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  • Question 1 - Enlargement of the spleen as seen in Gaucher's disease pushes the spleen downward...

    Incorrect

    • Enlargement of the spleen as seen in Gaucher's disease pushes the spleen downward and medially. What structure limits the straight-vertical-downward movement?

      Your Answer: Ligament of Treitz

      Correct Answer: Left colic flexure

      Explanation:

      The left colic flexure (also known as the splenic flexure), is the point where the colon takes a sharp turn downwards. It is the point where the transverse colon ends and the descending colon begins. It is located immediately inferior to the spleen so an enlarged spleen must move medially to avoid this colic flexure.

      The left suprarenal gland is retroperitoneal.

      The Ligament of Treitz suspends the fourth part of the duodenum from the posterior abdominal wall.

      The stomach, pancreas and liver lie medial to the spleen and thus would not prevent a vertical downward movement.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      9
      Seconds
  • Question 2 - A 47-year old-woman diagnosed with pancreatitis presented to the emergency department complaining of...

    Incorrect

    • A 47-year old-woman diagnosed with pancreatitis presented to the emergency department complaining of a worsening shortness of breath, fever, agitation and cough. Oxygen saturation was 67% in room air. Her respiratory status continued to deteriorate therefore she was intubated. She was admitted to the intensive care unit for management. Chest X-ray demonstrated bilateral perihilar opacities. The patient failed conventional treatment and died several days later. At autopsy, the lung shows growth of type 2 pneumocytes and thickened alveolar walls. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Adult respiratory distress syndrome

      Explanation:

      Acute (or adult) respiratory distress syndrome (ARDS) is a life-threatening lung condition characterised by a non-cardiogenic pulmonary oedema that leads to acute respiratory failure. The most common risk factors for ARDS include trauma with direct lung injury, sepsis, pneumonia, pancreatitis, burns, drug overdose, massive blood transfusion and shock. Acute onset of dyspnoea with hypoxemia, anxiety and agitation is typical. Chest X ray most commonly demonstrates bilateral pulmonary infiltrates. Histological changes include the exudative, proliferative and fibrotic phase. ARDS is mainly a clinical diagnosis.

    • This question is part of the following fields:

      • Pathology
      • Respiratory
      0
      Seconds
  • Question 3 - A 63-year-old woman complains of a new, persisting headache. She is diagnosed with...

    Incorrect

    • A 63-year-old woman complains of a new, persisting headache. She is diagnosed with vasculitis and the histopathological sample revealed giant-cell arteritis. What is the most probable diagnose?

      Your Answer:

      Correct Answer: Temporal arteritis

      Explanation:

      Giant cell arteritis (GCA), also known as temporal arteritis, is the most common systemic inflammatory vasculitis that occurs in adults. It is of unknown aetiology and affects arteries large to small however the involvement of the superficial temporal arteries is almost always present. Other commonly affected arteries include the ophthalmic, occipital and vertebral arteries, therefore GCA can result in systemic, neurologic, and ophthalmologic complications. GCA usually is found in patients older than 50 years of age and should always be considered in the differential diagnosis of a new-onset headache accompanied by an elevated erythrocyte sedimentation rate. Diagnosis depends on the results of artery biopsy.

    • This question is part of the following fields:

      • Cardiovascular
      • Pathology
      0
      Seconds
  • Question 4 - What is the 5 year survival rate of a patient who is diagnosed...

    Incorrect

    • What is the 5 year survival rate of a patient who is diagnosed with stage III colon cancer, who underwent successful resection and completed the prescribed session of adjuvant chemotherapy?

      Your Answer:

      Correct Answer: 30%–60%

      Explanation:

      In this patient who has stage III colon cancer, the survival rate is 30-60%. For stage I or Dukes’ stage A disease, the 5-year survival rate after surgical resection exceeds 90%. For stage II or Dukes’ stage B disease, the 5-year survival rate is 70%–85% after resection, with or without adjuvant therapy. For stage III or Dukes’ stage C disease, the 5-year survival rate is 30%– 60% after resection and adjuvant chemotherapy and for stage IV or Dukes’ stage D disease, the 5-year survival rate is poor (approximately 5%).

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      0
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  • Question 5 - A 24-year old patient diagnosed with a direct inguinal hernia was scheduled for...

    Incorrect

    • A 24-year old patient diagnosed with a direct inguinal hernia was scheduled for surgery to have the hernia repaired. The hernia was discovered to be protruding through the Hesselbach's triangle (inguinal triangle). Which of the following blood vessels that is a branch of the external iliac artery forms the lateral border of this triangle?

      Your Answer:

      Correct Answer: Inferior epigastric

      Explanation:

      The inguinal triangle is formed by the following structures; inguinal ligament at the base; inferior epigastric vessels laterally and the lateral border of the rectus sheath medially. This triangle (also known as Hesselebach’s triangle) is where direct inguinal hernias protrude. The inferior epigastric artery is this the branch of the external iliac artery being referred to. All the other blood vessels are branches of the internal iliac artery.

    • This question is part of the following fields:

      • Anatomy
      • Pelvis
      0
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  • Question 6 - A glycogen storage disorder is characterised by increased liver glycogen with a normal...

    Incorrect

    • A glycogen storage disorder is characterised by increased liver glycogen with a normal structure and no increase in serum glucose after oral intake of a protein-rich diet. Deficiency of which of the following enzymes is responsible for this disorder?

      Your Answer:

      Correct Answer: Glucose-6-phosphatase

      Explanation:

      The most common glycogen storage disorder is von Gierke’s disease or glycogen storage disease type I. It results from a deficiency of enzyme glucose-6-phosphatase which affects the ability of liver to produce free glucose from glycogen and gluconeogenesis; leading to severe hypoglycaemia. There is also increased glycogen storage in the liver and kidneys causing enlargement and various problems in their functioning. The disease also causes lactic acidosis and hyperlipidaemia. The main treatment includes frequent or continuous feedings of corn-starch or other carbohydrates.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      0
      Seconds
  • Question 7 - Which of the following is a potential cause of a positive D-dimer assay?...

    Incorrect

    • Which of the following is a potential cause of a positive D-dimer assay?

      Your Answer:

      Correct Answer: Deep venous thrombosis

      Explanation:

      A D-dimer test is performed to detect and diagnose thrombotic conditions and thrombosis. A negative result would rule out thrombosis and a positive result although not diagnostic, is highly suspicious of thrombotic conditions like a deep vein thrombosis, pulmonary embolism as well as DIC.

    • This question is part of the following fields:

      • General
      • Physiology
      0
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  • Question 8 - A surgeon ligates the left middle suprarenal artery while carrying out a left...

    Incorrect

    • A surgeon ligates the left middle suprarenal artery while carrying out a left adrenalectomy. Where does the left middle suprarenal artery originate?

      Your Answer:

      Correct Answer: Abdominal aorta

      Explanation:

      Middle suprarenal arteries arise from either side of the abdominal aorta, opposite the superior mesenteric artery.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
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  • Question 9 - Which nuclei of the posterior grey column of the spinal cord are likely...

    Incorrect

    • Which nuclei of the posterior grey column of the spinal cord are likely affected in a patient who has lost the sensation of pain and temperature?

      Your Answer:

      Correct Answer: Substantia gelatinosa

      Explanation:

      Substantia gelatinosa is one of the nuclei in the posterior grey column along side other posterior grey column nuclei like the nucleus dorsalis, nucleus proprius, and posteromarginal nucleus. These nuclei are a collection of cells in the posterior grey area found in throughout the spinal cord. The substantia gelatinosa receives direct input from the dorsal nerve roots (sensory), especially from thermoreceptors and nociceptors (receptors for temperature and pain).

    • This question is part of the following fields:

      • Anatomy
      • Neurology
      0
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  • Question 10 - Which part of the nephron would have to be damaged to stop the...

    Incorrect

    • Which part of the nephron would have to be damaged to stop the reabsorption of the majority of salt and water?

      Your Answer:

      Correct Answer: Proximal tubule

      Explanation:

      The proximal tubule is the portion of the duct system of the nephron of the kidney which leads from Bowman’s capsule to the loop of Henle. It is conventionally divided into the proximal convoluted tubule (PCT) and the proximal straight tubule (PST). The proximal tubule reabsorbs the majority (about two-thirds) of filtered salt and water. This is done in an essentially iso-osmotic manner. Both the luminal salt concentration and the luminal osmolality remain constant (and equal to plasma values) along the entire length of the proximal tubule. Water and salt are reabsorbed proportionally because the water is dependent on and coupled with the active reabsorption of Na+. The water permeability of the proximal tubule is high and therefore a significant transepithelial osmotic gradient is not possible.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds
  • Question 11 - When does the heart rate decrease? ...

    Incorrect

    • When does the heart rate decrease?

      Your Answer:

      Correct Answer: Pressure on the eyeball

      Explanation:

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

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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  • Question 12 - A 34-year-old Asian male presents with cervical lymphadenopathy. The patient is suspected to...

    Incorrect

    • A 34-year-old Asian male presents with cervical lymphadenopathy. The patient is suspected to have tuberculous lymphadenopathy. Excision biopsy of one of the nodes showed granulomatous inflammation. Which histopathologic feature is most likely consistent with the diagnosis of tuberculosis?

      Your Answer:

      Correct Answer: Caseation necrosis

      Explanation:

      The granulomas of tuberculosis tend to contain necrosis (caseating tubercles), but non-necrotizing granulomas may also be present. Multinucleated giant cells with nuclei arranged like a horseshoe (Langhans giant cells) and foreign body giant cells are often present, but are not specific for tuberculosis. A definitive diagnosis of tuberculosis requires identification of the causative organism by microbiological cultures.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      0
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  • Question 13 - The glossopharyngeal nerve provides the parasympathetic innervation of the: ...

    Incorrect

    • The glossopharyngeal nerve provides the parasympathetic innervation of the:

      Your Answer:

      Correct Answer: Parotid salivary gland

      Explanation:

      The glossopharyngeal nerve provides parasympathetic innervation for the parotid salivary gland via the auriculotemporal nerve. The facial nerve supplies the parasympathetic innervation of the lacrimal, nasal, sublingual and submandibular glands.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck; Neurology
      0
      Seconds
  • Question 14 - Injury to which of the following arteries is likely to affect the blood...

    Incorrect

    • Injury to which of the following arteries is likely to affect the blood supply to the seminal vesicles?

      Your Answer:

      Correct Answer: Middle rectal

      Explanation:

      Ligation of middle rectal artery is most likely to affect the blood supply of seminal vesicles since arteries supplying the seminal vesicles are derived from the middle and inferior vesical and middle rectal arteries.

    • This question is part of the following fields:

      • Anatomy
      • Pelvis
      0
      Seconds
  • Question 15 - Routine evaluation of a 38 year old gentleman showed a slightly lower arterial...

    Incorrect

    • Routine evaluation of a 38 year old gentleman showed a slightly lower arterial oxygen [pa(O2)] than the alveolar oxygen [pA(O2)]. This difference is:

      Your Answer:

      Correct Answer: Is normal and due to shunted blood

      Explanation:

      Blood that bypasses the ventilated parts of lung and enters the arterial circulation directly is known as shunted blood. It happens in normal people due to mixing of arterial blood with bronchial and some myocardial venous blood (which drains into the left heart). Diffusion limitation and reaction velocity with haemoglobin are immeasurably small. CO2 unloading will not affect the difference between alveolar and arterial p(O2). A large VSD will result in much lower arterial O2 as compared to alveolar O2.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
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  • Question 16 - Arterial blood gas analysis of a man admitted with acute exacerbation of chronic...

    Incorrect

    • Arterial blood gas analysis of a man admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD) showed the following: pH = 7.28, p(CO2) = 65.5 mmHg, p(O2)= 60 mmHg and standard bicarbonate = 30.5 mmol/l. This patient had:

      Your Answer:

      Correct Answer: Respiratory acidosis

      Explanation:

      Acidosis with high p(CO2) and normal standard bicarbonate indicates respiratory acidosis, commonly seen in acute worsening of COPD patients. Respiratory acidosis occurs due to alveolar hypoventilation which leads to increased arterial carbon dioxide concentration (p(CO2)). This in turn decreases the HCO3 –/p(CO2) and decreases pH. In acute respiratory acidosis, the p(CO2) is raised above the upper limit of normal (over 45 mm Hg) with a low pH. However, in chronic cases, the raised p(CO2) is accompanied with a normal or near-normal pH due to renal compensation and an increased serum bicarbonate (HCO3 – > 30 mmHg).

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
      Seconds
  • Question 17 - You observe a procedure to harvest the left internal thoracic (mammary) artery to...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds
  • Question 18 - A 23-year-old woman decides to donate a kidney through a kidney chain. Which...

    Incorrect

    • A 23-year-old woman decides to donate a kidney through a kidney chain. Which of the following indices would be expected to be decreased in the donor after full recovery from the operation?

      Your Answer:

      Correct Answer: Creatinine clearance

      Explanation:

      Since medication to prevent rejection is so effective, donors do not need to be similar to their recipient. Most donated kidneys come from deceased donors; however, the utilisation of living donors is on the rise. Most problems encountered with live donation are associated with the donor. Firstly, there are the potentially harmful investigative procedures carried out in the assessment phase, the most hazardous being renal angiography, where there is cannulation of the artery and injection of a radio-opaque dye to determine the blood supply to the kidney. Secondly, there are the short-term risks of nephrectomy surgery. According to the literature, there is a mortality rate of between 1 in 1600 and 1 in 3000, but this is no more than is associated with any anaesthetic. In the initial postoperative period creatinine clearance may be decreased but this recovers fully over a few weeks to months. Long-term complications include prolonged wound pain.

    • This question is part of the following fields:

      • Physiology
      • Renal
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  • Question 19 - A patient is suspected to have Blastomyces dermatidis infection. The patient contracted the...

    Incorrect

    • A patient is suspected to have Blastomyces dermatidis infection. The patient contracted the disease most likely through which port of entry?

      Your Answer:

      Correct Answer: Respiratory tract

      Explanation:

      Blastomycosis disease is a fungal infection acquired through inhalation of the spores. It caused by the organism Blastomyces dermatitidis and manifests as a primary lung infection in about 70% of cases. The onset is relatively slow and symptoms are suggestive of pneumonia.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      0
      Seconds
  • Question 20 - An ultrasound report of a 35-year old female patient revealed that she had...

    Incorrect

    • An ultrasound report of a 35-year old female patient revealed that she had cancer of the pancreas and presented with subsequent severe obstructive jaundice. In which part of this was woman's pancreas was the tumour most likely located?

      Your Answer:

      Correct Answer: Head

      Explanation:

      The pancreas is divided into five parts; the head, body, neck, tail, and the uncinate process. Of the five parts, tumours located at the head of the pancreas in most instances cause obstruction of the common bile duct more often than tumours in the other parts of the pancreas. This is because the common bile duct passes through the head of the pancreas from the gallbladder and the liver (it is formed where the cystic and the hepatic bile duct join) to empty bile into the duodenum. This biliary obstruction leads to accumulation of bile in the liver and a consequent bilirubinaemia (raised levels of blood bilirubin). This results in jaundice. The pancreas is not divided into lobes.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
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  • Question 21 - The oesophagus is an important part of the alimentary canal. It receives blood...

    Incorrect

    • The oesophagus is an important part of the alimentary canal. It receives blood from various arteries in the body. Which one of the following is an artery that will lead to some level of ischaemia to the oesophagus when ligated?

      Your Answer:

      Correct Answer: Left inferior phrenic

      Explanation:

      The oesophagus receives its blood supply from the following arteries: the inferior thyroid branch of the thyrocervical trunk, the descending thoracic aorta, the left gastric branch of the coeliac artery and the from the left inferior phrenic artery of the abdominal aorta. Hence ligation of the left inferior phrenic will lead to ischemia to some portions of the oesophagus.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
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  • Question 22 - Investigations in a 40-year old gentleman with splenomegaly reveal the following: haemoglobin 21.5...

    Incorrect

    • Investigations in a 40-year old gentleman with splenomegaly reveal the following: haemoglobin 21.5 g/dl, haematocrit 66%, mean corpuscular volume (MCV) 86 fl, mean cell haemoglobin concentration 34 g/dl, mean corpuscular haemoglobin 34.5 pg, platelet count 450 × 109/l, and white blood cell count 12 × 109/l, with 81% polymorphonuclear leukocytes, 4% bands, 3% monocytes, and 7% lymphocytes.

      What is the likely diagnosis?

      Your Answer:

      Correct Answer: Polycythaemia vera

      Explanation:

      The markedly increased haematocrit, along with thrombocytosis and the leucocytosis suggest a myeloproliferative disorder.

      Polycythaemia vera is the commonest myeloproliferative disorders occurring more often in males (about 1.4 to 1). The mean age at diagnosis is 60 years (range 15–90 years) with 5% of patients below 40 years at onset. It involves increased production of all cell lines, including red blood cells (independent of erythropoietin), white blood cells and platelets. If confined only to red blood cells, it is known as ‘primary erythrocytosis’. There is an increase in blood volume and hyperviscosity occurs, predisposing to thrombosis. Increased bleeding occurs due to abnormal functioning of platelets. Patients become hypermetabolic, and increased cell turnover leads to hyperuricaemia.

      Usually asymptomatic, occasionally symptoms include weakness, pruritus, headache, light-headedness, visual disturbances, fatigue and dyspnoea. Face appears red with engorged retinal veins. Lower extremities appear red and painful, along with digital ischaemia (erythromelalgia). Hepatomegaly is common and massive splenomegaly is seen in 75% patients. Thrombosis can lead to stroke, deep venous thrombosis, myocardial infarction, retinal artery or vein occlusion, splenic infarction (often with a friction rub) or Budd–Chiari syndrome. Gastrointestinal bleeding is seen in 10-20% patients. Hypermetabolism can lead to low-grade fevers and weight loss. Late features include complications of hyperuricaemia (e.g. gout, renal calculi). 1.5% to 10% cases transform to acute leukaemia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
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  • Question 23 - A 45-year old farmer was referred to the surgical clinic with complaints of...

    Incorrect

    • A 45-year old farmer was referred to the surgical clinic with complaints of pain in his right hypochondrium. Investigations confirmed the diagnosis of hepatocellular carcinoma with malignant ascites. According to you, what is the most likely cause of HCC in this patient?

      Your Answer:

      Correct Answer: Aflatoxin

      Explanation:

      Aflatoxins are naturally occurring toxins produced by the Aspergillus fungus (most often, A. flavus and A. parasiticus). These organisms are common and their native habitat is soil, decaying vegetation and grains. They can contaminate the grain before harvest or after storage, more likely in high-humidity (at least 7%) or high temperature environment of after stressful conditions like drought. Aflatoxins are mycotoxins and also carcinogenic. They get metabolized in the liver to an epoxide, aflatoxin M1. High exposure can lead to acute necrosis, cirrhosis or liver carcinoma. These substances can cause haemorrhage, acute liver damage, oedema, and alteration in digestion, absorption and/or metabolism of nutrients. Although humans are susceptible to these toxins like all other animals, they have a high tolerance level and hence, rarely develop acute aflatoxicosis. However, children are particularly susceptible to exposure leading to growth impairment and delayed development. Chronic exposure carries a high risk of hepatic cancer, due to intercalation of its metabolite aflatoxin M1 into the DNA and alkylation of the bases because of its epoxide moiety.

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
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  • Question 24 - The gradual depolarization in-between action potentials in pacemaker tissue is a result of?...

    Incorrect

    • The gradual depolarization in-between action potentials in pacemaker tissue is a result of?

      Your Answer:

      Correct Answer: A combination of gradual inactivation outward IK along with the presence of an inward ‘funny’ current (If) due to opening of channels permeable to both Na+ and K+ ions

      Explanation:

      One of the characteristic features of the pacemaker cell is the generation of a gradual diastolic depolarization also called the pacemaker potential. In phase 0, the upstroke of the action potential caused by an increase in the Ca2+ conductance, an influx of calcium occurs and a positive membrane potential is generated. The next is phase 3 which is repolarization caused by increased K+ conductance as a result of outwards K+ current. Phase 4 is a slow depolarization which accounts for the pacemaker activity, caused by increased conductance of Na+, inwards Na+ current called IF. it is turned on by repolarization.

    • This question is part of the following fields:

      • General
      • Physiology
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  • Question 25 - A biopsy taken from the respiratory passage of a 37 year old male,...

    Incorrect

    • A biopsy taken from the respiratory passage of a 37 year old male, chronic smoker will mostly likely show which cellular adaptation?

      Your Answer:

      Correct 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.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing; Respiratory
      • Pathology
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  • Question 26 - The primary area involved in the pathology of Parkinson's disease is: ...

    Incorrect

    • The primary area involved in the pathology of Parkinson's disease is:

      Your Answer:

      Correct Answer: Substantia nigra

      Explanation:

      Parkinson’s disease is a degenerative, movement disorder of the central nervous system, and is typically characterized by muscle rigidity, tremor and bradykinesia (in extreme cases, akinesia). Secondary symptoms include high-level cognitive dysfunction and subtle language problems.

      Parkinson’s disease is also called ‘primary Parkinsonism’ or ‘idiopathic Parkinson’s disease and is the most common cause of Parkinsonism, a group of similar symptoms. The disorder is caused due to loss of pigmented dopaminergic cells in the pars compacta region of the substantia nigra.

    • This question is part of the following fields:

      • Neurology
      • Physiology
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  • Question 27 - A 40-year old gentleman, known with a history of peptic ulcer disease, was...

    Incorrect

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

      Your Answer:

      Correct Answer: Metabolic alkalosis

      Explanation:

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

    • This question is part of the following fields:

      • Physiology
      • Respiratory
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  • Question 28 - An 18 year-old with an iron deficient diet was prescribed an iron supplement...

    Incorrect

    • An 18 year-old with an iron deficient diet was prescribed an iron supplement by her GP. Lack of iron often results in:

      Your Answer:

      Correct Answer: Hypochromic anaemia

      Explanation:

      Iron deficiency anaemia is the most common type of anaemia. It can occur due to deficiency of iron from decreased intake, increased loss or inadequate absorption. An MCV less than 80 will indicated iron deficiency anaemia. On the smear the RBCs will be microcytic hypochromic and will also show poikilocytosis. Iron profile tests are important to make a diagnosis. Clinically the patient will be pale and lethargic.

    • This question is part of the following fields:

      • General
      • Physiology
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  • Question 29 - A surgeon trainee is assisting in an operation to ligate the ductus arteriosus....

    Incorrect

    • A surgeon trainee is assisting in an operation to ligate the ductus arteriosus. The consultant supervising explains that caution is required when placing a clamp on the ductus to avoid injury to an important structure immediately dorsal to it. To which structure is the consultant referring?

      Your Answer:

      Correct Answer: Left recurrent laryngeal nerve

      Explanation:

      The left recurrent laryngeal nerve branches off the vagus and wraps around the aorta, posterior to the ductus arteriosus/ligamentum arteriosum from whence it courses superiorly to innervate the laryngeal muscles.

      Accessory Hemiazygous vein is on the left side of the body draining the posterolateral chest wall and emptying blood into the azygos vein.

      The left internal thoracic artery is branch of the left subclavian artery supplying blood to the anterior wall of the thorax.

      Left phrenic nerve is lateral to the vagus nerve.

      Thoracic duct: is behind the oesophagus, coursing between the aorta and the azygos vein in the posterior chest.

      Right recurrent laryngeal nerve: loops around the right subclavian artery and is not in danger in this procedure.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
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  • Question 30 - A 73-year-old woman goes to the doctor complaining of pain and stiffness in...

    Incorrect

    • A 73-year-old woman goes to the doctor complaining of pain and stiffness in her shoulders and hips for 4 months, which is worst in the mornings. She has also been suffering from fatigue, weight loss and depression. There were no abnormal findings on physical examination. The erythrocyte sedimentation rate was 110 mm/hour, and serum rheumatoid factor and antinuclear antibody assays were negative. Mild normochromic normocytic anaemia was also found. What is the most likely diagnosis in this case?

      Your Answer:

      Correct Answer: Polymyalgia rheumatica

      Explanation:

      Polymyalgia rheumatica (PMR) affects older adults, with an acute or subacute onset. Symptoms include severe pain and stiffness of the neck and pectoral or pelvic girdles, which is worse in the morning or after a period of inactivity and is usually bilateral. Other symptoms can include fatigue, weight loss, depression and fever. The erythrocyte sedimentation rate is usually elevated, and normochromic normocytic anaemia can occur. Other tests are usually normal in this disease.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Abdomen (0/1) 0%
Anatomy (0/1) 0%
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