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  • Question 1 - A glycogen storage disorder is characterised by increased liver glycogen with a normal...

    Incorrect

    • A glycogen storage disorder is characterised by increased liver glycogen with a normal structure and no increase in serum glucose after oral intake of a protein-rich diet. Deficiency of which of the following enzymes is responsible for this disorder?

      Your Answer: Glucokinase

      Correct Answer: Glucose-6-phosphatase

      Explanation:

      The most common glycogen storage disorder is von Gierke’s disease or glycogen storage disease type I. It results from a deficiency of enzyme glucose-6-phosphatase which affects the ability of liver to produce free glucose from glycogen and gluconeogenesis; leading to severe hypoglycaemia. There is also increased glycogen storage in the liver and kidneys causing enlargement and various problems in their functioning. The disease also causes lactic acidosis and hyperlipidaemia. The main treatment includes frequent or continuous feedings of corn-starch or other carbohydrates.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      26.1
      Seconds
  • Question 2 - The most likely cause of prominent U waves on the electrocardiogram (ECG) of...

    Correct

    • 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.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      5.5
      Seconds
  • Question 3 - Which of the following diseases causes abrupt vertigo, nausea, vomiting, tinnitus, and nystagmus?...

    Correct

    • Which of the following diseases causes abrupt vertigo, nausea, vomiting, tinnitus, and nystagmus?

      Your Answer: Vestibular neuronitis

      Explanation:

      Vestibular neuronitis or labyrinthitis causes a self-limited episode of vertigo, presumably due to inflammation of the vestibular division of cranial nerve VIII. Its causes are unknown, It may be due to a virus, but it can be related to a bacterial infection, head injury, stress, allergy, or as a reaction to medication. Symptoms can last up to 7-10 days.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      16.5
      Seconds
  • Question 4 - Carbon dioxide is principally transported in the blood in which form? ...

    Incorrect

    • Carbon dioxide is principally transported in the blood in which form?

      Your Answer: Carboxyhaemoglobin

      Correct Answer: Bicarbonate

      Explanation:

      Carbon dioxide is transported in the blood in various forms:

      – Bicarbonate (80–90%)

      – Carbamino compounds (5–10%)

      – Physically dissolved in solution (5%).

      Carbon dioxide is carried on the haemoglobin molecule as carbamino-haemoglobin; carboxyhaemoglobin is the combination of haemoglobin with carbon monoxide.

    • This question is part of the following fields:

      • Physiology
      • Respiratory; Cardiovascular
      14.3
      Seconds
  • Question 5 - A computer tomography guided needle biopsy is done on a patient with a...

    Correct

    • A computer tomography guided needle biopsy is done on a patient with a cystic swelling in the left chest. The radiologist inserted the biopsy needle into the 9th intercostal space along the mid axillary line to aspirate the swelling and obtain tissue for histological diagnosis. In which space is the swelling most likely to be?

      Your Answer: Costodiaphragmatic recess

      Explanation:

      The costodiaphragmatic recess is the lowest point of the pleural sac where the costal pleura becomes the diaphragmatic pleura. At the midclavicular line, this is found between ribs 6 and 8; at the paravertebral lines, between ribs 10 and 12 and between ribs 8 and 10 at the midaxillary line.

      The cardiac notch: is an indentation of the heart on the left lung, located on the anterior surface of the lung.

      Cupola: part of the parietal pleura that extends above the first rib.

      Oblique pericardial sinus: part of the pericardial sac located posterior to the heart behind the left atrium.

      Costomediastinal recess: a reflection of the pleura from the costal surface to the mediastinal surface, is on the anterior surface of the chest.

      The inferior mediastinum: is the space in the chest occupied by the heart.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      18.5
      Seconds
  • Question 6 - In what form are fats primarily transported in the body? ...

    Correct

    • 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.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      5
      Seconds
  • Question 7 - Enlargement of the spleen as seen in Gaucher's disease pushes the spleen downward...

    Correct

    • Enlargement of the spleen as seen in Gaucher's disease pushes the spleen downward and medially. What structure limits the straight-vertical-downward movement?

      Your Answer: Left colic flexure

      Explanation:

      The left colic flexure (also known as the splenic flexure), is the point where the colon takes a sharp turn downwards. It is the point where the transverse colon ends and the descending colon begins. It is located immediately inferior to the spleen so an enlarged spleen must move medially to avoid this colic flexure.

      The left suprarenal gland is retroperitoneal.

      The Ligament of Treitz suspends the fourth part of the duodenum from the posterior abdominal wall.

      The stomach, pancreas and liver lie medial to the spleen and thus would not prevent a vertical downward movement.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      13.2
      Seconds
  • Question 8 - What is the linea aspera: ...

    Incorrect

    • What is the linea aspera:

      Your Answer: Is a landmark on the tibia

      Correct Answer: Serves as an attachment for adductors of the thigh

      Explanation:

      The linea aspera is a prominent longitudinal ridge or crest on the middle third of the femur. It has a medial and a lateral lip and a narrow, rough, intermediate line. The vastus medialis arises from the medial lip of the linea aspera and has superior and inferior prolongations. The vastus lateralis takes origin from the lateral lip . The adductor magnus is inserted into the linea aspera. Two muscles are attached between the vastus lateralis and the adductor magnus: the gluteus maximus is inserted above and the short head of the biceps femoris arises below. Four muscles are inserted between the adductor magnus and the vastus medialis: the iliacus and pectineus superiorly, and the adductor brevis and adductor longus inferiorly.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      8.6
      Seconds
  • Question 9 - Fine-needle aspiration is a type of biopsy procedure. When performing a fine-needle aspiration...

    Correct

    • Fine-needle aspiration is a type of biopsy procedure. When performing a fine-needle aspiration of the lungs, which is the most common complication of the procedure?

      Your Answer: Pneumothorax

      Explanation:

      Pneumothorax is the most common complication of a fine-needle aspiration procedure. Various factors, such as lesion size, have been associated with increased risk of pneumothorax .

    • This question is part of the following fields:

      • Pathology
      • Respiratory
      14.3
      Seconds
  • Question 10 - A patient is admitted to the ICU, and is prescribed tazobactam, amongst other...

    Incorrect

    • A patient is admitted to the ICU, and is prescribed tazobactam, amongst other drugs. What is the mechanism of action of tazobactam?

      Your Answer: Inhibits CD3 receptor

      Correct Answer: Inhibits beta-lactamase

      Explanation:

      Tazobactam is a compound which inhibits the action of bacterial beta-lactamases. It is added to the extended-spectrum beta-lactam antibiotic piperacillin to broaden the spectrum of piperacillin by making it effective against organisms that express beta-lactamase and would normally degrade piperacillin.

    • This question is part of the following fields:

      • Pathology
      • Pharmacology
      22.6
      Seconds
  • Question 11 - 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
      15.6
      Seconds
  • Question 12 - The petrous part of the internal carotid artery is located inside of which...

    Correct

    • The petrous part of the internal carotid artery is located inside of which cranial bone?

      Your Answer: Temporal

      Explanation:

      The petrous segment, or C2, of the internal carotid is that which is inside the petrous part of the temporal bone. This segment extends until the foramen lacerum. The petrous portion classically has three sections: an ascending, or vertical portion; the genu, or bend; and the horizontal portion.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      11.3
      Seconds
  • Question 13 - Which portion of the renal tubule absorbs amino acids and glucose? ...

    Incorrect

    • Which portion of the renal tubule absorbs amino acids and glucose?

      Your Answer: Distal convoluted tubule

      Correct Answer: Proximal convoluted tubule

      Explanation:

      In relation to the morphology of the kidney as a whole, the convoluted segments of the proximal tubules are confined entirely to the renal cortex. Glucose, amino acids, inorganic phosphate and some other solutes are reabsorbed via secondary active transport in the proximal renal tubule through co-transport channels driven by the sodium gradient.

    • This question is part of the following fields:

      • Physiology
      • Renal
      8.9
      Seconds
  • Question 14 - A 50-year-old man is diagnosed with emphysema and cirrhosis of the liver. Which...

    Correct

    • A 50-year-old man is diagnosed with emphysema and cirrhosis of the liver. Which of the following condition may be the cause of both cirrhosis and emphysema in this patient?

      Your Answer: Alpha1-antitrypsin deficiency

      Explanation:

      Alpha-1 antitrypsin (A1AT) deficiency is a condition characterised by the lack of a protein that protects the lungs and liver from damage, called alpha1-antytripsin. The main complications of this condition are liver diseases such as cirrhosis and chronic hepatitis, due to accumulation of abnormal alpha 1-antytripsin and emphysema due to loss of the proteolytic protection of the lungs.

    • This question is part of the following fields:

      • Pathology
      • Respiratory
      15.6
      Seconds
  • Question 15 - The tensor villi palatini muscle is a broad thin, ribbon-like muscle in the...

    Correct

    • The tensor villi palatini muscle is a broad thin, ribbon-like muscle in the head that tenses the soft palate. Which of the following structures is associated with the tensor villi palatini muscle?

      Your Answer: The hamulus of the medial pterygoid plate

      Explanation:

      The pterygoid hamulus is a hook-like process at the lower extremity of the medial pterygoid plate of the sphenoid bone around which the tendon of the tensor veli palatini passes.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      16.3
      Seconds
  • Question 16 - After severe injury of the upper limb following an accident. The humerus is...

    Correct

    • 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.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      8.5
      Seconds
  • Question 17 - After finding elevated PSA levels, a 69-year-old man undergoes a needle biopsy and...

    Incorrect

    • After finding elevated PSA levels, a 69-year-old man undergoes a needle biopsy and is diagnosed with prostatic cancer. What is the stage of this primary tumour?

      Your Answer: T1b

      Correct Answer: T1c

      Explanation:

      The AJCC uses a TNM system to stage prostatic cancer, with categories for the primary tumour, regional lymph nodes and distant metastases:

      TX: cannot evaluate the primary tumour T0: no evidence of tumour

      T1: tumour present, but not detectable clinically or with imaging T1a: tumour was incidentally found in less than 5% of prostate tissue resected (for other reasons)

      T1b: tumour was incidentally found in more than 5% of prostate tissue resected

      T1c: tumour was found in a needle biopsy performed due to an elevated serum prostate-specific antigen

      T2: the tumour can be felt (palpated) on examination, but has not spread outside the prostate

      T2a: the tumour is in half or less than half of one of the prostate gland’s two lobes

      T2b: the tumour is in more than half of one lobe, but not both

      T2c: the tumour is in both lobes

      T3: the tumour has spread through the prostatic capsule (if it is only part-way through, it is still T2)

      T3a: the tumour has spread through the capsule on one or both sides

      T3b: the tumour has invaded one or both seminal vesicles

      T4: the tumour has invaded other nearby structures.

      In this case, the tumour has a T1c stage.

    • This question is part of the following fields:

      • Pathology
      • Urology
      1258.1
      Seconds
  • Question 18 - Which of the following factors will not affect the wound healing process in...

    Correct

    • Which of the following factors will not affect the wound healing process in a young women who suffered serious burns to her chest and hands?

      Your Answer: Vitamin A deficiency

      Explanation:

      Healing can be sped-up or slowed down due to various reasons: 1. blood supply, 2. infection, 3. denervation, 4. collection of blood/hematoma, 5. mechanical stress, 6. foreign body, 7. techniques used during surgery and 8. dressing of the wound. Other systemic factors include 1. nutrition e.g. deficiency of zinc, vitamin C, protein deficiency, 2. metabolic status, 3. circulatory status and 4. hormonal influence

    • This question is part of the following fields:

      • Cell Injury & Wound Healing
      • Pathology
      16.7
      Seconds
  • Question 19 - Which muscles are attached to the tibial tuberosity? ...

    Correct

    • Which muscles are attached to the tibial tuberosity?

      Your Answer: Vastus intermedius

      Explanation:

      The tuberosity of the tibia is the site of attachment to the ligamentum patella (the tendon of the quadriceps femoris muscle which include four heads: rectus femoris, vastus medialis, intermedius and lateralis).

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      11.4
      Seconds
  • Question 20 - The thyrocervical trunk branches into which artery that passes upward and in front...

    Correct

    • The thyrocervical trunk branches into which artery that passes upward and in front of the vertebral artery and longus colli muscle:

      Your Answer: Inferior thyroid

      Explanation:

      The inferior thyroid artery is an artery in the neck. It arises from the thyrocervical trunk and passes upward, in front of the vertebral artery and longus colli muscle.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      8.1
      Seconds
  • Question 21 - Diffusion is the movement of molecules from a region of high concentration to a...

    Correct

    • Diffusion is the movement of molecules from a region of high concentration to a region of low concentration. Which of these changes will decrease the rate of diffusion of a substance?

      Your Answer: An increase in the molecular weight of the substance

      Explanation:

      Unless given IV, a drug must cross several semipermeable cell membranes before it reaches the systemic circulation. Drugs may cross cell membranes by diffusion, amongst other mechanisms. The rate of diffusion of a substance is proportional to the difference in the concentration of the diffusing substance between the two sides of the membrane, the temperature of the solution, the permeability of the membrane and, in the case of ions, the electrical potential difference between the two sides of the membrane.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      16.9
      Seconds
  • Question 22 - A 50-year old lady presented to the clinic with chronic pain in the...

    Correct

    • A 50-year old lady presented to the clinic with chronic pain in the abdomen. On physical examination, she was found to be pale. Further investigations revealed a decrease in both serum iron and total iron-binding capacity, along with an increase in serum ferritin. These findings are seen in:

      Your Answer: Anaemia of chronic disease

      Explanation:

      Anaemia of chronic disease is characterized by low serum iron, iron-binding capacity and saturation with increased ferritin (storage iron). Haemolytic anaemia is characterized by normal iron levels as the haemoglobin released from the haemolysed red blood cells is recycled. Anaemia due to chronic blood loss leads to low serum iron, low ferritin and high total iron-binding capacity (TIBC). Malabsorption, especially with duodenal involvement can also lead to iron deficiency anaemia with low ferritin and high TIBC. Megaloblastic anaemia due to vitamin B12 and folate deficiency is not associated with abnormalities in metabolism of iron.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      17.1
      Seconds
  • Question 23 - If a tumour is found in both lobes of the prostate, without nodal...

    Correct

    • If a tumour is found in both lobes of the prostate, without nodal involvement or metastases, a histological grade of G2 and elevated PSA, what is the overall prostatic cancer stage?

      Your Answer: Stage II

      Explanation:

      The AJCC uses the TNM, Gleason score and PSA levels to determine the overall stage of prostatic cancer. This staging is as follows:

      Stage I: T1, N0, M0, Gleason score 6 or less, PSA less than 10; or T2a, N0, M0, Gleason score 6 or less, PSA less than 10

      Stage IIa: T1, N0, M0, Gleason score of 7, PSA less than 20; or T1, N0, M0, Gleason score of 6 or less, PSA at least 10 but less than 20; or T2a or T2b, N0, M0, Gleason score of 7 or less, PSA less than 20

      Stage IIb: T2c, N0, M0, any Gleason score, any PSA; or T1 or T2, N0, M0, any Gleason score PSA of 20 or more; or T1 or T2, N0, M0, Gleason score of 8 or higher, any PSA

      Stage III: T3, N0, M0, any Gleason score, any PSA Stage IV: T4, N0, M0,any Gleason score, any PSA; or any T, N1, M0,any Gleason score, any PSA; or Any T, any N, M1, any Gleason score, any PSA.

      The patient in this case has a T2 N0 M0 G2 tumour, meaning it belongs in stage II

    • This question is part of the following fields:

      • Pathology
      • Urology
      13.4
      Seconds
  • Question 24 - A histopathological analysis of a specimen showed loss of individual cell structure with...

    Incorrect

    • A histopathological analysis of a specimen showed loss of individual cell structure with karyorrhexis and fragmentation. The overall integrity of the tissue structure is preserved. This is typical of which of the following pathologies?

      Your Answer: Carcinoma insitu

      Correct Answer: Viral hepatitis

      Explanation:

      Viral infections will cause necrosis of the hepatocytes with characteristic changes of karyorrhexis and cell fragmentation.

      Brown atrophy of the heart is due to accumulation of lipofuscin in the myocardium.

      Tissue destruction associated with transplant rejection leads to widespread loss of structural integrity.

      Single cell necrosis is not characteristically seen in chronic alcoholic liver.

      Barbiturate overdose will result in hypertrophy of the smooth endoplasmic reticulum.

      Carcinoma insitu will cause dysplastic cells without the overall structural integrity being disrupted.

      Atrophy is due to apoptosis with ordered cellular fragmentation and phagocytosis and will not induce an inflammatory process unlike necrosis.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing
      • Pathology
      34.5
      Seconds
  • Question 25 - A 44-year old man, who was euthyroid underwent thyroidectomy following neoplastic cells found...

    Incorrect

    • A 44-year old man, who was euthyroid underwent thyroidectomy following neoplastic cells found on fine-needle aspiration. Frozen section of multiple thyroid masses showed malignant neoplasm of polygonal cells in nests. The neoplasm also showed presence of amyloid which was positive with Congo-red staining. Immunoperoxidase staining for calcitonin was also positive. Chest X-ray revealed no abnormality. However, his blood pressure was found to be raised, and his serum ionised calcium was high. What is the likely diagnosis?

      Your Answer: Parathyroid carcinoma

      Correct Answer: Multiple endocrine neoplasia type IIA

      Explanation:

      MEN (Multiple Endocrine Neoplasia) syndromes are a group of three separate familial disease which consists of adenomatous hyperplasia and neoplasia in several endocrine glands. All three conditions are inherited as an autosomal dominant trait, with a single gene producing multiple effects. MEN IIA is characterized by medullary carcinoma of the thyroid, pheochromocytoma and hyperparathyroidism. It should be suspected in patients with bilateral pheochromocytoma, a familial history of MEN, or at least two characteristic endocrine manifestations. Genetic testing is used to confirm the diagnosis. Early diagnosis is crucial to aid in complete excision of the localized tumour. Pheochromocytomas can be detected by plasma free metanephrines and fractionated urinary catecholamines, particularly adrenaline (epinephrine).

      Imaging studies such as computed tomography or magnetic resonance imaging might also prove useful. Hyperparathyroidism is diagnosed by the standard finding of hypercalcaemia, hypophosphatemia and an increased parathyroid hormone level. Once MEN IIA syndrome is identified in any patient, it is recommended that his or her first-degree relatives and any other symptomatic also undergo genetic testing. Relatives should be subjected to annual screening for hyperparathyroidism and pheochromocytoma beginning in early childhood and continue indefinitely. Serum calcium levels help in screening for hyperparathyroidism. Similarly, screening for pheochromocytoma is by history, measurement of the blood pressure and laboratory testing.

    • This question is part of the following fields:

      • Endocrine
      • Pathology
      243
      Seconds
  • Question 26 - A construction worker is brought to the A&E after a fall on site....

    Correct

    • A construction worker is brought to the A&E after a fall on site. The patient is conscious but complains of inability to feel his legs. A neurological examination reveals that he has no cutaneous sensation from his umbilicus to his toes. What is the likely level of the spinal cord that is injured?

      Your Answer: T10

      Explanation:

      The umbilicus has a relatively consistent position in humans and thus serves as an important land mark. The skin around the waist at the level of the umbilicus is supplied by the tenth thoracic spinal nerve (T10 dermatome).

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      15.7
      Seconds
  • Question 27 - Which of the following foramina will the ophthalmic artery pass through in order...

    Correct

    • Which of the following foramina will the ophthalmic artery pass through in order to reach the eye?

      Your 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.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      6.4
      Seconds
  • Question 28 - Which of the following substances is most likely to cause pulmonary vasodilatation? ...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      10.2
      Seconds
  • Question 29 - Coagulation in the body (in vivo) is a process in which several proteins...

    Incorrect

    • Coagulation in the body (in vivo) is a process in which several proteins known as coagulation factors are activated in a cascade effect to stop bleeding. Which of the following initiates this cascade effect?

      Your Answer: Fibrinogen

      Correct Answer: Tissue factor

      Explanation:

      Tissue factor (TF), also known as ‘factor III’ or ‘thromboplastin’, is an anti-coagulation protein that initiates the extrinsic coagulation. TF acts as a transmembrane receptor for Factor VII/VIIa . It is expressed by endothelial cells but also certain tissues, such as the heart and brain.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      13.4
      Seconds
  • Question 30 - An 80 year-old lady presents to the out patient clinic complaining of chest...

    Incorrect

    • An 80 year-old lady presents to the out patient clinic complaining of chest pain of 2 months' duration with a normal electrocardiogram and cardiac enzymes. A computed tomographic scan is done which reveals a mass lesion involving a structure in the middle mediastinum. Which among the following structures could be involved?

      Your Answer: Thoracic duct

      Correct Answer: Ascending aorta

      Explanation:

      The middle mediastinum is the broadest part of the mediastinal cavity containing the heart enclosed in the pericardium, ascending aorta, lower half of the superior vena cava with the azygos vein opening into it, the bifurcation of the trachea and the two bronchi, the pulmonary artery with its branches, pulmonary veins, phrenic nerves and bronchial lymph nodes. The most likely structure involved is the ascending aorta, perhaps with an aneurysm.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      115
      Seconds
  • Question 31 - The pudendal nerve is derived from? ...

    Incorrect

    • The pudendal nerve is derived from?

      Your Answer: L4, L5, S1

      Correct Answer: S2, S3, S4

      Explanation:

      The pudendal nerve derives it’s fibres from the ventral branches of the second, third and fourth sacral nerves (S2,3,4)

    • This question is part of the following fields:

      • Anatomy
      • Pelvis
      9
      Seconds
  • Question 32 - A 50-year-old gentleman was recently diagnosed with hypertension, with no other abnormalities on...

    Correct

    • A 50-year-old gentleman was recently diagnosed with hypertension, with no other abnormalities on physical examination. Further investigations revealed the following :
      Na+ 144 mmol/l
      K+ 3.0 mmol/l
      Cl- 107 mmol/l
      Bicarbonate 25 mmol/l.
      Blood glucose 5.8 mmol/l.
      What is the likely diagnosis?

      Your Answer: Conn syndrome

      Explanation:

      Overproduction of aldosterone (a mineralocorticoid) by the adrenal glands is known as Conn’s syndrome. It can be either due to an aldosterone-secreting adrenal adenoma (50-60% cases) or adrenal gland hyperplasia (40-50% cases). Excess aldosterone leads to sodium and water retention, along with potassium excretion. This leads to arterial (non-essential) hypertension. Conn’s syndrome is the commonest cause of primary hyperaldosteronism. Other symptoms include muscle cramps, headache (due to hypokalaemia) and metabolic alkalosis, which occurs due to increased secretion of H+ ions by the kidney. The raised pH of the blood traps calcium leading to symptoms of hypocalcaemia, which can be mimicked by liquorice ingestion and Liddle syndrome. To diagnose Conn’s syndrome, the ratio of renin and aldosterone is measured. Due to suppression of renin secretion, there is low renin to aldosterone ratio (<0.05). However, anti-hypertensives may affect the test results and should be withdrawn for 6 weeks. Computed tomography can also be done to detect the presence of adrenal adenoma. Cushing’s syndrome does not cause hypokalaemia with normal serum glucose levels. Nelson’s syndrome refers to increased ACTH secretion due to pituitary adenoma. Pheochromocytoma will not lead to hypokalaemia even though hypertension can be seen.

    • This question is part of the following fields:

      • Endocrine
      • Pathology
      18
      Seconds
  • Question 33 - Multiple cells were labelled using a fluorescent dye that doesn’t cross the cell...

    Correct

    • 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: 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
      20
      Seconds
  • Question 34 - A 7-year-old girl is given cephalexin to treat an infection and develops hives,...

    Correct

    • A 7-year-old girl is given cephalexin to treat an infection and develops hives, with localised facial oedema. Which of the following conditions will cause localised oedema?

      Your Answer: Angio-oedema

      Explanation:

      Angio-oedema, is the rapid swelling of the skin, mucosa and submucosal tissues. The underlying mechanism typically involves histamine or bradykinin. The version related to histamine is to due an allergic reaction to agents such as insect bites, food, or medications. The version related to bradykinin may occur due to an inherited C1 esterase inhibitor deficiency, medications e.g. angiotensin converting enzyme inhibitors, or a lymphoproliferative disorder.

    • This question is part of the following fields:

      • Physiology
      • Renal
      25.7
      Seconds
  • Question 35 - A 30 year old female presented in the emergency with an irregular pulse....

    Incorrect

    • A 30 year old female presented in the emergency with an irregular pulse. Her ECG showed absent P-waves with irregular RR interval. What is the most likely diagnosis?

      Your Answer: Ventricular fibrillation

      Correct Answer: Atrial fibrillation

      Explanation:

      Atrial fibrillation is one of the most common cardiac arrhythmias. It is often asymptomatic but may present with symptoms of palpitations, fainting, chest pain and heart failure. Characteristic findings are: absence of P-waves, unorganised electrical activity in their place, irregularity of RR interval due to irregular conduction of impulses to the ventricles and if paroxysmal AF is suspected, episodes may be documented with the use of Holter monitoring

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      24.9
      Seconds
  • Question 36 - A 28-year old lady comes to the surgical clinic with a recently detected...

    Correct

    • A 28-year old lady comes to the surgical clinic with a recently detected lump in her right breast. On examination, the lump is found to be 1cm, rubbery, mobile with no palpable axillary nodes. Mammography reveals no microcalcifications and the opposite breast appears normal. What is the likely diagnosis?

      Your Answer: Fibroadenoma

      Explanation:

      A benign breast tumour, fibroadenoma is common below the age of 30 years and occurs due to oestrogenic excess. It is characterised by proliferation of both glandular and stromal elements. Fibroadenomas are usually solitary and are mobile, not fixed to surrounding structures. The tumour is elastic, nodular and encapsulated with a grey-white cut surface. The two main histological types include intracanalicular and pericanalicular types, with both types often present in the same tumour. In the intracanalicular type, the stromal proliferation component predominates causing compression of ducts making them appear slit-like. In pericanalicular type, the fibrous stroma dominates around the ductal spaces so that they remain oval on cross section.

    • This question is part of the following fields:

      • Pathology
      • Women's Health
      278.3
      Seconds
  • Question 37 - Nephrotic syndrome is a condition that causes proteinuria, hypoalbuminemia and oedema. Which of...

    Correct

    • 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.

    • This question is part of the following fields:

      • Physiology
      • Renal
      17
      Seconds
  • Question 38 - The surgical registrar is doing an exploratory laparotomy on a 35 year old...

    Correct

    • The surgical registrar is doing an exploratory laparotomy on a 35 year old lady of African descent with tuberculous of the abdomen and suspected perforation. The small bowel is matted due to adhesions and it is difficult to differentiate the ileum from the jejunum. Which of the following features is typical of the jejunum?

      Your Answer: It has sparse aggregated lymph nodules

      Explanation:

      The jejunum has a wider diameter, is thicker and more vascularized, hence of a deeper colour compared to the ileum. The valvulae conniventes (circular folds) of its mucous membranes are large and thick and its villi are larger than those in the ileum. The jejunum also has sparse aggregates of lymph nodules and most of its part occupies the umbilical and left iliac regions whilst the ileum is mostly in the umbilical, hypogastric, right iliac and pelvic regions.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      23.9
      Seconds
  • Question 39 - A 13 year old girl presented with signs of shortness of breath, chest...

    Correct

    • A 13 year old girl presented with signs of shortness of breath, chest pain, non-productive cough, oedema of the lower extremities and cyanosis of the fingertips. She has a history of a ventricular septal defect not surgically corrected. The most probable cause of these symptoms is:

      Your Answer: Shunt reversal

      Explanation:

      A ventricular septal defect (VSD) is a common form of congenital heart defects and is characterised by the presence of a hole in the wall that separates the right from the left ventricle. Medium or large defects can cause many complications. One of these complication is Eisenmenger syndrome, characterised by reversal of the shunt (from left-to-right shunt into a right-to-left) ,cyanosis and pulmonary hypertension.

    • This question is part of the following fields:

      • Cardiovascular
      • Pathology
      26.5
      Seconds
  • Question 40 - Which of the following morphological features is most characteristic of hyaline degeneration? ...

    Incorrect

    • Which of the following morphological features is most characteristic of hyaline degeneration?

      Your Answer: Orphan Annie eye nucleus

      Correct Answer: Homogeneous, ground-glass, pink-staining appearance of cells

      Explanation:

      The characteristic morphological features of hyaline degeneration is ground-glass, pinking staining cytoplasm with an intact cell membrane. The accumulation of lipids, calcium salts, lipofuscin and an amorphous cytoplasm with an intact cell membrane are all characteristically found in different situations.

      Pyknotic nucleus and orphan Annie eye nucleus are not seen in hyaline degeneration.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing
      • Pathology
      18
      Seconds
  • Question 41 - Which of the given options best describes the metabolic changes which occur following...

    Correct

    • Which of the given options best describes the metabolic changes which occur following a severe soft tissue injury sustained after a PVA?

      Your Answer: Mobilisation of fat stores

      Explanation:

      The following metabolic responses occur following trauma as part of a coping mechanism for the additional stress. These include acid base changes (metabolic acidosis or alkalosis), decrease urine output and osmolality, reduced basal metabolic rate (BMR), gluconeogenesis with amino acid breakdown and shunting, hyponatraemia as a result of impaired functioning of sodium pumps, hypoxic injury, coagulopathies, decreased immunity, increase extracellular fluid and hypovolemic shock, increase permeability leading to oedema, break down and mobilization of fat reserves, pyrexia and reduced circulating levels of albumin.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing
      • Pathology
      34.2
      Seconds
  • Question 42 - A 57-year-old male smoker noted a lump on his inner lip. Upon physical...

    Incorrect

    • A 57-year-old male smoker noted a lump on his inner lip. Upon physical examination the lump measured more than 2 cm but less than 4 cm in its greatest dimension. He is diagnosed with squamous cell carcinoma of the lip. What is the stage of the patient's cancer according to the TNM staging for head and neck cancers?

      Your Answer: T1

      Correct Answer: T2

      Explanation:

      Head and neck cancer is a group of cancers that starts within the mouth, nose, throat, larynx, sinuses, or salivary glands. The TNM staging system used for head and neck cancers is a clinical staging system that allows physicians to compare results across patients, assess prognosis, and design appropriate treatment regimens. The staging is as follows; Primary tumour (T): Tis: pre-invasive cancer (carcinoma in situ), T0: no evidence of primary tumour, T1: tumour 2 cm or less in its greatest dimension, T2: tumour more than 2 cm but not more than 4 cm, T3: tumour larger than 4 cm, T4: tumour with extension to bone, muscle, skin, antrum, neck, etc and TX: minimum requirements to assess primary tumour cannot be met. Regional lymph node involvement (N): N0: no evidence of regional lymph node involvement, N1: evidence of involvement of movable homolateral regional lymph nodes, N2: evidence of involvement of movable contralateral or bilateral regional lymph nodes, N3: evidence of involvement of fixed regional lymph nodes and NX: Minimum requirements to assess the regional nodes cannot be met. Distant metastases (M): M0: no evidence of distant metastases, M1: evidence of distant metastases and MX: minimum requirements to assess the presence of distant metastases cannot be met. Staging: Stage I: T1 N0 M0, Stage II: T2 N0 M0, Stage III: T2NOMO and T3N1MO, Stage IV: T4N1M0, any TN2M0, any TN3M0, any T and any NM1. The depth of infiltration is predictive of the prognosis. With increasing depth of invasion of the primary tumour, the risk of nodal metastasis increases and survival decreases. The patient in this scenario therefore has a T2 tumour.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      23.2
      Seconds
  • Question 43 - A 15-day old baby was brought to the emergency department with constipation for...

    Correct

    • A 15-day old baby was brought to the emergency department with constipation for 4 days. On examination, the abdomen of the baby was found to be distended and tender all over. No bowel sounds were heard. A sigmoid colon biopsy was carried out, which showed absent ganglion cells. What is the diagnosis?

      Your Answer: Hirschsprung’s disease

      Explanation:

      Hirschsprung’s disease is characterized by congenital absence of the autonomic plexus (Meissner’s and Auerbach’s plexus) in the intestinal wall. Usually limited to the distal colon, it can occasionally involve the entire colon or even the small bowel. There is abnormal or absent peristalsis in the affected segment, resulting in continuous spasm of smooth muscle and partial/complete obstruction. This causes accumulation of intestinal contents and dilatation of proximal segment. Skip lesions are highly uncommon. This disease is seen early in life with 15% patients presenting in first month, 60% by 1 year of age and 85% by the age of 4 years. Symptoms include severe and complete constipation, abdominal distension and vomiting. Patients with involvement of ultra-short segments might have mild constipation with intervening diarrhoea. In older children, symptoms include failure to thrive, anorexia, and lack of an urge to defecate. On examination, an empty rectum is revealed with stool palpable high up in the colon. If not diagnosed in time, it can lead to Hirschsprung’s enterocolitis (toxic megacolon), which can be fulminant and lead to death. Diagnosis involves a barium enema or a rectal suction biopsy. Barium enema shows a transition in diameter between the dilated, normal colon proximal to the narrowed, affected distal segment. It is to be noted that barium enema should be done without prior preparation, which can dilate the abnormal segment, leading to a false-negative result. A 24-hour post-evacuation film can be obtained in the neonatal period – if the colon is still filled with barium, there is a high likelihood of Hirschsprung’s disease. Full-thickness rectal biopsy is diagnostic by showing the absence of ganglion cells. Acetylcholinesterase staining can be done to highlight the enlarged nerve trunks. Abnormal innervation can also be demonstrated by rectal manometry.

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
      20.5
      Seconds
  • Question 44 - In a study, breast lumps were analysed to determine the characteristic of malignant...

    Incorrect

    • 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: Anaplasia

      Correct 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.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      88.3
      Seconds
  • Question 45 - In the glomerulus of the kidney, the mesangium is a structure associated with the capillaries. It has extraglomerular mesangial...

    Incorrect

    • In the glomerulus of the kidney, the mesangium is a structure associated with the capillaries. It has extraglomerular mesangial cells that:

      Your Answer: Provide structural support for and regulate blood flow of the glomerular capillaries by their contractile activity

      Correct 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.

    • This question is part of the following fields:

      • Physiology
      • Renal
      18.3
      Seconds
  • Question 46 - After total thyroidectomy, which of the following investigations is recommended in the immediate...

    Correct

    • After total thyroidectomy, which of the following investigations is recommended in the immediate post-operative period?

      Your Answer: Serum calcium

      Explanation:

      Total thyroidectomy might sometimes result in inadvertent excision or damage of parathyroid glands, leading to hypoparathyroidism. Monitoring serum calcium levels in the post-operative period to detect hypocalcaemia is essential to diagnose and prevent this condition.

    • This question is part of the following fields:

      • Endocrine
      • Pathology
      14.3
      Seconds
  • Question 47 - Which of the following causes the maximum increase in the secretion of antidiuretic...

    Incorrect

    • Which of the following causes the maximum increase in the secretion of antidiuretic hormone (ADH)?

      Your Answer: Hypothalamic releasing factor

      Correct 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.

    • This question is part of the following fields:

      • Endocrinology
      • Physiology
      14
      Seconds
  • Question 48 - What is correct regarding the obturator artery? ...

    Incorrect

    • What is correct regarding the obturator artery?

      Your Answer: It exits through the greater sciatic foramen

      Correct Answer: It is found in the medial compartment of the thigh

      Explanation:

      The obturator artery is a branch of the internal iliac artery, which passes antero-inferiorly on the lateral wall of the pelvis, to the upper part of the obturator foramen. The posterior branch follows the posterior margin of the foramen and turns forward on the inferior ramus of the ischium. It also supplies an articular branch, which enters the hip joint through the acetabular notch, sending a branch along the ligamentum teres to the head of the femur. It is the main source of arterial supply to the medial compartment of the thigh

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      15.4
      Seconds
  • Question 49 - Due to a plantarflexion–inversion ankle sprain, which is the first ligament to rupture?...

    Incorrect

    • Due to a plantarflexion–inversion ankle sprain, which is the first ligament to rupture?

      Your Answer: Calcaneofibular ligament

      Correct Answer: Anterior talofibular ligament

      Explanation:

      The anterior talofibular ligament passes from the anterior margin of the fibular malleolus. It is the most commonly injured ligament, as part of the lateral ligament of the ankle.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      15.4
      Seconds
  • Question 50 - Calculate the total peripheral resistance for a patient with a blood pressure of...

    Incorrect

    • Calculate the total peripheral resistance for a patient with a blood pressure of 130/70 mm HG and cardiac output of 5 litres / min?

      Your Answer: 16 mmHg × min/l

      Correct Answer: 18 mmHg × min/l

      Explanation:

      Total peripheral resistance = Mean arterial pressure/Cardiac output. And the mean arterial pressure = Diastolic pressure + 1/3 (Systolic pressure – Diastolic pressure), i.e., 70 + 1/3 (130-70) = 90 mmHg. Therefore, total peripheral resistance = 90 mmHg/5 l per min = 18 mmHg × min/l.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      6.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gastroenterology (1/2) 50%
Physiology (6/14) 43%
Cardiovascular (2/4) 50%
Neurology (1/1) 100%
Pathology (12/20) 60%
Respiratory; Cardiovascular (0/1) 0%
Anatomy (11/16) 69%
Thorax (1/2) 50%
Abdomen (4/4) 100%
Lower Limb (1/4) 25%
Respiratory (2/3) 67%
Pharmacology (0/1) 0%
Head & Neck (4/4) 100%
Renal (2/4) 50%
Upper Limb (1/1) 100%
Urology (1/2) 50%
Cell Injury & Wound Healing (2/4) 50%
Fluids & Electrolytes (1/1) 100%
Haematology (1/2) 50%
Endocrine (2/3) 67%
Pelvis (0/1) 0%
General (1/1) 100%
Women's Health (1/1) 100%
Neoplasia (0/2) 0%
Gastrointestinal; Hepatobiliary (1/1) 100%
Endocrinology (0/1) 0%
Passmed