-
Question 1
Incorrect
-
Which of the following nerves has its terminal branch at the supratrochlear nerve?
Your Answer: Maxillary
Correct Answer: Frontal
Explanation:The supratrochlear nerve is a branch of the frontal nerve which comes from the ophthalmic division of cranial nerve V (trigeminal nerve). It passes above the superior oblique nerve and its descending filaments join the infratrochlear branch of the nasociliary nerve. From the orbit, it exits between the supraorbital foramen and the pulley of the superior oblique. It then curves up to the forehead beneath the corrugator supercilli and frontalis muscle. It further divides into branches that supply sensory innervation to the bridge of the nose, medial part of the upper eyelid and medial forehead.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 2
Correct
-
A patient who has used NSAIDS for many years presents to the A&E with symptoms of acute haemorrhagic shock. An emergency endoscopy is done that shows that a duodenal ulcer has perforated the posterior wall of the first part of the duodenum. Which artery is most likely to be the cause of the haemorrhage?
Your Answer: Gastroduodenal
Explanation:The gastroduodenal artery is a branch of the hepatic artery and descends near the pylorus between the first part of the duodenum and the neck of the pancreas to divide at the lower border of the duodenum into the right gastroepiploic and pancreaticoduodenal arteries. Before it divides, it gives off a few branches to the pyloric end of the stomach and to the pancreas. The artery that is most likely involved in this situation is the gastroduodenal artery since it is posterior to the first part of the duodenum.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 3
Correct
-
Which organ is responsible for the secretion of enzymes that aid in digestion of complex starches?
Your Answer: Pancreas
Explanation:α-amylase is secreted by the pancreas, which is responsible for hydrolysis of starch, glycogen and other carbohydrates into simpler compounds.
-
This question is part of the following fields:
- Gastroenterology
- Physiology
-
-
Question 4
Incorrect
-
The gastrosplenic ligament also known as the gastrolienal ligament is the structure that connects the greater curvature of the stomach to the hilum of the spleen. Which of the following arteries would most likely be injured if a surgeon accidentally tore this ligament?
Your Answer: Left gastric
Correct Answer: Short gastric
Explanation:The short gastric arteries arise from the end of the splenic arteries and form five to seven branches. The short gastric arteries inside the gastrosplenic ligament from the left to the right, supply the greater curvature of the stomach. The hepatic artery proper runs inside the hepatoduodenal ligament. The right gastric artery and the left gastric artery are contained in the hepatogastric ligament. The caudal pancreatic artery branches off from the splenic artery and supplies the tail of the pancreas. The middle colic artery supplies the transverse colon. The splenic artery does not travel in the gastrosplenic ligament and so it would not be damaged by a tear to this ligament.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 5
Correct
-
An 26-year-old man sought admission due to persistent non-bloody diarrhoea. The patient is HIV-positive. Examination of stool sample showed numerous acid-fast cysts. Which of the following organism is the most likely cause of diarrhoea?
Your Answer: Cryptosporidium parvum
Explanation:Cryptosporidium parvum is one of several species that causes cryptosporidiosis, a parasitic disease of the mammalian intestinal tract. Primary symptoms of C. parvum infection are acute, watery, and non-bloody diarrhoea. C. parvum infection is of particular concern in immunocompromised patients, where diarrhoea can reach 10–15 l per day.
-
This question is part of the following fields:
- Microbiology
- Pathology
-
-
Question 6
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.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 7
Correct
-
Myoglobin is released as a result of rhabdomyolysis from damaged skeletal muscles. What function do they perform in the muscle?
Your Answer: Acts like haemoglobin and binds with O2
Explanation:Myoglobin is a pigmented globular protein made up of 153 amino acids with a prosthetic group containing haem around which the apoprotein folds. It is the primary oxygen carrying protein of the muscles. The binding of oxygen to myoglobin is unaffected by the oxygen pressure as it has an instant tendency to bind given its hyperbolic oxygen curve. It releases oxygen at very low pO2 levels.
-
This question is part of the following fields:
- General
- Physiology
-
-
Question 8
Correct
-
Diffusion is the movement of molecules from a region of high concentration to a region of low concentration. Which of these changes will decrease the rate of diffusion of a substance?
Your Answer: An increase in the molecular weight of the substance
Explanation:Unless given IV, a drug must cross several semipermeable cell membranes before it reaches the systemic circulation. Drugs may cross cell membranes by diffusion, amongst other mechanisms. The rate of diffusion of a substance is proportional to the difference in the concentration of the diffusing substance between the two sides of the membrane, the temperature of the solution, the permeability of the membrane and, in the case of ions, the electrical potential difference between the two sides of the membrane.
-
This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
-
-
Question 9
Correct
-
Which of the following variables are needed to calculate inspiratory reserve volume of a patient?
Your Answer: Tidal volume, vital capacity and expiratory reserve volume
Explanation:Vital capacity = inspiratory reserve volume + tidal volume + expiratory reserve volume. Thus, inspiratory reserve volume can be calculated if tidal volume, vital capacity and expiratory reserve volume are known.
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 10
Incorrect
-
Which is the correct superficial to deep order of structures that would be affected following a knife wound to the lateral aspect of the knee?
Your Answer: Skin, anterior cruciate ligament, popliteus muscle tendon
Correct Answer: skin, fibular collateral ligament, popliteus muscle tendon, lateral meniscus
Explanation:Skin, fibular collateral ligament, popliteus muscle tendon and lateral meniscus is the correct order of structures covering the lateral aspect of the knee joint from a superficial to deep.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 11
Correct
-
A 45-year old gentleman presents with diarrhoea for two weeks. He has no history of fever and the diarrhoea stops on fasting. Which is the most likely type of diarrhoea that he is suffering from?
Your Answer: Osmotic
Explanation:The different types of diarrhoea are:
1. Secretory diarrhoea – Due to increased secretion or decreased absorption. There is minimal to no structural damage in this type. The most common cause is cholera toxin which stimulates secretion of anions (especially chloride), with sodium and water.
2. Osmotic diarrhoea – Due to increased osmotic load, there is water loss. This occurs in cases of maldigestion syndromes, such as coeliac or pancreatic disease.
3. Motility-related diarrhoea – Occurs in cases of abnormal gastrointestinal motility. Due to increased motility, there is poor absorption and this leads to diarrhoea. This is seen post-vagotomy or in diabetic neuropathy.
4. Inflammatory diarrhoea – Due to damage to the mucosa or brush border, there is a loss of protein-rich fluids and poor absorption. Features of all the above three types can be seen in this type. Aetiology includes bacterial, viral, parasitic infections or autoimmune problems including inflammatory bowel disease.
-
This question is part of the following fields:
- Gastroenterology
- Physiology
-
-
Question 12
Incorrect
-
During an OSCE exam a medical student is asked to locate the sternal angle. The sternal angle is a land mark for locating the level of the:
Your Answer: First costal cartilage
Correct Answer: Second costal cartilage
Explanation:The sternal angle, a key landmark used in the clinic for auscultating for heart sounds, is the point of attachment of the costal cartilage of rib 2 to the sternum. It thus corresponds to the location of the second rib. A horizontal plane through the sternal angle traverses the T4/T5 intervertebral disc and marks the inferior boundary of the superior mediastinum.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 13
Incorrect
-
After a total colectomy and ileotomy, a 50-year old diabetic man who was a known case of diabetic nephropathy had persistent metabolic acidosis. The patient appeared well perfused, with normal vital signs and normal fluid balance. Investigations revealed:
Sodium = 132 mmol/l
Potassium = 6.6 mmol/l
Creatinine = 185 μmol/l (2.16 mg/dl)
Chloride = 109 μmol/l
8am cortisol = 500 nmol/l (18 μg/dl)
pH = 7.29, p(CO2) = 27 mmHg
p(O2) = 107 mmHg
standard bicarbonate = 12 mmol/l.
What is the likely causes of his acidosis?Your Answer: Bowel perforation
Correct Answer: Renal tubular acidosis
Explanation:Acidosis here is due to low bicarbonate. The low p(CO2) is seen in compensation. The anion gap is normal, ruling out intra-abdominal ischaemia (which leads to metabolic acidosis). If it was a gastrointestinal aetiology, low potassium would be seen. The history of diabetic nephropathy predisposes to renal tubular acidosis. Type 4 (hyporeninaemic hypoaldosteronism) is associated with high potassium and is found in diabetic and hypertensive renal disease.
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 14
Incorrect
-
A 58-year-old woman presents with signs of inflammation in the first metatarsophalangeal joint: redness, swelling and pain. The analysis of synovial fluid reveals needle-shaped, strongly negatively birefringent crystals. What's the most likely diagnosis in this case?
Your Answer: Infectious arthritis
Correct Answer: Gout
Explanation:Gout is a rheumatic disease caused by the precipitation of monosodium urate crystals into tissues, usually joints. This causes acute or chronic pain; the acute illness initially affects only one joint, often the first metatarsophalangeal joint. The diagnosis of the disease requires the identification of crystal in the synovial fluid. These crystals are needle-shaped and strongly negatively birefringent.
-
This question is part of the following fields:
- Orthopaedics
- Pathology
-
-
Question 15
Incorrect
-
Which of the following changes in the histology of the cell is most likely to be accompanied by disruption of the cell membrane following an injury?
Your Answer: Apoptosis
Correct Answer: Coagulative necrosis
Explanation:The process of necrosis ends with the rupture of the cell membrane and the consequent release of the cellular components into the surrounding tissue. Apoptosis, pyknosis and karyorrhexis are not reversible events but the cell membrane remains intact. Cloudy swelling and hydropic changes are also reversible but again the cell membrane remains intact and they are therefore different and distinct from necrosis.
-
This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
-
-
Question 16
Incorrect
-
Which of the following is true about a patient who has undergone total colectomy and ileostomy?
Your Answer: This patient is at increased risk of anaemia due to malabsorption of iron
Correct 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.
-
This question is part of the following fields:
- Gastroenterology
- Physiology
-
-
Question 17
Incorrect
-
Which of the following statements regarding the arteries in the neck are TRUE?
Your Answer: The facial artery courses superficial to the submandibular salivary gland
Correct Answer: The thyrocervical trunk typically gives rise to the inferior thyroid artery, transverse cervical artery and suprascapular artery
Explanation:The thyrocervical trunk is one of the three branches of the first part of the subclavian artery and gives numerous branches which supply viscera of the neck, the brachial plexus, neck muscles and scapular anastomoses. The vertebral arteries are major arteries of the neck. They arise as branches from the subclavian arteries and merge to form the single midline basilar artery. The carotid sinus is a dilated area at the base of the internal carotid artery just superior to the bifurcation of the internal carotid and external carotid at the level of the superior border of thyroid cartilage.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 18
Incorrect
-
A surgeon performing a thymectomy to remove a malignant thymoma is careful to avoid damaging an important nerve lying around the arch of the aorta. Which nerve is the surgeon trying to preserve?
Your Answer: Left phrenic
Correct Answer: Left Vagus
Explanation:The left vagus nerve lies on the lateral surface of the aortic arch. The left recurrent laryngeal nerve arises from the vagus and loops around the arch of the aorta. This nerve is at risk of injury during surgery.
The right and left phrenic nerves, being lateral to the vagus, do not loop around the arch of the aorta.
The sympathetic trunks, both right and left, are located in the posterior chest; not near the aortic arch.
The right vagus: not involved with the aortic arch.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 19
Incorrect
-
A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and oliguria. She is diagnosed with chronic renal failure. Dipstick testing shows no protein, glucose, nitrite or ketones but a semi-quantitative sulphosalicylic acid test for urine protein is positive. Which of the following is the most probable cause of chronic renal failure in this patient.
Your Answer: Minimal-change disease
Correct Answer: Multiple myeloma
Explanation:Dipstick results are negative because the proteins found in the urine of this patient are not albumin but Bence Jones proteins. A Bence Jones protein is a monoclonal globulin protein commonly detected in patients affected by multiple myeloma. Multiple myeloma is a malignancy of plasma cells characterised by the production of monoclonal immunoglobulin. Symptoms include bone pain, bone fractures, bleeding, neurologic symptoms, fatigue, frequent infections and weight loss.
-
This question is part of the following fields:
- Pathology
- Renal
-
-
Question 20
Incorrect
-
Bile salt reuptake principally occurs where?
Your Answer: In the jejenum
Correct Answer: In the ileum
Explanation:90 – 95% of the bile salts are absorbed from the small intestine (mostly terminal ileum and then excreted again from the liver. This is known as the enterohepatic circulation. The entire pool recycles twice per meal and approximately 6 to 8 times per day.
-
This question is part of the following fields:
- Gastroenterology
- Physiology
-
-
Question 21
Incorrect
-
A CT-scan of the lung shows a tumour crossing the minor (horizontal) fissure. This fissure separates:
Your Answer: The lower lobe from both the middle and upper lobes
Correct Answer: The middle lobe from the upper lobe
Explanation:The horizontal fissure separates the upper lobe from the middle lobe. The oblique fissure on the other hand separates the lower lobe from both the middle and upper lobes. The lingula is found only on the left lung.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 22
Incorrect
-
In which of the following compartments of the femoral sheath is the femoral artery located?
Your Answer: Intermediate compartment
Correct Answer: Lateral compartment
Explanation:The femoral sheath also known as the crural sheath is made up of three compartments; lateral, intermediate and the medial. The femoral artery is contained in the lateral compartment of the femoral sheath while the femoral vein is in the intermediate compartment.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 23
Incorrect
-
Rapid eye movement (REM) sleep is likely to be affected by a lesion in the:
Your Answer: Basal ganglia
Correct Answer: Pons
Explanation:Rapid eye movement (REM) sleep is also known as paradoxical sleep, as the summed activity of the brain’s neurons is quite similar to that during waking hours. Characterised by rapid movements of the eyes, most of the vividly recalled dreams occur during this stage of sleep. The total time of REM sleep for an adult is about 90–120 min per night.
Certain neurones in the brainstem, known as REM sleep-on cells, which are located in the pontine tegmentum, are particularly active during REM sleep and are probably responsible for its occurrence. The eye movements associated with REM are generated by the pontine nucleus with projections to the superior colliculus and are associated with PGO (pons, geniculate, occipital) waves.
-
This question is part of the following fields:
- Neurology
- Physiology
-
-
Question 24
Incorrect
-
The gluteus medius muscle:
Your Answer: Flexes the thigh at the hip joint
Correct Answer: Is supplied by the superior gluteal nerve
Explanation:The gluteus medius is situated on the outer surface of the pelvis. It arises from the outer surface of the ilium between the iliac crest and posterior gluteal line above and the anterior gluteal line below. The gluteus medius is supplied by the fourth and fifth lumbar and first sacral nerves through the superior gluteal nerve
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 25
Incorrect
-
Which of the following is the most common germ cell tumour of the testis affecting an adult male?
Your Answer: Embryonal carcinoma
Correct 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%).
-
This question is part of the following fields:
- Pathology
- Urology
-
-
Question 26
Incorrect
-
A 14 year-old girl is found to have haemophilia B. What pathological problem does she have?
Your Answer: Deficiency of factor VIII
Correct Answer: Deficiency of factor IX
Explanation:Haemophilia B (also known as Christmas disease) is due to a deficiency in factor IX. Haemophilia A is due to a deficiency in factor VIII.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 27
Incorrect
-
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: Rabies
Correct 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.
-
This question is part of the following fields:
- Neurology
- Pathology
-
-
Question 28
Incorrect
-
An old man fell and fractured a carpal bone articulating with the pisiform bone. Which bone was most likely fractured?
Your Answer: Trapezoid
Correct Answer: Triquetral
Explanation:The pisiform bone has an oval facet for articulation with the triquetral bone. The pisiform bone is a sesamoid bone, and is anterior to the other carpal bones.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 29
Incorrect
-
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: Neuroblastoma
Correct 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.
-
This question is part of the following fields:
- Endocrine
- Pathology
-
-
Question 30
Incorrect
-
A 27-year old lady is shot in the chest. The bullet enters superior to the upper edge of the clavicle. She had difficulty in breathing which is interpreted by the A&E physician as a likely indicator of a collapsed lung. If that is the case, what portion of the pleura is most likely to have been punctured?
Your Answer:
Correct Answer: Cupola
Explanation:The cupola is part of the pleura that extends above the first rib into the root of the lung. Most likely to injured in a stab above the level of the clavicle.
Costodiaphragmatic recess: the lowest extent of the pleural sac.
Pulmonary ligament: is a fold of pleura located below the root of the lung.
Mediastinal pleura: part of the pleura that lines the mediastinal cavity.
Hilar reflection is the part of the pleura where the visceral pleura of the lung reflects to become continuous with the parietal pleura.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
SESSION STATS - PERFORMANCE PER SPECIALTY
