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Question 1
Correct
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Which of these HLA alleles is most likely to be present in ankylosing spondylitis?
Your Answer: HLA-B27
Explanation:Ankylosing spondylitis usually appears between the ages of 20-40 years old and is more frequent in men. It is strongly associated with HLA-B27, along with other spondyloarthropathies, which can be remembered through the mnemonic PAIR (Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, and Reactive arthritis).
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 2
Incorrect
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Which of the following over-the-counter drugs can cause a prolonged bleeding time?
Your Answer: Acetaminophen
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 3
Correct
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A 38-year old woman presents to the clinic with a 2 cm eczema-like lesion on the areolar region of her left breast, for 5 months. Biopsy of the lesion showed large cells at the dermal-epidermal junction with positive staining for mucin. What is the likely diagnosis?
Your Answer: Paget’s disease of the breast
Explanation:Paget’s disease of the breast or nipple resembles eczema in appearance with an underlying carcinoma typically. The disease is usually unilateral and presents with inflammation, oozing and crusting along with a non-healing ulcer. Treatment is often delayed due to the innocuous appearance but can be fatal. It results due to spread of neoplastic cells from the ducts of the mammary gland to the epithelium.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 4
Correct
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The LEAST mobile structure in the peritoneal cavity is the:
Your Answer: Pancreas
Explanation:The presence or absence of the mesentery determines mobility of abdominal contents. Structures like the stomach, transverse colon and appendix have mesenteries and thus are relatively mobile. In contrast, the pancreas is a retroperitoneal (behind the peritoneum) structure and therefore is fixed. The greater omentum is a large mobile fold of omentum that hangs down from 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 performing a Whipple's procedure, that involves mobilizing the head of the pancreases, accidentally injured a structure immediately posterior to the neck of the pancrease which bled out. Which structure is most likely to have been injured?
Your Answer: Superior mesenteric artery
Explanation:The structure immediately posterior to the neck of the pancreas is the superior mesenteric vein. The neck of the pancreas lies anterior to the superior mesenteric vein, which joins with the splenic vein to form the portal vein.
The superior mesenteric artery (SMA) is also located in proximity to the neck of the pancreas. Specifically, the SMA emerges from the abdominal aorta just below the level of the pancreas and passes posterior to the neck of the pancreas before it descends into the mesentery to supply the intestines. Thus, both the superior mesenteric vein and the superior mesenteric artery are key vascular structures related to the posterior aspect of the neck of the pancreas.
Bleeding out would suggest an arterial injury.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 6
Correct
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A 77-year-old woman's renal function is tested. The following results were obtained during a 24-h period:
Urine flow rate: 2. 0 ml/min
Urine inulin: 0.5 mg/ml
Plasma inulin: 0.02 mg/ml
Urine urea: 220 mmol/l
Plasma urea: 5 mmol/l.
What is the urea clearance?Your Answer: 88 ml/min
Explanation:Urea is reabsorbed in the inner medullary collecting ducts of the nephrons. 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. So, glomerular filtration rate = (0.220 × 2. 0)/0.005 = 88 ml/min.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 7
Incorrect
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Which nerve lies immediately medial to the psoas major muscle?
Your Answer: Ilioinguinal
Correct Answer: Obturator
Explanation:The obturator nerve is formed from the ventral divisions of the 2nd, 3rd and 4th lumbar nerves. It courses through the fibres of the psoas major and emerges from the medial border near the pelvic brim.
The iliohypogastric nerve comes from the first lumbar nerve and emerges from the upper part of the lateral border of psoas major.
The ilioinguinal nerve arises with the iliohypogastric nerve from the first lumbar nerve and also emerges from the lateral border of the psoas major muscle.
The lateral femoral cutaneous nerve comes from the posterior division of the 2nd and 3rd lumbar nerves to emerge from the lateral border of the psoas major muscle near its middle.
The femoral nerve also arises from the dorsal divisions, but of the 2nd, 3rd and 4th lumbar nerves and courses through the muscle fibres to emerge at the lower part of the lateral border.
The coccygeal nerve doesn’t arise from the lumbar plexus but from the sacral plexus.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 8
Correct
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A 40 year old man sustained a fracture to the surgical neck of his left humerus. Which of the following arteries is suspected to be injured in this case?
Your Answer: Posterior humeral circumflex
Explanation:The posterior humeral circumflex artery arises from the axillary artery and runs with the axillary nerve through the quadrangular space which is bounded laterally by the surgical neck of the humerus. After winding around the surgical neck of the humerus, it is distributed to the deltoid muscle and the shoulder joint. Thus fractures in the surgical neck of the humerus could result in an injury to this artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 9
Incorrect
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From which source does the lingual artery originate?
Your Answer: Sphenopalatine
Correct Answer: External carotid
Explanation:The lingual artery arises from the external carotid between the superior thyroid artery and facial artery. It can be located easily on the lower surface of the tongue. The terminal branch of the lingual artery is the deep lingual artery. On its course the lingual artery gives off side branches: dorsal lingual branches that supply the dorsum of the tongue till the epiglottis; sublingual artery that supplies the sublingual gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 10
Correct
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Difficulty in retracting the foreskin of the penis in an uncircumcised male is known as:
Your Answer: Phimosis
Explanation:Phimosis is the inability to fully retract the foreskin of the penis in an uncircumcised male. It can be physiological in infancy, in which it could be referred to as ‘developmental non-retractility of the foreskin. However, it is almost always pathological in older children and men. Causes include chronic inflammation (e.g. balanoposthitis), multiple catheterisations, or forceful foreskin retraction. One of the causes is chronic balanitis xerotica obliterans. It leads to development of a ring of indurated tissue near the tip of the prepuce, which prevents retraction. Contributory factors include infections, hormonal and inflammatory factors. The recommended treatment includes circumcision.
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This question is part of the following fields:
- Pathology
- Urology
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Question 11
Correct
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Langhans giant cells are characteristically seen in which type of inflammation?
Your Answer: Granulomatous inflammation
Explanation:Langhans giant cells are characteristically seen in granulomatous inflammation. They form when epithelioid cells fuse together. They usually contain a nuclei with a horseshoe-shaped pattern in the periphery of the cell.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 12
Incorrect
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A young male was diagnosed with hepatitis A, which clinically resolved in 2 weeks. What will his liver biopsy done after 6 months show?
Your Answer: Lobular fibrosis
Correct Answer: Normal architecture
Explanation:Hepatitis A is the most common acute viral hepatitis, more common in children and young adults. It is caused by Hepatitis A virus, which is a single-stranded RNA picornavirus. The primary route of spread of Hepatitis A is the faecal-oral route. Consumption of contaminated raw shellfish is also a likely causative factor. The shedding of the virus in faecal matter occurs before the onset of symptoms and continues a few days after. Hepatitis A does not lead to chronic hepatitis or cirrhosis, and there is no known chronic carrier state. Hence, a biopsy performed after recovery will show normal hepatocellular architecture.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 13
Incorrect
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Which of the following foramina will the ophthalmic artery pass through in order to reach the eye?
Your Answer: Superior orbital fissure
Correct Answer: Optic canal
Explanation:The optic foramen is the opening to the optic canal. The canal is located in the sphenoid bone; it is bounded medially by the body of the sphenoid and laterally by the lesser wing of the sphenoid. The superior surface of the sphenoid bone is bounded behind by a ridge, which forms the anterior border of a narrow, transverse groove, the chiasmatic groove (optic groove). The groove ends on either side in the optic foramen, which transmits the optic nerve and ophthalmic artery into the orbital cavity. Compared to the optic nerve, the ophthalmic artery is located inferolaterally within the canal.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 14
Correct
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When you rest your elbows on a desk, what bony landmark of the upper limb are you resting on?
Your Answer: Olecranon process of the ulna
Explanation:At the upper and back part of the ulna, there exists a curved eminence which is the olecranon process. This process lodges in the olecranon fossa of the humerus. It’s posterior surface is subcutaneous and this triangular area is what you rest your elbow upon.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 15
Correct
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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 16
Correct
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A 45-year-old pregnant woman develops high blood pressure at 20 weeks. She complains of headaches and swollen feet, and a test reveals proteinuria (350 mg/day). Which of the following is the most likely diagnosis?
Your Answer: Pre-eclampsia
Explanation:Pre-eclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure (two separate readings taken at least 6 h apart of 140/90 or more) and often a significant amount of protein in the urine (>300 mg of protein in a 24-h urine sample). While blood pressure elevation is the most visible sign of the disease, it involves generalised damage to the maternal endothelium of the kidneys and liver, with the release of vasopressive factors only secondary to the original damage. Pre-eclampsia may develop at varying times within pregnancy and its progress differs among patients; most cases present pre-term. It has no known cure apart from ending the pregnancy (induction of labour or abortion). It may also present up to 6 weeks post partum. Risk factors for pre-eclampsia include obesity, prior hypertension, older age, and diabetes mellitus.
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This question is part of the following fields:
- Physiology
- Renal
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Question 17
Incorrect
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During clinic, a medical student conducts a physical examination on a teenage boy with a lump in the inguinal region. The lump is protruding from the superficial inguinal ring. The student correctly concluded that it was:
Your Answer: Definitely a direct inguinal hernia
Correct Answer: Either a direct or an indirect inguinal hernia
Explanation:It is not possible to tell if an inguinal hernia is direct or indirect just by palpating it. Despite the fact that indirect inguinal hernias commonly come out of the superficial inguinal ring to enter the scrotum, direct inguinal hernia might still do this.
Femoral hernia goes through the femoral ring into the femoral canal (has nothing to do with the superficial inguinal ring).
Superficial inguinal lymph nodes lie in the superficial fascia parallel to the inguinal ligament; it would therefore feel more superficial and would not be mistaken for a hernia protruding through the inguinal ring.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 18
Incorrect
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A 36-year old gentleman with a history of cough for 4 weeks came to the hospital. Examination revealed multiple lymphadenopathy with splenomegaly. Investigations revealed haemoglobin 11 g/dl, haematocrit 32.4%, mean corpuscular volume (MCV) 93 fl, white blood cell count 63 × 109/l, and platelet count 39 × 109/l; along with characteristic Auer rods on peripheral blood smear. What is the likely diagnosis?
Your Answer: Acute lymphoblastic leukaemia (ALL)
Correct Answer: Acute myelogenous leukaemia (AML)
Explanation:AML, or acute myeloid leukaemia is the commonest acute leukaemia affecting adults. increasing in incidence with age. It is a malignancy of the myeloid line of white blood cells. It results in rapid proliferation of abnormal cells, which accumulate in the marrow. Interference with normal cell production leads to a drop in red blood cells, white blood cells and platelets. This causes symptoms such as tiredness, shortness of breath, tendency to bleed or bruise easily and recurrent infections. AML is known to progress quickly and can lead to death in weeks and months if not treated. Leukemic blasts of AML show presence of Auer rods. These are clumps of azurophilic granular material that form needles in the cytoplasm. Composed of fused lysosomes, these contain peroxidase, lysosomal enzymes and crystalline inclusions. Auer rods are classically present in myeloid blasts of M1, M2, M3 and M4 acute leukaemia. They also help to distinguish the preleukemia myelodysplastic syndromes.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 19
Incorrect
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Regarding the long head of the biceps femoris, which of the following is correct?
Your Answer: It arises from the same point as the gracilis muscle
Correct Answer: It crosses two joints
Explanation:The long head of the biceps femoris arises from the lower and inner impression on the back of the tuberosity of the ischium. It inserts with the short head in an aponeurosis which becomes a tendon and this tendon is inserted into the lateral side of the head of the fibula and the lateral condyle of the tibia, thus crossing two joints.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 20
Incorrect
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Which muscles are attached to the tibial tuberosity?
Your Answer: Adductor brevis
Correct Answer: Vastus intermedius
Explanation:The tuberosity of the tibia is the site of attachment to the ligamentum patella (the tendon of the quadriceps femoris muscle which include four heads: rectus femoris, vastus medialis, intermedius and lateralis).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 21
Incorrect
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A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect:
Your Answer: Vision
Correct Answer: Regulation of circadian rhythm
Explanation:The suprachiasmatic nucleus (SCN) in the hypothalamus is responsible for controlling endogenous circadian rhythms and destruction of the SCN leads to a loss of circadian rhythm.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 22
Correct
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Which of the following is a large artery that runs immediately posterior to the stomach?
Your Answer: Splenic
Explanation:The splenic artery is the large artery that would be found running off the posterior wall of the stomach. It is a branch of the coeliac trunk and sends off branches to the pancreas before reaching the spleen. The gastroduodenal artery on the other hand is found inferior to the stomach, posterior to the first portion of the duodenum. The left gastroepiploic artery runs from the left to the right of the greater curvature of the stomach. The common hepatic artery runs on the superior aspect of the lesser curvature of the stomach, and is a branch of the coeliac trunk. The superior mesenteric artery arises from the abdominal aorta just below the junction of the coeliac trunk.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 23
Correct
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Which is the correct superficial to deep order of structures that would be affected following a knife wound to the lateral aspect of the knee?
Your Answer: skin, fibular collateral ligament, popliteus muscle tendon, lateral meniscus
Explanation:Skin, fibular collateral ligament, popliteus muscle tendon and lateral meniscus is the correct order of structures covering the lateral aspect of the knee joint from a superficial to deep.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 24
Incorrect
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A patient with this condition has extracellular fluid volume expansion:
Your Answer: Burns
Correct Answer: Nephrotic syndrome
Explanation:Nephrotic syndrome is a syndrome comprising of signs of nephrosis, including proteinuria, hypoalbuminemia, and oedema. It is a component of glomerulonephritis, in which different degrees of proteinuria occur. Essentially, loss of protein through the kidneys leads to low protein levels in the blood , which causes water to be drawn into soft tissues (oedema). Severe hypoalbuminemia can also cause a variety of secondary problems, such as water in the abdominal cavity (ascites), around the heart or lung (pericardial effusion, pleural effusion), high cholesterol, loss of molecules regulating coagulation (hence increased risk of thrombosis). The most common sign is excess fluid in the body due to the serum hypoalbuminemia. Lower serum oncotic pressure causes fluid to accumulate in the interstitial tissues. Sodium and water retention aggravates the oedema.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 25
Correct
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A 55-year old gentleman presented to the doctor with worsening dysphagia for both solids and liquids over 6 months. This was associated with regurgitation of undigested food and occasional chest pain. Barium swallow revealed distal oesophageal dilatation with lack of peristalsis in the distal two-third oesophagus. The likely diagnosis is:
Your Answer: Achalasia
Explanation:Achalasia is an oesophageal motility disorder where inappropriate contractions in the oesophagus lead to reduced peristalsis and failure of the lower oesophageal sphincter to relax properly in response to swallowing. Classical triad of symptoms include dysphagia to fluids followed by solids, chest pain and regurgitation of undigested food. Other symptoms include belching, hiccups, weight loss and cough. Diagnosis is by:
– X-ray with a barium swallow or oesophagography : narrowing at the gastroesophageal junction (‘bird/parrot beak’ or ‘rat tail’ appearance) and various degrees of mega-oesophagus (oesophageal dilatation) as the oesophagus is gradually stretched by retained food. Effectiveness of treatment can be measured with a 5-minute timed barium swallow.
– Manometry – probe measures the pressure waves in different parts of oesophagus and stomach while swallowing.
– Endoscopy
– CT scan to exclude other causes like malignancy
– Pathological examination showing defect in the nerves which control oesophageal motility (myenteric plexus).
In Chagas disease, there is destruction of ganglion cells by Trypanosoma cruzi.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 26
Correct
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A young man came to the emergency room after an accident. The anterior surface of his wrist was lacerated with loss of sensation over the thumb side of his palm. Which nerves have been damaged?
Your Answer: Median
Explanation:The median nerve provides cutaneous innervation to the skin of the palmar radial three and a half fingers. Also the site of injury indicates that the medial nerve may have been injured as it passes into the hand by crossing over the anterior wrist.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 27
Incorrect
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A 31 -year-old female patient had a blood gas done on presentation to the emergency department. She was found to have a metabolic acidosis and decreased anion gap. The most likely cause of these findings in this patient would be?
Your Answer: Lactic acidosis
Correct Answer: Hypoalbuminemia
Explanation:A low anion gap might be caused by alterations in serum protein levels, primarily albumin (hypoalbuminemia), increased levels of calcium (hypercalcaemia) and magnesium (hypermagnesemia) or bromide and lithium intoxication. However, the commonest cause is hypoalbuminemia, thus if the albumin concentration falls, the anion gap will also be lower. The anion gap should be corrected upwards by 2.5 mmol/l for every 10g/l fall in the serum albumin.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 28
Incorrect
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A 38 year-old man falls on an outstretched hand. X-rays indicate an anterior dislocation of one of the carpal bones. Which carpal bone is most commonly dislocated?
Your Answer: Scaphoid
Correct Answer: Lunate
Explanation:The scaphoid bone is the most commonly fractured carpal bone and has an increased risk of avascular necrosis.
The lunate is the most commonly dislocated carpal bone. The displaced bone may compress the median nerve in the carpal tunnel.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 29
Incorrect
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Which one of the following groups of lymph nodes is most likely to be inflamed due to paronychia involving the big toe?
Your Answer: Deep inguinal lymph nodes
Correct Answer: Vertical group of superficial inguinal lymph nodes
Explanation:Paronychia affecting the big toe will result in inflammation of the superficial inguinal lymph nodes as it drains lymph from the big toe.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 30
Correct
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The following branch of the aorta is unpaired:
Your Answer: Coeliac artery
Explanation:Branches that stem from the abdominal aorta can be divided into three: the visceral branches, parietal branches and terminal branches. Of the visceral branches, the suprarenal, renal, testicular and ovarian arteries are paired while the coeliac artery and superior and inferior mesenteric arteries are unpaired. Of the parietal branches the inferior phrenic and lumbar arteries are paired while the middle sacral artery is unpaired. The terminal branches i.e. the common iliac arteries are paired.
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This question is part of the following fields:
- Abdomen
- Anatomy
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SESSION STATS - PERFORMANCE PER SPECIALTY
