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Question 1
Correct
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Nephrotic syndrome is a condition that causes proteinuria, hypoalbuminemia and oedema. Which of the following is the cause of the oedema in these patients?
Your Answer: Decreased oncotic pressure
Explanation:The glomeruli of the kidneys are the parts that normally filter the blood. They consist of capillaries that are fenestrated and allow fluid, salts and other small solutes to flow through, but normally not proteins. In nephrotic syndrome, the glomeruli become damaged allowing small proteins, such as albumin to pass through the kidneys into urine. Oedema usually occurs due to salt and water retention by the diseased kidneys as well as due to the reduced colloid oncotic pressure (because of reduced albumin in the plasma). Lower serum oncotic pressure causes fluid to accumulate in the interstitial tissues.
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This question is part of the following fields:
- Physiology
- Renal
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Question 2
Incorrect
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A patient with this type of tumour is advised to follow up regularly for monitoring of tumour size as there is a strong correlation with malignant potential and tumour size. Which of the following is the most likely tumour in this patient?
Your Answer: Prostate adenocarcinoma
Correct Answer: Renal adenocarcinoma
Explanation:The distinction between a benign renal adenoma and renal adenocarcinoma is commonly made on the basis of size. Tumours less than 2 cm in size rarely become malignant as opposed to those greater than 3 cm.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 3
Correct
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A biopsy taken from the respiratory passage of a 37 year old male, chronic smoker will mostly likely show which cellular adaptation?
Your 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.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Respiratory
- Pathology
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Question 4
Correct
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A 60-year old woman who has a left sided post-pneumonic effusion, was to have some pleural fluid aspirated for culture and sensitivity. If the medical intern in charge of the procedure decided to aspirate while the patient is sitting up on her bed, where in the pleural cavity would the fluid tend to accumulate?
Your Answer: Costodiaphragmatic recess
Explanation:The lowest part of the pleural cavity is the costodiaphragmatic recess and it the space in which the pleural fluid will accumulate when the patient sits up.
The cupola is part of the pleural cavity that extends into the root of the neck above the first rib.
The costomediastinal recess is the junction at which the costal pleura becomes the mediastinal pleura.
The middle mediastinum is the part of the mediastinum that is occupied by the heart.
The hilar reflection is the point where the mediastinal pleura is reflected to continue on as the visceral pleura.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 5
Incorrect
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A 17-year-old boy, who had developed shortness of breath and a loss of appetite over the last month, was referred to a haematologist because he presented with easy bruising and petechiae. His prothrombin time, platelet count, partial thromboplastin and bleeding time were all normal. Which of the following would explain the presence of the petechiae and easy bruising tendency?
Your Answer: Aspirin ingestion
Correct Answer: Scurvy
Explanation:Scurvy is a condition caused by a dietary deficiency of vitamin C, also known as ascorbic acid. Humans are unable to synthesize vitamin C, therefore the quantity of it that the body needs has to come from the diet. The presence of an adequate quantity of vitamin C is required for normal collagen synthesis. In scurvy bleeding tendency is due to capillary fragility and not coagulation defects, therefore blood tests are normal.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 6
Incorrect
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A sudden loud sound is more likely to result in cochlear damage than a slowly developing loud sound. This is because:
Your Answer: A sudden sound carries more energy
Correct Answer: There is a latent period before the attenuation reflex can occur
Explanation:On transmission of a loud sound into the central nervous system, an attenuation reflex occurs after a latent period of 40-80 ms. This reflex contracts the two muscles that pull malleus and stapes closer, developing a high degree of rigidity in the entire ossicular chain. This reduces the ossicular conduction of low frequency sounds to the cochlea by 30-40 decibels. In this way, the cochlea is protected from damage due to loud sounds (these are low frequency sounds) when they develop slowly.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 7
Incorrect
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A 17-year-old female was given an antibiotic for a urinary tract infection. After taking the medication the patient developed Steven-Johnson syndrome. Which particular antibiotic usually causes Steven-Johnson syndrome?
Your Answer: Tetracycline
Correct Answer: Sulphonamides
Explanation:Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulphonamide antibiotics, and nevirapine.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 8
Correct
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Selective destruction of which of the following cells will affect antibody synthesis?
Your Answer: Plasma cells
Explanation:Plasma cell are memory cells. After the antigen Is engulfed by the B cells it is presented to the CD4+ helper cells via the MCH II receptor and this leads to their activation which in turn stimulates the B cells to form antibodies against that specific antigen. Some B cells differentiate into plasma cells also called memory cells that get activated after subsequent infection.
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This question is part of the following fields:
- General
- Physiology
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Question 9
Incorrect
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A 25 year old primi gravida lady was scheduled for a regular antenatal check up. During the vaginal exam of this lady, the registrar discovered a malignant growth on the anterior wall of her vagina. Which of the following structures, adjacent to the vagina, is likely to be involved as well?
Your Answer: Fundus of the uterus
Correct Answer: Fundus of the bladder
Explanation:The fundus of the bladder is related anatomically to the anterior surface of the vagina and the urethra as well. If there was a malignant growth in the anterior surface of the vagina, then most likely the fundus of the bladder would be involved as well aspotentially the urethra.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 10
Correct
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Which name is given to the inferior fascia of the urogenital diaphragm?
Your Answer: Perineal membrane
Explanation:The urogenital fascia is mostly commonly referred to as the perineal membrane. This term refers to an anatomical fibrous membrane in the perineum. It is triangular in shape, and thus at times referred to as the triangular ligament. It is about 4 cm in depth. Its The perineal membrane’s apex is anterior and is separated from the arcuate pubic ligament by an oval opening for the passage of the deep dorsal vein of the penis. The lateral marginas of this triangular ligament are attached on either side to the inferior rami of the pubis and ischium, above the crus penis. Its base faces the rectum, and connects to the central tendinous point of the perineum. The pelvic fascia and Colle’s fascia is fused to the base of this triangle.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 11
Correct
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Regarding the posterior compartment of the leg, which is correct?
Your Answer: The muscles plantarflex the foot and are innervated by the tibial nerve
Explanation:The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris. Deep muscles include tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus. The superficial ( calf muscles) which are responsible for plantarflexion of the foot are supplied by the tibial nerve as follows: the gastrocnemius and soleus muscles are supplied by the first and second sacral nerves and the plantaris by the fourth and fifth lumbar and first sacral nerve (the tibial nerve).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 12
Incorrect
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A 27-yeaar-old woman is diagnosed with candidiasis and prescribed fluconazole. What is the mechanism of action of fluconazole?
Your Answer: Inhibits lipoprotein lipase
Correct Answer: Inhibits cytochrome P450
Explanation:Fluconazole is a triazole antifungal drug used in the treatment and prevention of superficial and systemic fungal infections. Like other imidazole- and triazole-class antifungals, fluconazole inhibits the fungal cytochrome P450 enzyme, 14-demethylase. It is used to treat candidiasis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, dermatophytosis, and pityriasis versicolor.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 13
Correct
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The primary area involved in the pathology of Parkinson's disease is:
Your Answer: Substantia nigra
Explanation:Parkinson’s disease is a degenerative, movement disorder of the central nervous system, and is typically characterized by muscle rigidity, tremor and bradykinesia (in extreme cases, akinesia). Secondary symptoms include high-level cognitive dysfunction and subtle language problems.
Parkinson’s disease is also called ‘primary Parkinsonism’ or ‘idiopathic Parkinson’s disease and is the most common cause of Parkinsonism, a group of similar symptoms. The disorder is caused due to loss of pigmented dopaminergic cells in the pars compacta region of the substantia nigra.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 14
Incorrect
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Which of these HLA alleles is most likely to be present in ankylosing spondylitis?
Your Answer: HLA-DR2
Correct Answer: HLA-B27
Explanation:Ankylosing spondylitis usually appears between the ages of 20-40 years old and is more frequent in men. It is strongly associated with HLA-B27, along with other spondyloarthropathies, which can be remembered through the mnemonic PAIR (Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, and Reactive arthritis).
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 15
Correct
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A 34-year-old woman with pelvic inflammatory disease is administered ceftriaxone. The subclass of antibiotics that ceftriaxone belongs to is:
Your Answer: Third-generation cephalosporins
Explanation:Ceftriaxone is a third-generation cephalosporin antibiotic. It has a broad spectrum of activity against Gram-positive and Gram-negative bacteria. Its indications include middle ear infections, endocarditis, meningitis, pneumonia, bone and joint infections, intra-abdominal infections, skin infections, urinary tract infections, gonorrhoea, and pelvic inflammatory disease.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 16
Correct
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A patient sustained an injury to the facial nerve after it emerges from the stylomastoid foramen. What is the clinical impact of this injury?
Your Answer: Facial expression
Explanation:The facial nerve is the seventh of the twelve paired cranial nerves. It emerges from the brainstem between the pons and the medulla. It controls the muscles of facial expression and supplies taste fibres to the anterior two-thirds of the tongue. It also supplies preganglionic parasympathetic fibres to several head and neck ganglia. Its branches and distribution are as follows:
Inside the facial canal (proximal to the stylomastoid foramen):
– Greater petrosal nerve – provides parasympathetic innervation to the lacrimal gland, as well as special taste sensory fibres to the palate via the nerve of pterygoid canal
– Nerve to stapedius – provides motor innervation for the stapedius muscle in the middle ear
– Chord tympani – provides parasympathetic innervation to the submandibular and sublingual glands and special sensory taste fibres for the anterior two-thirds of the tongue
Outside the skull (distal to the stylomastoid foramen):
– Posterior auricular nerve – controls the movements of some of the scalp muscles around the ear
– Five major facial branches (in the parotid gland), from top to bottom: temporal branch, zygomatic branch, buccal branch, marginal mandibular branch and cervical branch. From the description given above it is obvious that injury to the facial nerve distal to the stylomastoid foramen will affect facial expression.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 17
Incorrect
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The midgut loop, also called the primary intestinal loop in a developing embryo, is formed when the midgut bends around which of the following arteries?
Your Answer: Coeliac trunk
Correct Answer: Superior mesenteric
Explanation:In a developing foetus, the midgut develops to form most of the intestines. During this development process, the midgut usually bends around the superior mesenteric artery and forms what is referred to as the midgut loop.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 18
Correct
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Ventricular filling follows a delay caused by?
Your Answer: AV node
Explanation:The AV node is a conducting tissue found between the atria and the ventricles of the heart. It conducts electrical signal from the atria to the ventricles and acts a delaying mechanism preventing the atria and the ventricles from contracting at the same time. This decremental conduction prevents premature ventricular contraction in cases such as atrial fibrillation. A delay in the AV node is the reason for the PR segment seen on the ECG. In certain types of supraventricular tachycardia, a person could have two AV nodes; this will cause a loop in electrical current and uncontrollably rapid heart beat. When this electricity catches up with itself, it will dissipate and return to a normal heart rate.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 19
Incorrect
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A 34-year old gentleman presented with acute pancreatitis to the emergency department. On enquiry, there was found to be a history of recurrent pancreatitis, eruptive xanthomas and raised plasma triglyceride levels associated with chylomicrons. Which of the following will be found deficient in this patient?
Your Answer: High-density lipoprotein (HDL)
Correct Answer: Lipoprotein lipase
Explanation:The clinical features mentioned here suggest the diagnosis of hypertriglyceridemia due to lipoprotein lipase (LPL) deficiency. LPL aids in hydrolysing the lipids in lipoproteins into free fatty acids and glycerol. Apo-CII acts as a co-factor. Deficiency of this enzyme leads to hypertriglyceridemia.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 20
Incorrect
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A 45-year old male, who was a chronic smoker presented to the clinic with backache and dry, incessant cough. On examination, he was found to have raised blood pressure, purplish striae on his abdomen, truncal obesity and tenderness over the lower thoracic spine. These findings are suggestive of which condition?
Your Answer: Extra-adrenal paraganglioma
Correct Answer: Small-cell anaplastic (oat cell) carcinoma
Explanation:The symptoms suggest Cushing syndrome due to increased glucocorticoid levels. One cause of Cushing syndrome is ectopic production of adrenocorticotrophic hormone from oat cell carcinoma. As oat cell carcinoma is known to be highly metastatic, the tenderness in lower back could represent metastatic involvement.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 21
Incorrect
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The lateral thoracic artery:
Your Answer: Accompanies the thoracodorsal nerve to the serratus anterior muscle
Correct Answer: Accompanies the long thoracic nerve to the serratus anterior muscle
Explanation:The thoracic nerve, along with the lateral thoracic artery, follow the pectoralis minor to the side of the chest which supplies the serratus anterior and the pectoralis. It then sends branches across the axilla to the axillary glands and subscapularis. The pectoral branch of the thoraco-acromial anastomoses with the internal mammary, subscapular and intercostal arteries, which in women, supply an external mammary branch.
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This question is part of the following fields:
- Anatomy
- Breast
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Question 22
Correct
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Atrial septal defect (ASD) is most likely to be due to incomplete closure of which one of the following structures:
Your Answer: Foramen ovale
Explanation:Atrial septal defect is a congenital heart defect that results in a communication between the right and left atria of the heart and may involve the interatrial septum. It results from incomplete closure of the foramen ovale which is normally open during fetal life and closes just after birth.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 23
Correct
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The otic ganglion receives its preganglionic sympathetic fibres from which of the following nerves?
Your Answer: Glossopharyngeal nerve
Explanation:The otic ganglion is a small (2–3 mm), oval shaped, flattened parasympathetic ganglion of a reddish-grey colour, located immediately below the foramen ovale in the infratemporal fossa and on the medial surface of the mandibular nerve. The preganglionic parasympathetic fibres originate in the inferior salivatory nucleus of the glossopharyngeal nerve. They leave the glossopharyngeal nerve by its tympanic branch and then pass via the tympanic plexus and the lesser petrosal nerve to the otic ganglion. Here, the fibres synapse, and the postganglionic fibres pass by communicating branches to the auriculotemporal nerve, which conveys them to the parotid gland. They produce vasodilator and secretomotor effects.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 24
Correct
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Which of the following conditions is characterized by generalised oedema due to effusion of fluid into the extracellular space?
Your Answer: Anasarca
Explanation:Anasarca (or ‘generalised oedema’) is a condition characterised by widespread swelling of the skin due to effusion of fluid into the extracellular space. It is usually caused by liver failure (cirrhosis of the liver), renal failure/disease, right-sided heart failure, as well as severe malnutrition/protein deficiency.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 25
Correct
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A patient with a long standing lower motor neuron lesion will have:
Your Answer: Muscle wasting
Explanation:Lower motor neurons (LMNs) connect the brainstem and spinal cord to muscle fibres. Damage to lower motor neurons is indicated by abnormal electromyographic potentials, fasciculations, paralysis, weakening and wasting of skeletal muscles.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 26
Correct
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A 40-year-old woman is suspected to have an ovarian cancer. Which tumour marker should be requested to confirm the diagnosis?
Your Answer: CA-125
Explanation:CA-125 is a protein that is used as a tumour marker. This substance is found in high concentration in patients with ovarian cancer. It is the only tumour marker recommended for clinical use in the diagnosis and management of ovarian cancer.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 27
Incorrect
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For calculation of cardiac output by Fick's principle, which of the following vessels is the best source of venous blood to determine the arterial-to-venous oxygen tension difference?
Your Answer: Pulmonary vein
Correct Answer: Pulmonary artery
Explanation:Fick’s principle states that the total uptake (or release) of a substance by peripheral tissues is equal to the product of the blood flow to the peripheral tissues and the arterial– venous concentration difference (gradient) of the substance. It is used to measure the cardiac output, and the formula is Cardiac output = oxygen consumption divided by arteriovenous oxygen difference. Assuming there are no shunts across the pulmonary system, the pulmonary blood flow equals the systemic blood flow. The arterial and venous blood oxygen content is measured by sampling from the pulmonary artery (low oxygen content) and pulmonary vein (high oxygen content). Peripheral arterial blood is used as a surrogate for the pulmonary vein.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 28
Incorrect
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Which of the following organs of the abdominal cavity is completely covered by the peritoneum?
Your Answer: Kidney
Correct Answer: Spleen
Explanation:Of the organs listed, the spleen is the only organ that is completely intraperitoneal, that is entirely in the peritoneum. Other completely intraperitoneal organs include the stomach, liver, appendix and the small intestines. The kidney, Inferior vena cava, aorta and the suprarenal glands are all retroperitoneal organs. The pancreas and the duodenum are partially retroperitoneal, with the tail of the pancreas in the peritoneum found in the splenorenal ligament while only the first part of the duodenum is intraperitoneal. For the intraperitoneal organs remember SALTD SPRSS
S = Stomach
A = Appendix
L = Liver
T = Transverse colon
D = Duodenum (only the 1st part)
S = Small intestines
P = Pancreas (only the tail)
R = Rectum (only the upper 3rd)
S = Sigmoid colon
S = Spleen
For retroperitoneal, just remember SADPUCKER:
S = suprarenal glands
A = Aorta and IVC
D = Duodenum (all but the 1st part)
P = Pancreas (all but the tail)
U = Ureter and bladder
C = Colon (ascending and descending)
K = Kidneys
E = Oesophagus
R = Rectum (Lower two-thirds)
For secondarily retroperitoneal remember ‘Pussy Cat Dolls“:
P = Pancreas
C = Colon (only ascending and descending)
D = Duodenum (only parts 2-4) -
This question is part of the following fields:
- Abdomen
- Anatomy
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Question 29
Incorrect
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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 permits carbon dioxide to pass via facilitated diffusion
Correct 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.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 30
Correct
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If a 70-year-old man with known atrial fibrillation dies suddenly, which of these is the most likely cause of death?
Your Answer: Thromboembolism
Explanation:In atrial fibrillation, the abnormal atrial contraction can cause blood to stagnate in the left atrium and form a thrombus, which may then embolize. The patient’s history of AF suggest an embolic disease, which lead to his death.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
