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Question 1
Correct
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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 2
Correct
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Which of the following is a landmark to identify the site of the 2nd costal cartilage?
Your Answer: Sternal angle
Explanation:The sternal angle is an important part where the second costal cartilage attaches to the sternum. Finding the sternal angle will help in finding the second costal cartilage and intercostal space.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 3
Correct
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In multiple myeloma, which of these cell types confirms the diagnosis when found in a smear of bone marrow aspirate?
Your Answer: Plasma cells
Explanation:A bone marrow aspiration is the diagnostic test for multiple myeloma, which is a malignant bone tumour that usually affects older adults. The smear reveals clusters of plasma cells, while X-rays tend to show circumscribed lytic lesions or diffuse demineralisation.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 4
Correct
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A 75-year old patient is in atrial fibrallation but has never been on anticoagulation therapy. To reduce the risk of future emboli, she would benefit from starting on long-term warfarin. Arterial emboli leading to acute limb ischaemia most commonly lodge at which one of the following sites?
Your Answer: Common femoral artery
Explanation:The common femoral artery is the commonest site of arterial emboli causing acute limb ischemia. The treatment of choice is urgent femoral embolectomy.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 5
Incorrect
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Pseudomonas aeruginosa is a multidrug resistant pathogen that causes hospital-acquired infections. It is usually treated with piperacillin or another antibiotic. Which of the following is the other antibiotic?
Your Answer: Ciprofloxacin
Correct Answer: Azlocillin
Explanation:Azlocillin, like piperacillin, is an acylampicillin antibiotic with an extended spectrum of activity and greater in vitro potency than the carboxypenicillins. Azlocillin is similar to mezlocillin and piperacillin. It demonstrates antibacterial activity against a broad spectrum of bacteria, including Pseudomonas aeruginosa.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 6
Correct
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A 48-year-old woman has a mass in her right breast and has right axillary node involvement. She underwent radical mastectomy of her right breast. The histopathology report described the tumour to be 4 cm in its maximum diameter with 3 axillary lymph nodes with evidence of tumour. The most likely stage of cancer in this patient is:
Your Answer: IIB
Explanation:Stage IIB describes invasive breast cancer in which: the tumour is larger than 2 centimetres but no larger than 5 centimetres; small groups of breast cancer cells — larger than 0.2 millimetre but not larger than 2 millimetres — are found in the lymph nodes OR the tumour is larger than 2 centimetres but no larger than 5 centimetres; cancer has spread to 1 to 3 axillary lymph nodes or to lymph nodes near the breastbone (found during a sentinel node biopsy) OR the tumour is larger than 5 centimetres but has not spread to the axillary lymph nodes.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 7
Correct
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Inside the palatoglossal arch is a muscle. Which nerve innervates this muscle?
Your Answer: X
Explanation:The palatoglossal arch contains the palatoglossal muscle which is innervated by the vagus nerve which is the tenth cranial nerve. So the correct answer is X
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 8
Correct
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Which muscle is most likely to be affected following an injury to the thoracodorsal nerve (C6-C8)?
Your 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 9
Correct
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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: 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 10
Incorrect
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Which of the following nerves has its terminal branch at the supratrochlear nerve?
Your Answer: Maxillary
Correct Answer: Frontal
Explanation:The supratrochlear nerve is a branch of the frontal nerve which comes from the ophthalmic division of cranial nerve V (trigeminal nerve). It passes above the superior oblique nerve and its descending filaments join the infratrochlear branch of the nasociliary nerve. From the orbit, it exits between the supraorbital foramen and the pulley of the superior oblique. It then curves up to the forehead beneath the corrugator supercilli and frontalis muscle. It further divides into branches that supply sensory innervation to the bridge of the nose, medial part of the upper eyelid and medial forehead.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 11
Correct
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A 45-year-old woman was brought to the emergency department due to fever and chills. She has a history of recurrent UTI and complains of dysuria and urinary frequency. Urinary white blood cell count is >200 cell/high power field. If urine culture is performed, what is the most likely organism that will grow?
Your Answer: Escherichia coli
Explanation:The pathogen that most likely causes recurrent urinary tract infection in young women are E. coli, Enterococcus and Staphylococcus saprophyticus.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 12
Correct
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Carbachol is a cholinergic agonist. In which of these cases should carbachol be administered?
Your Answer: Cataract surgery
Explanation:Carbachol (carbamylcholine) is a cholinergic agent, a choline ester and a positively charged quaternary ammonium compound. It is primarily used for various ophthalmic purposes, such as for treating glaucoma, or for use during ophthalmic surgery. It is usually administered topically to the eye or through intraocular injection. It is not well absorbed in the gastro-intestinal tract and does not cross the blood–brain barrier.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 13
Incorrect
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Which of the following has the highest content of triglycerides?
Your Answer: LDL
Correct Answer: Chylomicron
Explanation:Created by the small intestinal cells, chylomicrons are large lipoprotein molecules which transport lipids to the liver, adipose, cardiac and skeletal tissue. Chylomicrons are mainly composed of triglycerides (,85%) along with some cholesterol and cholesteryl esters. Apo B-48 is the main apolipoprotein content.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 14
Correct
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What intrinsic muscle of the larynx is responsible for the tensing of the vocal cords?
Your Answer: Cricothyroid muscle
Explanation:The cricothyroid muscle is the only tensor muscle of the larynx aiding with phonation. It attaches to the anterolateral aspect of the cricoid and the inferior cornu and lower lamina of the thyroid cartilage. Its action tilts the thyroid forward to help tense the vocal cords.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 15
Correct
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A 34-year-old Asian male presents with cervical lymphadenopathy. The patient is suspected to have tuberculous lymphadenopathy. Excision biopsy of one of the nodes showed granulomatous inflammation. Which histopathologic feature is most likely consistent with the diagnosis of tuberculosis?
Your Answer: Caseation necrosis
Explanation:The granulomas of tuberculosis tend to contain necrosis (caseating tubercles), but non-necrotizing granulomas may also be present. Multinucleated giant cells with nuclei arranged like a horseshoe (Langhans giant cells) and foreign body giant cells are often present, but are not specific for tuberculosis. A definitive diagnosis of tuberculosis requires identification of the causative organism by microbiological cultures.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 16
Correct
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An 26-year-old man sought admission due to persistent non-bloody diarrhoea. The patient is HIV-positive. Examination of stool sample showed numerous acid-fast cysts. Which of the following organism is the most likely cause of diarrhoea?
Your Answer: Cryptosporidium parvum
Explanation:Cryptosporidium parvum is one of several species that causes cryptosporidiosis, a parasitic disease of the mammalian intestinal tract. Primary symptoms of C. parvum infection are acute, watery, and non-bloody diarrhoea. C. parvum infection is of particular concern in immunocompromised patients, where diarrhoea can reach 10–15 l per day.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 17
Correct
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The chest X-ray of a 72 year old patient reveals the presence of a round lesion containing an air-fluid level in the left lung. These findings are most probably suggestive of:
Your Answer: Lung abscess
Explanation:Lung abscesses are collections of pus within the lung that arise most commonly as a complication of aspiration pneumonia caused by oral anaerobes. Older patients are more at risk due to poor oral hygiene, gingivitis an inability to handle their oral secretions due to other diseases. Chest X-ray most commonly reveals the appearance of an irregularly shaped cavity with an air-fluid level.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 18
Incorrect
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During a street fight a boy sustained a laceration below the elbow. It was a deep cut that led to profuse bleeding from an artery situated on the supinator muscle immediately below the elbow. The vessel most likely to have been injured is?
Your Answer: Common interosseous artery
Correct Answer: Radial recurrent artery
Explanation:The radial recurrent artery is situated on the supinator muscle then passing between the brachialis and the brachioradialis muscles. It originates from the radial artery and ends by anastomosing with the terminal part of the Profunda brachii.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
Incorrect
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The anatomical dead space in a patient with low oxygen saturation, is 125 ml, with a tidal volume of 500 ml and pa(CO2) of 40 mm Hg. The dead space was determined by Fowler's method. If we assume that the patient's lungs are healthy, what will his mixed expired CO2 tension [pE(CO2)] be?
Your Answer: 60 mmHg
Correct Answer: 30 mmHg
Explanation:According to Bohr’s equation, VD/VT = (pA(CO2) − pE(CO2))/pA(CO2), where pE(CO2) is mixed expired CO2 and pA(CO2) is alveolar CO2pressure. Normally, the pa(CO2) is virtually identical to pA(CO2). Thus, VD/VT = (pa(CO2)) − pE(CO2)/pa(CO2). By Fowler’s method, VD/VT= 0.25. In the given problem, (pa(CO2) − pE(CO2)/pa(CO2) = (40 − pE(CO2)/40 = 0.25. Thus, pE(CO2) = 30 mmHg. If there is a great perfusion/ventilation inequality, pE(CO2) could be significantly lower than 30 mm Hg, and the patient’s physiological dead space would exceed the anatomical dead space.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 20
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 21
Incorrect
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Which of the following is likely to induce secretion of glucagon?
Your Answer: High serum concentration of glucose
Correct Answer: Low serum concentration of glucose
Explanation:The most potent stimulus for secretion of glucagon is hypoglycaemia whereas hyperglycaemia is a stimulus for insulin release. Glucagon secretion also occurs in response to high levels of amino acids. Somatostatin inhibits glucagon secretion. Parasympathetic stimulation increases pancreatic acinar secretion, but not of α-cells.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 22
Incorrect
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A 54-year-old woman with amyotrophic lateral sclerosis is diagnosed with respiratory acidosis. The patient’s renal excretion of potassium would be expected to:
Your Answer: Stay the same
Correct Answer: Fall, since tubular secretion of potassium is inversely coupled to acid secretion
Explanation:Respiratory acidosis is a medical emergency in which decreased ventilation (hypoventilation) increases the concentration of carbon dioxide in the blood and decreases the blood’s pH (a condition generally called acidosis). Secretion of acid and potassium by the renal tubule are inversely related. So, increased excretion of H+ during renal compensation for respiratory acidosis will result in decreased secretion (or increased retention) of potassium ions, with the result that the body’s potassium store rises. An increase in K+ excretion would be associated with renal compensation for respiratory alkalosis. The filtered load of K+depends only on K+ plasma concentration and glomerular filtration rate, not on plasma pH.
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This question is part of the following fields:
- Physiology
- Renal
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Question 23
Correct
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Which of the following is NOT a Gram-negative rod?
Your Answer: Clostridium tetani
Explanation:Gram-positive rods include Clostridia, Listeria and diphtheroids.
Gram-negative rods include Escherichia coli, Klebsiella, Yersinia, Haemohilus, Pseudomonas, Shigella, Legionella, proteus and Salmonella
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 24
Correct
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A histology report of a cervical biopsy taken from a patient with tuberculosis revealed the presence of epithelioid cells. What are these cells formed from?
Your Answer: Macrophages
Explanation:Granulomas formed in tuberculosis are called tubercles and are made up polynuclear phagocytes, Langhans cells and epithelioid cells. Macrophages when enlarged, consist of abundant cytoplasm and have a tendency of arranging themselves very closely to each other representing epithelial cells. These enlarged macrophages are therefore termed as epithelioid cells.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 25
Correct
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In what form are fats primarily transported in the body?
Your Answer: Free fatty acids
Explanation:Fat is mainly transported in the body as free fatty acids. Once out of the adipose cell, the free fatty acids get ionized and combine with albumin.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 26
Correct
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A 14-year old girl presented with a 2cm, mobile, cystic mass in the midline of her neck. Fine needle aspiration of the mass revealed clear fluid. This is most likely a case of:
Your Answer: Thyroglossal duct cyst
Explanation:Thyroglossal cyst is the most common congenital thyroid anomaly which is clinically significant and affects women more than men. It is a vestigial remnant of developing thyroid. Although the thyroglossal cyst can develop anywhere along the thyroglossal duct, the most common site is in the midline between the isthmus of thyroid and hyoid bone, or just above the hyoid. Thyroglossal cysts are also associated with ectopic thyroid tissue. Clinically, the cyst moves upward with protrusion of the tongue. Rarely, the persistent duct can become malignant (thyroglossal duct carcinoma) where the cancerous cells arise in the ectopic thyroid tissue that are deposited along the duct. Exposure to radiation is a predisposing factor.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 27
Correct
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A textbook of cardiac surgery explains that while doing a left pneumonectomy, a surgeon must be careful to avoid injury to a vital structure that leaves an impression on the mediastinal surface of the left lung. Which structure is it referring to?
Your Answer: Aortic arch
Explanation:Structures that leave an impression on the mediastinal surface of the left lung include: the oesophagus, subclavian artery, brachiocephalic vein, first rib, thymus, the heart, the diaphragm, descending aorta and arch of the aorta. The other structures form an impression on the mediastinal aspect of the right lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 28
Correct
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A 45-year old male patient with a long history of alcoholism developed liver cirrhosis that has led to portal hypertension. Which of the following plexuses of veins is most likely dilated in this patient?
Your Answer: Haemorrhoidal plexus
Explanation:The haemorrhoidal plexus or also known as the rectal plexus is a venous plexus that surrounds the rectum. This venous plexus in males communicates anteriorly with the vesical plexus and uterovaginal plexus in females. This venous plexus forms a site of free communication between the portal and systemic venous systems. In the case of portal hypertension this plexus would most likely dilate due to the increased pressure.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 29
Correct
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At which cervical level does the common carotid artery bifurcate into the internal and external carotid arteries?
Your Answer: C4
Explanation:The common carotid arteries are present on the left and right sides of the body. These arteries originate from different sources, but follow symmetrical courses. The right common carotid originates in the neck from the brachiocephalic trunk; the left from the aortic arch in the thorax. These split into the external and internal carotid arteries at the upper border of the thyroid cartilage, at around the level of the fourth cervical vertebra.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 30
Correct
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Arterial blood gas analysis of a man admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD) showed the following: pH = 7.28, p(CO2) = 65.5 mmHg, p(O2)= 60 mmHg and standard bicarbonate = 30.5 mmol/l. This patient had:
Your Answer: Respiratory acidosis
Explanation:Acidosis with high p(CO2) and normal standard bicarbonate indicates respiratory acidosis, commonly seen in acute worsening of COPD patients. Respiratory acidosis occurs due to alveolar hypoventilation which leads to increased arterial carbon dioxide concentration (p(CO2)). This in turn decreases the HCO3 –/p(CO2) and decreases pH. In acute respiratory acidosis, the p(CO2) is raised above the upper limit of normal (over 45 mm Hg) with a low pH. However, in chronic cases, the raised p(CO2) is accompanied with a normal or near-normal pH due to renal compensation and an increased serum bicarbonate (HCO3 – > 30 mmHg).
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 31
Correct
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A 78-year-old man who has been bedridden for a month is prescribed griseofulvin. What class of drugs does griseofulvin belong to?
Your Answer: Antifungal
Explanation:Griseofulvin is an antifungal drug. It is administered orally, and it is used to treat ringworm infections of the skin and nails. It binds to keratin in keratin precursor cells and makes them resistant to fungal infections. Griseofulvin works by interfering with fungal mitosis.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 32
Incorrect
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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: Radial 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 33
Correct
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Where does the ejaculatory duct open into?
Your Answer: Prostatic urethra
Explanation:There are two ejaculatory ducts, one on either side of the midline. Each ejaculatory duct is formed by the union of the duct from the seminal vesicles with the ductus deferens. They start at the base of the prostate and run forward and downward between the middle and lateral lobes and along the side of the prostatic utricle to end in the prostatic urethra.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 34
Correct
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The Henderson–Hasselbalch equation describes the derivation of pH as a measure of acidity. According to this equation, the buffering capacity of the system is at maximum when the number of free anions compared with undissociated acid is:
Your Answer: Equal
Explanation:In 1908, Lawrence Joseph Henderson wrote an equation describing the use of carbonic acid as a buffer solution. Later, Karl Albert Hasselbalch re-expressed that formula in logarithmic terms, resulting in the Henderson–Hasselbalch equation. The equation is also useful for estimating the pH of a buffer solution and finding the equilibrium pH in acid–base reactions. Two equivalent forms of the equation are: pH = pKa + log10 [A–]/[HA] or pH = pKa + log10 [base]/[acid]. Here, pKa is − log10(Ka) where Ka is the acid dissociation constant, that is: pKa = –log10(Ka) = –log10 ([H3 O+][A–]/[HA]) for the reaction: HA + H2 O ≈ A– + H3 O+ In these equations, A– denotes the ionic form of the relevant acid. Bracketed quantities such as [base] and [acid] denote the molar concentration of the quantity enclosed. Maximum buffering capacity is found when pH = pKa or when the number of free anions to undissociated acid is equal and buffer range is considered to be at a pH = pKa ± 1.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 35
Correct
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A space defined by the teres major muscle, the teres minor muscle, long head of the triceps brachii muscle and surgical neck of the humerus contains the axillary nerve and the?
Your Answer: Posterior circumflex humeral artery
Explanation:This quadrangular space transmits the posterior circumflex humeral vessels and the axillary nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 36
Correct
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what is the cause of a prolonged PT(prothrombin time)?
Your Answer: Liver disease
Explanation:PT measure the intrinsic pathway of coagulation. It determines the measure of the warfarin dose regime, liver disease and vit K deficiency status along with the clotting tendency of blood. PT measured factors are II,V,VII,X and fibrinogen. It is used along with aPTT which measure the intrinsic pathway.
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This question is part of the following fields:
- General
- Physiology
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Question 37
Correct
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In a study, breast lumps were analysed to determine the characteristic of malignant neoplasm on biopsy. What microscopic findings are suggestive of malignancy?
Your Answer: Invasion
Explanation:Invasion is suggestive of malignancy and an even better option would have been metastasis. Pleomorphism is found in both benign and malignant neoplasms along with atypia and anaplasia. A height nuclear/cytoplasmic ratio is suggestive of malignancy but not the best indicator. Malignant tumours are aggressive and growth rapidly. Necrosis can be seen in benign tumours if they deplete their blood supply.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 38
Correct
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The passage of leukocytes through the wall of the blood vessels is best described by which of the following terms?
Your Answer: Diapedesis
Explanation:The steps involved in leukocyte arrival and function are:
1. margination: cells migrate from the centre to the periphery of the vessel
2. rolling: selectins are upregulated on the vessel walls
3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes, interaction of these results in adhesion
4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product
5. phagocytosis: engulfing the offending substance/cell.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 39
Correct
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The following structures DO NOT lie between the layers of the mesosalpinx except for the?
Your Answer: Fallopian tube
Explanation:Mesosalpinx is the portion of the broad ligament that stretches from the fallopian tube to the ovary and contains the uterine tubes between it’s layers.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 40
Correct
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Question 41
Incorrect
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Regarding the extensor retinaculum of the wrist, which of these is CORRECT?
Your Answer: It contains a compartment for the thenar muscles
Correct Answer: It prevents the tendons of the posterior compartment of the forearm from ‘bowstringing’ when the hand is extended at the wrist
Explanation:This extensor retinaculum, as the name indicates, holds the tendons of the extensors against the dorsal surface of the distal radius and ulna. Therefore, the correct answer is that it prevents bowstringing of the extensor tendons with wrist extension. It forms compartments between it and its bony attachment, and these compartments guide and hold the tendons.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 42
Correct
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A 53 year old women with a history of atrial fibrillation developed an acute abdomen. On laparoscopic examination her bowels appeared to be dusky to red-purple in colour and her mesenteric veins appeared to be patent. Which of the following is most likely to occur in this situation?
Your Answer: Wet gangrene
Explanation:Infarction of the small bowel following a sudden and complete occlusion of the mesenteric artery can involve any portion of the bowel, whether small or a large. The splenic flexure is at most risk for infarction as it is the watershed area between the superior and inferior mesenteric vessels. Regardless of whether the arterial or the venous blood vessels are occluded, because of the blood reflow into the damaged portion, it will appear haemorrhagic. The bowel appearing congested at first and then becoming oedematous. If the artery is occluded then there will be a clear cut demarcation and in venous occlusion the dusky colour fades with the rest of the normal bowel. Wet gangrene is characteristic of ischaemic injury to the gut.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Gastrointestinal
- Pathology
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Question 43
Correct
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Nephrotic syndrome is a condition that causes proteinuria, hypoalbuminemia and oedema. Which of the following is the cause of the oedema in these patients?
Your Answer: Decreased oncotic pressure
Explanation:The glomeruli of the kidneys are the parts that normally filter the blood. They consist of capillaries that are fenestrated and allow fluid, salts and other small solutes to flow through, but normally not proteins. In nephrotic syndrome, the glomeruli become damaged allowing small proteins, such as albumin to pass through the kidneys into urine. Oedema usually occurs due to salt and water retention by the diseased kidneys as well as due to the reduced colloid oncotic pressure (because of reduced albumin in the plasma). Lower serum oncotic pressure causes fluid to accumulate in the interstitial tissues.
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This question is part of the following fields:
- Physiology
- Renal
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Question 44
Correct
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A 40 year old patient with an history of obesity has been diagnosed with meralgia parasthetica. The condition was discovered to be caused by the pinching of the lateral femoral cutaneous nerve. Injuries at what spinal levels usually affect this nerve?
Your Answer: L2, L3
Explanation:The lateral femoral cutaneous nerve of the thigh arises from the dorsal division of the lumbar plexus of the second and the third lumbar nerves (L2 – L3). Spinal injuries at this level are likely to affect the lateral femoral cutaneous nerve. The lateral femoral cutaneous nerve innervates the skin on the lateral aspect of the thigh.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 45
Incorrect
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A 79-year-old has been bedridden for 2 months after suffering from a stroke. She suddenly developed shortness of breath and chest pain, and was diagnosed with a pulmonary embolism. Which of the following is most likely to increase in this case?
Your Answer: Alveolar oxygen saturation
Correct Answer: Ventilation/perfusion ratio
Explanation:Pulmonary embolism (PE) is a blockage of an artery in the lungs by an embolus that has travelled from elsewhere in the body through the bloodstream. The change in cardiopulmonary function is proportional to the extent of the obstruction, which varies with the size and number of emboli obstructing the pulmonary arteries. The resulting physiological changes may include pulmonary hypertension with right ventricular failure and shock, dyspnoea with tachypnoea and hyperventilation, arterial hypoxaemia and pulmonary infarction. Consequent alveolar hyperventilation is manifested by a lowered pa(CO2). After occlusion of the pulmonary artery, areas of the lung are ventilated but not perfused, resulting in wasted ventilation with an increased ventilation/perfusion ratio – the physiological hallmark of PE – contributing to a further hyperventilatory state. The risk of blood clots is increased by cancer, prolonged bed rest, smoking, stroke, certain genetic conditions, oestrogen-based medication, pregnancy, obesity, and post surgery.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 46
Incorrect
-
Which of the following muscles are involved in abduction of the wrist?
Your Answer: Pronator teres and brachioradialis
Correct Answer: Extensor carpi radialis brevis and flexor carpi radialis
Explanation:The muscle of the wrist that cause abduction of the wrist otherwise also know as radial flexion of the wrist are the following:
-Abductor Pollicis Longus
-Flexor Carpi Radialis
-Extensor Carpi Radialis Longus
-Extensor Carpi Radialis Brevis
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 47
Correct
-
The cranial nerves of the brain provide motor and sensory innervation to the structures of the head and neck. Which of the following cranial nerves provide only motor innervation?
Your Answer: Abducens
Explanation:The cranial nerves emerge directly from the brain and the brain stem. They provide sensory, motor or both motor and sensory innervation. Here is a summary of the cranial nerves and their function:
Olfactory – Purely sensory
Optic – Sensory
Oculomotor – Mainly motor
Trochlear – Motor
Trigeminal – Both sensory and motor
Abducens – Mainly motor
Facial – Both sensory and motor
Vestibulocochlear – Mostly sensory
Glossopharyngeal – Both sensory and motor
Vagus – Both sensory and motor
Accessory – Mainly motor
Hypoglossal – Mainly motor
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 48
Incorrect
-
The gastrosplenic ligament also known as the gastrolienal ligament is the structure that connects the greater curvature of the stomach to the hilum of the spleen. Which of the following arteries would most likely be injured if a surgeon accidentally tore this ligament?
Your Answer: Splenic
Correct Answer: Short gastric
Explanation:The short gastric arteries arise from the end of the splenic arteries and form five to seven branches. The short gastric arteries inside the gastrosplenic ligament from the left to the right, supply the greater curvature of the stomach. The hepatic artery proper runs inside the hepatoduodenal ligament. The right gastric artery and the left gastric artery are contained in the hepatogastric ligament. The caudal pancreatic artery branches off from the splenic artery and supplies the tail of the pancreas. The middle colic artery supplies the transverse colon. The splenic artery does not travel in the gastrosplenic ligament and so it would not be damaged by a tear to this ligament.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 49
Incorrect
-
The muscle that stabilizes the stapes is innervated by which of the following nerves?
Your Answer: Trigeminal nerve
Correct Answer: Facial nerve
Explanation:The stapedius is the smallest skeletal muscle in the human body. At just over one millimetre in length, its purpose is to stabilize the smallest bone in the body, the stapes and is innervated by a branch of the facial nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 50
Incorrect
-
With respect to far accommodation, which of the following is a TRUE statement?
Your Answer: The pupils are constricted (accommodation response)
Correct Answer: The ciliary muscles are relaxed
Explanation:Myopia or near-sightedness is a disease due to elongated eyeballs or too strong a lens. For far accommodation (focus of a distant object onto the retina), the lens needs to decrease its refractive power, or in other words, increase its focal length. This is done by relaxation of ciliary muscles which tightens the zonular fibres and flattening of the lens. Relaxation of the zonular fibres, rounding of the lens, shortening of the focal length and constriction of the pupil occurs during near accommodation.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 51
Incorrect
-
A 30 year old female suffered from mismatched transfusion induced haemolysis. Which substance will be raised in the plasma of this patient?
Your Answer: Hemosiderin
Correct Answer: Bilirubin
Explanation:Bilirubin is a yellow pigment that is formed due to the break down of RBCs. Haemolysis results in haemoglobin that is broken down into a haem portion and globin which is converted into amino acids and used again. Haem is converted into unconjugated bilirubin in the macrophages and shunted to the liver. In the liver it is conjugated with glucuronic acid making it water soluble and thus excreted in the urine. Its normal levels are from 0.2-1 mg/dl. Increased bilirubin causes jaundice and yellowish discoloration of the skin.
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This question is part of the following fields:
- General
- Physiology
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Question 52
Correct
-
Which of the following arteries branch from the deep femoral artery and course between the pectineus and iliopsoas muscles?
Your Answer: Medial femoral circumflex
Explanation:The medial femoral circumflex artery is an artery in the upper thigh that supplies blood to the head and neck of the femur. It arises from the deep femoral artery and winds around the medial side of the femur. It passes first between pectineus and psoas major, and then between obturator externus and adductor brevis.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 53
Correct
-
Which of the following brings about a reduction in gastric blood flow?
Your Answer: Vasopressin
Explanation:Gastric blood flow is increased by vagal stimulation, gastrin, histamine and acetylcholine as they stimulate gastric section and the production of vasodilator metabolites. Acetylcholine and histamine also have a direct action on the gastric arterioles. Similarly, gastric blood flow is reduced by inhibitors of secretion – catecholamines, secretin and vasopressin.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 54
Correct
-
A 42 year old women presents with end stage renal failure and is prepared to receive a kidney from her husband. HLA testing showed that they are not a 100% match and she is given immunosuppressant therapy for this. Three months later when her renal function tests were performed she showed signs of deteriorating renal function, with decreased renal output, proteinuria of +++ and RBCs in the urine. She was given antilymphocyte globulins and her condition reversed. What type of graft did this patient receive?
Your Answer: Allograft
Explanation:Allograft describes a graft between two of the same species. As the donor and the recipients are history-incompatible, rejection of the graft is common and is controlled by immunosuppressive drug therapy. Isograft and syngraft are synonymous and referred to a graft transferred between genetically identical individuals e.g. identical twins. In this case rejection is rare as they are history-compatible.
Autograft refers to transfer of one part of the body to another location.
Xenograft is transfer of tissue from another species e.g. pig to human in valve replacement surgeries and rejection is very high.
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This question is part of the following fields:
- Inflammation & Immunology; Renal
- Pathology
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Question 55
Correct
-
A 22-year old man presented with a mass in his left scrotum which was more prominent when standing and felt like a 'bag of worms'. Examination revealed a non-tender mass along the spermatic cord. Also, the right testis was larger than the left testis. What is the likely diagnosis?
Your Answer: Varicocele
Explanation:Varicocele refers to dilatation and increased tortuosity of the pampiniform plexus – which is a network of veins found in spermatic cord that drain the testicle. Defective valves or extrinsic compression can result in outflow obstruction and cause dilatation near the testis. Normal diameter of the small vessels ranges from 0.5 – 1.5mm. A varicocele is a dilatation more than 2mm.
The plexus travels from the posterior aspect of testis into the inguinal canal with other structures forming the spermatic cord. They then form the testicular veins out of which the right testicular vein drains into the inferior vena cava and the left into the left renal vein.
It affects 15-20% men, and 40% of infertile males. Usually diagnosed in 15-25 years of age, they are rarely seen after 40 years of age. Because of the vertical path taken by the left testicular vein to drain into left renal vein, 98% idiopathic varicoceles occur on the left side. It is bilateral in 70% cases. Right-sided varicoceles are rare.
Symptoms include pain or heaviness in the testis, infertility, testicular atrophy, a palpable mass, which is non-tender and along the spermatic cord (resembling a ‘bag of worms’). The testis on the affected side might be smaller.
Diagnosis can be made by ultrasound. Provocative measures such as Valsalva manoeuvre or making the patient stand up to increase the dilatation by increasing the intra-abdominal venous pressure.
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This question is part of the following fields:
- Pathology
- Urology
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Question 56
Correct
-
Which nuclei of the posterior grey column of the spinal cord are likely affected in a patient who has lost the sensation of pain and temperature?
Your Answer: Substantia gelatinosa
Explanation:Substantia gelatinosa is one of the nuclei in the posterior grey column along side other posterior grey column nuclei like the nucleus dorsalis, nucleus proprius, and posteromarginal nucleus. These nuclei are a collection of cells in the posterior grey area found in throughout the spinal cord. The substantia gelatinosa receives direct input from the dorsal nerve roots (sensory), especially from thermoreceptors and nociceptors (receptors for temperature and pain).
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This question is part of the following fields:
- Anatomy
- Neurology
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Question 57
Correct
-
Which nodes are most likely to be enlarged in a patient complaining of a boil located on the labia majora?
Your Answer: Superficial inguinal
Explanation:The perineum, external genitalia, the labia majora and scrotum drain to the superficial inguinal lymph nodes. In a man, the testes do not drain to the superficial inguinal lymph nodes but rather travel in the spermatic cord and drain into the lumbar nodes. The lumbar nodes drain the internal pelvic organs. The sacral nodes drain the prostrate gland, uterus, vagina, rectum and posterior pelvic wall and the external iliac nodes in turn drain the lower limb. The internal iliac nodes drain the pelvis and gluteal region.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 58
Correct
-
A 40 year old man suffered severe trauma following a MVA. His BP is 72/30 mmhg, heart rate of 142 beats/mins and very feeble pulse. He was transfused 3 units of blood and his BP returned to 100/70 and his heart rate slowed to 90 beats/min. What decreased after transfusion?
Your Answer: Total peripheral resistance
Explanation:The patient is in hypovolemic shock, he is transfused with blood, this fluid resuscitation will result in a decreased sympathetic discharge and adequate ventricular filling which will result in the decreases TPR with an increased CO and cardiac filling pressures
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 59
Correct
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A 30-year-old man is brought to the emergency department suffering from extreme dehydration, and subsequent hypotension and tachycardia. Which part of the kidney will compensate for this loss?
Your Answer: Collecting ducts
Explanation:The collecting duct system of the kidney consists of a series of tubules and ducts that physically connect nephrons to a minor calyx or directly to the renal pelvis. The collecting duct system is the last component of the kidney to influence the body’s electrolyte and fluid balance. In humans, the system accounts for 4–5% of the kidney’s reabsorption of sodium and 5% of the kidney’s reabsorption of water. At times of extreme dehydration, over 24% of the filtered water may be reabsorbed in the collecting duct system.
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This question is part of the following fields:
- Physiology
- Renal
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Question 60
Incorrect
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The blood investigations of a 30-year old man with jaundice revealed the following : total bilirubin 6.5 mg/dl, direct bilirubin 1.1 mg/dl, indirect bilirubin 5.4 mg/dl and haemoglobin 7.3 mg/dl. What is the most likely diagnosis out of the following?
Your Answer: Schistosomiasis
Correct Answer: Haemolysis
Explanation:Hyperbilirubinemia can be caused due to increased bilirubin production, decreased liver uptake or conjugation, or decreased biliary excretion. Normal bilirubin level is less than 1.2 mg/dl (<20 μmol/l), with most of it unconjugated. Elevated unconjugated bilirubin (indirect bilirubin fraction >85%) can occur due to haemolysis (increased bilirubin production) or defective liver uptake/conjugation (Gilbert syndrome). Such increases are less than five-fold usually (<6 mg/dl or <100 μmol/l) unless there is coexistent liver disease.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 61
Correct
-
Following a lacerating injury along the anterior border of the trapezius muscle in the neck, a man has the point of his shoulder (scapula) sagging and he has difficulty with full abduction of his arm. Which nerve is most likely injured?
Your Answer: Accessory (cranial nerve XI)
Explanation:Injury to the accessory nerve denervates the trapezius muscle so that the person will no longer be able to raise the acromion of the shoulder. The dorsal scapular nerve supplies the rhomboids i.e. major and minor and the levator scapulae so that injury to this nerve weakens retraction of the scapula. The greater occipital nerve is responsible for sensation of the posterior scalp. The axillary nerve innervates the deltoid muscle which is responsible for abduction of the arm and the suprascapular nerve is responsible for rotating the humerus laterally. Cutaneous nerves supply the skin.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 62
Incorrect
-
Which of the following statements is true of Colles’ fracture?
Your Answer: Is typically associated with compression of the ulnar nerve
Correct Answer: Is a cause of carpal tunnel syndrome
Explanation:Colles’ fracture is a distal fracture of the radius that is a known cause of carpal tunnel syndrome (compression of the median nerve in the carpal tunnel). It rarely results in ulnar nerve compression. A Colles’ fracture is extra-articular and does not extend into the wrist joint, otherwise this would make it an intra-articular fracture (Barton’s fracture). The distal fragment in a Colles’ fracture is displaced dorsally, unlike in a Smith’s fracture where the distal fragment is displaced volarly (ventrally). Associated fracture of the ulnar styloid process may occur and is a common associated injury.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 63
Correct
-
What is the 5 year survival rate of a patient who is diagnosed with stage III colon cancer, who underwent successful resection and completed the prescribed session of adjuvant chemotherapy?
Your Answer: 30%–60%
Explanation:In this patient who has stage III colon cancer, the survival rate is 30-60%. For stage I or Dukes’ stage A disease, the 5-year survival rate after surgical resection exceeds 90%. For stage II or Dukes’ stage B disease, the 5-year survival rate is 70%–85% after resection, with or without adjuvant therapy. For stage III or Dukes’ stage C disease, the 5-year survival rate is 30%– 60% after resection and adjuvant chemotherapy and for stage IV or Dukes’ stage D disease, the 5-year survival rate is poor (approximately 5%).
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 64
Correct
-
Which of the following causes the maximum increase in the secretion of antidiuretic hormone (ADH)?
Your Answer: Increased plasma osmolarity
Explanation:The most potent stimulus for ADH release is increased plasma osmolarity. Decreased plasma volume is a less potent stimulus in comparison. However, decrease blood volume and arterial pressure due to severe haemorrhage does lead to ADH secretion. Hypothalamic releasing factors do not control the release of posterior pituitary hormones ADH and oxytocin.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 65
Correct
-
An 18 -year-old female is diagnosed with folliculitis in the left axilla. What is the most likely organism that could cause this condition?
Your Answer: Staphylococcus aureus
Explanation:Folliculitis is the inflammation of the hair follicles. It is usually caused by Staphylococcus infection.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 66
Correct
-
If a patient takes long-term corticosteroid therapy, which of the following diseases is most likely to develop?
Your Answer: Osteoporosis
Explanation:One of the complications of long-term intake of corticosteroids is osteoporosis. Some guidelines recommend prophylactic calcium and vitamin D supplementation in patients who take more than 30 mg hydrocortisone or 7.5 mg of prednisolone daily.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 67
Correct
-
A 66 year old male, was involved in a MVA. He sustained third degree burns to his abdomen and open bleeding wound to his left leg. The patient complains of dizziness. He is a known hypertensive but during examination was found to be hypotensive. His heart rate is 120/min, with regular rhythm. What is the possible cause of his hypotension?
Your Answer: Hypovolaemia
Explanation:Hypovolemia can be recognized by tachycardia, diminished blood pressure, and the absence of perfusion as assessed by skin signs (skin turning pale) and/or capillary refill time. The patient may feel dizzy, faint, nauseated, or very thirsty. Common causes of hypovolemia are loss of blood, loss of plasma which occurs in severe burns and lesions discharging fluid, loss of body sodium and consequent intravascular water which may occur in cases of diarrhoea and vomiting. In this case the cause of patients hypotension is due to hypovolemia from both loss of plasma and blood.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 68
Incorrect
-
Which of the following substances brings about a dilatation of the gastrointestinal resistance vessels?
Your Answer: Vasopressin
Correct Answer: Vasoactive intestinal peptide
Explanation:Gastric vasoconstrictors include catecholamines, angiotensin II and vasopressin. Vasodilators include vasoactive intestinal peptide and the hormones; gastrin, cholecystokinin and glucagon.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 69
Correct
-
What is the innervation of the laryngeal mucosa inferior to the true vocal cord?
Your Answer: Recurrent laryngeal nerve
Explanation:Motor innervation to all other muscles of the larynx and sensory innervation to the subglottis is by the recurrent laryngeal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 70
Correct
-
The following organs would be expected to lie within the right lower quadrant of the abdomen, assuming that the gastrointestinal tract is rotated normally:
Your Answer: Distal jejunum, caecum, vermiform appendix
Explanation:The abdomen is divided by theoretical anatomic lines into four quadrants. The median plane follows the linea alba and extends from the xiphoid process to the pubic symphysis and splits the abdomen in half. The transumbilical plane is a horizontal line that runs at the level of the umbilicus. This forms the upper right and left quadrants and the lower right and left quadrants. Structures in the right lower quadrant include: caecum, appendix, part of the small intestine, ascending colon, the right half of the female reproductive system, right ureter. Pain in this region is most commonly associated with appendicitis.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 71
Incorrect
-
The collaborative effort of the lateral pterygoid muscles produces which action on the jaw?
Your Answer: Retract the mandible
Correct Answer: Protrude the mandible
Explanation:The combined effort of the lateral pterygoid muscles results in the protrusion of the mandible. The lateral pterygoid muscle is a muscle of mastication located superiorly to the medial pterygoid muscle and has two heads. The superior head originates on the infratemporal surface and infratemporal crest of the greater wing of the sphenoid bone, and the inferior head on the lateral surface of the lateral pterygoid plate. The insertion of this muscle is on the front margin of the articular disc of the temporomandibular joint. The unilateral contraction of the pterygoid muscle results in the laterotrusion of the mandible. It is important to note that the lateral pterygoid muscle is the only muscle of mastication that can open the jaw.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 72
Incorrect
-
Renal function is an indication of the state of the kidney, measured by glomerular filtration rate (GFR). In a healthy person, GFR would be greatly increased by:Â
Your Answer: An increase in mean arterial pressure from 90 mmHg to 140 mmHg
Correct Answer: Substantial increases in renal blood flow
Explanation:An increase in the rate of renal blood flow (RBF) greatly increases the glomerular filtration rate (GFR). The more plasma available (from increased RBF), the more filtrate is formed. Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. Central to the physiologic maintenance of GFR is the differential basal tone of the afferent and efferent arterioles.
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This question is part of the following fields:
- Physiology
- Renal
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Question 73
Incorrect
-
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 74
Correct
-
A 34-year-old woman with severe burns, presented to casualty with a blood pressure of 75/40 mmHg and pulse of 172/minute. Obviously the patient is in shock. Which type of shock is it more likely to be?
Your Answer: Hypovolaemic shock
Explanation:Shock is a life-threatening condition that occurs when the organs and tissues of the body are not receiving a sufficient flow of blood. Lack of blood flow, oxygen and nutrients results in the inability to function properly and damage to many organs. Shock requires immediate treatment because, if left untreated the impaired tissue perfusion and cellular hypoxia can cause irreversible tissue injury, collapse, coma or even death. There are various types of physiological shock, including: cardiogenic (due to heart damage), hypovolaemic (due to low total volume of blood or plasma), neurogenic (due to nervous system damage), septic (due to infections) and anaphylactic shock (due to allergic reactions). Hypovolaemic shock can be caused by blood loss due to trauma, internal bleeding or other fluid loss due to severe burns, prolonged diarrhoea, vomiting and sweating.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 75
Correct
-
The principal motor and sensory nerve of the perineum is the?
Your Answer: Pudendal
Explanation:The pudendal nerve is formed by S1,2,4 anterior branches. It gives off the inferior haemorrhoid nerve before dividing terminally into the perineal nerve and the dorsal nerve of the clitoris or the penis. Thus, it is the principal motor and sensory nerve of the perineum.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 76
Correct
-
A 20-year-old woman had profuse watery diarrhoea for 2 days. She felt dizzy and weak, and thus decided to seek medical attention. At the emergency room her BP was 80/60 mmHg with a pulse of 118/min. What is the most appropriate intravenous treatment that should be given?
Your Answer: Isotonic saline
Explanation:Normal saline is typically the first fluid used when hypovolemia is severe enough to threaten the adequacy of blood circulation. It is isotonic and has long been believed to be the safest fluid to give quickly in large volumes.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 77
Correct
-
A 27-year old lady presented with dull, abdominal pain and some pain in her lower limbs. On enquiry, it was revealed that she has been suffering from depression for a few months. Physical examination and chest X-ray were normal. Further investigations revealed serum calcium 3.5 mmol/l, albumin 3.8 g/dl and phosphate 0.65 mmol/l. What is the diagnosis?
Your Answer: Parathyroid adenoma
Explanation:Hypercalcaemia with hypophosphatemia indicates parathyroid disorder and adenomas are more common than hyperplasia. In this young age group, metastatic disease is unlikely. Solitary adenomas are responsible for 80-85% cases of primary hyperparathyroidism. 10-15% cases are due to parathyroid hyperplasia and carcinomas account for 2-3% cases. Symptoms include bone pain (bones), nephrolithiasis (stones), muscular aches, peptic ulcer disease, pancreatitis (groans), depression (moans), anxiety and other mental disturbances.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 78
Incorrect
-
From which source does the lingual artery originate?
Your Answer: Maxillary
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 79
Correct
-
Which of the following will increase blood pressure and cause hypokalaemia?
Your Answer: Angiotensin II
Explanation:Angiotensin is a peptide that is released in response to a decrease in blood volume and blood pressure. It has multiple functions but mainly acts to cause vasoconstriction, increase BP and release aldosterone from the adrenal cortex. It is a powerful vasoconstrictor and release of aldosterone causes increased retention of sodium and excretion of potassium.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 80
Correct
-
A 60-year old woman who has a left sided post-pneumonic effusion, was to have some pleural fluid aspirated for culture and sensitivity. If the medical intern in charge of the procedure decided to aspirate while the patient is sitting up on her bed, where in the pleural cavity would the fluid tend to accumulate?
Your Answer: Costodiaphragmatic recess
Explanation:The lowest part of the pleural cavity is the costodiaphragmatic recess and it the space in which the pleural fluid will accumulate when the patient sits up.
The cupola is part of the pleural cavity that extends into the root of the neck above the first rib.
The costomediastinal recess is the junction at which the costal pleura becomes the mediastinal pleura.
The middle mediastinum is the part of the mediastinum that is occupied by the heart.
The hilar reflection is the point where the mediastinal pleura is reflected to continue on as the visceral pleura.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 81
Correct
-
Which of the following conditions is characterized by generalised oedema due to effusion of fluid into the extracellular space?
Your Answer: Anasarca
Explanation:Anasarca (or ‘generalised oedema’) is a condition characterised by widespread swelling of the skin due to effusion of fluid into the extracellular space. It is usually caused by liver failure (cirrhosis of the liver), renal failure/disease, right-sided heart failure, as well as severe malnutrition/protein deficiency.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 82
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 83
Correct
-
A 54-year-old woman is re-admitted to the hospital with shortness of breath and sharp chest pain 2 weeks after surgical cholecystectomy. The most probable cause of these clinical findings is:
Your Answer: Pulmonary embolus
Explanation:Pulmonary embolism is caused by the sudden blockage of a major lung blood vessel, usually by a blood clot. Symptoms include sudden sharp chest pain, cough, dyspnoea, palpitations, tachycardia or loss of consciousness. Risk factors for developing pulmonary embolism include long periods of inactivity, recent surgery, trauma, pregnancy, oral contraceptives, oestrogen replacement, malignancies and venous stasis.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 84
Correct
-
Following a bee sting, a women develops a 2cm red, raised, swollen lesion at the site of the sting . Which of the following findings is likely to be seen in this lesion?
Your Answer: Vasodilation
Explanation:Inflammation is the immediate response of the body towards infections or irritations. The cardinal signs of inflammation are 1. redness/rubor, 2. tumour/swelling, 3.dolar/pain, 4.calor/heat and organ dysfunction (function laesa). Inflammation has 2 components; vascular and cellular. Blood vessels dilate upstream of the inflamed area leading to the rubor and calor and constrict downstream, increasing pressure and causing fluid to leak out of the capillary, resulting in swelling. The cellular component includes infiltration by neutrophils. Leukocyte arrival and functions include; 1. margination: cells marginated from the centre to the periphery of the vessel, 2. rolling: selectins are upregulated on the vessel walls, 3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes resulting in adhesion, 4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product and 5. phagocytosis: engulfing the offending substance/cell.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 85
Correct
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A 45 year old female had a stroke and was diagnosed with a homonymous hemianopsia. Which of the following structures was likely affected?
Your Answer: Optic radiation
Explanation:Hemianopia or hemianopsia, is the loss of vision of half of the eye or loss of half the visual field. Homonymous hemianopia is the loss of vision or blindness on half of the same side of both eyes (visual field) – either both lefts of the eyes or both rights of the eyes. This condition is mainly caused by cerebrovascular accidents like a stroke that affects the optic radiation.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 86
Correct
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A patient in the intensive care unit developed hyperphosphatemia. The phosphate level is 160 mmol/L. Which of the following is most likely responsible for this abnormality?
Your Answer: Renal insufficiency
Explanation:Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood. It is caused by conditions that impair renal phosphate excretion (ex: renal insufficiency, hypoparathyroidism, parathyroid suppression) and conditions with massive extracellular fluid phosphate loads (ex: rapid administration of exogenous phosphate, extensive cellular injury or necrosis, transcellular phosphate shifts).
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 87
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 88
Correct
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Myoglobin is released as a result of rhabdomyolysis from damaged skeletal muscles. What function do they perform in the muscle?
Your Answer: Acts like haemoglobin and binds with O2
Explanation:Myoglobin is a pigmented globular protein made up of 153 amino acids with a prosthetic group containing haem around which the apoprotein folds. It is the primary oxygen carrying protein of the muscles. The binding of oxygen to myoglobin is unaffected by the oxygen pressure as it has an instant tendency to bind given its hyperbolic oxygen curve. It releases oxygen at very low pO2 levels.
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This question is part of the following fields:
- General
- Physiology
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Question 89
Correct
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Investigations in a 40-year old gentleman with splenomegaly reveal the following: haemoglobin 21.5 g/dl, haematocrit 66%, mean corpuscular volume (MCV) 86 fl, mean cell haemoglobin concentration 34 g/dl, mean corpuscular haemoglobin 34.5 pg, platelet count 450 × 109/l, and white blood cell count 12 × 109/l, with 81% polymorphonuclear leukocytes, 4% bands, 3% monocytes, and 7% lymphocytes.
What is the likely diagnosis?Your Answer: Polycythaemia vera
Explanation:The markedly increased haematocrit, along with thrombocytosis and the leucocytosis suggest a myeloproliferative disorder.
Polycythaemia vera is the commonest myeloproliferative disorders occurring more often in males (about 1.4 to 1). The mean age at diagnosis is 60 years (range 15–90 years) with 5% of patients below 40 years at onset. It involves increased production of all cell lines, including red blood cells (independent of erythropoietin), white blood cells and platelets. If confined only to red blood cells, it is known as ‘primary erythrocytosis’. There is an increase in blood volume and hyperviscosity occurs, predisposing to thrombosis. Increased bleeding occurs due to abnormal functioning of platelets. Patients become hypermetabolic, and increased cell turnover leads to hyperuricaemia.
Usually asymptomatic, occasionally symptoms include weakness, pruritus, headache, light-headedness, visual disturbances, fatigue and dyspnoea. Face appears red with engorged retinal veins. Lower extremities appear red and painful, along with digital ischaemia (erythromelalgia). Hepatomegaly is common and massive splenomegaly is seen in 75% patients. Thrombosis can lead to stroke, deep venous thrombosis, myocardial infarction, retinal artery or vein occlusion, splenic infarction (often with a friction rub) or Budd–Chiari syndrome. Gastrointestinal bleeding is seen in 10-20% patients. Hypermetabolism can lead to low-grade fevers and weight loss. Late features include complications of hyperuricaemia (e.g. gout, renal calculi). 1.5% to 10% cases transform to acute leukaemia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 90
Correct
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Which of the following is likely to result in hematocolpos in a 12-year old girl?
Your Answer: Imperforate hymen
Explanation:Hematocolpos means accumulation of blood in vagina and hematometra is accumulation of blood in the uterus. These are most likely seen with an imperforate hymen; which is seen I 1 in 2000 females. If spontaneous resolution does not occur, treatment involves making a hole in the hymen to allow discharge of menstrual blood.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 91
Incorrect
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An explorative laparotomy is done on a 23 year old following a gunshot abdominal injury through the right iliac fossa. It is found that the ileocolic artery is severed and the bullet had perforated the caecum. From which branch does the ileocolic artery originate?
Your Answer: Inferior mesenteric artery
Correct Answer: Superior mesenteric artery
Explanation:Ileocolic artery branches off from the superior mesenteric artery. It then divides to give a superior and inferior branch.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 92
Correct
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Leukotrienes normally function during an asthma attack and work to sustain inflammation. Which of the following enzymes would inhibit their synthesis?
Your Answer: 5-lipoxygenase
Explanation:Leukotrienes are produced from arachidonic acid with the help of the enzyme 5-lipoxygenase. This takes place in the eosinophils, mast cells, neutrophils, monocytes and basophils. They are eicosanoid lipid mediators and take part in allergic and asthmatic attacks. They are both autocrine as well as paracrine signalling molecules to regulate the body’s response and include: LTA4, LTB4, LTC4, LTD4, LTE4 and LTF4.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 93
Correct
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An 80 year-old quadriplegic man has been lying supine for 7 weeks in a critical care ward. He develops a right lung abscess that is draining by gravity to a particular region of the lung. Which is the most likely site of pus collection?
Your Answer: Superior segment of the lower lobe
Explanation:The superior segmental bronchus of the lower lobe of the right lung branches posteriorly off the intermediate bronchus or the inferior lobe bronchus. It is therefore more likely to receive fluid or foreign bodies that enter the right main bronchus especially when the patient is supine.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 94
Correct
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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: 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 95
Correct
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After severe injury of the upper limb following an accident. The humerus is injured as well as the nerve which innervates the muscles of the anterior compartment of the arm. Which nerve is injured?
Your Answer: Musculocutaneous
Explanation:The musculoskeletal nerve supplies the muscles of the anterior compartment of the arm including the coracobrachialis, biceps brachii and the greater part of the brachialis. This nerve derives its fibres from the fifth, sixth and seventh cervical nerves and arises from the lateral cord of the brachial plexus. It also provides a branch to the elbow joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 96
Correct
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In the glomerulus of the kidney, the mesangium is a structure associated with the capillaries. It has extraglomerular mesangial cells that:
Your Answer: Form the juxtaglomerular apparatus in combination with the macula densa and juxtaglomerular cells
Explanation:The mesangium is an inner layer of the glomerulus, within the basement membrane surrounding the glomerular capillaries. The mesangial cells are phagocytic and secrete the amorphous basement membrane-like material known as the mesangial matrix. They are typically separated from the lumen of the capillaries by endothelial cells. The other type of cells in the mesangium are the extraglomerular mesangial cells which form the juxtaglomerular apparatus in combination with two other types of cells: the macula densa of the distal convoluted tubule and juxtaglomerular cells of the afferent arteriole. This apparatus controls blood pressure through the renin–angiotensin–aldosterone system.
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This question is part of the following fields:
- Physiology
- Renal
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Question 97
Correct
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During hysterectomy, the ureter is most likely to be ligated when a surgeon is clamping the?
Your Answer: Uterine arteries
Explanation:The ureter forms the posterior boundary of a shallow depression which lodges the ovary and then runs medially and forward on the lateral aspect of the uterine cervix and upper part of the vagina to reach the fundus of the bladder. It is also situated about 2cm from the side of the cervix of the uterus. The relationship of the ureters and uterine arteries is of clinical significance because the arteries are at risk of iatrogenic injury during hysterectomy.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 98
Incorrect
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Which of the following substances is most likely to cause pulmonary vasodilatation?
Your Answer: Endothelin
Correct Answer: Nitric oxide
Explanation:In the body, nitric oxide is synthesised from arginine and oxygen by various nitric oxide synthase (NOS) enzymes and by sequential reduction of inorganic nitrate. The endothelium of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, so dilating the artery and increasing blood flow. Nitric oxide/oxygen blends are used in critical care to promote capillary and pulmonary dilation to treat primary pulmonary hypertension in neonatal patients post-meconium aspiration and related to birth defects.
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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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Severe abdominal pain radiating to the back, along with increased serum amylase levels, is seen in which of the following conditions?
Your Answer: Pancreatitis
Explanation:The primary test for diagnosis and monitoring of pancreatitis is amylase. Increased plasma levels of amylase can be found in: salivary trauma (including anaesthetic intubation), mumps, pancreatitis and renal failure. However, a rise in the total amylase levels over 10 times the upper limit of normal (ULN) is suggestive of pancreatitis; 5–10 times the ULN may indicate ileus or duodenal disease or renal failure. Lower levels are commonly found in salivary gland disease.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 100
Correct
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A 17-year-old female was given an antibiotic for a urinary tract infection. After taking the medication the patient developed Steven-Johnson syndrome. Which particular antibiotic usually causes Steven-Johnson syndrome?
Your Answer: Sulphonamides
Explanation:Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulphonamide antibiotics, and nevirapine.
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This question is part of the following fields:
- Microbiology
- Pathology
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