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  • Question 1 - A 45 year old women has a 4 cm non tender mass in...

    Incorrect

    • A 45 year old women has a 4 cm non tender mass in her right breast which is fixed to the chest wall. Another 2cm non-tender mass is palpable in the left axilla. Chest x ray reveals multiple nodules ranging from 0.5 - 0.2 cm in both the lungs. What is the stage of her disease?

      Your Answer: T2 N1 M0

      Correct Answer: T4 N1 M1

      Explanation:

      This woman has an invasive primary tumour mass with axillary node and lung metastases, making this stage T4 N1 M1. Looking at the other stems, T1 N1 M0 signifies a small primary cancer with nodal metastases but no distant metastases; T1 N0 M1 signifies a small primary cancer with no lymph node metastases but with distant metastases; T2 N1 M0 signifies a larger primary cancer with nodal metastases but no distant metastases; and T3 N0 M0 indicates a larger primary cancer with no metastases to either lymph nodes or to distant sites.

    • This question is part of the following fields:

      • Neoplasia; Female Health
      • Pathology
      122.5
      Seconds
  • Question 2 - upon stroking the plantar surface of a patient's foot, extension of toes was...

    Correct

    • upon stroking the plantar surface of a patient's foot, extension of toes was noted. This is likely to be accompanied with:

      Your Answer: Spasticity

      Explanation:

      An upper motor neuron lesion affects the neural pathway above the anterior horn cell or motor nuclei of the cranial nerves, whereas a lower motor neurone lesion affects nerve fibres travelling from the anterior horn of the spinal cord to the relevant muscles. An upper motor neurone lesions results in the following:

      – Spasticity in the extensor muscles (lower limbs) or flexor muscles (upper limbs).

      – ‘clasp-knife’ response where initial resistance to movement is followed by relaxation

      – Weakness in the flexors (lower limbs) or extensors (upper limbs) with no muscle wasting

      – Brisk tendon jerk reflexes

      – Positive Babinski sign (on stimulation of the sole of the foot, the big toe is raised rather than curled downwards)

    • This question is part of the following fields:

      • Neurology
      • Physiology
      35.5
      Seconds
  • Question 3 - What is the normal amount of oxygen that is carried in the blood?...

    Correct

    • What is the normal amount of oxygen that is carried in the blood?

      Your Answer: 20 ml oxygen/100 ml blood

      Explanation:

      Normally, 100 ml of blood contains 15g haemoglobin and a single gram of haemoglobin can bind to 1.34 ml oxygen when 100% saturated. Thus, 15 × 1.34 = 20 ml O2/100 ml blood. The haemoglobin in venous blood that is leaving the tissues is about 75% saturated with oxygen, and hence it carries about 15 ml O2/100 ml venous blood. This implies that for each 10 ml of blood, 5 ml oxygen is transported to the tissues. With a p(O2) > 100 mm Hg, only 3 ml of oxygen is dissolved in every one litre of plasma. By increasing the pA(O2) by breathing 100% oxygen, one can add an extra amount of oxygen in the plasma, but the amount of oxygen carried by haemoglobin will not increase significantly as it is already > 95% saturated.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      10.7
      Seconds
  • Question 4 - A 40-year old lady with a flail chest due to trauma was breathing...

    Correct

    • 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: 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
      315.5
      Seconds
  • Question 5 - A 42-year old woman presents to the doctor with jaundice. Her investigations show...

    Incorrect

    • A 42-year old woman presents to the doctor with jaundice. Her investigations show conjugated hyperbilirubinemia, raised urine bilirubin levels and low urine urobilinogen levels. What is the likely cause of her jaundice?

      Your Answer: Haemolytic anaemia

      Correct Answer: Blockage of the common bile duct

      Explanation:

      The description of the patient here fits the diagnosis of obstructive jaundice or cholestasis, which results in conjugated hyperbilirubinemia. Cholestasis occurs due to impairment of bile flow, which can be anywhere from the liver cell canaliculus to the ampulla of Vater. Causes can be divided into intrahepatic and extrahepatic.

      – Intrahepatic causes include hepatitis, drug toxicity, alcoholic liver disease, primary biliary cirrhosis, cholestasis of pregnancy and metastatic cancer.

      – Extrahepatic causes include common duct stone, pancreatic cancer, benign stricture of the common duct, ductal carcinoma, pancreatitis and sclerosing cholangitis.

      There is absence of bile constituents in the intestine, which causes spillage in the systemic circulation. Symptoms include pale stools, dark urine, pruritus, malabsorption leading to steatorrhea and deficiency of fat-soluble vitamins. Chronic cases can result in osteoporosis or osteomalacia due to vitamin D deficiency and Ca2+ malabsorption. Cholesterol and phospholipid retention produces hyperlipidaemia despite fat malabsorption (although increased liver synthesis and decreased plasma esterification of cholesterol also contribute); triglyceride levels are largely unaffected. The lipids circulate as a unique, low-density lipoprotein called lipoprotein X.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      28.1
      Seconds
  • Question 6 - A 44-year old gentleman presented to the hospital in congestive cardiac failure. On...

    Correct

    • A 44-year old gentleman presented to the hospital in congestive cardiac failure. On further investigation, he was found to have a right-sided retroperitoneal mass. On enquiry, he gave a history of intermittent hypertensive attacks. 24-hour urine specimen revealed raised metanephrine and vanillylmandelic acid levels. What is the likely diagnosis?

      Your Answer: Pheochromocytoma

      Explanation:

      A neuroendocrine tumour of the chromaffin cells in adrenal medulla, pheochromocytoma secretes excessive catecholamines – adrenaline (epinephrine) and noradrenaline (norepinephrine). Pheochromocytomas are also known as the ‘10% tumour’. This is because 10% of them are bilateral, 10% are malignant, and 10% are extra-adrenal. Extra-adrenal paragangliomas (also known as extra-adrenal pheochromocytomas) are less common than pheochromocytomas and arise in the ganglia of sympathetic nervous system. Around 25% of pheochromocytomas are familial. Symptoms are described as feeling of ‘impending doom’, and include tachycardia, hypertension, palpitations, anxiety, headaches and pallor. Orthostatic hypertension is typically seen where there is a more than 100 mmHg fall in systolic pressure when the patient stands up. Pheochromocytomas can also lead to malignant hypertension. Diagnosis is by measurement of catecholamines and metanephrines in blood or in 24-hour urine, after exclusion of other possible causes such as stress, hypoglycaemia and drugs (methyldopa, dopamine agonists, ganglion-blocking antihypertensive). Imaging is also needed to localize the tumour. Localization of the tumour can also be done by Iodine-131 meta-iodobenzylguanidine (I131-MIBG) imaging.

    • This question is part of the following fields:

      • Endocrine
      • Pathology
      24.8
      Seconds
  • Question 7 - A 27-year-old HIV patient started on an antifungal agent. Which antifungal agent that...

    Incorrect

    • A 27-year-old HIV patient started on an antifungal agent. Which antifungal agent that inhibits the biosynthesis of fungal ergosterol was given to the patient?

      Your Answer: Amphotericin

      Correct Answer: Ketoconazole

      Explanation:

      Ketoconazole is a synthetic imidazole antifungal drug used primarily to treat fungal infections. It inhibits the biosynthesis of ergosterol by blocking demethylation at the C14 site of the ergosterol precursor. Amphotericin B and Nystatin impair permeability of the cell membrane. Flucytosine interferes with DNA synthesis, while the target of griseofulvin is the microtubules

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      27.7
      Seconds
  • Question 8 - Which of the following organs is most likely to have dendritic cells? ...

    Incorrect

    • Which of the following organs is most likely to have dendritic cells?

      Your Answer: Muscle

      Correct Answer: Skin

      Explanation:

      Dendritic cells are part of the immune system and they function mainly as antigen presenting cells. They are present in small quantities in tissues which are in contact in the external environment. Mainly in the skin and to a lesser extent in the lining of the nose, lungs, stomach and intestines. In the skin they are known as Langerhans cells.

    • This question is part of the following fields:

      • General
      • Physiology
      21.4
      Seconds
  • Question 9 - A 50-year old gentleman who suffered a stroke was brought to the emergency...

    Incorrect

    • A 50-year old gentleman who suffered a stroke was brought to the emergency department by his relatives. The patient however denied the presence of paralysis of his left upper and lower limbs. What is the most likely site of the lesion in this patient?

      Your Answer:

      Correct Answer: Right posterior parietal cortex

      Explanation:

      A large injury to the non-dominant parietal cortex can make the patient neglect or refuse to acknowledge the presence of paralysis on the contralateral side. This can also involve the perception of the external world. Smaller injuries in this area which involve the precentral gyrus (primary motor cortex) or postcentral gyrus (primary sensory cortex) cause contralateral spastic paralysis or contralateral loss of tactile sensation respectively. A lesion in posterior inferior gyrus of the dominant frontal lobe results in motor aphasia. Involvement of the posterior superior gyrus of the dominant frontal lobe produces sensory aphasia.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds
  • Question 10 - During an anatomy revision session, medical students are told that the posterior wall...

    Incorrect

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

      Your Answer:

      Correct Answer: Arcuate line

      Explanation:

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

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

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

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

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds
  • Question 11 - A middle aged man presented in OPD with a low grade fever and...

    Incorrect

    • A middle aged man presented in OPD with a low grade fever and a persistent cough. His blood smear showed an increase in cells with large bi-lobed nuclei. Which of these cells represent the one seen on the smear?

      Your Answer:

      Correct Answer: Monocytes

      Explanation:

      Monocytes are white cells that protect the body against harmful pathogens. They are mobile and are produced in the bone marrow, mature there and circulate in the blood for about 1-3 days, where they enter the tissues and transform into macrophages. They are characteristically identified by their large bi-lobed nuclei.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      0
      Seconds
  • Question 12 - Which among the following vertebrae marks the lowest extent of the superior mediastinum?...

    Incorrect

    • Which among the following vertebrae marks the lowest extent of the superior mediastinum?

      Your Answer:

      Correct Answer: Fourth thoracic

      Explanation:

      The superior mediastinum lies between the manubrium anteriorly and the upper vertebrae of the thorax posteriorly. Below, it is bound by a slightly oblique plane that passes backward from the sternal angle to the lower part of the body of T4 and laterally by the pleura.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds
  • Question 13 - Which is the correct statement regarding gonadal venous drainage: ...

    Incorrect

    • Which is the correct statement regarding gonadal venous drainage:

      Your Answer:

      Correct Answer: The left ovarian vein drains into the left renal vein

      Explanation:

      Spermatic or testicular veins arise from the posterior aspect of the testis and receive tributaries from the epididymis. Upon uniting, they form the pampiniform plexus that makes up the greater mass of the spermatic cord. The vessels that make up this plexus rise up the spermatic cord in front of the ductus deferens. They then unite, below the superficial ring, to form three or four veins that traverse the inguinal canal and enter the abdomen through the deep inguinal ring. They further unite to form 2 veins that ascend up the psoas major muscle behind the peritoneum each lying on either side of the testicular artery. These further unite to form one vein that empties on the right side of the inferior vena cava at an acute angle and on the left side into the renal vein, at a right angle. The left testicular vein courses behind the iliac colon and is thus exposed to pressure from the contents of this part of the bowel. The ovarian vein is the equivalent of the testicular vein in women. They form a plexus in the broad ligament near the ovary and uterine tube and communicate with the uterine plexus. They drain into similar vessels as in a man.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds
  • Question 14 - What is the reason for a deranged thrombin clotting time? ...

    Incorrect

    • What is the reason for a deranged thrombin clotting time?

      Your Answer:

      Correct Answer: Heparin therapy

      Explanation:

      Thrombic clotting time is also known as thrombin time. It is clinically performed to determine the therapeutic levels of heparin. After plasma is isolated from the blood, bovine thrombin is added to it and the time it takes from the addition to clot is recorded. The reference interval is usually <21s. deranged results are indicative of heparin therapy, hypofibrinogenemia, hyperfibrinogenaemia or lupus anticoagulant.

    • This question is part of the following fields:

      • General
      • Physiology
      0
      Seconds
  • Question 15 - Loperamide is a drug used to treat diarrhoea. What is the mechanism of...

    Incorrect

    • Loperamide is a drug used to treat diarrhoea. What is the mechanism of action of loperamide?

      Your Answer:

      Correct Answer: Opiate agonist

      Explanation:

      Loperamide is an opioid-receptor agonist and acts on the mu opioid receptors in the myenteric plexus of large intestine. It works by decreasing the motility of the circular and longitudinal smooth muscles of the intestinal wall. It is often used for this purpose in gastroenteritis, inflammatory bowel disease, and short bowel syndrome.

    • This question is part of the following fields:

      • Pathology
      • Pharmacology
      0
      Seconds
  • Question 16 - When does the heart rate decrease? ...

    Incorrect

    • When does the heart rate decrease?

      Your Answer:

      Correct Answer: Pressure on the eyeball

      Explanation:

      Various vagotonic manoeuvres (e.g. Valsalva manoeuvre, carotid sinus massage, pressure on eyeballs, ice-water facial immersion, swallowing of ice-cold water) result in increased parasympathetic tone through the vagus nerve which results in a decrease in heart rate. These manoeuvres may be clinically useful in terminating supraventricular arrhythmias.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds
  • Question 17 - The vascular structure found on the right side of the fifth lumbar vertebra...

    Incorrect

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

      Your Answer:

      Correct Answer: Inferior vena cava

      Explanation:

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

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds
  • Question 18 - Which one of the following groups of lymph nodes is most likely to...

    Incorrect

    • Which one of the following groups of lymph nodes is most likely to be inflamed due to paronychia involving the big toe?

      Your Answer:

      Correct Answer: Vertical group of superficial inguinal lymph nodes

      Explanation:

      Paronychia affecting the big toe will result in inflammation of the superficial inguinal lymph nodes as it drains lymph from the big toe.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds
  • Question 19 - After a cerebral infarction, which of these histopathogical findings is most likely to...

    Incorrect

    • After a cerebral infarction, which of these histopathogical findings is most likely to be found?

      Your Answer:

      Correct Answer: Liquefactive necrosis

      Explanation:

      The brain has a high lipid content and typically undergoes liquefaction with ischaemic injury, because it contains little connective tissue but high amounts of digestive enzymes.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds
  • Question 20 - During a surgical procedure involving the carotid artery, which nerve in the cervical...

    Incorrect

    • During a surgical procedure involving the carotid artery, which nerve in the cervical plexus of nerves that is embedded in the carotid sheath is most susceptible to injury?

      Your Answer:

      Correct Answer: Ansa cervicalis

      Explanation:

      The ansa cervicalis is a loop of nerves that are part of the cervical plexus. They lie superficial to the internal jugular vein in the carotid triangle. Branches from the ansa cervicalis innervate the sternohyoid, sternothyroid and the inferior belly of the omohyoid. The superior root of the ansa cervicalis is formed by a branch of spinal nerve C1. These nerve fibres travel in the hypoglossal nerve before leaving to form the superior root. The superior root goes around the occipital artery and then descends embedded in the carotid sheath. It sends a branch off to the superior belly of the omohyoid muscle and is then joined by the inferior root. The inferior root is formed by fibres from spinal nerves C2 and C3.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      0
      Seconds
  • Question 21 - The passage of leukocytes through the wall of the blood vessels is best...

    Incorrect

    • The passage of leukocytes through the wall of the blood vessels is best described by which of the following terms?

      Your Answer:

      Correct Answer: Diapedesis

      Explanation:

      The steps involved in leukocyte arrival and function are:

      1. margination: cells migrate from the centre to the periphery of the vessel

      2. rolling: selectins are upregulated on the vessel walls

      3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes, interaction of these results in adhesion

      4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product

      5. phagocytosis: engulfing the offending substance/cell.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing
      • Pathology
      0
      Seconds
  • Question 22 - A 60-year-old male who was admitted due to cerebrovascular disease on his 5th...

    Incorrect

    • A 60-year-old male who was admitted due to cerebrovascular disease on his 5th hospital stay developed pneumonia. The most likely organism that causes hospital acquired pneumonia is pseudomonas aeruginosa. What is the most likely mechanism for the pathogenesis on pseudomonas infection?

      Your Answer:

      Correct Answer: Exotoxin

      Explanation:

      Pseudomonas aeruginosa is a common Gram-negative, rod-shaped bacterium that can cause disease in plants and animals, including humans. It is citrate, catalase, and oxidase positive. P. aeruginosa uses the virulence factor exotoxin A to inactivate eukaryotic elongation factor 2 via ADP-ribosylation in the host cell, much the same as the diphtheria toxin does. Without elongation factor 2, eukaryotic cells cannot synthesize proteins and necrotise. The release of intracellular contents induces an immunologic response in immunocompetent patients.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      0
      Seconds
  • Question 23 - A 29-year-old pregnant woman develops severe hypoxaemia with petechial rash and confusion following...

    Incorrect

    • A 29-year-old pregnant woman develops severe hypoxaemia with petechial rash and confusion following a fracture to her left femur. Which is the most probable cause of these symptoms in this patient?

      Your Answer:

      Correct Answer: Fat embolism

      Explanation:

      Fat embolism is a life-threatening form of embolism in which the embolus consists of fatty material or bone marrow particles that are introduced into the systemic venous system. It may be caused by long-bone fractures, orthopaedic procedures, sickle cell crisis, parenteral lipid infusion, burns and acute pancreatitis. Patients with fat embolism usually present with symptoms that include skin, brain, and lung dysfunction.

    • This question is part of the following fields:

      • Cardiovascular
      • Pathology
      0
      Seconds
  • Question 24 - A 40-year old gentleman, known with a history of peptic ulcer disease, was...

    Incorrect

    • A 40-year old gentleman, known with a history of peptic ulcer disease, was brought to the clinic in a dehydrated state with persistent vomiting. His blood investigations revealed:
      • sodium = 142 mmol/l
      • potassium = 2.6 mmol/l
      • chloride = 85 mmol/l
      • pH = 7.55
      • p(CO2) = 50 mmHg
      • p(O2) = 107 mmHg
      • standard bicarbonate = 40 mmol/l
      This patient has a:

      Your Answer:

      Correct Answer: Metabolic alkalosis

      Explanation:

      High pH with high standard bicarbonate indicates metabolic alkalosis. The pa(CO2) was appropriately low in compensation. This is hypokalaemic hypochloraemic metabolic acidosis due to prolonged vomiting. Treatment includes treating the cause and intravenous sodium chloride with potassium.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
      Seconds
  • Question 25 - The specimen sent to the pathologist for examination was found to be benign....

    Incorrect

    • The specimen sent to the pathologist for examination was found to be benign. Which one of the following is most likely a benign tumour?

      Your Answer:

      Correct Answer: Warthin’s tumour

      Explanation:

      Warthin’s tumour is also known as papillary cystadenoma lymphomatosum. It is a benign cystic tumour of the salivary glands containing abundant lymphocytes and germinal centres. It has a slightly higher incidence in males and most likely occur in older adults aged between 60 to 70 years. This tumour is also associated with smoking. Smokers have an eight-fold greater risk in developing the tumour compared to non-smokers.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      0
      Seconds
  • Question 26 - Nephrotic syndrome is a condition that causes proteinuria, hypoalbuminemia and oedema. Which of...

    Incorrect

    • 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:

      Correct 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
      0
      Seconds
  • Question 27 - A 33-year old lady presented to the gynaecology clinic with amenorrhoea for 6...

    Incorrect

    • A 33-year old lady presented to the gynaecology clinic with amenorrhoea for 6 months and a recent-onset of milk discharge from her breasts. She was not pregnant or on any medication. On enquiry, she admitted to having frequent headaches the last 4 months. Which of the following findings would you expect to see in her condition?

      Your Answer:

      Correct Answer: Hyperprolactinaemia

      Explanation:

      Excessively high levels of prolactin in the blood is called hyperprolactinaemia. Normally, prolactin levels are less than 580 mIU/l in females and less than 450 mIU/l in men. The biologically inactive macroprolactin can lead to a false high reading. However, the patient remains asymptomatic. Dopamine down-regulates prolactin whereas oestrogen upregulates it. Hyperprolactinaemia can be caused due to lack of inhibition (compression of pituitary stalk or low dopamine levels), or increased production due to a pituitary adenoma (prolactinoma). Either of these causes can lead to a prolactin level of 1000-5000 mIU/l. However, levels more than 5000mIU/l are usually associated due to an adenoma and >100,000 mIU/l are seen in macroadenomas (tumours < 1cm in diameter). Increased prolactin causes increased dopamine release from the arcuate nucleus of hypothalamus. This increased dopamine in turn, inhibits the GnRH (Gonadotrophin Releasing Hormone) thus blocking gonadal steroidogenesis resulting in the symptoms of hyperprolactinaemia. In women, it includes hypoestrogenism, anovulatory infertility, decreased or irregular menstruation or complete amenorrhoea. It can even cause production of breast milk, loss of libido, vaginal dryness and osteoporosis. In men, the symptoms include impotence, decreased libido, erectile dysfunction and infertility. In men, treatment can be delayed due to late diagnosis as they have no reliable indicator such as menstruation that might indicate a problem. Most of the male patients seek help only when headaches and visual defects start to surface.

    • This question is part of the following fields:

      • Endocrine
      • Pathology
      0
      Seconds
  • Question 28 - A patient with a long standing lower motor neuron lesion will have: ...

    Incorrect

    • A patient with a long standing lower motor neuron lesion will have:

      Your Answer:

      Correct 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.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds
  • Question 29 - A 70-year old man presents to the surgical out patient clinic with a...

    Incorrect

    • A 70-year old man presents to the surgical out patient clinic with a direct inguinal hernia on the right side. He had undergone and appendicectomy 6 months prior. The examining doctor correlated the development of the hernia to iatrogenic nerve injury that happened during the operation. Which nerve had been injured?

      Your Answer:

      Correct Answer: Ilioinguinal

      Explanation:

      Direct inguinal hernias occur because of weakness in the abdominal muscles. The ilioinguinal nerve is important for innervating the muscles of the lower abdominal wall and damage during appendicectomy therefore prevents the man from being able to contract abdominal muscles to pull the falx inguinalis over the weak fascia.

      The genitofemoral nerve innervates the cremaster muscle and injury to it would cause inability to elevate the testes.

      The subcostal nerve and the ventral primary ramus of T10 innervate the muscles, skin and fascia of the upper abdominal wall.

      The iliohypogastric nerve supplies the skin over the upper part of the buttock behind the area supplied by the subcostal nerve.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds
  • Question 30 - How are amino acids transported across the luminal surface of the small intestinal...

    Incorrect

    • How are amino acids transported across the luminal surface of the small intestinal epithelium?

      Your Answer:

      Correct Answer: Co-transport with sodium ions

      Explanation:

      Once complex peptides are broken down into amino acids by the peptidases present in the brush border of small intestine, they are ready for absorption by at least four sodium-dependent amino acid co-transporters – one each for acidic, basic, neutral and amino acids, present on the luminal plasma membrane. These transporters first bind sodium and can then bind the amino acids. Thus, amino acid absorption is totally dependent on the electrochemical gradient of sodium across the epithelium. The basolateral membrane in contrast, possesses additional transporters to carry amino acids from the cell into the blood, but these are sodium-independent.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Neoplasia; Female Health (0/1) 0%
Pathology (1/3) 33%
Neurology (1/1) 100%
Physiology (3/5) 60%
Respiratory (2/2) 100%
Gastroenterology (0/1) 0%
Endocrine (1/1) 100%
Microbiology (0/1) 0%
General (0/1) 0%
Passmed