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Question 1
Correct
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The basilar artery arises from the confluence of which two arteries?
Your Answer: Vertebral
Explanation:The basilar artery is part of the vertebrobasilar system. It is formed by the confluence of the two vertebral arteries which arise from the subclavian arteries. These two vertebral arteries merge at the level of cranial nerve VI at the junction between the pons and the medulla oblangata to form what is know as the basilar artery. This vertebrobasilar system supplies the upper spinal cord, brainstem, cerebellum, and posterior part of brain.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 2
Correct
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A biopsy is performed on a 67-year-old-man with testicular seminoma; it reveals that the tumour affects the tunica vaginalis. The tumour stage in this case is:
Your Answer: T2
Explanation:The primary tumour staging for testicular seminoma is as follows, according to AJCC guidelines:
Tis: intratubular germ cell neoplasia (carcinoma in situ)
T1: tumour limited to testis/epididymis without vascular or lymphatic invasion; the tumour can invade into the tunica albuginea but not the tunica vaginalis
T2: tumour limited to testis/epididymis with vascular or lymphatic invasion or tumour extending through the tunica albuginea with involvement of the tunica vaginalis
T3: tumour invading the spermatic cord, with or without vascular/lymphatic invasion
T4: tumour invading the scrotum, with or without vascular/lymphatic invasion.
According to these guidelines, the tumour in this case has a T2 stage.
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This question is part of the following fields:
- Pathology
- Urology
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Question 3
Correct
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Which name is given to the inferior fascia of the urogenital diaphragm?
Your Answer: Perineal membrane
Explanation:The urogenital fascia is mostly commonly referred to as the perineal membrane. This term refers to an anatomical fibrous membrane in the perineum. It is triangular in shape, and thus at times referred to as the triangular ligament. It is about 4 cm in depth. Its The perineal membrane’s apex is anterior and is separated from the arcuate pubic ligament by an oval opening for the passage of the deep dorsal vein of the penis. The lateral marginas of this triangular ligament are attached on either side to the inferior rami of the pubis and ischium, above the crus penis. Its base faces the rectum, and connects to the central tendinous point of the perineum. The pelvic fascia and Colle’s fascia is fused to the base of this triangle.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 4
Correct
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During gastrectomy, the operating surgeon ligates the short gastric arteries along the greater curvature of the stomach. Where do the short gastric arteries branch from?
Your Answer: Splenic artery
Explanation:Short gastric arteries arise from the splenic artery at the end or from its terminal divisions. They are about 5 or 7 in number, passing from the left to the right in between the layers of the gastrosplenic ligament to be distributed along the greater curvature of the stomach.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 5
Correct
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A surgeon trainee is assisting in an operation to ligate the ductus arteriosus. The consultant supervising explains that caution is required when placing a clamp on the ductus to avoid injury to an important structure immediately dorsal to it. To which structure is the consultant referring?
Your Answer: Left recurrent laryngeal nerve
Explanation:The left recurrent laryngeal nerve branches off the vagus and wraps around the aorta, posterior to the ductus arteriosus/ligamentum arteriosum from whence it courses superiorly to innervate the laryngeal muscles.
Accessory Hemiazygous vein is on the left side of the body draining the posterolateral chest wall and emptying blood into the azygos vein.
The left internal thoracic artery is branch of the left subclavian artery supplying blood to the anterior wall of the thorax.
Left phrenic nerve is lateral to the vagus nerve.
Thoracic duct: is behind the oesophagus, coursing between the aorta and the azygos vein in the posterior chest.
Right recurrent laryngeal nerve: loops around the right subclavian artery and is not in danger in this procedure.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 6
Correct
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Which of the following is most likely to cause hypovolaemic hypernatremia:
Your Answer: Hyperalimentation
Explanation:Hypernatremia, characterised by a high serum sodium concentration, is rarely associated with volume overload (hypervolemia). A hypovolaemic hypernatremia may be seen during excessive administration of hypertonic sodium bicarbonate, hypertonic saline or hyperalimentation.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 7
Correct
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Which of the following can lead to haemolytic anaemia?
Your Answer: Presence of haemoglobin S
Explanation:Haemoglobin S is an abnormal type of haemoglobin seen in sickle cell anaemia. This allows for the haemoglobin to crystalize within the RBC upon exposure to low partial pressures of oxygen. This results in rupture of the RBCs as they pass through microcirculation, especially in the spleen. This can cause blockage of the vessel down stream and ischaemic death of tissues, accompanied by severe pain.
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This question is part of the following fields:
- General
- Physiology
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Question 8
Correct
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During a laparoscopic surgery, the surgeon visualizes the medical umbilical folds on the deep surface of the anterior abdominal wall. What causes the medial umbilical folds?
Your Answer: Obliterated umbilical arteries
Explanation:The medial umbilical ligament is a structure found on the deep surface of the anterior abdominal wall and is covered by the medial umbilical folds. It is a paired structure that represents the remnants of the fetal umbilical artery. They have no role in humans after birth other than to be used as a landmark for exploring the medial inguinal fossa during laparoscopic inguinal hernia repair.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 9
Correct
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The chest X-ray of an 10-year-old boy, that presented with low-grade fever and cough, revealed hilar enlargement and parenchymal consolidation in the middle lobes. These X-ray findings are more typical for which of the following diagnoses?
Your Answer: Pulmonary tuberculosis
Explanation:Primary pulmonary tuberculosis is seen in patients exposed to Mycobacterium tuberculosis for the firs time. The main radiographic findings in primary pulmonary tuberculosis include homogeneous parenchymal consolidation typically in the lower and middle lobes, lymphadenopathy, miliary opacities and pleural effusion.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 10
Incorrect
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A 56-year-old man undergoes tests to determine his renal function. His results over a period of 24 hours were:
Urine flow rate: 2. 0 ml/min
Urine inulin: 1.0 mg/ml
Plasma inulin: 0.01 mg/ml
Urine urea: 260 mmol/l
Plasma urea: 7 mmol/l
What is the glomerular filtration rate?Your Answer: 125 ml/min
Correct Answer: 200 ml/min
Explanation:Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. GFR is equal to the inulin clearance because inulin is freely filtered into Bowman’s capsule but is not reabsorbed or secreted. The clearance (C) of any substance can be calculated as follows: C = (U × V)/P, where U and P are the urine and plasma concentrations of the substance, respectively and V is the urine flow rate. Thus, glomerular filtration rate = (1.0 × 2. 0)/0.01 = 200 ml/min.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 11
Correct
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A 20-year old cyclist falls off a speeding bike and fractures a structure that articulates with the tubercle of the 7th rib. Which structure is fractured?
Your Answer: Transverse process of vertebra T7
Explanation:A rib tubercle is a projection that is postero-inferior and lateral to the neck of a rib which articulates with the transverse process of the corresponding vertebra i.e. of the same number. Therefore, the tubercle of rib 7 articulates with the transverse process of T7 vertebra. The head of the rib 7, on the other hand, articulates with the 6th vertebra superiorly and the 7th vertebra inferiorly.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 12
Correct
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A 55-year old patient with signs and symptoms of internal haemorrhage was brought in for emergency surgery to control the bleeding. Angiography results revealed an advanced duodenal tumour that had perforated the blood vessel immediately behind the first part of the duodenum. Which of the following is the most likely blood vessel that was ruptured by the cancer?
Your Answer: Gastroduodenal artery
Explanation:The gastroduodenal artery is the artery that lies just behind the first portion of the duodenum. The gastroduodenal artery would be the most likely artery to be perforated by a cancer in this area. The perforation is as a result of the spillage of the acidic content of the chyme in the duodenum. All the other blood vessels in the list would less likely be affected by the gastric expellant from the duodenum. The coronary vein is located in the lesser curvature of the stomach. The inferior pancreaticoduodenal arcade is located inferiorly to the first part of the duodenum on the head of the pancreas. The hepatic artery proper is a branch of the common hepatic artery that is located superior to the first portion of the duodenum. The splenic vein arises from the spleen; it forms the portal vein by joining the superior mesenteric vein. It is laterally detached from the duodenum. Both the left gastric vein and the splenic vein are located superior to the first portion of the duodenum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 13
Correct
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A 25-year old man presented to the clinic with swelling of the penis. His uncircumcised penis was erythematous and oedematous. The foreskin could not be retracted over the glans. Which of the following agents is the likely cause of his condition?
Your Answer: Staphylococcus aureus
Explanation:Inflammation of the glans penis is known as balanitis. Associated involvement of the foreskin is then known as balanoposthitis. More likely to occur in men who have a tight foreskin that is difficult to pull back, or poor hygiene.
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This question is part of the following fields:
- Pathology
- Urology
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Question 14
Incorrect
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Rapid eye movement (REM) sleep is likely to be affected by a lesion in the:
Your Answer: Basal ganglia
Correct Answer: Pons
Explanation:Rapid eye movement (REM) sleep is also known as paradoxical sleep, as the summed activity of the brain’s neurons is quite similar to that during waking hours. Characterised by rapid movements of the eyes, most of the vividly recalled dreams occur during this stage of sleep. The total time of REM sleep for an adult is about 90–120 min per night.
Certain neurones in the brainstem, known as REM sleep-on cells, which are located in the pontine tegmentum, are particularly active during REM sleep and are probably responsible for its occurrence. The eye movements associated with REM are generated by the pontine nucleus with projections to the superior colliculus and are associated with PGO (pons, geniculate, occipital) waves.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 15
Correct
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The normal location of the major duodenal papilla:
Your Answer: Descending part of the duodenum
Explanation:The major duodenal papilla is on the descending portion of the duodenum on the medial side, about 7-10cm from the pylorus. The pancreatic ducts and the common bile ducts unite and open by a common orifice on the summit of the duodenal papilla.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 16
Correct
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Thalamic syndrome will most likely result in:
Your Answer: Hyperaesthesia
Explanation:Signs and symptoms of thalamic syndrome include contralateral hemi anaesthesia, burning or aching sensation in one half of a body (hyperaesthesia), often accompanied by mood swings.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 17
Correct
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A 47-year-old male smoker, who had been self-medicating with oral steroids for the last two years due to persistent breathlessness presented to the doctor complaining of a productive cough, fever and chest pain. A chest X-ray revealed bilateral patchy opacities. He was diagnosed with bilateral bronchopneumonia. Which of these organisms is most probably causing these findings?
Your Answer: Nocardia asteroides
Explanation:Nocardia is a Gram-positive aerobic actinomycete. Several species have been identified but the most common human pathogen is Nocardia asteroides. The predominant clinical finding in the majority of patients affected by nocardiosis is pulmonary disease. Predisposing factors for pulmonary nocardiosis include leukaemia, human immunodeficiency virus (HIV) infection, organ transplantation, diabetes and receiving prolonged corticosteroids.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 18
Correct
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A 70-year old man had had a large indirect inguinal hernia for 3 years. He presents at the out patient clinic complaining of pain in the scrotum. There is, however, no evidence of obstruction or inflammation. You conclude that the hernial sac is most probably compressing the:
Your Answer: Ilioinguinal nerve
Explanation:The ilioinguinal nerve arises together with the iliohypogastric nerve from the first lumbar nerve to emerge from the lateral border of the psoas major muscle just below the iliohypogastric and passing obliquely across the quadratus lumborum and iliacus muscles. It perforates the transversus abdominis, near the anterior part of the iliac crest and communicates with the iliohypogastric nerve between the internal oblique and the transversus. It then pierces the internal oblique to distribute filaments to it and accompanying the spermatic cord through the subcutaneous inguinal ring, is distributed to the skin of the upper and medial parts of the thigh, the skin over the root of the penis and the upper part of the scrotum in man and to the skin covering the mons pubis and labium majus in the woman. As the ilioinguinal nerve runs through the inguinal canal, it could easily be compressed by a hernial sac.
The femoral branch of genitofemoral nerve provides sensory innervation of the upper medial thigh.
The femoral nerve innervates the compartment of the thigh and also has some cutaneous sensory branches to the thigh.
The iliohypogastric nerve innervates the skin of the lower abdominal wall, upper hip and upper thigh. The subcostal nerve innervates the skin of the anterolateral abdominal wall and the anterior scrotal nerve is a terminal branch of the ilioinguinal nerve.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 19
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 20
Correct
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Calculate the resistance of the artery if the pressure at one end is 60 mmHg, pressure at the other end is 20 mm Hg and the flow rate in the artery is 200 ml/min.
Your Answer: 0.2
Explanation:Flow in any vessel = Effective perfusion pressure divided by resistance, where effective perfusion pressure is the mean intraluminal pressure at the arterial end minus the mean pressure at the venous end. Thus, in the given problem, resistance = (60 − 20)/200 = 0.2 mmHg/ml per min.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 21
Correct
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Post-total gastrectomy, there will be a decreased production of which of the following enzymes?
Your Answer: Pepsin
Explanation:Pepsin is a protease that is released from the gastric chief cells and acts to degrade proteins into peptides. Released as pepsinogen, it is activated by hydrochloric acid and into pepsin itself. Gastrin and the vagus nerve trigger the release of pepsinogen and HCl when a meal is ingested. Pepsin functions optimally in an acidic environment, especially at a pH of 2.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 22
Correct
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A medical intern wanting to perform her first thoracentesis (remove fluid from the pleural cavity) wishes to be reminded where to insert the needle to aspirate in order to avoid injuring the lung or neurovascular elements. Where is this place?
Your Answer: The bottom of interspace 9 in the midaxillary line
Explanation:Thoracentesis is performed in the costodiaphragmatic recess. The needle needs to be inserted below the level of the lungs to avoid injury to the lungs. At the paravertebral line, is between ribs 10 and 12, at the midaxillary line between ribs 8 and 10 and at the midclavicular line between interspaces 6 and 8. The needle should be inserted at the top of the rib (or the bottom of the interspace) to avoid damage to the neurovascular structures found below the rib running in the costal groove.
The recommended location for the needle insertion varies depending upon the source. It is critical that the patient hold his or her breath to avoid piercing of the lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 23
Correct
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Different substances have different renal clearance rates. Which of the following substances should have the lowest renal clearance rate in a healthy patient?
Your Answer: Glucose
Explanation:Under normal conditions the renal clearance of glucose is zero, since glucose is completely reabsorbed in the renal tubules and not excreted. Glycosuria – the excretion of glucose into the urine- is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 24
Correct
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An old woman complains of a lack of sensation halfway down the anterior surface of the thigh. The cause of this:
Your Answer: Would result from damage to the nerve that innervates the pectineus muscle
Explanation:The pectineus is supplied by the second, third and fourth lumbar nerves through the femoral nerve and by the third lumbar through the accessory obturator when it exists. The anterior surface of the thigh receives its innervation from the femoral nerve as well, thus this is the nerve most likely to be injured
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 25
Correct
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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: 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 26
Correct
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A 50-year-old gentleman was recently diagnosed with hypertension, with no other abnormalities on physical examination. Further investigations revealed the following :
Na+ 144 mmol/l
K+ 3.0 mmol/l
Cl- 107 mmol/l
Bicarbonate 25 mmol/l.
Blood glucose 5.8 mmol/l.
What is the likely diagnosis?Your Answer: Conn syndrome
Explanation:Overproduction of aldosterone (a mineralocorticoid) by the adrenal glands is known as Conn’s syndrome. It can be either due to an aldosterone-secreting adrenal adenoma (50-60% cases) or adrenal gland hyperplasia (40-50% cases). Excess aldosterone leads to sodium and water retention, along with potassium excretion. This leads to arterial (non-essential) hypertension. Conn’s syndrome is the commonest cause of primary hyperaldosteronism. Other symptoms include muscle cramps, headache (due to hypokalaemia) and metabolic alkalosis, which occurs due to increased secretion of H+ ions by the kidney. The raised pH of the blood traps calcium leading to symptoms of hypocalcaemia, which can be mimicked by liquorice ingestion and Liddle syndrome. To diagnose Conn’s syndrome, the ratio of renin and aldosterone is measured. Due to suppression of renin secretion, there is low renin to aldosterone ratio (<0.05). However, anti-hypertensives may affect the test results and should be withdrawn for 6 weeks. Computed tomography can also be done to detect the presence of adrenal adenoma. Cushing’s syndrome does not cause hypokalaemia with normal serum glucose levels. Nelson’s syndrome refers to increased ACTH secretion due to pituitary adenoma. Pheochromocytoma will not lead to hypokalaemia even though hypertension can be seen.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 27
Incorrect
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Which of the following proteins acts as cofactor in the thrombin-induced activation of anticoagulant protein C?
Your Answer: Prekallikrein
Correct Answer: Thrombomodulin
Explanation:Thrombomodulin is a protein cofactor expressed on the surface of endothelial cells. Thrombomodulin binds with thrombin forming a complex which activates protein C, initiating the anticoagulant pathway.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 28
Correct
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In a cardiac cycle, what event does the closing of atrioventricular (AV) valves coincide with?
Your Answer: First heart sound
Explanation:In the cardiac cycle, the closing of the atrioventricular (AV) valves coincides with the onset of ventricular systole. This event marks the beginning of the isovolumetric contraction phase, where the ventricles begin to contract, but the volume of blood in the ventricles remains the same because both the AV valves and the semilunar valves (aortic and pulmonary valves) are closed. The closing of the AV valves produces the first heart sound, known as “S1” or “lub.”
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 29
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 30
Correct
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Endometrial hyperplasia is most likely to be associated with which of the following conditions?
Your Answer: Fibrothecoma
Explanation:A benign tumour arising from the ovarian stroma, fibrothecoma are bilateral in 10% cases. The thecoma component of the tumour can produce oestrogen leading to endometrial hyperplasia. The thecoma is rich in lipid content and is responsible for the yellowish appearance of the tumour. Meig’s syndrome is the presence of fibrothecoma with a right-sided hydrothorax.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 31
Correct
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Medulloblastoma usually occurs in children between 5 to 9 years old. Where does medulloblastoma commonly originate from?
Your Answer: Cerebellar vermis
Explanation:Medulloblastoma is the most common malignant brain tumour in children, accounting for 10-20% of primary CNS neoplasms. Most of the tumours originate in the cerebellar vermis.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 32
Correct
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Enlargement of the spleen as seen in Gaucher's disease pushes the spleen downward and medially. What structure limits the straight-vertical-downward movement?
Your Answer: Left colic flexure
Explanation:The left colic flexure (also known as the splenic flexure), is the point where the colon takes a sharp turn downwards. It is the point where the transverse colon ends and the descending colon begins. It is located immediately inferior to the spleen so an enlarged spleen must move medially to avoid this colic flexure.
The left suprarenal gland is retroperitoneal.
The Ligament of Treitz suspends the fourth part of the duodenum from the posterior abdominal wall.
The stomach, pancreas and liver lie medial to the spleen and thus would not prevent a vertical downward movement.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 33
Correct
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A 50-year old gentleman who suffered a stroke was brought to the emergency department by his relatives. The patient however denied the presence of paralysis of his left upper and lower limbs. What is the most likely site of the lesion in this patient?
Your Answer: Right posterior parietal cortex
Explanation:A large injury to the non-dominant parietal cortex can make the patient neglect or refuse to acknowledge the presence of paralysis on the contralateral side. This can also involve the perception of the external world. Smaller injuries in this area which involve the precentral gyrus (primary motor cortex) or postcentral gyrus (primary sensory cortex) cause contralateral spastic paralysis or contralateral loss of tactile sensation respectively. A lesion in posterior inferior gyrus of the dominant frontal lobe results in motor aphasia. Involvement of the posterior superior gyrus of the dominant frontal lobe produces sensory aphasia.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 34
Correct
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The thoracic duct :
Your Answer: varies in length from 38 to 45 cm
Explanation:The thoracic duct is the main drainage of lymph in the body. It varies in length from 38 to 45 cm and extends from the second lumbar vertebra to the root of the neck.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 35
Correct
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A 13 year old girl presented with signs of shortness of breath, chest pain, non-productive cough, oedema of the lower extremities and cyanosis of the fingertips. She has a history of a ventricular septal defect not surgically corrected. The most probable cause of these symptoms is:
Your Answer: Shunt reversal
Explanation:A ventricular septal defect (VSD) is a common form of congenital heart defects and is characterised by the presence of a hole in the wall that separates the right from the left ventricle. Medium or large defects can cause many complications. One of these complication is Eisenmenger syndrome, characterised by reversal of the shunt (from left-to-right shunt into a right-to-left) ,cyanosis and pulmonary hypertension.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 36
Correct
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The superior ulnar collateral artery is a direct branch of this artery:
Your Answer: Brachial
Explanation:The brachial artery gives rise to a small branch at the middle of the arm, which is the superior collateral artery. It descends accompanied by the ulnar nerve and anastomoses with the posterior ulnar recurrent and inferior ulnar collateral.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 37
Incorrect
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A 54 year old man fell off his bicycle. He felt a severe pain in his hand and wasn't able to move it. It was found that a carpal bone in the distal row was fractured. Which is the most likely bone?
Your Answer: Scaphoid
Correct Answer: Trapezium
Explanation:There are eight carpal bones which are arranged in two rows, proximal and distal; scaphoid, lunate, triquetral and pisiform are of proximal row. Trapezium, trapezoid, capitate and hamate are of the distal row.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 38
Incorrect
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Which of the following conditions is likely to result in splenomegaly, hypochromic anaemia and hemochromatosis in a young male?
Your Answer: Hereditary spherocytosis
Correct Answer: β-Thalassaemia
Explanation:Beta-thalassaemia is due to decreased production of β-polypeptide chains, with an autosomal inheritance pattern. Carrier patients (heterozygotes) are asymptomatic and have mild to moderate microcytic anaemia. This is known as thalassaemia minor. Homozygotes (β-thalassaemia major, or Cooley’s anaemia) develop severe anaemia and marrow hyperactivity. The disease presents at 1-2 years of age with severe anaemia and transfusional and absorptive iron overload. Patients also present with jaundice, leg ulcers, massive splenomegaly and cholelithiasis. The disease can also lead to splenic sequestration leading to faster destruction of transfused red blood cells. Increased marrow activity causes thickening of cranial bones. Involvement of long bones is also seen, which can cause pathological fractures and growth impairment. There is iron deposition in various organs, which can lead to heart failure or hepatic failure (leading to cirrhosis). Thalassaemias are suspected in presence of family history, or signs suggesting microcytic haemolytic anaemia. Further test and quantitative haemoglobin studies are useful. In beta-thalassaemia, there is an increase in serum bilirubin, iron and ferritin levels. There is severe anaemia, often with haemoglobin < 6 g/dl. There is an elevated red blood cell count, which are microcytic. Peripheral blood smear is diagnostic with nucleated erythroblasts, target cells, small pale red blood cells, and punctate basophilia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 39
Correct
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Dicloxacillin is an antibiotic; the subclass that dicloxacillin belongs to is:
Your 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 40
Incorrect
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What is a major source of fuel being oxidised by the skeletal muscles of a man who has undergone starvation for 7 days?
Your Answer: Muscle triglycerides
Correct Answer: Serum fatty acids
Explanation:Starvation is the most extreme form of malnutrition. Prolonged starvation can lead to permanent organ damage and can be fatal. Starved individuals eventually lose significant fat and muscle mass as the body uses these for energy.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 41
Correct
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A cancer patient was found to have a radio resistant tumour. Which tumour does the patient most likely have?
Your Answer: Liposarcoma
Explanation:Liposarcoma is a cancer that arises in fat cells in deep soft tissue. Commonly it occurs inside the thigh or retroperitoneum. It usually affects middle-aged and older adults, over 40 years. Liposarcoma is the most common soft-tissue sarcoma. It is very radio resistant. Five-year survival rates vary from 100% to 56% based on histological subtype.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 42
Incorrect
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A 60-year old patient having a history of cholelithiasis that led to recurrent pain, bloating, nausea and vomiting, was scheduled for surgery to have the gallbladder removed. During the cholecystectomy, the registrar conducting the procedure accidentally punctured a blood vessel that lies immediately posterior to the omental foramen and blood filled the operating field. Which of the following blood vessels was likely punctured?
Your Answer: Portal vein
Correct Answer: Inferior vena cava
Explanation:The omental foramen is the pathway that connects the greater peritoneal sac and the lesser peritoneal sac. The omental foramen is bordered posteriorly by the inferior vena cava. This is the blood vessel that would most likely be punctured.
The aorta and its branch, the renal artery, lie postero-lateral to the omental foramen and are deeper than the inferior vena cava hence making them less likely to be injured.
The hepatic portal vein, the hepatic artery and the superior mesenteric vein borders the omental foramen anteriorly and would not be injured by a jab on the posterior border of the omental foramen.
Finally, the splenic artery is found in the splenorenal ligament that borders the omental foramen laterally to the left.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 43
Correct
-
Which statement is true about the inferior sagittal sinus?
Your Answer: Is formed between two layers of meningeal dura
Explanation:The inferior sagittal sinus is also known as the inferior longitudinal sinus. It courses along the inferior border of the falx cerebri, superior to the corpus callosum. It is cylindrical in shape and increases in size as it passes backward ending in the straight sinus. It receives blood from the deep and medial aspects of the cerebral hemispheres and drains into the straight sinus.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 44
Correct
-
Calculate the cardiac output in an adult male with the following parameters:
Heart rate 70 beats/min
Arterial [O2] 0.24 ml O2/min
Venous [O2] 0.16 ml O2/mi
Whole body O2 consumption 500 ml/min
Pulmonary diastolic pressure 15 mmHg
Pulmonary systolic pressure 25 mmHg
Wedge pressure 5 mmHg.Your Answer: 6.25 l/min
Explanation:As per Fick’s principle, VO2 = (CO × CAO2) – (CO × CVO2) where VO2 = oxygen consumption, CO = cardiac output, CAO2 = oxygen concentration of arterial blood and CVO2 = oxygen concentration of venous blood. Thus, CO = VO2/CAO2– CVO2, CO = 500/0.24 – 0.16, CO = 500/0.8, CO = 6.25 l/min.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 45
Correct
-
Action potentials are used extensively by the nervous system to communicate between neurones and muscles or glands. What happens during the activation of a nerve cell membrane?
Your Answer: Sodium ions flow inward
Explanation:During the generation of an action potential, the membrane gets depolarized which cause the voltage gated sodium channels to open and sodium diffuses inside the neuron, resulting in the membrane potential moving towards a positive value. This positive potential will then open the voltage gated potassium channels and cause more K+ to move out decreasing the membrane potential and restoring the membrane potential to its resting value.
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This question is part of the following fields:
- General
- Physiology
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Question 46
Correct
-
The following joint has an anastomotic circulation that is provided by branches of the brachial artery:
Your Answer: Elbow joint
Explanation:The arterial anastomoses of the elbow joint is contributed by branches of the brachial artery and the Profunda brachii artery. The brachial artery gives off the superior ulnar collateral artery and the inferior collateral artery. On the other hand, the Profunda brachii gives off the radial and medial recurrent arteries.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 47
Correct
-
Atrial septal defect (ASD) is most likely to be due to incomplete closure of which one of the following structures:
Your Answer: Foramen ovale
Explanation:Atrial septal defect is a congenital heart defect that results in a communication between the right and left atria of the heart and may involve the interatrial septum. It results from incomplete closure of the foramen ovale which is normally open during fetal life and closes just after birth.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 48
Incorrect
-
A 69 Year old lady presented to the emergency department following a massive myocardial infarction. She was found to be in hypotensive shock with focal neurological signs. Unfortunately the patient demised. What would be the expected findings on the brain biopsy?
Your Answer: Caseous necrosis
Correct Answer: Liquefactive necrosis
Explanation:Liquefactive necrosis is often associated with bacterial or fungal infections. However, hypoxic death of cells within the central nervous system can also result in liquefactive necrosis. The focal area is soft with a liquefied centre containing necrotic debris and dead white cells. This may later be enclosed by a cystic wall
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This question is part of the following fields:
- Cell Injury & Wound Healing; Neurology
- Pathology
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Question 49
Incorrect
-
A 7-month-old abandoned baby with congenital non-communicating hydrocephalus is hosted by a clinic at its new-born hostel. A CT scan of the baby's brain reveals what might be a blockage of the ventricular system between the third and the fourth ventricles. Which of the following is the most likely blocked structure?
Your Answer: Foramen of Magendie
Correct Answer: Cerebral aqueduct
Explanation:The drainage of cerebral spinal fluid from the third ventricle to the fourth ventricle is carried out by the cerebral aqueduct. The cerebral aqueduct is the narrowest passageway in the entire ventricular system and thus forms the most common site of blockage of flow of cerebrospinal fluid. The interventricular foramen allows passage of CSF to the third ventricle. The foramen of Luschka and Magendie are located on the fourth ventricle and allow passage of CSF to the subarachnoid space from the ventricular system. The pontine cistern is a space located on the ventral aspect of the pons. The cisterna magna is an opening on the subarachnoid space between the pia matter and the arachnoid.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 50
Incorrect
-
Which muscle is most likely to be affected following an injury to the thoracodorsal nerve (C6-C8)?
Your Answer: Serratus posterior inferior
Correct Answer: Latissimus dorsi
Explanation:Latissimus dorsi is a triangular, flat muscle that covers the lumbar region and the lower half of the thoracic region. It is supplied by the sixth, seventh and eighth cervical nerves through the thoracodorsal (long subscapular) nerve.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 51
Correct
-
Cervical intraepithelial neoplasia on Pap smear of a 34-year old lady is most likely associated with which of the following?
Your Answer: Human papillomavirus infection
Explanation:CIN (Cervical intraepithelial neoplasia) is considered a precursor of cervical cancer and is likely caused due to infection with human papillomavirus (HPV) types 16, 18, 31, 33, 35 or 39. The risk factors for cervical cancer include multiple sex partners, young age at the time of first intercourse, intercourse with men whose previous partners had cervical cancer. Also, smoking and immunodeficient states are considered contributory. CIN is graded as mild (grade I), moderate (grade II) and severe dysplasia or carcinoma in situ (grade III). CIN III rarely regresses spontaneously and can lead to invasive carcinoma by invading the basement membrane. Squamous cell carcinomas are the commonest cervical cancer seen in 80-85% of all cases. Others are commonly adenocarcinomas. Cervical cancer can spread by direct extension, lymphatic spread to pelvic and para-aortic nodes or by hematogenous route.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 52
Incorrect
-
A patients sciatic nerve has been severed following a stab injury. What would be affected?
Your Answer: The sartorius and gracilis muscles would not be able to contract
Correct Answer: There would still be cutaneous sensation over the anteromedial surface of the thigh
Explanation:The sciatic nerve supplies nearly all of the sensation of the skin of the leg and the muscles of the back of the thigh, leg and foot. A transection of the sciatic nerve at its exit from the pelvis will affect all the above-mentioned functions except cutaneous sensation over the anteromedial surface of the thigh, which comes from the femoral nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 53
Incorrect
-
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: Smoking
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 54
Incorrect
-
An electronic manufacturing engineer had abdominal distension and underwent a CT scan of the abdomen. Thereafter he was diagnosed with hepatic angiosarcoma. Exposure to what agent is responsible for the development of this neoplasm?
Your Answer: Dust particles
Correct Answer: Arsenic
Explanation:Hepatic angiosarcomas are associated with particular carcinogens which includes: arsenic , thorotrast, and polyvinyl chloride. With exposure to this three agents, there is a very long latent period of many years between exposure and the development of tumours.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 55
Incorrect
-
Raised alkaline phosphatase and positive antimitochondrial antibody indicates which of the following conditions presenting with pruritus?
Your Answer: Haemochromatosis
Correct Answer: Primary biliary cirrhosis
Explanation:An autoimmune disease, primary biliary cirrhosis results in destruction of intrahepatic bile ducts. This leads to cholestasis, cirrhosis and eventually, hepatic failure. Symptoms includes fatigue, pruritus and steatorrhea. Increased IgM levels, along with antimitochondrial antibodies are seen in the serum. Liver biopsy is diagnostic, and also aids in staging of disease.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 56
Incorrect
-
In the case of an injury to the sub sartorial canal, which of the following structures is most likely to be injured?
Your Answer: Great saphenous vein
Correct Answer: Nerve to vastus medialis
Explanation:The adductor canal (sub sartorial canal) is situated in the middle third of the thigh.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 57
Incorrect
-
A patient is unable to move their mandible to the left. Which muscle is affected in this case?
Your Answer: Right temporalis muscle
Correct Answer: Right lateral pterygoid muscle
Explanation:Patients with paralysis of the right pterygoid muscle are unable to move their mandible laterally to the left.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 58
Incorrect
-
A 33-year old lady presented to the gynaecology clinic with amenorrhoea for 6 months and a recent-onset of milk discharge from her breasts. She was not pregnant or on any medication. On enquiry, she admitted to having frequent headaches the last 4 months. Which of the following findings would you expect to see in her condition?
Your Answer: Hyponatraemia
Correct Answer: Hyperprolactinaemia
Explanation:Excessively high levels of prolactin in the blood is called hyperprolactinaemia. Normally, prolactin levels are less than 580 mIU/l in females and less than 450 mIU/l in men. The biologically inactive macroprolactin can lead to a false high reading. However, the patient remains asymptomatic. Dopamine down-regulates prolactin whereas oestrogen upregulates it. Hyperprolactinaemia can be caused due to lack of inhibition (compression of pituitary stalk or low dopamine levels), or increased production due to a pituitary adenoma (prolactinoma). Either of these causes can lead to a prolactin level of 1000-5000 mIU/l. However, levels more than 5000mIU/l are usually associated due to an adenoma and >100,000 mIU/l are seen in macroadenomas (tumours < 1cm in diameter). Increased prolactin causes increased dopamine release from the arcuate nucleus of hypothalamus. This increased dopamine in turn, inhibits the GnRH (Gonadotrophin Releasing Hormone) thus blocking gonadal steroidogenesis resulting in the symptoms of hyperprolactinaemia. In women, it includes hypoestrogenism, anovulatory infertility, decreased or irregular menstruation or complete amenorrhoea. It can even cause production of breast milk, loss of libido, vaginal dryness and osteoporosis. In men, the symptoms include impotence, decreased libido, erectile dysfunction and infertility. In men, treatment can be delayed due to late diagnosis as they have no reliable indicator such as menstruation that might indicate a problem. Most of the male patients seek help only when headaches and visual defects start to surface.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 59
Incorrect
-
A 27-year-old HIV patient started on an antifungal agent. Which antifungal agent that inhibits the biosynthesis of fungal ergosterol was given to the patient?
Your Answer: Amphotericin
Correct Answer: Ketoconazole
Explanation:Ketoconazole is a synthetic imidazole antifungal drug used primarily to treat fungal infections. It inhibits the biosynthesis of ergosterol by blocking demethylation at the C14 site of the ergosterol precursor. Amphotericin B and Nystatin impair permeability of the cell membrane. Flucytosine interferes with DNA synthesis, while the target of griseofulvin is the microtubules
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 60
Incorrect
-
The prostatic plexus of nerves contains nerve fibres that innervate penile tissue allowing for erection. From which of the following nerves do these fibres originate?
Your Answer: Genitofemoral
Correct Answer: Pelvic splanchnics
Explanation:Pelvic splanchnic nerves are examples of the parasympathetic nerves that innervate the smooth muscle and glands of the pelvic viscera. They are also the nerves contributing fibres to the prostatic plexus which innervate penile erectile tissue.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 61
Incorrect
-
Which of these is secreted by both macrophages and muscle cells?
Your Answer: Interleukin-9
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 62
Incorrect
-
An excision of a mass in the right parietal area of the head will be performed. In which layer of the scalp are the nerves and blood vessels located?
Your Answer: Pericranium
Correct Answer: Connective tissue
Explanation:The scalp is the anatomical area bordered by the face at the front, and by the neck at the sides and back. The scalp is usually described as having five layers:
1. The skin which contains numerous sebaceous glands and hair follicles.
2. The connective tissue, a dense subcutaneous layer of fat and fibrous tissue that lies beneath the skin, containing the nerves and vessels of the scalp.
3. The aponeurosis or galea aponeurotica, a tough layer of dense fibrous tissue which runs from the frontalis muscle anteriorly to the occipitalis posteriorly.
4. The loose areolar connective tissue layer provides an easy plane of separation between the upper three layers and the pericranium.
5. The pericranium is the periosteum of the skull bones and provides nutrition to the bone and the capacity for repair.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 63
Incorrect
-
Which of the following over-the-counter drugs can cause a prolonged bleeding time?
Your Answer: Codeine
Correct Answer: Acetylsalicylic acid
Explanation:Acetylsalicylic acid, or aspirin, is a nonsteroidal anti-inflammatory drug that is widely used as an analgesic and antipyretic. Aspirin is as a cyclo-oxygenase inhibitor that leads to decreased prostaglandin production. Decreased platelet aggregation is another effect of this drug, achieved by long-lasting use of aspirin.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 64
Correct
-
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 65
Incorrect
-
The lateral thoracic artery:
Your Answer: Is a branch of the brachial artery
Correct Answer: Accompanies the long thoracic nerve to the serratus anterior muscle
Explanation:The thoracic nerve, along with the lateral thoracic artery, follow the pectoralis minor to the side of the chest which supplies the serratus anterior and the pectoralis. It then sends branches across the axilla to the axillary glands and subscapularis. The pectoral branch of the thoraco-acromial anastomoses with the internal mammary, subscapular and intercostal arteries, which in women, supply an external mammary branch.
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This question is part of the following fields:
- Anatomy
- Breast
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Question 66
Correct
-
Urine specific gravity allows the assessment of which of the following renal functions?
Your Answer: Concentration
Explanation:Concentrating ability of kidneys is assessed by measuring the urine specific gravity. Normal values of urine specific gravity fall between 1.002 and 1.030 g/ml.
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This question is part of the following fields:
- Pathology
- Renal
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Question 67
Correct
-
A 19 year old male patient exhibiting signs of shock was brought to the casualty after he had fallen from the 3rd floor of a building. An examination carried out revealed tenderness on the left mid-posterior axillary line and low blood pressure. Further palpation revealed a large swelling that protruded downward and medially below the left costal margin. X-rays showed that the 9th and the 10th ribs were fractured near their angles. Considering these results, which abdominal organ was likely injured by the fractured ribs.
Your Answer: Spleen
Explanation:The spleen, left kidney, stomach, the splenic flexure of the colon and the suprarenal glands are all in the same quadrant- the left upper quadrant. However, the spleen is the most readily injured organ when there is fracture to the 10th, 11th and the 12th ribs because of its close association with these ribs. This patient exhibits a great indication of a ruptured spleen (tenderness on the left mid and posterior axillary line). The spleen is a thin capsulated organ with a spongy parenchyma, allowing it to bleed profusely in the event of injury. The liver, head of the pancreas and the duodenum are all in the right upper quadrant.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 68
Correct
-
Injury to this nerve will result to the loss of general sensory innervation of the lacrimal gland:
Your Answer: Ophthalmic nerve
Explanation:The lacrimal glands are paired, almond-shaped exocrine glands, that secrete the aqueous layer of the tear film. The lacrimal nerve, derived from the ophthalmic nerve, supplies the sensory component of the lacrimal gland. The greater petrosal nerve, derived from the facial nerve, supplies the parasympathetic autonomic component of the lacrimal gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 69
Incorrect
-
Which best describes the suprascapular nerve?
Your Answer: It branches from the middle trunk of the brachial plexus
Correct Answer: It contains nerve fibres from C5 and C6 spinal cord segments
Explanation:The suprascapular nerve arises from the cervical spinal nerves 5 and 6 after coming together to form common trunk. This nerve supplies the supraspinatus and infraspinatus muscles giving off branches to the shoulder joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 70
Incorrect
-
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: T1
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 71
Incorrect
-
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: Cavernous sinus
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 72
Incorrect
-
What occurs during cellular atrophy?
Your Answer: Cell wall breakdown
Correct Answer: Cell size decreases
Explanation:Atrophy is the decrease in the size of cells, tissues, or organs. There are several causes including inadequate nutrition, poor circulation, loss of hormonal support or nerve supply, disuse, lack of exercise, or disease. An increase in cell size is termed hypertrophy which is distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Urology
- Pathology
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Question 73
Incorrect
-
A 29-year-old pregnant woman develops severe hypoxaemia with petechial rash and confusion following a fracture to her left femur. Which is the most probable cause of these symptoms in this patient?
Your Answer: Gestational hypertension
Correct Answer: Fat embolism
Explanation:Fat embolism is a life-threatening form of embolism in which the embolus consists of fatty material or bone marrow particles that are introduced into the systemic venous system. It may be caused by long-bone fractures, orthopaedic procedures, sickle cell crisis, parenteral lipid infusion, burns and acute pancreatitis. Patients with fat embolism usually present with symptoms that include skin, brain, and lung dysfunction.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 74
Incorrect
-
Selective destruction of which of the following cells will affect antibody synthesis?
Your Answer: Reticulocytes
Correct Answer: Plasma cells
Explanation:Plasma cell are memory cells. After the antigen Is engulfed by the B cells it is presented to the CD4+ helper cells via the MCH II receptor and this leads to their activation which in turn stimulates the B cells to form antibodies against that specific antigen. Some B cells differentiate into plasma cells also called memory cells that get activated after subsequent infection.
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This question is part of the following fields:
- General
- Physiology
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Question 75
Incorrect
-
Following an accident, a man was unable to extend the wrist and metacarpophalangeal joints, despite sensation being intact. Which nerve was likely damaged?
Your Answer: Ulnar nerve
Correct Answer: Posterior interosseous nerve
Explanation:The posterior interosseous nerve which causes, what is known as the posterior interosseous nerve syndrome. The nerve is compressed before it bifurcates to form the medial and lateral branches. The compression is beyond the origin of the branches to the radial wrist extensors and the radial sensory nerve. The result of such a case is paralysis of the digital extensors and the extensor carpi ulnaris, resulting in dorsoradial deviation of the wrist.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 76
Incorrect
-
A man was stabbed in the thigh following a bar brawl. A superficial vein was injured which terminates in the femoral vein. This superficial vein is?
Your Answer: Tibial
Correct Answer: Great saphenous
Explanation:The great saphenous vein is considered the longest vein in the body. It terminates in the femoral vein nearly 3cm below the inguinal ligament. It begins at the dorsum of the foot in the medial marginal vein and ascends at the medial side of the leg in relation with the saphenous nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 77
Incorrect
-
A chest X-ray in a healthy, non-smoker, asymptomatic 48-year-old woman reveals a 2cm left lower lobe well-defined round opacity. Which of the following conditions is most probably responsible for this finding?
Your Answer: Metastatic adenocarcinoma
Correct Answer: Pulmonary hamartoma
Explanation:An asymptomatic healthy patient with no history of smoking and a lesion of small size most probably has a benign lung lesion. Hamartomas are one of the most common benign tumours of the lung that accounts for approximately 6% of all solitary pulmonary nodules. Pulmonary hamartomas are usually asymptomatic and therefore are found incidentally when performing an imaging test for other reasons.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 78
Incorrect
-
Which of the following mediators of inflammation requires arachidonic acid for synthesis?
Your Answer: Interferon-gamma
Correct Answer: Prostaglandins
Explanation:Arachidonic acid is normally present in the phospholipids that make up the cell membrane and is cleaved by phospholipase A2 from the phospholipid. Arachidonic acid is a precursor for the production of eicosanoids which include: 1) prostaglandins, prostacyclins and thromboxane, 2) leukotrienes and 3) anandamides. The production of these products along with their action on the body is called the arachidonic acid cascade.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 79
Incorrect
-
Which is the correct order of tendons passing from medial to lateral-posterior to the medial malleolus?
Your Answer: Flexor digitorum longus, flexor hallucis longus, posterior tibial
Correct Answer: Posterior tibial, flexor digitorum longus, flexor hallucis longus
Explanation:The correct order of structures is the tendon of tibialis posterior, tendon of flexor digitorum longus, posterior tibial artery (and vein), tibial nerve and tendon of flexor hallucis longus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 80
Correct
-
A 55 year old lady underwent an uneventful appendicectomy. Two hours later, her arterial blood gas analysis on room revealed pH: 7.30, p(CO2): 53 mmHg and p(O2): 79 mmHg. What is the most likely cause of these findings?
Your Answer: Alveolar hypoventilation
Explanation:In the given problem, there is respiratory acidosis due to hypercapnia from a low respiratory rate and/or volume (hypoventilation). Causes of hypoventilation include conditions impairing the central nervous system (CNS) respiratory drive, impaired neuromuscular transmission and other causes of muscular weakness (drugs and sedatives), along with obstructive, restrictive and parenchymal pulmonary disorders. Hypoventilation leads to hypoxia and hypercapnia reduces the arterial pH. Severe acidosis leads to pulmonary arteriolar vasoconstriction, systemic vascular dilatation, reduced myocardial contractility, hyperkalaemia, hypotension and cardiac irritability resulting in arrhythmias. Raised carbon dioxide concentration also causes cerebral vasodilatation and raised intracranial pressure. Over time, buffering and renal compensation occurs. However, this might not be seen in acute scenarios where the rise in p(CO2) occurs rapidly.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 81
Correct
-
Which of the following physiological changes will you see in a young man who has been trekking in the Himalayas for 3 years?
Your Answer: Increased renal excretion of HCO3 –
Explanation:The atmospheric pressure is lower at high altitudes as compared with sea level. This leads to a decrease in the partial pressure of oxygen. Once 2100 m (7000 feet) of altitude is reached, there is a drop in saturation of oxyhaemoglobin. The oxygen saturation of haemoglobin determines the oxygen content in the blood. The body physiological tries to adapt to high altitude by acclimatization. Immediate effects include hyperventilation, fluid loss (due to a decreased thirst drive), increase in heart rate and slightly lowered stroke volume. Long term effects include lower lactate production, compensatory alkali loss in urine, decrease in plasma volume, increased erythropoietin release and red cell mass, increased haematocrit, higher concentration of capillaries in striated muscle tissue, increase in myoglobin, increase in mitochondria, increase in aerobic enzyme concentration such as 2,3-DPG and pulmonary vasoconstriction.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 82
Incorrect
-
Which type of thyroid tumour represents 75 - 80% of thyroid cancer cases? This type is predominant in children and in patients who have had a previous history of head or neck radiation.
Your Answer: Anaplastic carcinoma
Correct Answer: Papillary carcinoma
Explanation:Papillary thyroid carcinoma is the most common thyroid cancer. This cancer has a high cure rate with 10-year survival rates for all patients with papillary thyroid cancer estimated at 80% to 90%.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 83
Incorrect
-
A 15-day old male baby was brought to the emergency department with sweating and his lips turning blue while feeding. He was born full term. On examination, his temperature was 37.9°C, blood pressure 75/45 mmHg, pulse was 175/min, and respiratory rate was 42/min. A harsh systolic ejection murmur could be heard at the left upper sternal border. X-ray chest showed small, boot-shaped heart with decreased pulmonary vascular markings. He most likely has:
Your Answer: Endocardial fibroelastosis
Correct Answer: Tetralogy of Fallot
Explanation:The most common congenital cyanotic heart disease and the most common cause of blue baby syndrome, Tetralogy of Fallot shows four cardiac malformations occurring together. These are ventricular septal defect (VSD), pulmonary stenosis (right ventricular outflow obstruction), overriding aorta (degree of which is variable), and right ventricular hypertrophy. The primary determinant of severity of disease is the degree of pulmonary stenosis. Tetralogy of Fallot is seen in 3-6 per 10,000 births and is responsible for 5-7% congenital heart defects, with slightly higher incidence in males. It has also been associated with chromosome 22 deletions and DiGeorge syndrome. It gives rise to right-to-left shunt leading to poor oxygenation of blood. Primary symptom is low oxygen saturation in the blood with or without cyanosis at birth of within first year of life. Affected children ay develop acute severe cyanosis or ‘tet spells’ (sudden, marked increase in cyanosis, with syncope, and may result in hypoxic brain injury and death). Other symptoms include heart murmur, failure to gain weight, poor development, clubbing, dyspnoea on exertion and polycythaemia. Chest X-ray reveals characteristic coeur-en-sabot (boot-shaped) appearance of the heart. Treatment consists of immediate care for cyanotic spells and Blalock–Taussig shunt (BT shunt) followed by corrective surgery.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 84
Correct
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A patient came into the emergency in a state of shock. His blood group is not known, but on testing it clotted when mixed with Type A antibodies. Which blood should be transfused?
Your Answer: B +ve
Explanation:There are two stages to determine the blood group, known as ABO typing. The first stage is called forward typing. In this method, RBCs are mixed with two separate solutions of type A or type B antibodies to see if they agglutinate. If this blood clumps, this indicates the presence of antigens within the blood sample. For example, a sample of type B blood will clump when tested with type A antibodies as it contains type B antigens. Group B – has only the B antigen on red cells (and A antibody in the plasma)
Group B – has only the B antigen on red cells (and A antibody in the plasma)
Group AB – has both A and B antigens on red cells (but neither A nor B antibody in the plasma)
Group O – has neither A nor B antigens on red cells (but both A and B antibody are in the plasma). Many people also have a Rh factor on the red blood cell’s surface. This is also an antigen and those who have it are called Rh+. Those who have not are called Rh–. A person with Rh– blood does not have Rh antibodies naturally in the blood plasma (as one can have A or B antibodies, for instance) but they can develop Rh antibodies in the blood plasma if they receive blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies. A person with Rh+ blood can receive blood from a person with Rh– blood without any problems. The patient’s blood group is B positive as he has antigen B, antibody A and Rh antigens.
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This question is part of the following fields:
- General
- Physiology
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Question 85
Incorrect
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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: Saphenous nerve
Correct 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 86
Incorrect
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A young girl who presented with a clinical picture of type I hypersensitivity reaction with eosinophilia is most likely to have?
Your Answer: Amyloidosis
Correct Answer: Liver flukes
Explanation:Usually a parasitic infection will be associated with a type I hypersensitivity reaction.
Amyloid deposition will not cause an immune reaction.
Organic dust will lead to a type III hypersensitivity reaction.
Cell mediated as well as humoral immune mechanism play a part in syphilis, but they are do not specifically cause a type I reaction.
Malaria is cause by plasmodium and is not cause of a hypersensitivity reaction.
Atopic dermatitis will not be accompanied by eosinophilia.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 87
Incorrect
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A 55-years-old man presented to the emergency department complaining of a squeezing sensation in his chest that has spread to his neck with associated worsening shortness of breath. Which of these laboratory tests would you ask for in this patient:
Your Answer: Antinuclear antibody test
Correct Answer: Creatine kinase-MB
Explanation:Creatine kinase-MB is a test that usually is ordered when the patient has chest pain as a cardiac marker. When a heart attack is suspected and a troponin test (which is more specific for heart damage), is not available CK-MB is ordered. There are 3 forms of CK: CK-MM, CK-BB and CK-MB. CK-MB is commonly found in heart tissue, therefore injured heart muscle cells release CK-MB into the blood. Elevated CK-MB levels indicate that it is probable that a person has recently had a heart attack.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 88
Incorrect
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A 60 year-old patient being treated for hypertension presents to the ED with swelling of the left upper limb due to poor venous return. On examination, it is found that an aneurysm of the ascending aorta is impinging on a large vein lying immediately anterosuperior to it. Which vein is it likely to be?
Your Answer: Right brachiocephalic
Correct Answer: Left brachiocephalic
Explanation:Among the veins listed, only the left brachiocephalic vein is anterosuperior to the ascending aorta. The right brachiocephalic vein being on the right side would not be affected by the aortic aneurysm.
The azygos vein lies deep in the chest on the right side.
The internal thoracic vein lies interior to the anterior wall of the chest.
The left superior intercostal vein is close to the aortic arch, crossing it laterally. This vein drains the 2nd to 4th interspaces on the left side.
The Right internal jugular vein joins the right brachiocephalic vein which would not be affected by the aneurysm.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 89
Incorrect
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A 56-year old male with history of previous abdominal surgery presents to the emergency department with severe abdominal pain that is increasing in intensity. This pain is associated with abdominal distension and faint, high-pitched bowel sounds. An old scar is also noted on the abdomen. An erect abdominal X-ray shows multiple air-fluid levels in dilated bowel loops. No occult blood was found in stool sample. What is the most likely predisposing factor for his present condition?
Your Answer: Meckel’s diverticulum
Correct Answer: Adhesions from previous surgery
Explanation:The described features suggest acute bowel obstruction. The scar described points toward previous surgery, which suggests development of peritoneal adhesions that could lead to obstruction. Hepatitis does not lead to dilated bowel loops. Amoebiasis could lead to inflammatory bowel disease, however, occult blood in stool is usually positive. Ileal adenocarcinoma is rare. Meckel’s diverticulum can possibly lea to obstruction but the findings described here are more consistent with obstruction due to peritoneal adhesions from a past surgery.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 90
Incorrect
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A 13-year-old boy's mother notices he has a lump in his arm, near his right shoulder. An X-ray reveals a lateral projection in the metaphyseal region of his humerus. The lesion is removed and it is found to be composed of bony cortex, capped by cartilage. What's the most likely diagnosis in this case?
Your Answer: Giant-cell tumour
Correct Answer: Osteochondroma
Explanation:Osteochondromas, or osteocartilaginous exostoses, are the most common benign bone tumours, and tend to appear near the ends of long bones. The overgrowth can occur in any bone where cartilage forms bone, and they are capped by cartilage. They are most common in people between the ages of 10-20 years old.
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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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13 year old girl developed sun burnt cheeks after spending the day playing on the beach. What is the underlying mechanism to her injury?
Your Answer: Vasoconstriction
Correct Answer: Free radical injury
Explanation:Free radicals are a by-product of chemical reactions with an unpaired electron in their outer most shell. They are capable of causing wide spread damage to cells. They can cause autolytic reactions thereby converting the reactants into free radicals. By absorbing sun light, the energy is used to hydrolyse water into hydroxyl (OH) and hydrogen (H) free radicals which can cause injury by lipid peroxidation of membranes, oxidative modification of proteins and damage to the DNA structure.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Dermatology
- Pathology
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Question 92
Incorrect
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Which of the following conditions can present with multiple abscesses that may discharge sulphur granules?
Your Answer: Histoplasmosis
Correct Answer: Actinomycosis
Explanation:Actinomycosis is primarily caused by any of the several members of the bacterial genus Actinomyces. These bacteria are generally anaerobes. And can cause multiple abscesses that may discharge sulphur granules.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 93
Incorrect
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Which cells are most commonly seen in a granulomatous lesion that suggests an underlying chronic inflammation?
Your Answer: Neutrophils
Correct Answer: Lymphocytes
Explanation:Lymphocytes and monocytes are commonly and characteristically recognised in a case of chronic inflammation.
Eosinophils and neutrophils are seen with acute inflammation.
Mast cells release histamine in early inflammation.
Basophils are seen with allergies.
Plasma cells are seen with viral infection.
Platelets are not characteristic of any type of inflammation.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 94
Correct
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Routine evaluation of a 38 year old gentleman showed a slightly lower arterial oxygen [pa(O2)] than the alveolar oxygen [pA(O2)]. This difference is:
Your Answer: Is normal and due to shunted blood
Explanation:Blood that bypasses the ventilated parts of lung and enters the arterial circulation directly is known as shunted blood. It happens in normal people due to mixing of arterial blood with bronchial and some myocardial venous blood (which drains into the left heart). Diffusion limitation and reaction velocity with haemoglobin are immeasurably small. CO2 unloading will not affect the difference between alveolar and arterial p(O2). A large VSD will result in much lower arterial O2 as compared to alveolar O2.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 95
Incorrect
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Which of the following is the source of blood supply to the artery of the round ligament at the head of the femur?
Your Answer: Common iliac artery
Correct Answer: Obturator artery
Explanation:The posterior branch of the obturator artery provides an articular branch to the head of the femur.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 96
Incorrect
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The circle of Willis is one of the cerebrovascular safeguards comprised of the left and the right posterior communicating artery. Which of the following arteries in the brain is connected to the posterior cerebral artery by these posterior communicating arteries?
Your Answer: Anterior cerebral artery
Correct Answer: Internal carotid artery
Explanation:The Circle of Willis is an anastomosis of cerebral arteries that are located at the base of the brain. The Circle of Willis is one of the important safeguards that ensure back up of blood supply to parts of the brain in case of any cerebrovascular accident. The Circle of Willis is made up of an anterior portion of arteries including; the anterior cerebral arteries. The anterior cerebral arteries are connected to the posterior portion of the circle of Willis by the anterior communicating artery. The posterior portion is made up of the posterior cerebral artery which branch off from the basilar artery. The posterior cerebral artery are connected to the anterior portion of the circle of Willis by the posterior communicating artery. The posterior communicating artery connects the posterior cerebral artery to the internal carotid artery. The circle of Willis receives blood supply from the left and right internal carotid arteries that continues as the middle cerebral artery and posteriorly from the two vertebral arteries that join to form the basilar artery.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 97
Incorrect
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An 18 year-old with an iron deficient diet was prescribed an iron supplement by her GP. Lack of iron often results in:
Your Answer: Megaloblastic anaemia
Correct Answer: Hypochromic anaemia
Explanation:Iron deficiency anaemia is the most common type of anaemia. It can occur due to deficiency of iron from decreased intake, increased loss or inadequate absorption. An MCV less than 80 will indicated iron deficiency anaemia. On the smear the RBCs will be microcytic hypochromic and will also show poikilocytosis. Iron profile tests are important to make a diagnosis. Clinically the patient will be pale and lethargic.
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This question is part of the following fields:
- General
- Physiology
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Question 98
Correct
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Driving pressure is considered to be a strong predictor of mortality in patients with ARDS. What is the normal mean intravascular driving pressure for the respiratory circulation?
Your Answer: 10 mmHg
Explanation:Driving pressure is the difference between inflow and outflow pressure. For the pulmonary circulation, this is the difference between pulmonary arterial (pa) and left atrial pressure (pLA). Normally, mean driving pressure is about 10 mmHg, computed by subtracting pLA (5 mmHg) from pA (15 mmHg). This is in contrast to a mean driving pressure of nearly 100 mmHg in the systemic circulation.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 99
Correct
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Which of the following is the most accurate test for the diagnosis of primary syphilis?
Your Answer: Dark-field microscopy
Explanation:Primary syphilis is transmitted via sexual contact. Lesions on genitalia, called a chancre occur after an asymptomatic incubation period of 10-90 days (average 21 days) after exposure. This chancre is a typically solitary (can be multiple), firm, painless, ulceration over the skin at the point of exposure to spirochete, seen on penis, vagina or rectum. It heals spontaneously after 4-6 weeks. Local lymphadenopathy can be seen.
Diagnosis is made by microscopy of fluid from lesion using dark-field illumination, taking care to not confuse with other treponemal disease. Screening tests include rapid plasma regain (RPR) and Venereal Diseases Research Laboratory (VDRL) tests. False positives are known to occur with these tests and can be seen in viral infections like hepatitis, varicella, Epstein-Barr virus, tuberculosis, lymphoma, pregnancy and IV drug use. More specific tests should therefore be carried out in case these screening tests are positive.
The Treponema pallidum hemagglutination assay (TPHA) and the fluorescent treponemal antibody absorption (FTAABS) test are based on monoclonal antibodies and immunofluorescence and are more specific. However, they can too show false positives with other treponemal diseases like yaws or pinta. Other confirmatory tests include those based on enzyme-linked immunoassays.
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This question is part of the following fields:
- Pathology
- Urology
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Question 100
Incorrect
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Skeletal muscle fibres are divided into two basic types, type I (slow-twitch fibres) and type II (fast-twitch fibres). Fast muscle fibres do which of the following:
Your Answer:
Correct Answer: Use anaerobic metabolism
Explanation:Skeletal muscles are divided into two types:
1) type I also known as the slow twitch fibres. They use oxygen for their metabolism and as a result they have a high endurance potential. To support this they have abundant mitochondria and myoglobin, so they appear red/dark.
2) type II fibres also called fast twitch fibres, are low endurance fibres used during anaerobic metabolism. They are required for short bursts of strength and cannot sustain contractions for long periods of time.
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This question is part of the following fields:
- General
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
