adult, it is incorporated into the wall of the right atrium to form a smooth part called the sinus venarum, which is separated from the rest of the atrium by a ridge of fibres called the crista terminalis. The sinus venosus also forms the SA node and the coronary sinus.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 93
Incorrect
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A patient with chronic renal disease, missed a day of his dialysis schedule., His serum potassium was 7.6 mmol/L when his electrolytes were checked. What is the ECG finding expected in this patient?
Your Answer: Flattened T waves
Correct Answer: Tented T waves
Explanation:ECG characteristics of hyperkalaemia may show the following changes: P-waves are widened and of low amplitude due to slowing of conduction, widened QRS complex, QRS-T fusion, loss of ST segment and tall tented T waves.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 94
Incorrect
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In a hypertensive patient with secondary hyperaldosteronism, aldosterone is released mainly in response to:
Your Answer: High volume states (fluid overload)
Correct Answer: Angiotensin II
Explanation:Secondary hyperaldosteronism in hypertension is either due to primary renin overproduction by the kidneys or renin overproduction secondary to decreased renal blood flow. The main stimulus for aldosterone release are adrenocorticotrophic hormone (ACTH), angiotensin II and high plasma K+ levels. Low plasma Na+ might also stimulate the adrenal cortex. Fluid overload will reduce aldosterone secretion. Atrial natriuretic peptide is secreted under conditions of expanded extracellular volume and will not lead to aldosterone secretion.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 95
Correct
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A glycogen storage disorder is characterised by increased liver glycogen with a normal structure and no increase in serum glucose after oral intake of a protein-rich diet. Deficiency of which of the following enzymes is responsible for this disorder?
Your Answer: Glucose-6-phosphatase
Explanation:The most common glycogen storage disorder is von Gierke’s disease or glycogen storage disease type I. It results from a deficiency of enzyme glucose-6-phosphatase which affects the ability of liver to produce free glucose from glycogen and gluconeogenesis; leading to severe hypoglycaemia. There is also increased glycogen storage in the liver and kidneys causing enlargement and various problems in their functioning. The disease also causes lactic acidosis and hyperlipidaemia. The main treatment includes frequent or continuous feedings of corn-starch or other carbohydrates.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 96
Incorrect
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From which fascia of the pelvic wall muscle does the levator ani muscle arise?
Your Answer: Psoas major
Correct Answer: Obturator internus
Explanation:The levator ani muscle arises from the posterior surface of the superior ramus of the pubis lateral to the symphysis, behind the inner surface of the spine of the ischium and between these points from the obturator internus fascia. It is attached to the inner surface of the side of the lesser pelvic cavity, supports the viscera in the cavity and surrounds the various structures that pass through it.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 97
Correct
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The presence of oval fat bodies in the urine is most likely to be seen in which of the following conditions?
Your Answer: Nephrotic syndrome
Explanation:Nephrotic syndrome is associated with the presence of oval fat bodies on urinalysis due to increased proteinuria and lipiduria.
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This question is part of the following fields:
- Pathology
- Renal
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Question 98
Incorrect
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Both the arytenoid muscles and the lateral cricoarytenoid muscles perform this action on the glottis:
Your Answer: Abduction
Correct Answer: Adduction
Explanation:Both the arytenoid and the cricoartenoid muscles close the glottis. The lateral cricoarytenoid muscles extend from the lateral cricoid cartilage to the muscular process of the arytenoid cartilage. By rotating the arytenoid cartilages medially, these muscles adduct the vocal cords and thereby close the rima glottidis. The arytenoid muscle adducts or approximates the arytenoid cartilages, and thus closes the aperture of the glottis.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 99
Incorrect
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Which of the following conditions causes an elevation of the pH in the tissues with elevated arterial CO2 content?
Your Answer: Metabolic acidosis
Correct Answer: Metabolic alkalosis
Explanation:Metabolic alkalosis is a metabolic condition in which the pH of tissue is elevated beyond the normal range (7.35-7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate, or alternatively a direct result of increased bicarbonate concentrations. Normally, arterial pa(CO2) increases by 0.5–0.7 mmHg for every 1 mEq/l increase in plasma bicarbonate concentration, a compensatory response that is very quick. If the change in pa(CO2) is not within this range, then a mixed acid–base disturbance occurs.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 100
Correct
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A 45-year-old-female is suspected to have a pulmonary mass. Supposing that she has a neoplasm, which of the following are most commonly found to involve the lung:
Your Answer: Pulmonary metastases
Explanation:Lung metastases occur when a cancer started in another part of the body (primary site) spreads to the lungs. The lungs are among the most common site where cancer can spread due to its rich systemic venous drainage, almost every type of cancer can spread to the lung. The most common types of cancer that spread to the lung are breast, colorectal, kidney, testicular, bladder, prostate, head and neck cancers.
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This question is part of the following fields:
- Pathology
- Respiratory
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