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Question 1
Correct
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The following branch of the aorta is unpaired:
Your Answer: Coeliac artery
Explanation:Branches that stem from the abdominal aorta can be divided into three: the visceral branches, parietal branches and terminal branches. Of the visceral branches, the suprarenal, renal, testicular and ovarian arteries are paired while the coeliac artery and superior and inferior mesenteric arteries are unpaired. Of the parietal branches the inferior phrenic and lumbar arteries are paired while the middle sacral artery is unpaired. The terminal branches i.e. the common iliac arteries are paired.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 2
Incorrect
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Which of the following is NOT a nutritional factor involved in wound healing:
Your Answer: Vitamin A
Correct Answer: Vitamin B3
Explanation:Vitamin B6 is required for collagen cross-links.
Vitamin A is required for epithelial cell proliferation.
Zinc is required for RNA and DNA synthesis.
Copper is required for cross-linking of collagen.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Physiology
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Question 3
Correct
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Causes of metabolic acidosis with a normal anion gap include:
Your Answer: Diarrhoea
Explanation:Excess acid intake and excess bicarbonate loss as in diarrhoea, are causes of metabolic acidosis with a normal anion gap. The other conditions all result in an increased anion gap.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 4
Incorrect
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When exposing the right saphenofemoral junction for flush-ligation of the saphenous vein, which of the following is the most likely to be seen passing through this opening?
Your Answer: Superficial circumflex iliac artery
Correct Answer: Superficial external pudendal artery
Explanation:The saphenous opening is an oval opening in the fascia lata. It is covered by the cribriform fascia and It is so called because it is perforated by the great saphenous vein and by numerous blood and lymphatic vessels and the superficial external pudendal artery pierces it.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 5
Correct
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A young girl who presented with a clinical picture of type I hypersensitivity reaction with eosinophilia is most likely to have?
Your Answer: Liver flukes
Explanation:Usually a parasitic infection will be associated with a type I hypersensitivity reaction.
Amyloid deposition will not cause an immune reaction.
Organic dust will lead to a type III hypersensitivity reaction.
Cell mediated as well as humoral immune mechanism play a part in syphilis, but they are do not specifically cause a type I reaction.
Malaria is cause by plasmodium and is not cause of a hypersensitivity reaction.
Atopic dermatitis will not be accompanied by eosinophilia.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 6
Correct
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A 40-year old gentleman underwent a computed tomographic scan for the abdomen to rule out blunt abdominal trauma, after a vehicular accident. The scan revealed no abnormal finding except for a 1 cm-sized cortical mass in the left adrenal gland. The doctor-on-call decided to not intervene for this mass because it was likely to be a:
Your Answer: Non-functioning adrenal adenoma
Explanation:Adrenal adenomas are common, benign lesions which are asymptomatic and seen in 10% of population. Usually detected incidentally on Computed tomography (‘incidentaloma’), only around 1 in 10,000 are malignant (adenocarcinoma). Adrenal adenomas rarely need to be investigated, especially if they are homogenous and less than 3 cm in diameter. Follow-up imaging can be done after an interval of 3-6 months to assess any change in size. Some adenomas can secrete cortisol (leading to Cushing syndrome), or aldosterone (leads to Conn syndrome) or androgens (leading to hyperandrogenism).
Haematomas and simple cysts are not usually seen in adrenal gland. Infection due to Histoplasma capsulatum is usually bilateral and leads to multiple granulomas. Adrenal metastasis will usually demonstrate a lung primary and the adrenal lesions will be often multiple and larger than 1 cm.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 7
Correct
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An 80 year-old quadriplegic man has been lying supine for 7 weeks in a critical care ward. He develops a right lung abscess that is draining by gravity to a particular region of the lung. Which is the most likely site of pus collection?
Your Answer: Superior segment of the lower lobe
Explanation:The superior segmental bronchus of the lower lobe of the right lung branches posteriorly off the intermediate bronchus or the inferior lobe bronchus. It is therefore more likely to receive fluid or foreign bodies that enter the right main bronchus especially when the patient is supine.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 8
Correct
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Destruction of the ventromedial nucleus of the hypothalamus will result in:
Your Answer: Loss of satiety
Explanation:The ventromedial nucleus of the hypothalamus is divided into an anterior and a superior part. The anterior part controls the female sexual drive, whereas the superior part is responsible for satiety. Destruction of the superior part of the nucleus will result in overeating, as no signal tells the body that it is satisfied.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 9
Correct
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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.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 10
Correct
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Passing through the lesser sciatic foramen are the:
Your Answer: Pudendal nerve
Explanation:Structures that pass through the lesser sciatic foramen include:
– the pudendal nerve
– the nerve to obturator internus
– internal pudendal artery
– the tendon of obturator internus
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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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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 12
Correct
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When you rest your elbows on a desk, what bony landmark of the upper limb are you resting on?
Your Answer: Olecranon process of the ulna
Explanation:At the upper and back part of the ulna, there exists a curved eminence which is the olecranon process. This process lodges in the olecranon fossa of the humerus. It’s posterior surface is subcutaneous and this triangular area is what you rest your elbow upon.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 13
Incorrect
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Question 14
Correct
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Calculate the cardiac output in an adult male with the following parameters:
Heart rate 70 beats/min
Arterial [O2] 0.24 ml O2/min
Venous [O2] 0.16 ml O2/mi
Whole body O2 consumption 500 ml/min
Pulmonary diastolic pressure 15 mmHg
Pulmonary systolic pressure 25 mmHg
Wedge pressure 5 mmHg.Your Answer: 6.25 l/min
Explanation:As per Fick’s principle, VO2 = (CO × CAO2) – (CO × CVO2) where VO2 = oxygen consumption, CO = cardiac output, CAO2 = oxygen concentration of arterial blood and CVO2 = oxygen concentration of venous blood. Thus, CO = VO2/CAO2– CVO2, CO = 500/0.24 – 0.16, CO = 500/0.8, CO = 6.25 l/min.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 15
Correct
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Diffusion is the movement of molecules from a region of high concentration to a region of low concentration. Which of these changes will decrease the rate of diffusion of a substance?
Your Answer: An increase in the molecular weight of the substance
Explanation:Unless given IV, a drug must cross several semipermeable cell membranes before it reaches the systemic circulation. Drugs may cross cell membranes by diffusion, amongst other mechanisms. The rate of diffusion of a substance is proportional to the difference in the concentration of the diffusing substance between the two sides of the membrane, the temperature of the solution, the permeability of the membrane and, in the case of ions, the electrical potential difference between the two sides of the membrane.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 16
Correct
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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: 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.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 17
Correct
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Which of the following compensatory parameters is responsible for causing an increase in the blood pressure in a 30 year old patient with a BP of 40 mmHg?
Your Answer: Baroreceptor reflex
Explanation:The baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for regulating blood pressure. It provides a negative feedback response in which an elevated blood pressure will causes blood pressure to decrease; similarly, decreased blood pressure depresses the baroreflex, causing blood pressure to rise. The system relies on specialised neurones (baroreceptors) in the aortic arch, carotid sinuses and elsewhere to monitor changes in blood pressure and relay them to the brainstem. Subsequent changes in blood pressure are mediated by the autonomic nervous system. Baroreceptors include those in the auricles of the heart and vena cava, but the most sensitive baroreceptors are in the carotid sinuses and aortic arch. The carotid sinus baroreceptors are innervated by the glossopharyngeal nerve (CN IX); the aortic arch baroreceptors are innervated by the vagus nerve (CN X).
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 18
Incorrect
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In the adult heart, the sinus venosus gives rise to the:
Your Answer: Fossa ovalis
Correct Answer: Coronary sinus
Explanation:The sinus venosus is a large quadrangular cavity which precedes the atrium on the venous side of the chordate heart. It exists distinctly only in the embryonic heart (where it is found between the two venae cavae); however, the sinus venosus persists in the adult. In the adult, it is incorporated into the wall of the right atrium to form a smooth part called the sinus venarum, which is separated from the rest of the atrium by a ridge of fibres called the crista terminalis. The sinus venosus also forms the SA node and the coronary sinus.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 19
Correct
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The following joint has an anastomotic circulation that is provided by branches of the brachial artery:
Your Answer: Elbow joint
Explanation:The arterial anastomoses of the elbow joint is contributed by branches of the brachial artery and the Profunda brachii artery. The brachial artery gives off the superior ulnar collateral artery and the inferior collateral artery. On the other hand, the Profunda brachii gives off the radial and medial recurrent arteries.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 20
Correct
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Following a posterolateral thoracotomy, a surgeon may wish to infiltrate local anaesthetic above and below the incision to block the nerves supplying the thoracic wall. This wall is innervated by?
Your Answer: Intercostal nerves
Explanation:Intercostal nerves are the ventral primary rami of spinal nerves T1–T11. They give branches which supply the thoracic wall.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 21
Correct
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A 12-year old girl was brought to the hospital with recurrent headaches for 6 months. Her physical examination revealed no abnormality. A CT scan of the head revealed a suprasellar mass with calcifications, eroding the surrounding sella turcica. The lesion is likely to represent:
Your Answer: Craniopharyngioma
Explanation:Craniopharyngiomas (also known as Rathke pouch tumours, adamantinomas or hypophyseal duct tumours) affect children mainly between the age of 5 and 10 years. It constitutes 9% of brain tumours affecting the paediatric population. These are slow-growing tumours which can also be cystic, and arise from the pituitary stalk, specifically the nests of epithelium derived from Rathke’s pouch. Histologically, this tumour shows nests of squamous epithelium which is lined on the outside by radially arranged cells. Calcium deposition is often seen with a papillary type of architecture.
ACTH-secreting pituitary adenomas are rare and mostly microadenomas. Paediatric astrocytoma’s usually occur in the posterior fossa. Although null cell adenomas can cause mass effect and give rise to the described symptoms, they are not suprasellar. Prolactinomas can also show symptoms of headache and disturbances in the visual field, however they are known to be small and slow-growing.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 22
Correct
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Which of the following is the most common germ cell tumour of the testis affecting an adult male?
Your Answer: Seminoma
Explanation:Germ cell tumours represent 90% of primary tumours arising in the testis. They are broadly divided into seminomas and non-seminomas. Seminomas are the most common testicular germ cell tumour seen in 40% cases. The other non-seminomatous histological subtypes include embryonal (25%), teratocarcinoma (25%), teratoma (5%) and pure choriocarcinoma (1%).
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This question is part of the following fields:
- Pathology
- Urology
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Question 23
Correct
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A 30-year-old woman known with Von Willebrand disease (vWD) has to undergo surgery. Which of these complications is most unlikely in this patient?
Your Answer: Hemarthrosis
Explanation:Von Willebrand disease (vWD) is an inherited haemorrhagic disorder characterised by the impairment of primary haemostasis. It is caused by the deficiency or dysfunction of a protein named von Willebrand factor. The most common manifestation due to the condition is abnormal bleeding. Complications include easy bruising, hematomas, epistaxis, menorrhagia, prolonged bleeding and severe haemorrhage. Hemarthrosis is a complication that is more commonly found in haemophilia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 24
Correct
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While conducting a physical examination of a patient, the GP passed a finger down the edge of the medial crus of the superficial inguinal ring and felt a bony prominence deep to the lateral edge of the spermatic cord. What was this bony prominence?
Your Answer: Pubic tubercle
Explanation:At the superficial inguinal ring, the pubic tubercle would be felt as a bony prominence lateral to the edge of the spermatic cord. This tubercle is the point of attachment of the inguinal ligament that makes up the floor of the inguinal canal.
Pecten pubis is the ridge on the superior surface of the superior pubic ramus and the point of attachment of the pectineal ligament.
The pubic symphysis is the joint between the two pubic bones and the iliopubic eminence is a bony process on the pubis found near the articulation of the pubis and the ilium.
The iliopectineal line is formed by the arcuate line of the ilium and the pectineal line of the pubis. It is the line that marks the transition between the abdominal and pelvic cavity.
The sacral promontory is found on the posterior wall of the pelvis and would not be felt through the inguinal ring.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 25
Correct
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A recognised side-effect of prefrontal leukotomy is:
Your Answer: Confusion
Explanation:Used previously as a treatment for psychiatric disorders, prefrontal leucotomy severs the connection between the prefrontal cortical association area and the thalamus. This leads to functional isolation of the prefrontal and orbitofrontal association cortex. Thus, along with the desired reduction in anger and frustration, undesirable side effects included changes in mood and affect, as well as confusion.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 26
Incorrect
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Which of these foramen is located at the base of the skull and transmits the accessory meningeal artery?
Your Answer: Foramen magnum
Correct Answer: Foramen ovale
Explanation:At the base of the skull the foramen ovale is one of the larger of the several holes that transmit nerves through the skull. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery, lesser petrosal nerve, a branch of the glossopharyngeal nerve, emissary vein connecting the cavernous sinus with the pterygoid plexus of veins and occasionally the anterior trunk of the middle meningeal vein.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 27
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 28
Correct
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Production of pain is most likely associated with:
Your Answer: Substance P
Explanation:Substance P is a short-chain polypeptide that functions as a neurotransmitter and as a neuromodulator, and is thus, a neuropeptide. It has been linked with pain regulation, mood disorders, stress, reinforcement, neurogenesis, respiratory rhythm, neurotoxicity, nausea and emesis. It is also a potent vasodilator as it brings about release of nitric oxide from the endothelium. Its release can also cause hypotension.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 29
Correct
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A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for the last 5 days. A CT scan reveals an oedematous mass with ring enhancement in the left temporal region. It is biopsied, revealing glial cells, necrosis, neutrophils and lymphocytes. What is the most likely diagnosis?
Your Answer: Cerebral abscess
Explanation:A cerebral abscess can result from direct extension of cranial infections, penetrating head trauma, haematogenous spread, or for unknown causes. An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts. Oedema around the abscess can increase the intracranial pressure. Symptoms result from increased intracranial pressure and mass effects. It is most frequent in the third decade of life, and when it occurs in children, it is usually associated with congenital heart disease.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 30
Correct
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A CT-scan report of a patient with gastric carcinoma shows that the lymph nodes around the coeliac trunk are enlarged. The coeliac trunk:
Your Answer: Gives rise to the splenic, left gastric and common hepatic arteries
Explanation:The coeliac trunk is a branch of the aorta arising just below the aortic hiatus of the diaphragm to pass nearly horizontally forward to divide into 3 large branches i.e. the left gastric, the hepatic and the splenic arteries. Occasionally it may give off one of the inferior phrenic arteries. It is covered by the lesser omentum and on the right side bordered by the right coeliac ganglion and the cardiac end of the stomach. Inferiorly it is bordered by the upper border of the pancreas and splenic vein. The embryonic midgut is supplied by the superior mesenteric artery.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 31
Incorrect
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A 60-year old patient having a history of cholelithiasis that led to recurrent pain, bloating, nausea and vomiting, was scheduled for surgery to have the gallbladder removed. During the cholecystectomy, the registrar conducting the procedure accidentally punctured a blood vessel that lies immediately posterior to the omental foramen and blood filled the operating field. Which of the following blood vessels was likely punctured?
Your Answer: Portal vein
Correct Answer: Inferior vena cava
Explanation:The omental foramen is the pathway that connects the greater peritoneal sac and the lesser peritoneal sac. The omental foramen is bordered posteriorly by the inferior vena cava. This is the blood vessel that would most likely be punctured.
The aorta and its branch, the renal artery, lie postero-lateral to the omental foramen and are deeper than the inferior vena cava hence making them less likely to be injured.
The hepatic portal vein, the hepatic artery and the superior mesenteric vein borders the omental foramen anteriorly and would not be injured by a jab on the posterior border of the omental foramen.
Finally, the splenic artery is found in the splenorenal ligament that borders the omental foramen laterally to the left.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 32
Correct
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Endometrial hyperplasia is most likely to be associated with which of the following conditions?
Your Answer: Fibrothecoma
Explanation:A benign tumour arising from the ovarian stroma, fibrothecoma are bilateral in 10% cases. The thecoma component of the tumour can produce oestrogen leading to endometrial hyperplasia. The thecoma is rich in lipid content and is responsible for the yellowish appearance of the tumour. Meig’s syndrome is the presence of fibrothecoma with a right-sided hydrothorax.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 33
Correct
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A 30 year old lawyer presented with a history of pleural effusions, pericarditis, arthralgia without joint deformity and episodes of myalgia for the past 12 months. Blood tests reveal a normocytic anaemia. Which of the following tests should be performed to investigate this condition further?
Your Answer: Antinuclear antibody test
Explanation:These non specific findings are suggestive of autoimmune disease. Antinuclear antibody (ANA) is the first test that should be performed when autoimmune diseases are suspected and later on more specific tests should be performed. This tests aids in the diagnosis of SLE, scleroderma, Sjogren’s syndrome, Raynaud’s disease, juvenile chronic arthritis, rheumatoid arthritis and antiphospholipid antibody syndrome etc. To confirm the disease a history, physical examination along with specific tests are required.
CPK is more specific for acute conditions.
ESR is a non specific test for inflammation.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 34
Correct
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What is the basic chemical reaction that takes place in the breakdown of complex foodstuffs?
Your Answer: Hydrolysis
Explanation:Breakdown of complex food into simpler compounds is achieved by hydrolysis, with the help of different enzymes specific for different compounds.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 35
Correct
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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.
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This question is part of the following fields:
- Physiology
- Renal
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Question 36
Correct
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A young girl injured her arm following a fall down the steps On examination, it was found that her left proximal radioulnar joint had dislocated and the annular ligament was stretched. This will make which movement extremely painful?
Your Answer: Supination
Explanation:Supination is the rotation of the forearm so that the palm of the hand faces anteriorly. This is performed by the biceps brachii and supinator of the extensor muscles of the thumb. The opposite action of moving the palm from an anterior-facing position to a posterior-facing position is called pronation. Pronation is performed by the pronator teres and pronator quadratus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 37
Correct
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During a clinical rotation in the ENT clinic, you observe a flexible bronchoscopy. As the scope is passed down the trachea, you see a cartilaginous structure that resembles a ship's keel and separates the right and the left main stem bronchi. This structure is the:
Your Answer: Carina
Explanation:The carina (a keel-like cartilage) is found at the bifurcation of the trachea separating the right from the left main stem bronchi. It is a little more to the left than to the right.
The cricoid cartilage is the inferior and posterior cartilage of the larynx.
The costal cartilage on the other hand elongates the ribs anteriorly and contribute to the elasticity of the thoracic cage.
The pulmonary ligament is a fold of pleura located below the root of the lung.
Tracheal rings are rings of cartilage that support the trachea.
Peritracheal fascia is a layer of connective tissue that invests the trachea from the outside and is not visible on bronchoscopy.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 38
Correct
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Regarding abduction of the digits of the hand, which of the following is correct?
Your Answer: All of the adductors of the digits take at least part of their attachments from metacarpal bones
Explanation:Lying on the palmer surfaces of the metacarpal bones are four palmar interossei which are smaller than the dorsal interossei. Arising from the entire length of the metacarpal bone of one finger, is a palmar interosseous, which is inserted into the side of the base of the first phalanx and the aponeurotic expansion of the extensor digitorum communis tendon to the same finger. All the interossei are innervated by the eighth cervical nerve, through the deep palmar branch of the ulnar nerve. The palmar interossei adducts the fingers to an imaginary line drawn longitudinally through the centre of the middle finger.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 39
Correct
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A patient gives a history of dull discomfort in her abdomen associated with pain that she points to be on her right shoulder and right scapula. The following organs are most likely to be source of her pain:
Your Answer: Liver, duodenum and gallbladder
Explanation:Referred pain is felt at a point away from the source of the pain or the unpleasant sensation. It arises when a nerve is damaged or compressed at a point but the pain is felt at another site that is the territory of that nerve. Common abdominal causes of referred pain to the shoulder and the shoulder blade are the liver, duodenum and gall bladder.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 40
Correct
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Which of the following muscles attach to the hyoid bone?
Your Answer: Middle pharyngeal constrictor
Explanation:The hyoid bone is a horseshoe-shaped bone situated in the anterior midline of the neck between the chin and the thyroid cartilage. A large number of muscles attach to the hyoid: Superiorly – the middle pharyngeal constrictor muscle, hyoglossus muscle, genioglossus, intrinsic muscles of the tongue and suprahyoid muscles. Inferiorly – the thyrohyoid muscle, omohyoid muscle and sternohyoid muscle.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 41
Incorrect
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The tympanic membrane is a thin semi-transparent membrane that separates the tympanic cavity from the bottom of the external acoustic meatus. The interior of the tympanic membrane is innervated by which of the following cranial nerves?
Your Answer: Facial
Correct Answer: Glossopharyngeal
Explanation:The glossopharyngeal nerve, known as the ninth cranial nerve (CN IX), is a mixed nerve that carries afferent sensory and efferent motor information. The glossopharyngeal nerve has five distinct general functions:
– The branchial motor (special visceral efferent), supplies the stylopharyngeus muscle.
– The visceral motor (general visceral efferent), provides parasympathetic innervation of the parotid gland via the otic ganglion.
– The visceral sensory (general visceral afferent), carries visceral sensory information from the carotid sinus and carotid body.
– The general sensory (general somatic afferent), provides general sensory information from the inner surface of the tympanic membrane, upper pharynx (GVA), and the posterior one-third of the tongue.
– The visceral afferent (special visceral afferent), provides taste sensation from the posterior one-third of the tongue, including the circumvallate papillae.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 42
Correct
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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.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 43
Incorrect
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Which statement is true about the inferior sagittal sinus?
Your Answer: It drains into the transverse sinus
Correct Answer: Is formed between two layers of meningeal dura
Explanation:The inferior sagittal sinus is also known as the inferior longitudinal sinus. It courses along the inferior border of the falx cerebri, superior to the corpus callosum. It is cylindrical in shape and increases in size as it passes backward ending in the straight sinus. It receives blood from the deep and medial aspects of the cerebral hemispheres and drains into the straight sinus.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 44
Correct
-
During work up for a 29 year-old lady who complained of chest pain, a computed tomography showed a large mass in the posterior mediastinum. Which among the following structures could be involved?
Your Answer: Lymph nodes
Explanation:Boundaries of the posterior mediastinum include:
Superior: a plane through the sternal angle and T4/5
Inferior: the diaphragm
Anterior: the middle mediastinal structures
Posterior the spinal cord.
Structures in the posterior mediastinum include the descending thoracic aorta, the azygos system, oesophagus, thoracic duct and lymph nodes. The great vessels and structures at the root of the lung are part of the middle mediastinum. In this case, the lymph nodes is the correct answer.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 45
Correct
-
Which of the cranial nerves is responsible for touch sensation on the skin over the maxilla region and the mandible?
Your Answer: Trigeminal
Explanation:The sensation of the face is provided by the trigeminal nerve which is cranial nerve V. It is also responsible for other motor functions such as biting and chewing. The trigeminal nerve has three branches; the ophthalmic nerve (V1), the maxillary nerve((V2) and the mandibular nerve (V3). These three branches exit the skull through separate foramina, namely; the superior orbital fissure, the foramen rotundum and the foramen ovale respectively. The mnemonic for this is ‘Standing room only’. The sensory fibres of the maxillary nerve are distributed to the lower eyelid and cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa, the palate and roof of the pharynx, the maxillary, ethmoid and sphenoid sinuses, and parts of the meninges. The sensory fibres of the mandibular nerve are distributed to the lower lip, the lower teeth and gums, the floor of the mouth, the anterior two-thirds of the tongue, the chin and jaw (except the angle of the jaw, which is supplied by C2–C3), parts of the external ear, and parts of the meninges. The mandibular nerve carries touch/ position and pain/temperature sensation from the mouth. The sensory fibres of the ophthalmic nerve are distributed to the scalp and forehead, the upper eyelid, the conjunctiva and cornea of the eye, the nose (including the tip of the nose), the nasal mucosa, the frontal sinuses and parts of the meninges (the dura and blood vessels). The sensory fibres of the maxillary nerve are distributed to the lower eyelid and cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa, the palate and roof of the pharynx, the maxillary, ethmoid and sphenoid sinuses, and parts of the meninges.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 46
Correct
-
A 46-year old female patient experienced a stroke that affected her glossopharyngeal nerve. Damage to the glossopharyngeal nerve would most likely:
Your Answer: Result in general sensory deficit to the pharynx
Explanation:The glossopharyngeal nerve (CN IX) has many functions which include:
– Contributes to the pharyngeal plexus
– Receiving general somatic sensory fibres from the tonsils, pharynx, the middle ear and the posterior third of the tongue.
– supplies motor fibres to only one muscle; the stylopharyngeus muscle.
– provides parasympathetic fibres to the parotid gland via the otic ganglion.
– Receives visceral sensory fibres from the carotid bodies & carotid sinus.
– Receives special visceral sensory fibres from the posterior third of the tongue.
The above functions will directly be affected by the damage of the glossopharyngeal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 47
Correct
-
Which best describes the sartorius muscle?
Your Answer: Will flex the leg at the knee joint
Explanation:The sartorius muscle arises from tendinous fibres from the superior iliac spine. It passes obliquely across the thigh from lateral to medial and is inserted into the upper part of the medial side of the tibia. When the sartorius muscle contracts it will flex the leg at the knee joint.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 48
Incorrect
-
A patient with a long standing lower motor neuron lesion will have:
Your Answer: Spasticity
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.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 49
Correct
-
Which muscle is most likely to be affected following an injury to the thoracodorsal nerve (C6-C8)?
Your Answer: Latissimus dorsi
Explanation:Latissimus dorsi is a triangular, flat muscle that covers the lumbar region and the lower half of the thoracic region. It is supplied by the sixth, seventh and eighth cervical nerves through the thoracodorsal (long subscapular) nerve.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 50
Correct
-
Bloody discharge from the nipple of a 40-year old woman with no obvious lump or abnormality on mammography is suggestive of:
Your 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.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 51
Correct
-
After finding elevated PSA levels, a 69-year-old man undergoes a needle biopsy and is diagnosed with prostatic cancer. What is the stage of this primary tumour?
Your Answer: T1c
Explanation:The AJCC uses a TNM system to stage prostatic cancer, with categories for the primary tumour, regional lymph nodes and distant metastases:
TX: cannot evaluate the primary tumour T0: no evidence of tumour
T1: tumour present, but not detectable clinically or with imaging T1a: tumour was incidentally found in less than 5% of prostate tissue resected (for other reasons)
T1b: tumour was incidentally found in more than 5% of prostate tissue resected
T1c: tumour was found in a needle biopsy performed due to an elevated serum prostate-specific antigen
T2: the tumour can be felt (palpated) on examination, but has not spread outside the prostate
T2a: the tumour is in half or less than half of one of the prostate gland’s two lobes
T2b: the tumour is in more than half of one lobe, but not both
T2c: the tumour is in both lobes
T3: the tumour has spread through the prostatic capsule (if it is only part-way through, it is still T2)
T3a: the tumour has spread through the capsule on one or both sides
T3b: the tumour has invaded one or both seminal vesicles
T4: the tumour has invaded other nearby structures.
In this case, the tumour has a T1c stage.
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This question is part of the following fields:
- Pathology
- Urology
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Question 52
Correct
-
After a cerebral infarction, which of these histopathogical findings is most likely to be found?
Your 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.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 53
Correct
-
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: 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.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 54
Correct
-
During a car accident, the side mirror shattered and a broken piece of glass severed the posterolateral aspect of the driver's neck. A physical examination reveals that the driver is unable to elevate the tip of his shoulder on the side that was injured. Which nerve was injured?
Your Answer: Accessory
Explanation:The tip of the shoulder is formed by the acromion of the scapula. This part is moved by the trapezius muscle which is innervated by the accessory nerve. Damage to this nerve therefore will prevent the patient from lifting the tip of the shoulder.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 55
Incorrect
-
What is the normal amount of oxygen that is carried in the blood?
Your Answer: 5 ml oxygen/100 ml blood
Correct 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.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 56
Incorrect
-
During an operation for a sigmoid colectomy the surgeon ligates the sigmoid arteries. From which artery do the sigmoid arteries branch?
Your Answer: Middle colic artery
Correct Answer: Inferior mesenteric artery
Explanation:Sigmoid arteries are branches of the inferior mesenteric artery (IMA). Sigmoid artery gives off branches that supply the lower descending colon, the iliac colon and the sigmoid colon.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 57
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.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 58
Incorrect
-
Calculate the pulmonary vascular resistance in an adult male with the following parameters:
Heart rate 70 beats/min
Arterial [O2] 0.24 ml O2/min
Venous [O2] 0.16 ml O2/mi
Whole body O2 consumption 500 ml/min
Pulmonary diastolic pressure 15 mmHg
Pulmonary systolic pressure 25 mmHg
Wedge pressure 5 mmHg.Your Answer: 1.5 resistance units (mmHg/l per min)
Correct Answer: 2.0 resistance units (mmHg/l per min)
Explanation:Pulmonary vascular resistance (PVR) = (Mean pulmonary artery pressure – Pulmonary capillary wedge pressure) divided by Cardiac output. To get cardiac output, Fick’s principle needs to be applied which states that VO2 = (CO × CAO2) – (CO × CVO2) where VO2 = oxygen consumption, CO = cardiac output, CA = oxygen concentration of arterial blood and CVO2 = oxygen concentration of venous blood. Thus, CO = VO2/CAO2– CVO2, CO = 500/0.24–0.16, CO = 500/0.8, CO = 6.25 l/min. To calculate mean pulmonary artery pressure, we use the formula: Mean pulmonary artery pressure = Diastolic pressure + 1/3(Systolic pressure – Diastolic pressure). Thus, Mean pulmonary artery pressure = 15 + 1/3(25 – 15) = 15 + 3. 33 = 18.33. Substituting these values in the first formula, PVR = 18.3–5/6.25 = 13.5/5.25 = 2.0 resistance units (mmHg/l per min) approximately.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 59
Correct
-
Which of the following is true regarding factor XI?
Your Answer: Deficiency causes haemophilia C
Explanation:Factor XI is also known as plasma thromboplastin and is one of the enzymes of the coagulation cascade. It is produced in the liver and is a serine protease. It is activated by factor XIIa, thrombin and by itself. Deficiency of factor XI causes the rare type of haemophilia C. Low levels of factor XI also occur in other disease states, including Noonan syndrome. High levels of factor XI have been seen in thrombosis.
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This question is part of the following fields:
- General
- Physiology
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Question 60
Correct
-
Which of the following is responsible for the maximum increase in total peripheral resistance on sympathetic stimulation?
Your Answer: Arterioles
Explanation:Arterioles are also known as the resistance vessels as they are responsible for approximately half the resistance of the entire systemic circulation. They are richly innervated by the autonomic nervous system and hence, will bring about the maximum increase in peripheral resistance on sympathetic stimulation.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 61
Correct
-
Which of the following is the most likely cause of massive splenomegaly in a 35-year old gentleman?
Your Answer: Myelofibrosis
Explanation:Causes of massive splenomegaly include chronic myelogenous leukaemia, chronic lymphocytic leukaemia, lymphoma, hairy cell leukaemia, myelofibrosis, polycythaemia vera, sarcoidosis, Gaucher’s disease and malaria.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 62
Correct
-
A 30-year old lady was admitted to the general surgical ward after a diagnosis of perforation of the first part of the duodenum that resulted from a long standing ulcer. If this perforation led to the expulsion of the gastric content that resulted to the erosion of an artery found in this part of the duodenum (the posterior of the first part of the duodenum). Which of the following arteries is this most likely to be?
Your Answer: Gastroduodenal
Explanation:The proximal part of the duodenum is supplied by the gastroduodenal artery. This artery is found descending behind the first part of the duodenum after branching from the hepatic artery. If gastric content was to be expelled in the posterior portion of the first part of the duodenum, then this artery would be most likely to be damaged. The common hepatic artery and the left gastric artery are branches of the coeliac trunk that are found superior to the duodenum. The proper hepatic artery is a branch of the common hepatic artery also found superior to the duodenum. The superior mesenteric artery is found behind the pancreas as a branch of the aorta that is at the bottom of the L1 level. The right gastric artery arises above the pylorus from the proper hepatic artery and supplies the lesser curvature of the stomach. The intestinal arteries supply the ileum and the jejunum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 63
Correct
-
A 58-year-old woman has had a headache, fever, lethargy and nausea for the last 10 days. He undergoes a CT scan which reveals a lesion in his frontal lobe, which, after a biopsy, is found to be formed by granulation tissue with collagenisation, gliosis and oedema. What's the most likely diagnosis?
Your Answer: Chronic brain abscess
Explanation:A cerebral abscess can result from direct extension of cranial infections, penetrating head trauma, haematogenous spread, or for unknown causes. An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts. Oedema around the abscess can increase the intracranial pressure. Symptoms result from increased intracranial pressure and mass effects. In a CT scan, an abscess appears as an oedematous mass with ring enhancement.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 64
Correct
-
Where is the foramen ovale located?
Your Answer: Sphenoid
Explanation:The foramen ovale is an oval shaped opening in the middle cranial fossa located at the posterior base of the greater wing of the sphenoid bone, lateral to the lingula. It transmits the mandibular division of the trigeminal nerve (CN Vc), accessory meningeal artery, emissary veins between the cavernous sinuses and pterygoid plexus, otic ganglion, and occasionally the nervus spinosus and lesser petrosal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 65
Incorrect
-
Risk factors for hepatocellular carcinoma do NOT include:
Your Answer: Anabolic steroids
Correct Answer: Heptitis E
Explanation:Risk factors for hepatocellular carcinoma include hepatitis B and C, aflatoxin, anabolic steroids, alcohol cirrhosis and primary liver disease.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 66
Correct
-
An excision of a mass in the right parietal area of the head will be performed. In which layer of the scalp are the nerves and blood vessels located?
Your Answer: Connective tissue
Explanation:The scalp is the anatomical area bordered by the face at the front, and by the neck at the sides and back. The scalp is usually described as having five layers:
1. The skin which contains numerous sebaceous glands and hair follicles.
2. The connective tissue, a dense subcutaneous layer of fat and fibrous tissue that lies beneath the skin, containing the nerves and vessels of the scalp.
3. The aponeurosis or galea aponeurotica, a tough layer of dense fibrous tissue which runs from the frontalis muscle anteriorly to the occipitalis posteriorly.
4. The loose areolar connective tissue layer provides an easy plane of separation between the upper three layers and the pericranium.
5. The pericranium is the periosteum of the skull bones and provides nutrition to the bone and the capacity for repair.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 67
Correct
-
A 48-year-old woman has a mass in her right breast and has right axillary node involvement. She underwent radical mastectomy of her right breast. The histopathology report described the tumour to be 4 cm in its maximum diameter with 3 axillary lymph nodes with evidence of tumour. The most likely stage of cancer in this patient is:
Your Answer: IIB
Explanation:Stage IIB describes invasive breast cancer in which: the tumour is larger than 2 centimetres but no larger than 5 centimetres; small groups of breast cancer cells — larger than 0.2 millimetre but not larger than 2 millimetres — are found in the lymph nodes OR the tumour is larger than 2 centimetres but no larger than 5 centimetres; cancer has spread to 1 to 3 axillary lymph nodes or to lymph nodes near the breastbone (found during a sentinel node biopsy) OR the tumour is larger than 5 centimetres but has not spread to the axillary lymph nodes.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 68
Correct
-
A 25 year-old male patient was brought to the hospital due to a vehicular accident. A skull x-ray was done which revealed a fracture along the base of the middle cranial fossa. The patient has no sense of touch over the skin over his cheek and chin. Injury to the maxillary and the mandibular nerves is suspected. In which foramina do these two affected sensory branches leave the cranial cavity.
Your Answer: Foramen rotundum and foramen ovale
Explanation:The patient’s clinical manifestations suggests an injury to the maxillary and mandibular nerves. The maxillary branch (V2) of the trigeminal nerve (CN V) passes through and exits the skull via the pterygopalatine fossa and the foramen rotundum. At the base of the skull the foramen ovale (Latin: oval window) is one of the larger of the several holes (the foramina) that transmit nerves through the skull. The foramen ovale is situated in the posterior part of the sphenoid bone, posterolateral to the foramen rotundum. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery (small meningeal or paradural branch, sometimes derived from the middle meningeal artery), lesser petrosal nerve, a branch of the glossopharyngeal nerve and an emissary vein connecting the cavernous sinus with the pterygoid plexus of veins. Occasionally it will also carry the anterior trunk of the middle meningeal vein.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 69
Correct
-
A construction worker is brought to the A&E after a fall on site. The patient is conscious but complains of inability to feel his legs. A neurological examination reveals that he has no cutaneous sensation from his umbilicus to his toes. What is the likely level of the spinal cord that is injured?
Your Answer: T10
Explanation:The umbilicus has a relatively consistent position in humans and thus serves as an important land mark. The skin around the waist at the level of the umbilicus is supplied by the tenth thoracic spinal nerve (T10 dermatome).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 70
Correct
-
The ability of the bacteria to cause disease or its virulence is related to :
Your Answer: Toxin and enzyme production
Explanation:The pathogenicity of an organism or its ability to cause disease is determined by its virulence factors. Many bacteria produce virulence factors that inhibit the host’s immune system. The virulence factors of bacteria are typically proteins or other molecules that are synthesized by enzymes. These proteins are coded for by genes in chromosomal DNA, bacteriophage DNA or plasmids. The proteins made by the bacteria can poison the host cells and cause tissue damage.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 71
Incorrect
-
Which of the deep fasciae located in the anterolateral abdominal wall form the inguinal ligament?
Your Answer: Transverse abdominal aponeurosis
Correct Answer: External abdominal oblique aponeurosis
Explanation:The inguinal ligament is the inferior border of the aponeurosis of the external oblique abdominis and extends from the anterior superior iliac spine to the pubic tubercle from whence it is reflected backward and laterally to attach to the pectineal line and form the lacunar ligament.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 72
Correct
-
Which of the following has the highest content of triglycerides?
Your Answer: Chylomicron
Explanation:Created by the small intestinal cells, chylomicrons are large lipoprotein molecules which transport lipids to the liver, adipose, cardiac and skeletal tissue. Chylomicrons are mainly composed of triglycerides (,85%) along with some cholesterol and cholesteryl esters. Apo B-48 is the main apolipoprotein content.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 73
Incorrect
-
A 27-yeaar-old woman is diagnosed with candidiasis and prescribed fluconazole. What is the mechanism of action of fluconazole?
Your Answer: Inhibits viral protease
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 74
Incorrect
-
Which of the following is the source of blood supply to the artery of the round ligament at the head of the femur?
Your Answer: Lateral femoral circumflex artery
Correct Answer: Obturator artery
Explanation:The posterior branch of the obturator artery provides an articular branch to the head of the femur.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 75
Correct
-
A 66-year-old man complains of constant headaches. On physical examination, the only relevant sign is a dark brown mole located on left his arm which has grown in size over the years and is itchy and painful. A MRI of the brain revealed a solitary lesion at the grey-white junction in the right frontal lobe, without ring enhancement. This lesion is most likely to be:
Your Answer: Metastatic carcinoma
Explanation:The location of the mass at the grey–white junction is typical of a metastasis. The most frequent types of metastatic brain tumours originate in the lung, skin, kidney, breast and colon. These tumour cells reach the brain via the bloodstream. This patient is likely to have skin cancer, which caused the metastatic brain tumour.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 76
Correct
-
A 70-year-old man who was previously healthy develops a rapidly progressing neurological deficit. A MRI reveals a large, poorly defined mass with central necrosis in his left temporal lobe. What is the most likely diagnosis?
Your Answer: Glioblastoma multiforme
Explanation:Glioblastoma multiforme, or grade 4 astrocytoma, is the most common and aggressive primary brain tumour. They are formed by small areas of necrotising tissue surrounded by highly anaplastic cells. Most of them arise from the deep white matter of the brain and quickly infiltrate it, becoming very large before they are symptomatic. The most common symptom is progressive memory, personality or neurological deficit due to temporal and frontal lobe involvement. It is most common in men, and risk factors include: neurofibromatosis, tuberous sclerosis, Von Hippel-Lindau disease, Li-Fraumeni syndrome, and Turcot syndrome.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 77
Correct
-
A 60-year-old female has sudden onset of high-grade fever associated with cough with productive rusty-coloured sputum. Chest x-ray showed left-sided consolidation. What is the most accurate test for the diagnosis of this patient?
Your Answer: Sputum culture
Explanation:Sputum culture is used to detect and identify the organism that are infecting the lungs or breathing passages.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 78
Correct
-
Which tumour site is more commonly involved in adults than in children?
Your Answer: Lung
Explanation:In adults, the most common primary site of tumour is in the lungs, compared to children wherein the most common primary site is the blood.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 79
Correct
-
A 40-year old gentleman, who is a known with ulcerative colitis, complains of recent-onset of itching and fatigue. On examination, his serum alkaline phosphatase level was found to be high. Barium radiography of the biliary tract showed a 'beaded' appearance. What is the likely diagnosis?
Your Answer: Sclerosing cholangitis
Explanation:Primary sclerosing cholangitis is characterised by patchy inflammation, fibrosis and strictures in intra- and extra-hepatic bile ducts. It is a chronic cholestatic condition with 80% patients having associated inflammatory bowel disease (likely to be ulcerative colitis). Symptoms include pruritus and fatigue. ERCP (endoscopic retrograde cholangiopancreatography) or MRCP (magnetic resonance cholangiopancreatography) are diagnostic. Disease can lead to complete obliteration of ducts, which can result in liver failure. Cholangiocarcinoma is also a recognised complication..
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 80
Correct
-
The passage of leukocytes through the wall of the blood vessels is best described by which of the following terms?
Your 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.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 81
Correct
-
The posterior boundary of the carotid triangle is bounded by which of the following muscles?
Your Answer: Sternocleidomastoid
Explanation:The carotid triangle is a portion of the anterior triangle of the neck. It is bounded superiorly by the posterior belly of the digastric muscle, antero-inferiorly by the superior belly of omohyoid and posteriorly by the sternocleidomastoid. The floor is formed by the thyrohyoid, hyoglossus, middle and inferior pharyngeal constrictors and the roof is formed by the skin, superficial fascia, platysma and deep fascia.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 82
Correct
-
An infant, 5 weeks and 6 days old born with a large sub-aortic ventricular septal defect, is prepared for pulmonary artery banding through a left thoracotomy (the child is not fit for a surgical closure). The surgeon initially passes his index finger immediately behind two great arteries in the pericardial sac to mobilise the great arteries in order to pass the tape around the pulmonary artery. Into which space is the surgeon's finger inserted?
Your Answer: Transverse pericardial sinus
Explanation:Cardiac notch: is an indentation on the left lung of the heart.
Coronary sinus: a venous sinus on the surface of the heart (the posterior aspect) that receives blood from the smaller veins that drain the heart.
Coronary sulcus: a groove on the heart between the atria and ventricles.
Transverse pericardial sinus: located behind the aorta and pulmonary trunk and anterior to the superior vena cava.
Oblique pericardial sinus: located behind the left atrium. Accessed from the inferior side (or the apex) of the heart upwards.
Horizontal pericardial sinus: this is a made-up term.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 83
Correct
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Injury of the ventral rami at this cervical spinal level will result in paralysis of the rectus capitis anterior muscle:
Your Answer: C1, C2
Explanation:The rectus capitis anterior is a short, flat muscle, situated immediately behind the upper part of the longus capitis. It is also known as the obliquus capitis superior. It aids in flexion of the head and the neck. Nerve supple is from C1 and C2.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 84
Correct
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A 16 year old girl fractured a bone in her left foot. Upon examination the clinician discovered that the fracture affected the insertion of the peroneus brevis muscle. Which of the following bones was most likely affected?
Your Answer: Base of the fifth metatarsal
Explanation:The peroneus brevis muscle originates from the lower two-thirds of the lateral body of the fibula and has inserts at the base of the fifth metatarsal. Fractures to this bone are common and can be due to infection, trauma, overuse and repetitive use.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 85
Incorrect
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A young boy fell from a tree, sustaining an injury to the elbow area and damaging the nerve behind the medial epicondyle of the humerus. What is the most likely result from that injury?
Your Answer: Function of lumbricals 1 and 2
Correct Answer: Flexion in the distal interphalangeal joint of digit 5
Explanation:The nerve injured in this situation is the ulnar nerve. It passes posterior to the medial epicondyle of the humerus before going between the two heads of the flexor carpi ulnaris muscle. This nerve supplies the muscles and skin of forearm and hand. At the level of medial epicondyle, the injury will led to paralysis in flexor carpi ulnaris and the ulnar half of the flexor digitorum profundus as well as the palmar interossei and hypothenar muscles in the hand. The correct answer will be that the boy will suffer from inability to flex the distal interphalangeal joint of digit 5
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 86
Incorrect
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As per the Poiseuille-Hagen formula, doubling the diameter of a vessel will change the resistance of the vessel from 16 peripheral resistance units (PRU) to:
Your Answer: 4 PRU
Correct Answer: 1 PRU
Explanation:Poiseuille-Hagen formula for flow in along narrow tube states that F = (PA– PB) × (Π/8) × (1/η) × (r4/l) where F = flow, PA– PB = pressure difference between the two ends of the tube, η = viscosity, r = radius of tube and L = length of tube. Also, flow is given by pressure difference divided by resistance. Hence, R = 8ηL ÷ Πr4. Hence, the resistance of the vessel changes in inverse proportion to the fourth power of the diameter. So, if the diameter of the vessel is increased to twice the original, it will lead to decrease in resistance to one-sixteenth its initial value.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 87
Incorrect
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An organ transplant patient may be at risk of developing which type of cancer?
Your Answer: Thyroid cancer
Correct Answer: Skin cancer
Explanation:The most common malignancies encountered in the post–solid organ transplant setting are non-melanoma skin cancers, post-transplant lymphoproliferative disorders and Kaposi’s sarcoma (KS). The pathogenesis of these tumours is likely related to the immunosuppressive drugs used post-transplantation and subsequent viral infection.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 88
Correct
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Where is factor VIII predominantly synthesised?
Your Answer: Vascular endothelium
Explanation:Factor VIII is an important part of the coagulation cascade. Deficiency causes haemophilia A. It is synthesised predominantly by the vascular endothelium and is not affected by liver disease. In the circulation it is bound to von Willebrand factor and it forms a stable complex with it. It is activated by thrombin or factor Xa and acts as a co factor to factor IXa to activate factor X which is a co factor to factor Va. Thrombin cleaves fibrinogen in fibrin and forms a meshwork to trap RBC and platelets to form a clot.
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This question is part of the following fields:
- General
- Physiology
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Question 89
Correct
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A 51-year old woman after undergoing a barium swallowing was discovered to be suffering from an oesophageal hiatal hernia. Which muscle fibres of the diaphragm border this hernia directly if the stomach herniates through an enlarged oesophageal hiatus?
Your Answer: Right crus
Explanation:The oesophageal hiatus is a natural fissure on the thoracic diaphragm that allows passage of the oesophagus and the vagal nerve. The oesophageal hiatus is located in one of the tendinous structures of the diaphragm that connect it to the spine which is known as the right crus. In case of an hiatal hernia, this diaphragmatic structure would be the one bordering the hernia as it is the structure that encircles the oesophageal hiatus.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 90
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 91
Correct
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A patient is brought to the accident and emergency department. He is said to have been involved in a mall explosion. Chest imaging reveals metal fragments in his thoracic cavity. He also has a pericardial effusion suggestive of a pericardial tear. An emergency thoracotomy is done which revealed a tear of the pericardium inferiorly. The surgeon began to explore for fragments in the pericardial sac with his hand from below the apex. He slips his fingers upward and to the right within the sac until they were stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart. His finger tips were now in the:
Your Answer: Oblique pericardial sinus
Explanation:Transverse sinus: part of pericardial cavity that is behind the aorta and pulmonary trunk and in front of the superior vena cava separating the outflow vessels from the inflow vessels.
Oblique pericardial sinus: is behind the left atrium where the visceral pericardium reflects onto the pulmonary veins and the inferior vena cava. Sliding a finger under the heart will take you to this sinus.
Coronary sinus: large vein that drains the heart into the right atrium. Located on the surface of the heart.
Coronary sulcus: groove on the heart demarcating the atria from the ventricles.
Costomediastinal recess: part of the pleural sac where the costal pleura transitions to become the mediastinal pleura.
Sulcus terminalis: a groove between the right atrium and the vena cava.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 92
Correct
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Which of the following chemotherapy regimens is most likely to be used in colorectal cancer?
Your Answer: FOLFOX
Explanation:Chemotherapy regimens are often identified by acronyms, identifying the agents used in the drug combination. However, the letters used are not consistent across regimens. FOLFOX is a chemotherapy regimen used for the treatment of colorectal cancer, made up of the following drugs: • FOL: fluorouracil (5-fluorouracil or 5-FU) • F: folinic acid (leucovorin) • OX: oxaliplatin (Eloxatin®).
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 93
Correct
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Which of the following is true about a patient who has undergone total colectomy and ileostomy?
Your Answer: Following total colectomy and ileostomy, the volume and water content of ileal discharge decreases over time
Explanation:After a patient has undergone total colectomy and ileostomy, the volume of ileal discharge, along with its water content gradually decreases over time. Post surgery, most patients can live a normal life. Iron and vitamin B12 absorption do not take place in the colon and hence are not affected significantly by a colectomy.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 94
Correct
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A neurotransmitter of the nigrostriatal pathway is:
Your Answer: Dopamine
Explanation:Dopamine acts as a neurotransmitter in the brain, activating dopamine receptors. It is also a neurohormone released from the hypothalamus. It plays an important role in the reward system. It is believed that dopamine provides a teaching signal to parts of the brain responsible for acquiring new motor sequences (behaviours), by activation of dopamine neurons when an unexpected reward is presented. Loss of dopamine neurones in the nigrostriatal pathway causes Parkinson’s disease. In the frontal lobes, dopamine controls the flow of information from other areas of the brain, and thus, dopamine disorders in this region can cause a decline in neurocognitive functions, especially memory, attention and problem solving. Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention-deficit disorder and some symptoms of schizophrenia. Dopamine is also the primary neuroendocrine regulator of the secretion of prolactin from the anterior pituitary gland. Dopamine is also commonly associated with the pleasure system of the brain. This plays a key role in understanding the mechanism of action of drugs (such as cocaine and the amphetamines), which seem to be directly or indirectly related to the increase of dopamine.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 95
Correct
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The Henderson–Hasselbalch equation describes the derivation of pH as a measure of acidity. According to this equation, the buffering capacity of the system is at maximum when the number of free anions compared with undissociated acid is:
Your Answer: Equal
Explanation:In 1908, Lawrence Joseph Henderson wrote an equation describing the use of carbonic acid as a buffer solution. Later, Karl Albert Hasselbalch re-expressed that formula in logarithmic terms, resulting in the Henderson–Hasselbalch equation. The equation is also useful for estimating the pH of a buffer solution and finding the equilibrium pH in acid–base reactions. Two equivalent forms of the equation are: pH = pKa + log10 [A–]/[HA] or pH = pKa + log10 [base]/[acid]. Here, pKa is − log10(Ka) where Ka is the acid dissociation constant, that is: pKa = –log10(Ka) = –log10 ([H3 O+][A–]/[HA]) for the reaction: HA + H2 O ≈ A– + H3 O+ In these equations, A– denotes the ionic form of the relevant acid. Bracketed quantities such as [base] and [acid] denote the molar concentration of the quantity enclosed. Maximum buffering capacity is found when pH = pKa or when the number of free anions to undissociated acid is equal and buffer range is considered to be at a pH = pKa ± 1.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 96
Correct
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You observe a procedure to harvest the left internal thoracic (mammary) artery to be used as a graft for coronary artery bypass surgery. The left internal thoracic artery is mobilised from the inside of the chest wall and divided near the caudal end of the sternum. After dividing the internal thoracic artery at its distal end, the specialist registrar asks you to name the artery that will now have increased blood supply so that adequate blood flow is maintained to the rectus abdominis on the left side. What would your answer be?
Your Answer: Inferior epigastric artery
Explanation:The rectus abdominis muscle is supplied by the superior epigastric artery which is a branch of the internal thoracic artery. If the internal thoracic artery is thus ligated, blood would no longer flow to it. However, the superior epigastric artery communicates with the inferior epigastric artery (a branch of the external iliac artery). This means that blood could flow from the external iliac, to the inferior epigastric, to the superior epigastric to the rectus abdominis.
The superficial circumflex iliac artery and the superficial epigastric are two superficial branches of the femoral artery and do not supply the deep branches of the abdomen.
The deep circumflex iliac artery travels along the iliac crest on the inner surface of the abdominal wall; being too lateral it doesn’t supply blood to the rectus abdominis.
The distal portions of the umbilical arteries are obliterated in adults to form the medial umbilical folds.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 97
Correct
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A 70-year old man had had a large indirect inguinal hernia for 3 years. He presents at the out patient clinic complaining of pain in the scrotum. There is, however, no evidence of obstruction or inflammation. You conclude that the hernial sac is most probably compressing the:
Your Answer: Ilioinguinal nerve
Explanation:The ilioinguinal nerve arises together with the iliohypogastric nerve from the first lumbar nerve to emerge from the lateral border of the psoas major muscle just below the iliohypogastric and passing obliquely across the quadratus lumborum and iliacus muscles. It perforates the transversus abdominis, near the anterior part of the iliac crest and communicates with the iliohypogastric nerve between the internal oblique and the transversus. It then pierces the internal oblique to distribute filaments to it and accompanying the spermatic cord through the subcutaneous inguinal ring, is distributed to the skin of the upper and medial parts of the thigh, the skin over the root of the penis and the upper part of the scrotum in man and to the skin covering the mons pubis and labium majus in the woman. As the ilioinguinal nerve runs through the inguinal canal, it could easily be compressed by a hernial sac.
The femoral branch of genitofemoral nerve provides sensory innervation of the upper medial thigh.
The femoral nerve innervates the compartment of the thigh and also has some cutaneous sensory branches to the thigh.
The iliohypogastric nerve innervates the skin of the lower abdominal wall, upper hip and upper thigh. The subcostal nerve innervates the skin of the anterolateral abdominal wall and the anterior scrotal nerve is a terminal branch of the ilioinguinal nerve.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 98
Correct
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Which is the correct statement regarding gonadal venous drainage:
Your 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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 99
Correct
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A 28 years old women presents with a history of chronic cough with fever for the past 2 months. A chest x ray revealed a diffuse bilateral reticulonodular pattern. A transbronchial biopsy was performed and histological examination showed focal areas of inflammation with epithelioid macrophages, Langhans cells and lymphocytes. Which of the immune reaction is responsible for this?
Your Answer: Type IV hypersensitivity
Explanation:A reactivated tuberculosis with granuloma formation is characteristic of type IV reaction. It is also called a delayed type of hypersensitivity reaction and takes around 2-8 days to deliver. It is a cell mediated response with the involvement of CD8 and CD4 cells and the release of IL-1 from macrophages that further activate these CD cells.
Granulomatous reactions are mostly cell-mediated.
Type I reactions are allergic and anaphylactic reactions and type II are complement-mediated immune reactions.
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This question is part of the following fields:
- Inflammation & Immunology; Respiratory
- Pathology
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Question 100
Incorrect
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A 50-year old gentleman who was admitted for elective surgery was found to have haemoglobin 9.5 g/dl, white blood cell count of 1.4 × 109/l and a mean corpuscular volume (MCV) of 134 fl. Which of the following is the likely finding on his peripheral blood smear?
Your Answer: Blasts
Correct Answer: Hypersegmented neutrophils
Explanation:The likely diagnosis is megaloblastic anaemia, which also shows the presence of hypersegmented neutrophils.
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This question is part of the following fields:
- Haematology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
