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Question 1
Incorrect
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The nasolacrimal duct is a membranous canal. It extends from the lower part of the lacrimal sac and drains into which structure?
Your Answer: Middle meatus
Correct Answer: Inferior meatus
Explanation:The nasolacrimal duct carries tears from the lacrimal sac of the eye into the nasal cavity. The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. The opening of the nasolacrimal duct into the inferior nasal meatus of the nasal cavity is partially covered by a mucosal fold (valve of Hasner or plica lacrimalis). Excess tears flow through the nasolacrimal duct which drains into the inferior nasal meatus.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 2
Correct
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A man in his sixties underwent surgery to remove a lump from his axilla. During removal, a nerve originating from the lateral cord of the brachial plexus was damaged. Which nerve is this referring to?
Your Answer: Lateral pectoral
Explanation:The only branch of the lateral cord of brachial plexus in the options given, is the lateral pectoral nerve. It supplies the pectoralis major muscle and sends a branch to join the medial pectoral nerve forming a loop in front of the first part of the axillary artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 3
Correct
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A 65-year-old female is taking different medications for various medical conditions. Which medication would most likely predispose the patient to develop hyperkalaemia?
Your Answer: Spironolactone
Explanation:The most important potential side effect of spironolactone is hyperkalaemia (high potassium levels), which, in severe cases, can be life-threatening. Hyperkalaemia in these patients can present as a non anion-gap metabolic acidosis.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 4
Incorrect
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Cancer of the testis most likely metastases to which set of lymph nodes?
Your Answer: Superficial inguinal
Correct Answer: Aortic
Explanation:The lymphatic drainage of an organ is related to its blood supply. The lymphatic drainage of the testis drains along the testicular artery to reach the lymph nodes along the aorta.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 5
Correct
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Which of the following is the cause of flattened (notched) T waves on electrocardiogram (ECG)?
Your Answer: Hypokalaemia
Explanation:The T-wave is formed due to ventricular repolarisation. Normally, it is seen as a positive wave. It can be normally inverted (negative) in V1 (occasionally in V2-3 in African-Americans/Afro-Caribbeans). Hyperacute T-waves are the earliest ECG change of acute myocardial infarction. ECG findings of hyperkalaemia include high, tent-shaped T-waves, a small P-wave and a wide QRS complex. Hypokalaemia results in flattened (notched) T-waves, U-waves, ST-segment depression and prolonged QT interval.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 6
Correct
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During hysterectomy, the ureter is most likely to be ligated when a surgeon is clamping the?
Your Answer: Uterine arteries
Explanation:The ureter forms the posterior boundary of a shallow depression which lodges the ovary and then runs medially and forward on the lateral aspect of the uterine cervix and upper part of the vagina to reach the fundus of the bladder. It is also situated about 2cm from the side of the cervix of the uterus. The relationship of the ureters and uterine arteries is of clinical significance because the arteries are at risk of iatrogenic injury during hysterectomy.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 7
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 8
Correct
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The pterion is clinically significant as it marks an area of weakness on the skull. What structure lies beneath it?
Your Answer: Anterior branches of the middle meningeal artery
Explanation:The pterion is the area where four bones, the parietal, frontal, greater wing of sphenoid and the squamous part of the temporal bone meet. It overlies the anterior branch of the middle meningeal artery on the internal aspect of the skull. The pterion is the weakest part of the skull. Slight trauma to this region can cause extradural hematoma.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 9
Correct
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A lesion involving the lateral portion of the dorsal columns at the level of the nape of the neck will most likely affect:
Your Answer: Vibratory sensations from the ipsilateral arm
Explanation:At the level mentioned in the question, the lateral portion of dorsal columns comprises of the fasciculus cuneatus. Axons carrying the sensations of touch, vibration and proprioception from the ipsilateral arm enter the spinal cord and ascend in the fasciculus cuneatus, synapsing in the nucleus cuneatus of the caudal medulla. Secondary neurons from this nucleus give rise to internal arcuate fibres, which decussate and ascend to the thalamus as the medial lemniscus. Tertiary neurons from there project to the ipsilateral somatosensory cortex. Thus, any damage to the fasciculus cuneatus will result in a deficit in tactile, proprioceptive and vibratory sensations in the ipsilateral arm, and not the contralateral arm.
Fine motor control of the fingers is mainly carried by the ipsilateral lateral corticospinal tract in the lateral funiculus of the cord. Motor control of the contralateral foot is carried by the ipsilateral corticospinal tract in the lateral funiculus of the cord. Lack of sweating of the face could be produced by interruption of sympathetic innervation. Proprioception from the ipsilateral leg is carried by the fasciculus gracilis in the medial part of the dorsal columns.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 10
Correct
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Signals pass through neuromuscular junctions via the neurotransmitter acetylcholine. After release from the skeletal neuromuscular junction, acetylcholine:
Your Answer: Causes postsynaptic depolarisation
Explanation:Acetylcholine is released from the presynaptic membrane into the cleft where it binds to the ion gated channels on the post synaptic membrane, causing them to open. This results in sodium entering into the fibre and further depolarizing it, creating an action potential.
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This question is part of the following fields:
- General
- Physiology
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Question 11
Correct
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A lad involved in a road traffic accident is rushed to casualty where physical examination reveals that he has limited extension of his right humerus. Which of the following nerves is most likely to have been injured?
Your Answer: Thoracodorsal nerve
Explanation:Extension of the humerus is a function of the latissimus dorsi. This muscle is supplied by the thoracodorsal nerve which is a branch of the posterior cord of the plexus whose fibres are derived from cranial nerves V, VI and VII.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
Incorrect
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A 59-year-old woman with hyperaldosteronism is prescribed a diuretic. Which of the following diuretics promotes diuresis by opposing the action of aldosterone?
Your Answer: Loop diuretic
Correct Answer: Potassium-sparing diuretic
Explanation:The term potassium-sparing refers to an effect rather than a mechanism or location. Potassium-sparing diuretics act by either antagonising the action of aldosterone (spironolactone) or inhibiting Na+ reabsorption in the distal tubules (amiloride). This group of drugs is often used as adjunctive therapy, in combination with other drugs, for the management of chronic heart failure. Spironolactone, the first member of the class, is also used in the management of hyperaldosteronism (including Conn’s syndrome) and female hirsutism (due to additional antiandrogen actions).
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This question is part of the following fields:
- Physiology
- Renal
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Question 13
Correct
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Where would you insert the needle when drawing blood from a patient's median cubital vein?
Your Answer: Anterior aspect of the elbow
Explanation:The correct answer is to insert it into the anterior aspect of the elbow. If you look at the venous drainage of the upper limb, you will find that there are two main veins, the basilic and the cephalic vein; the connecting branch between these two veins is the median cubital vein. and this vein passes via the cubital fossa which is on the anterior aspect of the forearm.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 14
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 15
Incorrect
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What is the action of the muscle of the orbit that originates on the lesser wing of the sphenoid bone, just above the optic foramen?
Your Answer: Temporal rotation of the eyeball
Correct Answer: Elevation of the upper eyelid
Explanation:The levator palpebrae superioris is the muscle in the orbit that elevates the superior (upper) eyelid. The levator palpebrae superioris originates on the lesser wing of the sphenoid bone, just above the optic foramen and receives somatic motor input from the ipsilateral superior division of the oculomotor nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 16
Incorrect
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Digital rectal examination of a 75-year old gentleman who presented to the surgical clinic with urinary retention revealed an enlarged, nodular prostate. PSA was found to be elevated, favouring the diagnosis of prostatic malignancy. Which of the given options is the most common malignant lesion affecting the prostate gland?
Your Answer: Squamous cell carcinoma
Correct Answer: Adenocarcinoma
Explanation:Prostatic adenocarcinoma is the commonest solid malignancy and non-dermatological cancer in men above 50 years age. Increasing in incidence with age and the highest risk seen in the black population. About 75% of cases are seen in men over 65 years. Other tumours affecting the prostate include undifferentiated prostate cancer, squamous cell carcinoma, and ductal transitional carcinoma, but these occur less commonly. Sarcomas usually affect children. Hormones play a role in the aetiology of prostate adenocarcinoma unlike the other types. Intraepithelial neoplasia is considered a precursor of invasive malignancy.
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This question is part of the following fields:
- Pathology
- Urology
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Question 17
Incorrect
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A victim of assault in a domestic violence is stabbed in the left chest. The tip of the pen knife entered the pleural space just above the cardiac notch. Luckily the lung was spared as it would only occupy this space during deep inspiration. Which of these structures was pierced by the knife?
Your Answer: Pulmonary ligament
Correct Answer: Costomediastinal recess
Explanation:The costomediastinal recess is located immediately next to the cardiac notch. The medial aspect of the superior lobe of the left lung, when fully inflated expands to this place. The lung wouldn’t enter the anterior or the posterior mediastinum which are found between the two pleural cavities.
The costodiaphragmatic recess is the lowest extent of the pleural cavity where the inferior lobes of the lungs would expand into in deep inhalation.
The cupola, is the part of the pleural cavity that extends above the first rib into the root of the neck. The superior most part of the superior lobe of the lung might extend into this part.
Pulmonary ligament: pleural fold that is located below the root of the lung where the visceral pleura and the mediastinal pleura are in continuity.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 18
Incorrect
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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: Three times more
Correct 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 19
Correct
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During a procedure to treat an ulcer in the first part of the duodenum, the most appropriate site to make the incision on the anterior abdominal wall to approach this ulcer would be the:
Your Answer: Epigastric region
Explanation:The abdomen is divided into nine regions for descriptive purposes. The epigastric region contains the first part of the duodenum, part of the stomach, part of the liver and pancreas. This would be the region that the surgeon would need to enter to access the ulcer.
Typically, a midline incision in the epigastric region, extending from just below the xiphoid process down to the umbilicus, provides excellent access to the first part of the duodenum.
The left inguinal region contains the sigmoid colon.
The left lumbar region contains the descending colon and kidney.
The right lumbar region contains the right kidney and descending colon.
The right hypochondrial region contains part of the liver and gall bladder.
The hypogastric region contains the urinary bladder and the rectum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 20
Correct
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Which of the following causes the maximum increase in the secretion of antidiuretic hormone (ADH)?
Your Answer: Increased plasma osmolarity
Explanation:The most potent stimulus for ADH release is increased plasma osmolarity. Decreased plasma volume is a less potent stimulus in comparison. However, decrease blood volume and arterial pressure due to severe haemorrhage does lead to ADH secretion. Hypothalamic releasing factors do not control the release of posterior pituitary hormones ADH and oxytocin.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 21
Correct
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A 70 year old women, died suddenly. She had a history of hypertension and aortic stenosis. On autopsy her heart weighed 550g. What is the most likely cause of this pathology?
Your Answer: Hypertrophy
Explanation:Due to increased pressure on the heart as a result of hypertension and aortic stenosis, the myocardial fibres hypertrophied to adapt to the increased pressure and to effectively circulate blood around the body. Hyperplasia could not occur, as myocardial fibres are stable cells and cannot divide further.
Fat does not deposit in the heart due to volume overload.
Myocardial oedema is not characteristic of a myocardial injury.
Metaplasia is a change in the type of epithelium.
Atrophy would result in a decreased heart size and inability to function.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Cardiovascular
- Pathology
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Question 22
Correct
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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: 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.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 23
Incorrect
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A 15-year-old girl was diagnosed with bacterial meningitis. Gram staining of the spinal fluid shows numerous polymorphonuclear neutrophils and Gram-positive cocci. Which is the empiric drug of choice to be given to the patient until the antibiotic sensitivity report is available?
Your Answer: Penicillin
Correct Answer: Ceftriaxone
Explanation:Acute meningitis is a medical emergency. All suspects should receive their first dose of antibiotics immediately and be transferred to hospital as soon as possible. If facilities for blood culture and/or lumbar puncture (LP) are immediately available, they should be performed before administration
of the first dose of antibiotics (see contraindications to LP below). Neither procedure should lead to a significant delay in antibiotic administration.
Administer ceftriaxone 80-100 mg/kg (maximum 2 g, 12 hourly) intravenously. The intramuscular or intraosseous route can be used if there is no vascular access. Penicillin allergy is not a contraindication to ceftriaxone in acute meningitis (C-1). Omit ceftriaxone only if there has been documented ceftriaxone anaphylaxis. Give chloramphenicol 25 mg/kg (maximum 500 mg) intravenously instead, if available. Administer adequate analgesia and transfer the patient immediately to hospital, detailing all administered
medication in the referral letter. -
This question is part of the following fields:
- Microbiology
- Pathology
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Question 24
Correct
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A 25 year-old female medical student presents with fever, lack of appetite, rashes, sore throat and lymphadenopathy. Peripheral smear shows atypical lymphocytes. Which is the most likely organism responsible for this patient's condition?
Your Answer: Epstein–Barr virus
Explanation:Epstein-Barr virus is in the herpes family of viruses and most people will become infected with EBV sometime during their lives. EBV commonly causes infectious mononucleosis, or mono, a contagious viral illness that initially attacks the lymph nodes in the neck and throat. When these tissues become less effective in fighting infection, sore throats, swelling of the nodes and fever may result.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 25
Correct
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A 45 year old man who complains of chronic post prandial, burning epigastric pain undergoes a gastrointestinal endoscopy. There is no apparent mass or haemorrhage and a biopsy is taken from the lower oesophageal mucosa just above the gastro-oesophageal junction. The results reveal the presence of columnar cells interspersed with goblet cells. Which change best explains the above mentioned histology?
Your Answer: Metaplasia
Explanation:Metaplasia is the transformation of one type of epithelium into another as a means to better cope with external stress on that epithelium. In this case metaplasia occurs due to the inflammation resulting from gastro-oesophageal reflux disease. Dysplasia is disordered cellular growth. Hyperplasia is an increase in cell number but not cell type i.e. transformation. Carcinoma is characterized by cellular atypia. Ischaemia would result in necrosis with ulceration. Carcinoma insitu involves dysplastic atypical cells with the basement membrane intact and atrophy would mean a decrease in number of cells.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Gastrointestinal
- Pathology
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Question 26
Correct
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Following a bee sting, a women develops a 2cm red, raised, swollen lesion at the site of the sting . Which of the following findings is likely to be seen in this lesion?
Your Answer: Vasodilation
Explanation:Inflammation is the immediate response of the body towards infections or irritations. The cardinal signs of inflammation are 1. redness/rubor, 2. tumour/swelling, 3.dolar/pain, 4.calor/heat and organ dysfunction (function laesa). Inflammation has 2 components; vascular and cellular. Blood vessels dilate upstream of the inflamed area leading to the rubor and calor and constrict downstream, increasing pressure and causing fluid to leak out of the capillary, resulting in swelling. The cellular component includes infiltration by neutrophils. Leukocyte arrival and functions include; 1. margination: cells marginated 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 resulting in adhesion, 4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product and 5. phagocytosis: engulfing the offending substance/cell.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 27
Correct
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With respect to far accommodation, which of the following is a TRUE statement?
Your Answer: The ciliary muscles are relaxed
Explanation:Myopia or near-sightedness is a disease due to elongated eyeballs or too strong a lens. For far accommodation (focus of a distant object onto the retina), the lens needs to decrease its refractive power, or in other words, increase its focal length. This is done by relaxation of ciliary muscles which tightens the zonular fibres and flattening of the lens. Relaxation of the zonular fibres, rounding of the lens, shortening of the focal length and constriction of the pupil occurs during near accommodation.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 28
Incorrect
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How are amino acids transported across the luminal surface of the small intestinal epithelium?
Your Answer: Primary active transport
Correct Answer: Co-transport with sodium ions
Explanation:Once complex peptides are broken down into amino acids by the peptidases present in the brush border of small intestine, they are ready for absorption by at least four sodium-dependent amino acid co-transporters – one each for acidic, basic, neutral and amino acids, present on the luminal plasma membrane. These transporters first bind sodium and can then bind the amino acids. Thus, amino acid absorption is totally dependent on the electrochemical gradient of sodium across the epithelium. The basolateral membrane in contrast, possesses additional transporters to carry amino acids from the cell into the blood, but these are sodium-independent.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 29
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 30
Correct
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Regarding the extensor retinaculum of the wrist, which of these is CORRECT?
Your Answer: It prevents the tendons of the posterior compartment of the forearm from ‘bowstringing’ when the hand is extended at the wrist
Explanation:This extensor retinaculum, as the name indicates, holds the tendons of the extensors against the dorsal surface of the distal radius and ulna. Therefore, the correct answer is that it prevents bowstringing of the extensor tendons with wrist extension. It forms compartments between it and its bony attachment, and these compartments guide and hold the tendons.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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SESSION STATS - PERFORMANCE PER SPECIALTY
