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  • Question 1 - During cardiac catheterisation in a 20-year old man, the following data is obtained:...

    Incorrect

    • During cardiac catheterisation in a 20-year old man, the following data is obtained: Pressure (mmHg), O2 saturation (%) Right atrium 7 (N = 5) 90 (N = 75), Right ventricle 35/7 (N = 25/5) 90 (N = 75), Pulmonary artery 35/8 (N = 25/15), 90 (N = 75), Left atrium 7 (N = 9) 95 (N = 95), Left ventricle 110/7 (N = 110/9) 95 (N = 95), Aorta 110/75 (N = 110/75) 95 (N = 95) where N = Normal value. What is the likely diagnosis?

      Your Answer: Pulmonary stenosis

      Correct Answer: Atrial septal defect

      Explanation:

      A congenital heart disease, ASD or atrial septal defect leads to a communication between the right and left atria due to a defect in the interatrial septum. This leads to mixing of arterial and venous blood from the right and left side of the heart. The hemodynamic significance of this defect depends on the presence of shunting of blood. Normally, the left side of the heart has higher pressure than the right as the left side has to pump blood throughout the body. A large ASD (> 9 mm) will result in a clinically significant left-to-right shunt, causing volume overload of the right atrium and ventricle, eventually leading to heart failure. Cardiac catheterization would reveal very high oxygen saturation in the right atrium, right ventricle and pulmonary artery. Eventually, the left-to-right shunt will lead to pulmonary hypertension and increased afterload in the right ventricle, along with the increased preload due to the shunted blood. This will either cause right ventricular failure, or raise the pressure in the right side of the heart to equal or more than that in the left. Elevation of right atrial pressure to that of left atrial pressure would thus lead to diminishing or complete cessation of the shunt. If left uncorrected, there will be reversal of the shunt, known as Eisenmenger syndrome, resulting in clinical signs of cyanosis as the oxygen-poor blood form right side of the heart will mix with the blood in left side and reach the peripheral vascular system.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      348.6
      Seconds
  • Question 2 - When a penile tumour invades the subepithelial connective tissue of the penis, what...

    Incorrect

    • When a penile tumour invades the subepithelial connective tissue of the penis, what is its stage?

      Your Answer: T2

      Correct Answer: T1

      Explanation:

      The TNM staging used for penile cancer is as follows:

      TX: primary tumour cannot be assessed

      T0: primary tumour is not evident

      Tis: carcinoma in situ is present

      Ta: non-invasive verrucous carcinoma is present

      T1: tumour is invading subepithelial connective tissue

      T2: tumour is invading the corpora spongiosum or cavernosum

      T3: tumour invading the urethra or prostate

      T4: tumour invading other adjacent structures.

      In this case, the patient has a T1 tumour.

    • This question is part of the following fields:

      • Pathology
      • Urology
      12.1
      Seconds
  • Question 3 - The operating surgeon notices a structure lying alongside a herniated mass whilst repairing...

    Correct

    • The operating surgeon notices a structure lying alongside a herniated mass whilst repairing an indirect inguinal hernia in a female patient. Which structure could this be?

      Your Answer: Round ligament of the uterus

      Explanation:

      The main structure traversing the inguinal canal in women is the round ligament. In men, it is the spermatic cord.

      The iliohypogastric nerve innervates the abdominal wall and runs between the transversus abdominis and internal oblique muscles before piercing the internal oblique at the anterior superior iliac spine to run between the internal and external obliques.

      The inferior epigastric artery is between the peritoneum and the transversus abdominis creating the lateral umbilical fold.

      The ovarian artery and the ovarian vein are branches from the descending aorta and inferior vena cava that supply the ovary in the pelvic cavity.

      The pectineal ligament is a thick fascial layer over the pectineal line of the pubis. It doesn’t traverse the canal.

      The broad ligament if found on the lateral sides of the uterus.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      46.1
      Seconds
  • Question 4 - A 40 year old man suffered severe trauma following an MVA. His BP...

    Incorrect

    • A 40 year old man suffered severe trauma following an MVA. His BP is 70/33 mmhg, heart rate of 140 beats/mins and very feeble pulse. He was transfused 3 units of blood resulting in his BP returning to 100/70 and his heart rate to 90 beats/min. What decreased following transfusion?

      Your Answer: Cardiac output

      Correct Answer: Total peripheral resistance

      Explanation:

      The patient is in hypovolemic shock, he is transfused with blood to replace the volume lost. It is important not only to replace fluids but stop active bleeding in resuscitation. Fluid replacement will result in a decreased sympathetic discharge and adequate ventricular filling thus reducing total peripheral resistance and increasing cardiac output and cardiac filling pressures.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      102.3
      Seconds
  • Question 5 - Investigations in a 40-year old gentleman with splenomegaly reveal the following: haemoglobin 21.5...

    Correct

    • 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.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      55
      Seconds
  • Question 6 - Multiple cells were labelled using a fluorescent dye that doesn’t cross the cell...

    Incorrect

    • Multiple cells were labelled using a fluorescent dye that doesn’t cross the cell membrane. One cell in the middle was bleached with a light that destroys the dye, but the cell soon recovers its stain. The presence of which structures best explains this?

      Your Answer: Glycosaminoglycans

      Correct Answer: Gap junctions

      Explanation:

      Gap junctions are attachments between cells that permit intercellular communication e.g. they permit current flow and electrical coupling between myocardial cells. They allow direct electrical transmission among cells and also permit certain substance to pass through as well. They are either homotypic, formed by two identical hemichannels or heterotypic, formed by different hemichannels.

    • This question is part of the following fields:

      • General
      • Physiology
      34.4
      Seconds
  • Question 7 - A 68-year-old woman complains of headaches, dizziness, and memory loss. About a month...

    Incorrect

    • A 68-year-old woman complains of headaches, dizziness, and memory loss. About a month ago, she fell from a staircase but only suffered mild head trauma. What is the most likely diagnosis in this case?

      Your Answer: Intracerebral haematoma

      Correct Answer: Chronic subdural haematoma

      Explanation:

      A quarter to a half of patients with chronic subdural haematoma have no identifiable history of head trauma. If a patient does have a history of head trauma, it usually is mild. The average time between head trauma and chronic subdural haematoma diagnosis is 4–5 weeks. Symptoms include decreased level of consciousness, balance problems, cognitive dysfunction and memory loss, motor deficit (e.g. hemiparesis), headache or aphasia. Some patients present acutely. They usually result from tears in bridging veins which cross the subdural space, and may cause an increase in intracranial pressure (ICP).

    • This question is part of the following fields:

      • Neurology
      • Pathology
      33.8
      Seconds
  • Question 8 - Which of the following is the most abundant WBC seen in a smear...

    Correct

    • Which of the following is the most abundant WBC seen in a smear from a healthy person.

      Your Answer: Neutrophils

      Explanation:

      neutrophils are the most abundant cell type of the WBC. These phagocytes are found normally in the blood and increase in number are seen during an acute inflammation. These the percentages of WBC in blood Neutrophils: 40 to 60%

      Lymphocytes: 20 to 40%

      Monocytes: 2 to 8%

      Eosinophils: 1 to 4%

      Basophils: 0.5 to 1%

      Band (young neutrophil): 0 to 3%. eosinophils, basophils, neutrophils are known as granulocytes and monocytes and lymphocytes as agranulocytes.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      18.2
      Seconds
  • Question 9 - During an anatomy revision session, medical students are told that the posterior wall...

    Correct

    • During an anatomy revision session, medical students are told that the posterior wall of the rectus sheath ends in a thin curved margin whose concavity is directed downwards. What is the name of this inferior border of the rectus sheath?

      Your Answer: Arcuate line

      Explanation:

      The rectus sheath is a tendinous sheath that encloses the rectus abdominis muscle. It covers the entire anterior surface however on the posterior surface of the muscle the sheath is incomplete ending inferiorly at the arcuate line. Below the arcuate line, the rectus abdominis is covered by the transversalis fascia. The linea alba is a band of aponeurosis on the midline of the anterior abdominal wall, which extends from the xiphoid process to the pubic symphysis. It is formed by the combined abdominal muscle aponeuroses. This is a useful site for midline incision during abdominal surgery because it does not carry many blood vessels. All of the other answer choices are related to the inguinal canal.

      The falx inguinalis (sometimes called the inguinal falx or conjoint tendon), is the inferomedial attachment of the transversus abdominis with some fibres of the internal abdominal oblique – it contributes to the posterior wall of the inguinal canal.

      The inguinal ligament is the ligament that connects the anterior superior iliac spine with the pubic tubercle – it makes the floor of the inguinal canal.

      The internal (deep) inguinal ring is the entrance to the inguinal canal, where the transversalis fascia pouches out and creates an opening through which structures can leave the abdominal cavity.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      47.4
      Seconds
  • Question 10 - Which of the following is true about myasthenia gravis? ...

    Correct

    • Which of the following is true about myasthenia gravis?

      Your Answer: Response of skeletal muscle to nerve stimulation is weakened

      Explanation:

      An autoimmune disorder, myasthenia gravis leads to progressive muscle weakness. It occurs due to formation of antibodies against the nicotinic acetylcholine (ACh) receptor of the motor endplate, which leads to impaired neuromuscular transmission. Thus, nerve stimulation will lead to a weakened muscle response, but direct electrical stimulation will bring about a normal response. Diagnostic test includes improvement of muscle weakness by small doses of acetylcholinesterase inhibitors (physostigmine or edrophonium). However, a large dose of physostigmine worsens the weakness due to desensitisation of the endplate to persistent Ach. One of the investigative tools includes radiolabelled snake venom α-bungarotoxin. It is an in vitro study performed on muscle biopsy specimens and used to quantify the number of ACh receptors at the motor endplate.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      184.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular (0/2) 0%
Physiology (1/4) 25%
Pathology (2/4) 50%
Urology (0/1) 0%
Abdomen (2/2) 100%
Anatomy (2/2) 100%
Haematology (1/1) 100%
General (0/1) 0%
Neurology (1/2) 50%
Inflammation & Immunology (1/1) 100%
Passmed