00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - A woman that presented with dyspnoea, chest pain and cough was found to...

    Correct

    • A woman that presented with dyspnoea, chest pain and cough was found to have a serous pleural effusion. This finding is most likely to be associated with which of the following conditions?

      Your Answer: Congestive heart failure

      Explanation:

      A pleural effusion is defined as an abnormal collection of fluid in the pleural space. Pleural effusion can result from excess fluid production or decreased absorption or both. Thoracentesis and laboratory testing help determine the origin of the accumulated fluid. Serous fluid accumulation in the pleural space indicates the presence of a hydrothorax and is most likely to develop secondary to congestive heart failure.

    • This question is part of the following fields:

      • Pathology
      • Respiratory
      20.3
      Seconds
  • Question 2 - A 30-year old lady presented to her GP with complaints of tremors, excessive...

    Correct

    • A 30-year old lady presented to her GP with complaints of tremors, excessive emotional outbursts, weight loss and increased sweating over 20 days. On examination, she had warm and moist skin, a fine tremor of the fingers and hyperreflexia. Her vital signs were normal. What is the likely diagnosis?

      Your Answer: Hyperthyroidism

      Explanation:

      Excess of circulating free thyroid hormones (thyroxine and/or triiodothyronine) leads to hyperthyroidism. Common causes include Graves’ disease, toxic thyroid adenoma and toxic multinodular goitre. Grave’s disease is the most common cause and is responsible for 70-80% cases of hyperthyroidism. Other causes include excess intake of thyroid hormone, amiodarone-related. It is important that hyperthyroidism is not confused with hyperthyroxinaemia (high levels of thyroid hormone in blood), which includes causes like thyroiditis. Both the conditions lead to thyrotoxicosis (symptoms due to hyperthyroxinemia). Symptoms include weight loss associated with increased appetite, anxiety, weakness, heat intolerance, depression, increased sweating, dyspnoea, loss of libido, diarrhoea, palpitations and occasionally arrhythmias. If there is an acute increase in metabolic rate, the condition is known as ‘thyroid storm’. Elderly sometimes present only with fatigue and weight loss and this is called apathetic hyperthyroidism. Neurological symptoms are also seen in hyperthyroidism and these are tremor, chorea, myopathy and periodic paralysis. One of the most serious complications of hyperthyroidism is stroke of cardioembolic origin due to coexisting atrial fibrillation.

    • This question is part of the following fields:

      • Endocrine
      • Pathology
      24.6
      Seconds
  • Question 3 - Decreased velocity of impulse conduction through the atrioventricular node (AV node) in the...

    Correct

    • Decreased velocity of impulse conduction through the atrioventricular node (AV node) in the heart will lead to:

      Your Answer: Increased PR interval

      Explanation:

      AV node damage may lead to an increase in the PR interval to as high as 0.25 – 0.40 s (normal = 0.12 – 0.20 s). In the case of severe impairment, there might be a complete failure of passage of impulses leading to complete block. In this case, the atria and ventricles will beat independently of each other.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      8.1
      Seconds
  • Question 4 - A 45-year-old man with short bowel syndrome requires parenteral nutrition. The solution of...

    Correct

    • A 45-year-old man with short bowel syndrome requires parenteral nutrition. The solution of choice for parenteral nutrition is:

      Your Answer: Crystalline amino acids

      Explanation:

      Total parenteral nutrition (TPN), is the practice of feeding a person intravenously, circumventing the gut. It is normally used in the following situations: surgery, when feeding by mouth is not possible, when a person’s digestive system cannot absorb nutrients due to chronic disease or if a person’s nutrient requirement cannot be met by enteral feeding and supplementation. A sterile bag of nutrient solution, between 500 ml and 4L, is provided. The pump infuses a small amount (0.1–10 ml/h) continuously to keep the vein open. The nutrient solution consists of water, glucose, salts, amino acids, vitamins and sometimes emulsified fats. Ideally each patient is assessed individually before commencing on parenteral nutrition, and a team consisting of doctors, nurses, clinical pharmacists and dietitians evaluate the patient’s individual data and decide what formula to use and at what rate.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      9.2
      Seconds
  • Question 5 - A 30-year-old man is brought to the emergency department suffering from extreme dehydration,...

    Correct

    • A 30-year-old man is brought to the emergency department suffering from extreme dehydration, and subsequent hypotension and tachycardia. Which part of the kidney will compensate for this loss?

      Your Answer: Collecting ducts

      Explanation:

      The collecting duct system of the kidney consists of a series of tubules and ducts that physically connect nephrons to a minor calyx or directly to the renal pelvis. The collecting duct system is the last component of the kidney to influence the body’s electrolyte and fluid balance. In humans, the system accounts for 4–5% of the kidney’s reabsorption of sodium and 5% of the kidney’s reabsorption of water. At times of extreme dehydration, over 24% of the filtered water may be reabsorbed in the collecting duct system.

    • This question is part of the following fields:

      • Physiology
      • Renal
      8.2
      Seconds
  • Question 6 - A 53 year old women with a history of atrial fibrillation developed an...

    Correct

    • A 53 year old women with a history of atrial fibrillation developed an acute abdomen. On laparoscopic examination her bowels appeared to be dusky to red-purple in colour and her mesenteric veins appeared to be patent. Which of the following is most likely to occur in this situation?

      Your Answer: Wet gangrene

      Explanation:

      Infarction of the small bowel following a sudden and complete occlusion of the mesenteric artery can involve any portion of the bowel, whether small or a large. The splenic flexure is at most risk for infarction as it is the watershed area between the superior and inferior mesenteric vessels. Regardless of whether the arterial or the venous blood vessels are occluded, because of the blood reflow into the damaged portion, it will appear haemorrhagic. The bowel appearing congested at first and then becoming oedematous. If the artery is occluded then there will be a clear cut demarcation and in venous occlusion the dusky colour fades with the rest of the normal bowel. Wet gangrene is characteristic of ischaemic injury to the gut.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing; Gastrointestinal
      • Pathology
      12.9
      Seconds
  • Question 7 - A 18-year old girl presents to her doctor with an excessively enlarged left...

    Correct

    • A 18-year old girl presents to her doctor with an excessively enlarged left breast as compared to the right breast since puberty. The most likely cause for this is:

      Your Answer: Virginal breast hypertrophy

      Explanation:

      Virginal breast hypertrophy’ is the term assigned to excessive growth of breasts during puberty and is a common phenomenon. It is also known as ‘juvenile macromastia’ or ‘ juvenile gigantomastia’. The breast hypertrophy often starts with menarche and occasionally occurs in growth spurts. These spurts can cause physical discomfort, red and itchy skin or pain in the breasts. The breasts can also grow continuously over several years and lead to overdevelopment of a normal breast. Nipples also undergo enlargement along with the breasts.

    • This question is part of the following fields:

      • Pathology
      • Women's Health
      10.4
      Seconds
  • Question 8 - Which of these infectious agents tends to affect people under 20 and over...

    Correct

    • Which of these infectious agents tends to affect people under 20 and over 40 years old, can cause acute encephalitis with cerebral oedema and petechial haemorrhages, along with haemorrhagic lesions of the temporal lobe. A lumbar puncture will reveal clear cerebrospinal fluid with an elevated lymphocyte count?

      Your Answer: Herpes simplex virus

      Explanation:

      Haemorrhagic lesions of the temporal lobe are typical of Herpes simplex encephalitis (HSE). It tends to affect patients aged under 20 or over 40 years, and is often fatal if left untreated. In acute encephalitis, cerebral oedema and petechial haemorrhages occur and direct viral invasion of the brain usually damages neurones. The majority of cases of herpes encephalitis are caused by herpes simplex virus-1 (HSV-1), and about 10% of cases of herpes encephalitis are due to HSV-2, which is typically spread through sexual contact.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      25.6
      Seconds
  • Question 9 - A sexually active 21 year old man presents with the history of dysuria...

    Correct

    • A sexually active 21 year old man presents with the history of dysuria for the past 3 days. Urine culture confirmed Neisseria gonorrhoeae and smear showed abundant neutrophils. Which of the following mediators is responsible for causing diapedesis of the neutrophils to reach the site of infection?

      Your Answer: Complement C5a

      Explanation:

      C5a is part of the complement cascade and is released frim the complement C5. It acts as a chemotactic factor for neutrophils. Other chemotactic mediators are TNF, leukotrienes and bacterial products.

      Bradykinin is associated with the production of pain and vasodilation.

      Hageman factor is a clotting factor.

      Histamine causes vasodilation.

      C3B causes opsonisation.

      IL-6 and IL-12 are inflammatory mediators causing B cell maturation and mediating inflammation and prostaglandins are involved with pain, increasing cell permeability and vasodilation.

    • This question is part of the following fields:

      • Inflammation & Immunology; Urology
      • Pathology
      16.7
      Seconds
  • Question 10 - After a severe asthma attack, a 26-year-old woman is left in a markedly...

    Correct

    • After a severe asthma attack, a 26-year-old woman is left in a markedly hypoxic state. In which of the following organs are the arterial beds most likely to be vasoconstricted due to the hypoxia?

      Your Answer: Lungs

      Explanation:

      Hypoxic pulmonary vasoconstriction is a local response to hypoxia resulting primarily from constriction of small muscular pulmonary arteries in response to reduced alveolar oxygen tension. This unique response of pulmonary arterioles results in a local adjustment of perfusion to ventilation. This means that if a bronchiole is obstructed, the lack of oxygen causes contraction of the pulmonary vascular smooth muscle in the corresponding area, shunting blood away from the hypoxic region to better-ventilated regions. The purpose of hypoxic pulmonary vasoconstriction is to distribute blood flow regionally to increase the overall efficiency of gas exchange between air and blood.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      13.8
      Seconds
  • Question 11 - The blood-brain barrier is a membrane that separates the circulating blood from the...

    Correct

    • The blood-brain barrier is a membrane that separates the circulating blood from the brain extracellular fluid in the central nervous system (CNS). Which of the following statements regarding the blood– brain barrier is CORRECT?

      Your Answer: It breaks down in areas of brain that are infected

      Explanation:

      The blood–brain barrier is a membrane that controls the passage of substances from the blood into the central nervous system. It is a physical barrier between the local blood vessels and most parts of the central nervous system and stops many substances from travelling across it. During meningitis, the blood–brain barrier may be disrupted. This disruption may increase the penetration of various substances (including either toxins or antibiotics) into the brain. A few regions in the brain, including the circumventricular organs, do not have a blood–brain barrier.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      5.6
      Seconds
  • Question 12 - 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 13 - A 43-year-old diabetic man complains of headaches, palpitations, anxiety, abdominal pain and weakness....

    Incorrect

    • A 43-year-old diabetic man complains of headaches, palpitations, anxiety, abdominal pain and weakness. He is administered sodium bicarbonate used to treat:

      Your Answer: Metabolic alkalosis

      Correct Answer: Metabolic acidosis

      Explanation:

      Sodium bicarbonate is indicated in the management of metabolic acidosis, which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis. Bicarbonate is given at 50-100 mmol at a time under scrupulous monitoring of the arterial blood gas readings. This intervention, however, has some serious complications including lactic acidosis, and in those cases, should be used with great care.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      386.9
      Seconds
  • Question 14 - Which of the following accumulates within a cell due to the aging process?...

    Correct

    • Which of the following accumulates within a cell due to the aging process?

      Your Answer: Lipofuscin

      Explanation:

      Lipofuscin , also known as lipochrome, is a wear and tear pigment or an aging pigment. It represents free radical injury or lipid peroxidation. On microscopic examination is appears as a yellowish brown pigment around the nucleus (perinuclear pigment). It is often seen in cells which are undergoing regressive changes, commonly in the liver and heart of old patients or patients with cancer, cachexia or severe malnutrition.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing
      • Pathology
      4.5
      Seconds
  • Question 15 - A 79-year-old has been bedridden for 2 months after suffering from a stroke....

    Correct

    • A 79-year-old has been bedridden for 2 months after suffering from a stroke. She suddenly developed shortness of breath and chest pain, and was diagnosed with a pulmonary embolism. Which of the following is most likely to increase in this case?

      Your Answer: Ventilation/perfusion ratio

      Explanation:

      Pulmonary embolism (PE) is a blockage of an artery in the lungs by an embolus that has travelled from elsewhere in the body through the bloodstream. The change in cardiopulmonary function is proportional to the extent of the obstruction, which varies with the size and number of emboli obstructing the pulmonary arteries. The resulting physiological changes may include pulmonary hypertension with right ventricular failure and shock, dyspnoea with tachypnoea and hyperventilation, arterial hypoxaemia and pulmonary infarction. Consequent alveolar hyperventilation is manifested by a lowered pa(CO2). After occlusion of the pulmonary artery, areas of the lung are ventilated but not perfused, resulting in wasted ventilation with an increased ventilation/perfusion ratio – the physiological hallmark of PE – contributing to a further hyperventilatory state. The risk of blood clots is increased by cancer, prolonged bed rest, smoking, stroke, certain genetic conditions, oestrogen-based medication, pregnancy, obesity, and post surgery.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      6.9
      Seconds
  • Question 16 - 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
      25
      Seconds
  • Question 17 - A patient is suspected to have a chromosomal abnormality. Which tumour and chromosomal...

    Incorrect

    • A patient is suspected to have a chromosomal abnormality. Which tumour and chromosomal association is correct?

      Your Answer: Neurofibromas – chromosome 13

      Correct Answer: Neuroblastoma – chromosome 1

      Explanation:

      Neuroblastoma is associated with a deletion on chromosome 1 and inactivation of a suppressor gene. Neurofibromas and osteogenic sarcoma are associated with an abnormality on chromosome 17. Retinoblastoma (Rb) is associated with an abnormality on chromosome 13. Wilms’ tumours of the kidney are associated with an abnormality on chromosome 11.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      12.2
      Seconds
  • Question 18 - 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
      18.7
      Seconds
  • Question 19 - A previously healthy 40-year-old housewife suddenly complains of a headache and loses consciousness....

    Correct

    • A previously healthy 40-year-old housewife suddenly complains of a headache and loses consciousness. A CT scan reveals subarachnoid haemorrhage. Which of the following is the most probable cause?

      Your Answer: Ruptured berry aneurysm

      Explanation:

      Saccular aneurysms, also known as berry aneurysms, appear as a round outpouching and are the most common form of cerebral aneurysm. They are a congenital intracranial defect, and haemorrhage can occur at any age, but is most common between the ages of 40-65 years. A second rupture (rebleeding) sometimes occurs, most often within about 7 days of the first bleed.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      11.8
      Seconds
  • Question 20 - A 36-year-old woman suddenly suffers from a generalized seizure. She was previously healthy....

    Correct

    • A 36-year-old woman suddenly suffers from a generalized seizure. She was previously healthy. An emergency CT scan reveals a mass in the posterior fossa, with distortion of the lateral ventricles. After removing the tumour, the biopsy reveals it contains glial fibrillary acidic protein (GEAP). What's the most likely diagnosis?

      Your Answer: Astrocytoma

      Explanation:

      Astrocytomas are primary intracranial tumours derived from astrocyte cells of the brain. They can arise in the cerebral hemispheres, in the posterior fossa, in the optic nerve and, rarely, in the spinal cord. These tumours express glial fibrillary acidic protein (GFAP). In almost half of cases, the first symptom of an astrocytoma is the onset of a focal or generalised seizure. Between 60% and 75% of patients will have recurrent seizures during the course of their illness. Secondary clinical sequelae may be caused by elevated intracranial pressure (ICP) cause by the direct mass effect, increased blood volume, or increased cerebrospinal fluid (CSF) volume. CT will usually show distortion of the third and lateral ventricles, with displacement of the anterior and middle cerebral arteries. Histological diagnosis with tissue biopsy will normally reveal an infiltrative character suggestive of the slow growing nature of the tumour.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      24.9
      Seconds
  • Question 21 - Which of the following diseases affects young adults, causing pain in any bone...

    Incorrect

    • Which of the following diseases affects young adults, causing pain in any bone -particularly long bones- which worsens at night, and is typically relieved by common analgesics, such as aspirin?

      Your Answer: Chondrosarcoma

      Correct Answer: Osteoid osteoma

      Explanation:

      Osteoid osteoma, which tends to affect young adults, can occur in any bone but is most common in long bones. It can cause pain (usually worse at night) that is typically relieved by mild analgesics, such as non-steroidal anti-inflammatory drugs. X-ray findings include a small radiolucent zone surrounded by a larger sclerotic zone.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      20.8
      Seconds
  • Question 22 - Different portions of the renal tubule have varying degrees of water permeability. Which...

    Correct

    • Different portions of the renal tubule have varying degrees of water permeability. Which of the following renal sites is characterised by low water permeability under normal circumstances?

      Your Answer: Thick ascending limb of the loop of Henlé

      Explanation:

      Within the nephron of the kidney, the ascending limb of the loop of Henle is a segment of the loop of Henle downstream of the descending limb, after the sharp bend of the loop. Both the thin and the thick ascending limbs of the loop of Henlé have very low permeability to water. Since there are no regulatory mechanisms to alter its permeability, it remains poorly permeable to water under all circumstances. Sodium and chloride are transported out of the luminal fluid into the surrounding interstitial spaces, where they are reabsorbed. Water must remain behind because it is not reabsorbed, so the solute concentration becomes less and less (the luminal fluid becomes more dilute). This is one of the principal mechanisms (along with diminution of ADH secretion) for the production of a dilute, hypo-osmotic urine (water diuresis).

    • This question is part of the following fields:

      • Physiology
      • Renal
      17.7
      Seconds
  • Question 23 - Which of the following diseases can cause paraesthesia along the distribution of the...

    Correct

    • Which of the following diseases can cause paraesthesia along the distribution of the median nerve of the hand, especially after activities which require flexion and extension of the wrist?

      Your Answer: Carpal tunnel syndrome

      Explanation:

      Carpal tunnel syndrome tends to occur in women between the ages of 30-50. There are many risk factors, including diabetes, hypothyroidism, obesity, pregnancy, and repetitive wrist work. Symptoms include pain in the hand and wrist, tingling, and numbness distributed along the median nerve (the palmar side of the thumb, the index and middle fingers, and the radial half of the ring finger), which worsens at night.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      10.7
      Seconds
  • Question 24 - A 25-year-old female had a painful abdomen and several episodes of vomiting. She...

    Correct

    • A 25-year-old female had a painful abdomen and several episodes of vomiting. She was severely dehydrated when she was brought to the hospital. Her ABG showed a pH 7.7, p(O2) 75 mmHg, p(CO2) 46 mmHg and bicarbonate 48 mmol/l. The most likely interpretation of this ABG report would be:

      Your Answer: Metabolic alkalosis

      Explanation:

      Metabolic alkalosis is a primary increase in bicarbonate (HCO3−) with or without compensatory increase in carbon dioxide partial pressure (Pco2); pH may be high or nearly normal. Metabolic alkalosis occurs as a consequence of a loss of H+ from the body or a gain in HCO3 -. In its pure form, it manifests as alkalemia (pH >7.40). As a compensatory mechanism, metabolic alkalosis leads to alveolar hypoventilation with a rise in arterial carbon dioxide tension p(CO2), which diminishes the change in pH that would otherwise occur. Normally, arterial p(CO2) increases by 0.5–0.7 mmHg for every 1 mmol/l increase in plasma bicarbonate concentration, a compensatory response that occurs very rapidly. If the change in p(CO2) is not within this range, then a mixed acid–base disturbance occurs. Likewise, if the increase in p(CO2) is less than the expected change, then a primary respiratory alkalosis is also present. However an elevated serum bicarbonate concentration can also occur due to a compensatory response to primary respiratory acidosis. A bicarbonate concentration greater than 35 mmol/l is almost always caused by metabolic alkalosis (as is the case in this clinical scenario). Calculation of the serum anion gap can also help to differentiate between primary metabolic alkalosis and the metabolic compensation for respiratory acidosis. The anion gap is frequently elevated to a modest degree in metabolic alkalosis because of the increase in the negative charge of albumin and the enhanced production of lactate. However, the only definitive way to diagnose metabolic alkalosis is by performing a simultaneous blood gases analysis, which reveals elevation of both pH and arterial p(CO2) and increased calculated bicarbonate.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Pathology
      17.8
      Seconds
  • Question 25 - A 42 year old women presents with end stage renal failure and is...

    Correct

    • A 42 year old women presents with end stage renal failure and is prepared to receive a kidney from her husband. HLA testing showed that they are not a 100% match and she is given immunosuppressant therapy for this. Three months later when her renal function tests were performed she showed signs of deteriorating renal function, with decreased renal output, proteinuria of +++ and RBCs in the urine. She was given antilymphocyte globulins and her condition reversed. What type of graft did this patient receive?

      Your Answer: Allograft

      Explanation:

      Allograft describes a graft between two of the same species. As the donor and the recipients are history-incompatible, rejection of the graft is common and is controlled by immunosuppressive drug therapy. Isograft and syngraft are synonymous and referred to a graft transferred between genetically identical individuals e.g. identical twins. In this case rejection is rare as they are history-compatible.

      Autograft refers to transfer of one part of the body to another location.

      Xenograft is transfer of tissue from another species e.g. pig to human in valve replacement surgeries and rejection is very high.

    • This question is part of the following fields:

      • Inflammation & Immunology; Renal
      • Pathology
      21.5
      Seconds
  • Question 26 - Bloody discharge from the nipple of a 40-year old woman with no obvious...

    Incorrect

    • Bloody discharge from the nipple of a 40-year old woman with no obvious lump or abnormality on mammography is suggestive of:

      Your Answer: Infiltrating ductal carcinoma

      Correct Answer: Intraductal papilloma

      Explanation:

      A small benign tumour, namely intraductal papilloma is most common in women between 35-55 years of age. It is also the commonest cause of spontaneous discharge from a single duct. A lump below the nipple may be sometimes palpable. Ultrasound and ductography are useful investigations., along with cytology of discharge to assess the presence of malignant cells. Confirmation is by breast biopsy.

    • This question is part of the following fields:

      • Pathology
      • Women's Health
      15.7
      Seconds
  • Question 27 - A 55-year-old woman died 3 years after a cardiac transplant due to worsening...

    Incorrect

    • A 55-year-old woman died 3 years after a cardiac transplant due to worsening congestive heart failure. Autopsy revealed diffuse hyperplasia of the vascular intima involving the entire length of the coronary arteries. The most probable cause of deterioration of the cardiac function is:

      Your Answer: Amyloidosis

      Correct Answer: Coronary atherosclerosis

      Explanation:

      Allograft coronary artery disease (CAD) can begin right after the transplant and is the major cause of later death in cardiac transplant recipients. This form of atherosclerosis progresses quickly resulting in allograft failure. Due to lack of premonitory symptoms CAD may lead to sudden death.

    • This question is part of the following fields:

      • Cardiovascular
      • Pathology
      25.6
      Seconds
  • Question 28 - A 75-year old patient is in atrial fibrallation but has never been on...

    Incorrect

    • A 75-year old patient is in atrial fibrallation but has never been on anticoagulation therapy. To reduce the risk of future emboli, she would benefit from starting on long-term warfarin. Arterial emboli leading to acute limb ischaemia most commonly lodge at which one of the following sites?

      Your Answer: Popliteal artery

      Correct Answer: Common femoral artery

      Explanation:

      The common femoral artery is the commonest site of arterial emboli causing acute limb ischemia. The treatment of choice is urgent femoral embolectomy.

    • This question is part of the following fields:

      • Cardiovascular
      • Pathology
      18.9
      Seconds
  • Question 29 - Urine specific gravity allows the assessment of which of the following renal functions?...

    Correct

    • Urine specific gravity allows the assessment of which of the following renal functions?

      Your Answer: Concentration

      Explanation:

      Concentrating ability of kidneys is assessed by measuring the urine specific gravity. Normal values of urine specific gravity fall between 1.002 and 1.030 g/ml.

    • This question is part of the following fields:

      • Pathology
      • Renal
      19.3
      Seconds
  • Question 30 - Which of the following is likely to result in hematocolpos in a 12-year...

    Correct

    • Which of the following is likely to result in hematocolpos in a 12-year old girl?

      Your Answer: Imperforate hymen

      Explanation:

      Hematocolpos means accumulation of blood in vagina and hematometra is accumulation of blood in the uterus. These are most likely seen with an imperforate hymen; which is seen I 1 in 2000 females. If spontaneous resolution does not occur, treatment involves making a hole in the hymen to allow discharge of menstrual blood.

    • This question is part of the following fields:

      • Pathology
      • Women's Health
      6
      Seconds
  • Question 31 - A cancer patient was found to have a radio resistant tumour. Which tumour...

    Incorrect

    • A cancer patient was found to have a radio resistant tumour. Which tumour does the patient most likely have?

      Your Answer: Lymphoma

      Correct Answer: Liposarcoma

      Explanation:

      Liposarcoma is a cancer that arises in fat cells in deep soft tissue. Commonly it occurs inside the thigh or retroperitoneum. It usually affects middle-aged and older adults, over 40 years. Liposarcoma is the most common soft-tissue sarcoma. It is very radio resistant. Five-year survival rates vary from 100% to 56% based on histological subtype.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      37
      Seconds
  • Question 32 - A 29-year-old woman presents to the doctor complaining of cough, shortness of breath,...

    Correct

    • A 29-year-old woman presents to the doctor complaining of cough, shortness of breath, fever and weight loss. Chest X-ray revealed bilateral hilar and mediastinal lymph node enlargement and bilateral pulmonary opacities. Non-caseating granulomas were found on histological examination. The most likely diagnosis is:

      Your Answer: Sarcoidosis

      Explanation:

      Sarcoidosis is an inflammatory disease of unknown aetiology that affects multiple organs but predominantly the lungs and intrathoracic lymph nodes. Systemic and pulmonary symptoms may both be present. Pulmonary involvement is confirmed by a chest X-ray and other imaging studies. The main histological finding is the presence of non-caseating granulomas.

    • This question is part of the following fields:

      • Pathology
      • Respiratory
      16.2
      Seconds
  • Question 33 - 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: HIV antibody test

      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
      16.2
      Seconds
  • Question 34 - Lack of findings in the bladder but presence of atypical epithelial cells in...

    Incorrect

    • Lack of findings in the bladder but presence of atypical epithelial cells in urinalysis is most often associated with which of the following conditions?

      Your Answer: Acute interstitial nephritis

      Correct Answer: Transitional cell carcinoma of renal pelvis

      Explanation:

      The presence of atypical cells in urinalysis without findings in the bladder suggests a lesion located higher up, most probably in ureters or renal pelvis. Transitional cell cancer of the renal pelvis is a disease in which malignant cells form in the renal pelvis and is characterised by the presence of abnormal cells in urine cytology.

    • This question is part of the following fields:

      • Pathology
      • Renal
      27.1
      Seconds
  • Question 35 - Which cells are most commonly seen in a granulomatous lesion that suggests an...

    Correct

    • Which cells are most commonly seen in a granulomatous lesion that suggests an underlying chronic inflammation?

      Your Answer: Lymphocytes

      Explanation:

      Lymphocytes and monocytes are commonly and characteristically recognised in a case of chronic inflammation.

      Eosinophils and neutrophils are seen with acute inflammation.

      Mast cells release histamine in early inflammation.

      Basophils are seen with allergies.

      Plasma cells are seen with viral infection.

      Platelets are not characteristic of any type of inflammation.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      15.4
      Seconds
  • Question 36 - Under normal conditions, what is the major source of energy of cardiac muscles?...

    Correct

    • Under normal conditions, what is the major source of energy of cardiac muscles?

      Your Answer: Fatty acids

      Explanation:

      Under basal conditions, most of the energy needed by cardiac muscle for metabolism is derived from fats (60%), 35% by carbohydrates, and 5% by ketones and amino acids. However, after intake of large amounts of glucose, lactate and pyruvate are mainly used. During prolonged starvation, fat acts as the primary source. 50% of the used lipids are sourced from circulating fatty acids.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      14.1
      Seconds
  • Question 37 - A 40-year old lady with a flail chest due to trauma was breathing...

    Incorrect

    • A 40-year old lady with a flail chest due to trauma was breathing with the help of a mechanical ventilator in the ICU, and was heavily sedated on muscle relaxants. Due to sudden power failure, a nurse began to hand-ventilate the patient with a Ambu bag. What change will occur in the following parameters: (Arterial p(CO2), pH) in the intervening period between power failure and hand ventilation?

      Your Answer: Decrease, Increase

      Correct Answer: Increase, Decrease

      Explanation:

      Respiratory acidosis occurs due to alveolar hypoventilation which leads to increased arterial carbon dioxide concentration (p(CO2)). This in turn decreases the HCO3 –/p(CO2) and decreases pH. Respiratory acidosis can be acute or chronic. In acute respiratory acidosis, the p(CO2) is raised above the upper limit of normal (over 45 mm Hg) with low pH. However, in chronic cases, the raised p(CO2) is accompanied with a normal or near-normal pH due to renal compensation and an increased serum bicarbonate (HCO3 – > 30 mmHg). The given problem represents acute respiratory acidosis and thus, will show a increase in arterial p(CO2) and decrease in pH.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      4.4
      Seconds
  • Question 38 - A 58-year-old woman presents with signs of inflammation in the first metatarsophalangeal joint:...

    Incorrect

    • A 58-year-old woman presents with signs of inflammation in the first metatarsophalangeal joint: redness, swelling and pain. The analysis of synovial fluid reveals needle-shaped, strongly negatively birefringent crystals. What's the most likely diagnosis in this case?

      Your Answer: Osteoarthritis

      Correct Answer: Gout

      Explanation:

      Gout is a rheumatic disease caused by the precipitation of monosodium urate crystals into tissues, usually joints. This causes acute or chronic pain; the acute illness initially affects only one joint, often the first metatarsophalangeal joint. The diagnosis of the disease requires the identification of crystal in the synovial fluid. These crystals are needle-shaped and strongly negatively birefringent.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      10.6
      Seconds
  • Question 39 - Which of the following coagulation factors cross-links fibrin? ...

    Incorrect

    • Which of the following coagulation factors cross-links fibrin?

      Your Answer: Factor VII

      Correct Answer: Factor XIII

      Explanation:

      Factor XIII, also known as fibrin stabilizing factor, is an enzyme of the coagulation cascade that crosslinks fibrin. Deficiency of FXIII may cause bleeding tendency but paradoxically, it may also predispose to thrombosis.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      6.3
      Seconds
  • Question 40 - A 60-year-old man complains of pain in his left thigh. An X-ray reveals...

    Correct

    • A 60-year-old man complains of pain in his left thigh. An X-ray reveals bowing of the affected femur, increased bone density, bony enlargement, abnormal bone architecture with coarse cortical trabeculations, and stress microfractures. Which is the most likely diagnosis in this case?

      Your Answer: Paget’s disease of bone

      Explanation:

      Paget’s disease of bone is a chronic disorder of the adult skeleton in which bone turnover is accelerated in localised areas, replacing normal matrix with softened and enlarged bone and causing gradual pain and deformity in some cases. It is more predominant in men over the age of 40. Characteristic X-ray findings include increased bone density, abnormal architecture with coarse cortical trabeculation or cortical thickening, bowing and bony enlargement; there might also be stress microfractures of the tibia or femur.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      5.9
      Seconds
  • Question 41 - A 45 year-old male, with behavioural changes developed euvolemic hyponatraemia. Which of the...

    Incorrect

    • A 45 year-old male, with behavioural changes developed euvolemic hyponatraemia. Which of the following conditions most likely predisposed the patient to develop euvolemic hyponatraemia?

      Your Answer: Pancreatitis

      Correct Answer: Psychosis

      Explanation:

      In euvolemic hyponatraemia, there is volume expansion in the body, there is no oedema, but hyponatremia occurs. Causes include: state of severe pain or nausea, psychosis, brain trauma, SIADH, hypothyroidism and glucocorticoid deficiency.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Pathology
      57.9
      Seconds
  • Question 42 - A 25-year-old woman complains of generalised swelling and particularly puffiness around the eyes...

    Incorrect

    • A 25-year-old woman complains of generalised swelling and particularly puffiness around the eyes which is worst in the morning. Laboratory studies showed:

      Blood urea nitrogen (BUN) = 30 mg/dl

      Creatinine = 2. 8 mg/dl

      Albumin = 2. 0 mg/dl

      Alanine transaminase (ALT) = 25 U/l

      Bilirubin = 1 mg/dl

      Urine analysis shows 3+ albumin and no cells.

      Which of the following is the most likely diagnosis?

      Your Answer: Interstitial renal disease

      Correct Answer: Nephrotic syndrome

      Explanation:

      Nephrotic syndrome is a disorder in which the glomeruli have been damaged, characterized by:

      – Proteinuria (>3.5 g per 1.73 m2 body surface area per day, or > 40 mg per square meter body surface area per hour in children)

      – Hypoalbuminemia (< 2,5 g/dl) – Hyperlipidaemia, and oedema (generalized anasarca).

    • This question is part of the following fields:

      • Physiology
      • Renal
      18.6
      Seconds
  • Question 43 - 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
      10
      Seconds
  • Question 44 - Which is a feature of the action of insulin? ...

    Incorrect

    • Which is a feature of the action of insulin?

      Your Answer: Promotes calcium release from bone

      Correct Answer: Promotes protein synthesis

      Explanation:

      Insulin is produced by the beta-cells of the islets of Langerhans in the pancreas. Its actions include:

      – promoting uptake of glucose into cells

      – glycogen synthesis (glycogenesis)

      – protein synthesis

      – stimulation of lipogenesis (fat formation).

      – driving potassium into cells – used to treat hyperkaelamia.

      Parathyroid hormone and activated vitamin D are the principal hormones involved in calcium/phosphate metabolism, rather than insulin.

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      4.1
      Seconds
  • Question 45 - A 25 year old women is pregnant with her second child. She is...

    Incorrect

    • A 25 year old women is pregnant with her second child. She is A- blood group. Her first child was Rh+ and the father is also Rh+. The second child is at a risk of developing which condition?

      Your Answer: Drug-induced haemolytic anaemia

      Correct Answer: Haemolytic disease of the new-born

      Explanation:

      This infant is at risk for haemolytic disease of the new born also known as erythroblastosis fetalis. In the pregnancy, Rh-positive RBC’s cross the placenta and enter the mothers blood system. She then becomes sensitised and forms IgG antibodies/anti-Rh antibodies against them. The second child is at a greater risk for this disease than the first child with Rh-positive blood group as during the second pregnancy, a more powerful response is produced. IgG has the ability to cross the placenta and bind to the fetal RBCs (type II hypersensitivity reaction) which are phagocytosed by the macrophages.

    • This question is part of the following fields:

      • Inflammation & Immunology; Haematology
      • Pathology
      20.8
      Seconds
  • Question 46 - A biopsy taken from the respiratory passage of a 37 year old male,...

    Incorrect

    • A biopsy taken from the respiratory passage of a 37 year old male, chronic smoker will mostly likely show which cellular adaptation?

      Your Answer: Squamous cell anaplasia

      Correct Answer: Stratified squamous metaplasia

      Explanation:

      Metaplasia is a change in the cell type caused in part due to an extrinsic stress on the organ. It involves a change in the surface epithelium from one cell type to the another, most commonly squamous to columnar. This is a reversible process, and removal of the stress should theoretically reverse the surface epithelium back to normal morphology. Respiratory tract metaplasia is a classic example, in which the normal pseudostratified columnar epithelium is replaced by stratified squamous epithelium to better cope with the stress. Under continuous stress metaplasia can progress to dysplasia which is a disordered growth of cells eventually leading to the development of carcinoma.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing; Respiratory
      • Pathology
      22.5
      Seconds
  • Question 47 - A 27-year-old woman, who had been taking a combined oral contraceptive for 6...

    Incorrect

    • A 27-year-old woman, who had been taking a combined oral contraceptive for 6 months, presented with inguinal pain and oedema of the left leg. Which of the following investigations would you recommend to help confirm the diagnosis?

      Your Answer: D-dimer test

      Correct Answer: Duplex scan

      Explanation:

      Oral combined contraceptive pill (OCCP) is a drug used for birth control and treating a number of other conditions. Women who take the OCP have a higher risk of developing deep vein thrombosis (DVT), usually in the legs. Duplex ultrasonography is a safe and non-invasive technique which is used for diagnosing the presence of lower extremity thrombi.

    • This question is part of the following fields:

      • Cardiovascular
      • Pathology
      16.6
      Seconds
  • Question 48 - Which of the given options best describes the metabolic changes which occur following...

    Incorrect

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

      Your Answer: Respiratory alkalosis

      Correct 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
      10.1
      Seconds
  • Question 49 - A 58-year-old woman diagnosed with deep vein thrombosis had been using warfarin for...

    Incorrect

    • A 58-year-old woman diagnosed with deep vein thrombosis had been using warfarin for 10 days. When she presented to the doctor she had haemorrhagic bullae and necrotic lesions in her lower limbs and buttocks. Deficiency of which of the following proteins may have caused the necrotic skin lesions?

      Your Answer: Protein S

      Correct Answer: Protein C

      Explanation:

      Warfarin-induced skin necrosis is a rare complication of anticoagulant therapy that requires immediate drug cessation. The most common cutaneous findings include petechiae that progress to ecchymoses and haemorrhagic bullae. Warfarin inactivates vitamin K-dependent clotting factors II, VII, IX, and X and vitamin K-dependent proteins C and S. The concentration of protein C falls more rapidly than other vitamin K-dependent factors because they have a shorter half-lives. Skin necrosis is seen mainly in patients with prior protein C deficiency.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      25.2
      Seconds
  • Question 50 - 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: Cerebral contusion

      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
      13
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Pathology (31/38) 82%
Respiratory (6/6) 100%
Endocrine (2/2) 100%
Cardiovascular (4/6) 67%
Physiology (12/13) 92%
Fluids & Electrolytes (4/5) 80%
Renal (5/5) 100%
Cell Injury & Wound Healing; Gastrointestinal (1/1) 100%
Women's Health (2/3) 67%
Neurology (4/4) 100%
Inflammation & Immunology; Urology (1/1) 100%
Cell Injury & Wound Healing (3/3) 100%
Haematology (5/5) 100%
Neoplasia (0/2) 0%
Orthopaedics (2/4) 50%
Inflammation & Immunology; Renal (1/1) 100%
Inflammation & Immunology (1/1) 100%
Inflammation & Immunology; Haematology (1/1) 100%
Cell Injury & Wound Healing; Respiratory (1/1) 100%
Passmed