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  • Question 1 - Internal haemorrhoids are painless and only sensitive to stretch. They are formed from...

    Incorrect

    • Internal haemorrhoids are painless and only sensitive to stretch. They are formed from folds of the mucous membrane and the submucosa of the anal canal which contain varicose branches of the:

      Your Answer: Inferior rectal vein

      Correct Answer: Superior rectal vein

      Explanation:

      Internal haemorrhoids are formed by varicosities of the branches of the superior rectal vein.

      External haemorrhoids are formed by varicosities of the branches of the inferior rectal vein.

    • This question is part of the following fields:

      • Anatomy
      • Colorectal
      16.2
      Seconds
  • Question 2 - There are several mechanisms involved in the transport of sodium ions from blood...

    Incorrect

    • There are several mechanisms involved in the transport of sodium ions from blood to interstitial fluid of the muscle cells. Which of the following mechanisms best describes this phenomenon?

      Your Answer: Diffusion through endothelial cell membrane

      Correct Answer: Diffusion through channels between endothelial cells

      Explanation:

      Capillaries are the smallest of the body’s blood vessels, measuring 5–10 μm and they help to enable the exchange of water, oxygen, carbon dioxide, and many other nutrients and waste substances between the blood and the tissues surrounding them. The walls of capillaries are composed of only a single layer of cells, the endothelium. Ion channels are pore-forming proteins that help to establish and control the small voltage gradient that exists across the plasma membrane of all living cells by allowing the flow of ions down their electrochemical gradient. An ion channel is an integral membrane protein or more typically an assembly of several proteins. The archetypal channel pore is just one or two atoms wide at its narrowest point. It conducts a specific ion such as sodium or potassium and conveys them through the membrane in single file.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      24.9
      Seconds
  • Question 3 - Elevated mean corpuscular volume with hypersegmented neutrophils and low reticulocyte index is seen...

    Incorrect

    • Elevated mean corpuscular volume with hypersegmented neutrophils and low reticulocyte index is seen in on the blood count of a middle-aged lady about to undergo elective surgery. On enquiry, she mentions feeling tired for a few months. Which of the following investigations should be carried out in her to reach a diagnosis?

      Your Answer: Bone marrow biopsy

      Correct Answer: Serum vitamin B12 and folate

      Explanation:

      Elevated levels of MCV indicates megaloblastic anaemia, which are associated with hypersegmented neutrophils. Likely causes include vitamin B12 or folate deficiency. Megaloblastic anaemia results from defective synthesis of DNA. As RNA production continues, the cells enlarge with a large nucleus. The cytoplasmic maturity becomes greater than nuclear maturity. Megaloblasts are produced initially in the marrow, before blood. Dyspoiesis makes erythropoiesis ineffective, causing direct hyperbilirubinemia and hyperuricemia. As all cell lines are affected, reticulocytopenia, thrombocytopenia and leukopenia develop. Large, oval blood cells (macro-ovalocytes) are released in the circulation, along with presence of hypersegmented neutrophils.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      1022
      Seconds
  • Question 4 - The gradual depolarization in-between action potentials in pacemaker tissue is a result of?...

    Incorrect

    • The gradual depolarization in-between action potentials in pacemaker tissue is a result of?

      Your Answer: A gradual change in the ratio of extracellular to intracellular ion concentration across the cell membrane

      Correct Answer: A combination of gradual inactivation outward IK along with the presence of an inward ‘funny’ current (If) due to opening of channels permeable to both Na+ and K+ ions

      Explanation:

      One of the characteristic features of the pacemaker cell is the generation of a gradual diastolic depolarization also called the pacemaker potential. In phase 0, the upstroke of the action potential caused by an increase in the Ca2+ conductance, an influx of calcium occurs and a positive membrane potential is generated. The next is phase 3 which is repolarization caused by increased K+ conductance as a result of outwards K+ current. Phase 4 is a slow depolarization which accounts for the pacemaker activity, caused by increased conductance of Na+, inwards Na+ current called IF. it is turned on by repolarization.

    • This question is part of the following fields:

      • General
      • Physiology
      30.2
      Seconds
  • Question 5 - Which of these nerves controls adduction of hand? ...

    Correct

    • Which of these nerves controls adduction of hand?

      Your Answer: Ulnar nerve

      Explanation:

      The adductors of the fingers are the palmer interossei. They are supplied by the ulnar nerve, which is a branch of the medical cord of the brachial plexus.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      12.1
      Seconds
  • Question 6 - A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for...

    Correct

    • A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for the last 5 days. A CT scan reveals an oedematous mass with ring enhancement in the left temporal region. It is biopsied, revealing glial cells, necrosis, neutrophils and lymphocytes. What is the most likely diagnosis?

      Your Answer: Cerebral abscess

      Explanation:

      A cerebral abscess can result from direct extension of cranial infections, penetrating head trauma, haematogenous spread, or for unknown causes. An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts. Oedema around the abscess can increase the intracranial pressure. Symptoms result from increased intracranial pressure and mass effects. It is most frequent in the third decade of life, and when it occurs in children, it is usually associated with congenital heart disease.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      15.3
      Seconds
  • Question 7 - Which lymph nodes are likely to be enlarged in a patient who has...

    Incorrect

    • Which lymph nodes are likely to be enlarged in a patient who has malignant growth involving the anus?

      Your Answer: Internal iliac

      Correct Answer: Superficial inguinal

      Explanation:

      The lymphatics from the anus, skin of the perineum and the scrotum end in the superficial inguinal nodes. In case of a malignant growth of the anus, the superficial inguinal lymph nodes would most likely be enlarge.

    • This question is part of the following fields:

      • Anatomy
      • Pelvis
      16.1
      Seconds
  • Question 8 - A 60-year-old female has sudden onset of high-grade fever associated with cough with...

    Correct

    • A 60-year-old female has sudden onset of high-grade fever associated with cough with productive rusty-coloured sputum. Chest x-ray showed left-sided consolidation. What is the most accurate test for the diagnosis of this patient?

      Your Answer: Sputum culture

      Explanation:

      Sputum culture is used to detect and identify the organism that are infecting the lungs or breathing passages.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      22.5
      Seconds
  • Question 9 - Following a bee sting, a women develops a 2cm red, raised, swollen lesion...

    Incorrect

    • 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: Neutrophilic migration

      Correct 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.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      13
      Seconds
  • Question 10 - Which of the following substances is most likely to cause pulmonary vasodilatation? ...

    Correct

    • Which of the following substances is most likely to cause pulmonary vasodilatation?

      Your 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.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      5.4
      Seconds
  • Question 11 - A 60-year-old woman has had persistent diarrhoea for a week. A stool test...

    Correct

    • A 60-year-old woman has had persistent diarrhoea for a week. A stool test reveals an infection by Clostridium difficile. Which of the following antibiotics could be used to treat the infection?

      Your Answer: Oral vancomycin

      Explanation:

      Three antibiotics are effective against Clostridium difficile:

      Metronidazole 500 mg orally three times daily is the drug of choice, because of superior tolerability, lower price and comparable efficacy.

      Oral vancomycin 125 mg four times daily is second-line therapy in particular cases of relapse or where the infection is unresponsive to metronidazole treatment.

      Thirdly, the use of linezolid might also be considered.

    • This question is part of the following fields:

      • Pathology
      • Pharmacology
      28.8
      Seconds
  • Question 12 - A pedestrian sustained a left fibula fractured following a hit-and-run. X-rays showed that...

    Incorrect

    • A pedestrian sustained a left fibula fractured following a hit-and-run. X-rays showed that there was a transverse fracture of the upper end of the fibula. It was manifested clinically by inability to flex his foot at the ankle joint plus weak extension of the phalanges. What nerve is suspected to be injured in such a case?

      Your Answer: Superficial peroneal

      Correct Answer: Deep peroneal

      Explanation:

      The deep peroneal nerve supplies the muscles allowing for flexion of the foot at the ankle joint, namely the tibialis anterior and peroneus tertius muscles. The peroneus tertius, peroneus brevis, and peroneus longus evert the foot, whereas the tibialis anterior and tibialis posterior invert the foot. Fibres of the deep peroneal nerve originate from L4, L5, and S1.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      18.4
      Seconds
  • Question 13 - An old man presented with atrophy of the thenar eminence despite the sensation...

    Correct

    • An old man presented with atrophy of the thenar eminence despite the sensation over it still being intact. What is the injured nerve in this case?

      Your Answer: Median nerve

      Explanation:

      Atrophy of the thenar muscles means injury to the motor supply of these muscles. The nerve that sends innervation to it is the median nerve. But the median nerve does not provide sensory innervation to the overlying skin so sensation is spared.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      5.5
      Seconds
  • Question 14 - The vascular structure found on the right side of the fifth lumbar vertebra...

    Incorrect

    • The vascular structure found on the right side of the fifth lumbar vertebra is?

      Your Answer: Right renal vein

      Correct Answer: Inferior vena cava

      Explanation:

      The most likely vascular structure is the inferior vena cava. The inferior vena cava is formed by the joining of the two common iliac arteries, the right and the left iliac artery, at the level of the fifth lumbar vertebra( L5). The inferior vena cava passes along the right side of the vertebral column. It enters the thoracic cavity into the underside of the heart through the caval opening of the diaphragm at the level of the eight thoracic vertebra (T8).

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      14.2
      Seconds
  • Question 15 - An intern is attempting to put in an arterial line in an ICU...

    Incorrect

    • An intern is attempting to put in an arterial line in an ICU patients left foot. Which is the best site to feel for the pulsation of the dorsalis pedis artery in the foot?

      Your Answer: In the second dorsal metatarsal space

      Correct Answer: Just lateral to the tendon of extensor hallucis longus

      Explanation:

      The dorsalis pedis artery is the continuation of the anterior tibial artery. The pulse of the posterior tibial artery, which comes from the posterior compartment of the leg, may be felt behind the medial malleolus just lateral to the tendon of the extensor hallucis longus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      15.8
      Seconds
  • Question 16 - A 55-year old patient with signs and symptoms of internal haemorrhage was brought...

    Correct

    • A 55-year old patient with signs and symptoms of internal haemorrhage was brought in for emergency surgery to control the bleeding. Angiography results revealed an advanced duodenal tumour that had perforated the blood vessel immediately behind the first part of the duodenum. Which of the following is the most likely blood vessel that was ruptured by the cancer?

      Your Answer: Gastroduodenal artery

      Explanation:

      The gastroduodenal artery is the artery that lies just behind the first portion of the duodenum. The gastroduodenal artery would be the most likely artery to be perforated by a cancer in this area. The perforation is as a result of the spillage of the acidic content of the chyme in the duodenum. All the other blood vessels in the list would less likely be affected by the gastric expellant from the duodenum. The coronary vein is located in the lesser curvature of the stomach. The inferior pancreaticoduodenal arcade is located inferiorly to the first part of the duodenum on the head of the pancreas. The hepatic artery proper is a branch of the common hepatic artery that is located superior to the first portion of the duodenum. The splenic vein arises from the spleen; it forms the portal vein by joining the superior mesenteric vein. It is laterally detached from the duodenum. Both the left gastric vein and the splenic vein are located superior to the first portion of the duodenum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      9.6
      Seconds
  • Question 17 - Which of the following is likely to induce secretion of glucagon? ...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Endocrinology
      • Physiology
      14.1
      Seconds
  • Question 18 - Which of these structures does NOT pass posterior to the medial malleolus? ...

    Correct

    • Which of these structures does NOT pass posterior to the medial malleolus?

      Your Answer: Saphenous vein

      Explanation:

      The saphenous vein passes anterior to the medial malleolus. The structures passing posterior, from nearest to furthest include: tibial, posterior tendon, flexor digitorum longus tendon, posterior tibial artery, posterior tibial vein, posterior tibial nerve and the flexor hallucis longus tendon.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      19.3
      Seconds
  • Question 19 - Which of the following statements is true regarding the umbilical cord? ...

    Correct

    • Which of the following statements is true regarding the umbilical cord?

      Your Answer: Is filled with jelly of Wharton

      Explanation:

      The umbilical cord that connects the fetus to the placenta is about 50cm long. This tissue consists of the body stalk and vitelline duct. The former containing the allantoic diverticulum and the umbilical vessels. The latter contains the connection linking the digestive tube and the yolk sac. This cord is wrapped by stratum of ectoderm and gelatinous tissue or jelly of Wharton. The right umbilical vein plus the vitelline vessels and ducts disappear and this at birth the cord has three vessels which are the umbilical vein and two umbilical arteries.

    • This question is part of the following fields:

      • Anatomy
      • Embryology
      8.7
      Seconds
  • Question 20 - The extent of cancer growth can be described through staging. What is taken...

    Correct

    • The extent of cancer growth can be described through staging. What is taken into consideration when staging a cancer?

      Your Answer: Local invasion

      Explanation:

      Cancer stage is based on four characteristics: the size of cancer, whether the cancer is invasive or non-invasive, whether the cancer has spread to the lymph nodes, and whether the cancer has spread to other parts of the body, in this case beyond the breast. Staging is important as it is often a good predictor of outcomes and treatment is adjusted accordingly.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      10.7
      Seconds
  • Question 21 - A patient presented with continuous bleeding several hours after dental extraction. Which of...

    Correct

    • A patient presented with continuous bleeding several hours after dental extraction. Which of the following findings is most often associated with clinical bleeding?

      Your Answer: Factor IX deficiency

      Explanation:

      Factor IX deficiency, also called Haemophilia B or Christmas disease, is a disorder caused by missing or defective clotting factor IX. Deficiency of the factor IX causes irregular bleeding that can happen spontaneously or after mild trauma, surgery and dental extractions.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      33.8
      Seconds
  • Question 22 - Which of the following is NOT a nutritional factor involved in wound healing:...

    Incorrect

    • Which of the following is NOT a nutritional factor involved in wound healing:

      Your Answer: Copper

      Correct Answer: Vitamin B3

      Explanation:

      Vitamin B6 is required for collagen cross-links.

      Vitamin A is required for epithelial cell proliferation.

      Zinc is required for RNA and DNA synthesis.

      Copper is required for cross-linking of collagen.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing
      • Physiology
      9.8
      Seconds
  • Question 23 - What is a major source of fuel being oxidised by the skeletal muscles...

    Correct

    • What is a major source of fuel being oxidised by the skeletal muscles of a man who has undergone starvation for 7 days?

      Your Answer: Serum fatty acids

      Explanation:

      Starvation is the most extreme form of malnutrition. Prolonged starvation can lead to permanent organ damage and can be fatal. Starved individuals eventually lose significant fat and muscle mass as the body uses these for energy.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      4.6
      Seconds
  • Question 24 - A correct statement about the RECTUM: ...

    Correct

    • A correct statement about the RECTUM:

      Your Answer: It is an important anastomotic site for the portal and caval (systemic) venous systems

      Explanation:

      The rectum is part of the gastrointestinal tract that is continuous above with the sigmoid colon and below with the anal canal. It contains both longitudinal and circular smooth muscles. These are supplied by the enteric nervous system. It is about 12 cm long. It has no sacculations comparable with those of the colon. It has three permanent transverse folds called the valves of Houston. The peritoneum is related to the upper two thirds of the rectum only whereas the lower part is not covered by peritoneum. It is supplied by the superior rectal (hemorrhoidal) branch of the inferior mesenteric artery and the median sacral artery that is a direct branch from the abdominal aorta. It is drained by veins that begin as a plexus that surround the anus. These veins form anastomoses with the portal system (portocaval anastomoses).

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      86.9
      Seconds
  • Question 25 - The superior pancreaticoduodenal artery, the artery that supplies blood to the pancreas and...

    Incorrect

    • The superior pancreaticoduodenal artery, the artery that supplies blood to the pancreas and the duodenum, is a branch of the:

      Your Answer: Coeliac artery

      Correct Answer: Gastroduodenal artery

      Explanation:

      The superior pancreaticoduodenal artery together with the right gastroepiploic artery form the two branches of the gastroduodenal artery which divides at the lower border of the duodenum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      9.2
      Seconds
  • Question 26 - A sudden loud sound is more likely to result in cochlear damage than...

    Correct

    • A sudden loud sound is more likely to result in cochlear damage than a slowly developing loud sound. This is because:

      Your Answer: There is a latent period before the attenuation reflex can occur

      Explanation:

      On transmission of a loud sound into the central nervous system, an attenuation reflex occurs after a latent period of 40-80 ms. This reflex contracts the two muscles that pull malleus and stapes closer, developing a high degree of rigidity in the entire ossicular chain. This reduces the ossicular conduction of low frequency sounds to the cochlea by 30-40 decibels. In this way, the cochlea is protected from damage due to loud sounds (these are low frequency sounds) when they develop slowly.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      21.7
      Seconds
  • Question 27 - A neonate is diagnosed with cryptorchidism of the right side (undescended testis). Which...

    Correct

    • A neonate is diagnosed with cryptorchidism of the right side (undescended testis). Which is the LEAST likely place to find the testis?

      Your Answer: Perineum

      Explanation:

      Embryologically the testes are retroperitoneal structures in the posterior abdominal wall, attached to the anterolateral abdominal wall by the gubernaculum. The gubernaculum ‘pulls’ the testes through the deep inguinal ring, inguinal canal and superficial inguinal ring and over the pelvic brim. The gubernaculum is preceded by the processus vaginalis that is derived from the peritoneum anterior to the testes. The processus vaginalis pushes the muscle and fascial layers. These eventually make up the canal and the spermatic cord, into the scrotum. The gubernaculum persists as the scrotal ligament while part of the processus vaginalis remains as a bursa-like sac i.e. the tunica vaginalis testes. The testes therefore could be caught in any one of these places along its path of descending. The testes are never in the perineum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      11.2
      Seconds
  • Question 28 - Structures passing through the foramen magnum do NOT include the: ...

    Incorrect

    • Structures passing through the foramen magnum do NOT include the:

      Your Answer: Accessory nerve

      Correct Answer: Vagus nerve

      Explanation:

      Structures passing through the foramen magnum include the medulla, meninges, tectorial membrane, anterior spinal artery, vertebral artery and spinal branches of the accessory nerve.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      6.7
      Seconds
  • Question 29 - When conducting an exploratory laparotomy procedure of a patient diagnosed with a bleeding...

    Incorrect

    • When conducting an exploratory laparotomy procedure of a patient diagnosed with a bleeding ulcer of the lesser curvature of the stomach, which artery in this patient are you most likely to ligate to control the bleeding?

      Your Answer: Gastroduodenal

      Correct Answer: Left gastric

      Explanation:

      The lesser curvature of the stomach is supplied by the left gastric artery along with the right gastric artery. These two arteries are the ones to most likely be ligated if bleeding was to be stopped at the lesser curvature of the stomach. The splenic artery branches from the celiac branch and supplies the spleen. The left gastro-omental, the right and left gastroepiploic arteries supply the greater curvature.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      21.6
      Seconds
  • Question 30 - A 35-year-old woman is in a comatose state following a traumatic head injury,...

    Incorrect

    • A 35-year-old woman is in a comatose state following a traumatic head injury, and is receiving intravenous (IV) antibiotics and IV fluids containing saline and 5% dextrose. A serum biochemistry analysis is performed five days later which shows a low serum potassium level. This is most likely to be due to:

      Your Answer: Aldosterone deficiency

      Correct Answer: Nothing per oral regimen

      Explanation:

      In this patient the cause for hypokalaemia is insufficient consumption of potassium as she is nil-per mouth with no intravenous supplementation. Parenteral nutrition has been used for comatose patients, although enteral feeding is usually preferable, and less prone to complications.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      43.5
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (7/15) 47%
Colorectal (0/1) 0%
Fluids & Electrolytes (0/2) 0%
Physiology (3/8) 38%
Haematology (1/2) 50%
Pathology (5/7) 71%
General (0/1) 0%
Upper Limb (2/2) 100%
Neurology (2/2) 100%
Pelvis (0/1) 0%
Microbiology (1/1) 100%
Inflammation & Immunology (0/1) 0%
Respiratory (1/1) 100%
Pharmacology (1/1) 100%
Lower Limb (1/3) 33%
Abdomen (3/6) 50%
Endocrinology (0/1) 0%
Embryology (1/1) 100%
Neoplasia (1/1) 100%
Cell Injury & Wound Healing (0/1) 0%
Gastroenterology (1/1) 100%
Head & Neck (0/1) 0%
Passmed