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Question 1
Correct
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A growing tumour is impinging on the lingual artery in the floor of the mouth. Which structure will experience decreased blood flow?
Your Answer: The sublingual gland
Explanation:The paired sublingual glands are major salivary glands in the mouth. They are the smallest, most diffuse, and the only unencapsulated major salivary glands. They provide only 3-5% of the total salivary volume. The gland receives its blood supply from the sublingual and submental arteries. The sublingual artery is a branch of the lingual artery, thus damage to the lingual artery will decrease the blood flow to the sublingual gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 2
Incorrect
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A man had noticed weakness in his left arm causing flexion of the elbow and supination of the forearm. Which nerve in this case was injured?
Your Answer: Median
Correct Answer: Musculocutaneous
Explanation:The musculocutaneous nerve supplies the biceps brachii and the brachialis muscles. The first one flexes the elbow and the shoulder. It is also involved in supination. The brachialis muscle flexes the forearm. The injury to the musculocutaneous nerve results in paralysis of these muscles.
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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 29-year-old pregnant woman suffering from hyperemesis gravidarum is prescribed metoclopramide. What is the mechanism of action of metoclopramide?
Your Answer: Dopamine antagonist
Explanation:Metoclopramide is a potent dopamine-receptor antagonist with anti-emetic and prokinetic properties. It is therefore commonly used to treat nausea and vomiting, and to facilitate gastric emptying in patients with gastric stasis. The anti-emetic action of metoclopramide is due to its antagonist activity at D2 receptors in the chemoreceptor trigger zone (CTZ) in the central nervous system. Common adverse drug reactions associated with metoclopramide include restlessness (akathisia), and focal dystonia.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 4
Correct
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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 5
Correct
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When a patient is standing erect, pleural fluid would tend to accumulate in which part of the pleural space?
Your Answer: Costodiaphragmatic recess
Explanation:The costo-diaphragmatic recess is the lowest extent of the pleural cavity or sac. Any fluid in the pleura will by gravity accumulate here when a patient is standing erect.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 6
Incorrect
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A 55-year-old woman died 3 years after a cardiac transplant due to worsening congestive heart failure. Autopsy revealed diffuse hyperplasia of the vascular intima involving the entire length of the coronary arteries. The most probable cause of deterioration of the cardiac function is:
Your Answer: Amyloidosis
Correct Answer: Coronary atherosclerosis
Explanation:Allograft coronary artery disease (CAD) can begin right after the transplant and is the major cause of later death in cardiac transplant recipients. This form of atherosclerosis progresses quickly resulting in allograft failure. Due to lack of premonitory symptoms CAD may lead to sudden death.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 7
Incorrect
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Following nerve injury, paralysis of the quadriceps femoris muscle occurs. Which of the following movements will be affected?
Your Answer: Flexion of the leg
Correct Answer: Extension of the leg
Explanation:The quadriceps muscle is a great extensor of the thigh. Therefore, following nerve injury or cutting nerve supply to the quadriceps will affect extension of the thigh
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 8
Incorrect
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An enlarged lymph node which shows well-defined, prominent paracortical follicles with germinal centres is most likely from which of the following patients?
Your Answer: A 40-year-old man with peripheral basophilia noted on a peripheral blood smear
Correct Answer: A 5-year-old boy with a sore throat and runny nose
Explanation:Lymphadenopathy is common in children and is usually reactive in nature. The description fits that of a benign, reactive lymph node.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 9
Correct
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Which of the following features is indicative of poor prognosis in a case of breast carcinoma?
Your Answer: Axillary lymph node metastases
Explanation:Lymphatic spread indicates poor prognosis. Presence of family history is not a prognostic factor despite being linked to higher incidence. Aneuploidy is a poor prognostic factor. A breast tumour positive for oestrogen receptors is a good prognostic factor as it increases the responsiveness of the tumour to certain therapies. In-situ tumours carry the best prognosis.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 10
Correct
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A 35 year-old woman is undergoing thyroidectomy. The external laryngeal nerve may be injured whilst ligating this artery during the procedure due to its close relationship?
Your Answer: Superior thyroid artery
Explanation:The superior thyroid artery arises from the external carotid artery just below the level of the greater cornu of the hyoid bone and ends in the thyroid gland. This artery must be ligated at the thyroid when conducting a thyroidectomy. If the artery is severed, but not ligated, it will bleed profusely. In order to gain control of the bleeding, the surgeon may need to extend the original incision laterally to ligate the artery at its origin at the external carotid artery. The external laryngeal branch of the superior laryngeal nerve courses in close proximity to the superior thyroid artery, making it at risk for injury during surgery.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 11
Incorrect
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The primary motor cortex is located in the:
Your Answer: Postcentral gyrus
Correct Answer: Precentral gyrus
Explanation:The primary motor cortex is located in the dorsal part of the precentral gyrus and the anterior bank of the central sulcus. The precentral gyrus lies anterior to the postcentral gyrus and is separated from it by a central sulcus. Its anterior border is the precentral sulcus, while inferiorly it borders to the lateral fissure (Sylvian fissure).
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This question is part of the following fields:
- Neurology
- Physiology
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Question 12
Incorrect
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Regarding the long head of the biceps femoris, which of the following is correct?
Your Answer: It will extend the leg at the knee
Correct Answer: It crosses two joints
Explanation:The long head of the biceps femoris arises from the lower and inner impression on the back of the tuberosity of the ischium. It inserts with the short head in an aponeurosis which becomes a tendon and this tendon is inserted into the lateral side of the head of the fibula and the lateral condyle of the tibia, thus crossing two joints.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 13
Correct
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When conducting an exploratory laparotomy procedure of a patient diagnosed with a bleeding ulcer of the lesser curvature of the stomach, which artery in this patient are you most likely to ligate to control the bleeding?
Your Answer: Left gastric
Explanation:The lesser curvature of the stomach is supplied by the left gastric artery along with the right gastric artery. These two arteries are the ones to most likely be ligated if bleeding was to be stopped at the lesser curvature of the stomach. The splenic artery branches from the celiac branch and supplies the spleen. The left gastro-omental, the right and left gastroepiploic arteries supply the greater curvature.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 14
Correct
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A 43-year-old diabetic man complains of headaches, palpitations, anxiety, abdominal pain and weakness. He is administered sodium bicarbonate used to treat:
Your Answer: Metabolic acidosis
Explanation:Sodium bicarbonate is indicated in the management of metabolic acidosis, which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis. Bicarbonate is given at 50-100 mmol at a time under scrupulous monitoring of the arterial blood gas readings. This intervention, however, has some serious complications including lactic acidosis, and in those cases, should be used with great care.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 15
Correct
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A computer tomography guided needle biopsy is done on a patient with a cystic swelling in the left chest. The radiologist inserted the biopsy needle into the 9th intercostal space along the mid axillary line to aspirate the swelling and obtain tissue for histological diagnosis. In which space is the swelling most likely to be?
Your Answer: Costodiaphragmatic recess
Explanation:The costodiaphragmatic recess is the lowest point of the pleural sac where the costal pleura becomes the diaphragmatic pleura. At the midclavicular line, this is found between ribs 6 and 8; at the paravertebral lines, between ribs 10 and 12 and between ribs 8 and 10 at the midaxillary line.
The cardiac notch: is an indentation of the heart on the left lung, located on the anterior surface of the lung.
Cupola: part of the parietal pleura that extends above the first rib.
Oblique pericardial sinus: part of the pericardial sac located posterior to the heart behind the left atrium.
Costomediastinal recess: a reflection of the pleura from the costal surface to the mediastinal surface, is on the anterior surface of the chest.
The inferior mediastinum: is the space in the chest occupied by the heart.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 16
Incorrect
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A 30 year old gym coach presented to the surgical out patient clinic with a lump in the inguinal region. He was booked for surgery, during which, the surgeon opened the inguinal region and found a hernial sac with a small segment of intestine projecting through the abdominal wall. It was located just above the inguinal ligament and lateral to the inferior epigastric vessels. What type of hernia was this?
Your Answer: A direct inguinal hernia
Correct Answer: An indirect inguinal hernia
Explanation:An indirect inguinal hernia exits the abdominal cavity lateral to the inferior epigastric vessels and enters the inguinal canal through the deep inguinal ring. These are the most common types of hernias often caused by heavy weigh lifting. Direct inguinal hernias exit the abdominal cavity medial to the inferior epigastric vessels through weak fascia.
Congenital inguinal hernias are indirect hernias that occur due to persistence of the processus vaginalis.
Femoral hernias occur when abdominal viscera push through the femoral ring in the femoral canal.
Incisional hernia occurs after surgery when the omentum or organ protrudes through a previous site of incision.
Obturator hernia are a very rare type of hernia where the pelvic or abdominal contents protrude through the obturator foramen.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 17
Incorrect
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Which muscle extends to form the cremasteric muscle?
Your Answer: External abdominal oblique muscle
Correct Answer: Internal abdominal oblique muscle
Explanation:The cremasteric muscle is a thin layer of muscle composed of several fasciculi that originate from the middle of the inguinal ligament. At its point of origin the fibres are continuous with the fibres of internal oblique and sometimes with the transversus abdominis. It then passes along the lateral side of the spermatic cord and descends with it through the superficial inguinal ring on the front and sides of the cord.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 18
Incorrect
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C5a (a complement component) is a potent?
Your Answer: Cytokine
Correct Answer: Anaphylotoxin
Explanation:C5a is a strong chemoattractant as well as an anaphylotoxin and is involved in the recruitment of inflammatory cells such as neutrophils, eosinophils, monocytes, and T lymphocytes. It is also involved in activation of phagocytic cells, release of granule-based enzymes and generation of oxidants. All of which contribute to innate immune functions.
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This question is part of the following fields:
- General
- Physiology
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Question 19
Incorrect
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The sciatic nerve does NOT supply which of the following muscles?
Your Answer: Biceps femoris
Correct Answer: Obturator externus
Explanation:The sciatic nerve supplies both gemellae, quadratus femoris, semitendinosus, semimembranosus, both heads of the biceps femoris, the hamstring half of abductor magnus and obturator internus. Obturator externus is supplied by the obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 20
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 21
Incorrect
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A 20-year old boy presented with low grade fever, night sweats and weakness over two months. On examination, he had multiple, non-tender, cervical, supraclavicular and axillary adenopathy. Microscopy of lymph node biopsy showed the presence of Reed-Sternberg cells. He is likely suffering from:
Your Answer: Burkitt’s lymphoma
Correct Answer: Hodgkin’s lymphoma
Explanation:Hodgkin’s lymphoma is a disease characterized by malignant proliferation of cells of the lymphoreticular system. It can be localized or disseminated, and can involve the nodes, spleen, liver and marrow. Symptoms of the disease include non-tender lymphadenopathy, fever, night sweats, weight loss, itching and hepatosplenomegaly. Histologically, the involved nodes show the presence of Reed-Sternberg cells, which are large, binucleated cells, in a heterogenous cellular infiltrate of histiocytes, lymphocytes, monocytes, plasma cells and eosinophils.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 22
Incorrect
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Urine specific gravity allows the assessment of which of the following renal functions?
Your Answer: Filtration
Correct Answer: Concentration
Explanation:Concentrating ability of kidneys is assessed by measuring the urine specific gravity. Normal values of urine specific gravity fall between 1.002 and 1.030 g/ml.
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This question is part of the following fields:
- Pathology
- Renal
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Question 23
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 24
Correct
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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 25
Incorrect
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A 55-year-old male has a mass on the right lung with involvement of the right mediastinal lymph nodes. What is the nodal staging according to the TNM staging?
Your Answer: N1
Correct Answer: N2
Explanation:The N stages for lung cancer are from NO to N3 : NO, there is no lung cancer in any lymph nodes: N1, there is lung cancer in the proximal lymph nodes: N2, there is lung cancer in the mediastinal hilar lymph nodes, but on the same side as the affected lung or there is lung cancer in the carinal lymph nodes: N3, there is metastatic lung cancer in lymph nodes on the opposite side of the chest, in the cervical or apical lymph nodes. In this patient the ipsilateral mediastinal node is involved, thus it is classified as N2.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 26
Correct
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What best describes the muscles of the posterior compartment of the leg?
Your Answer: One of the posterior compartment leg muscles laterally rotates the femur
Explanation:The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris and are the chief extensors of the foot at the ankle joint. Deep muscles include the tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 27
Correct
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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 28
Incorrect
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A football player sustained an injury to his ankle. The wound went through the skin, subcutaneous tissue and flexor retinaculum. Which other structure passing under the retinaculum may be injured?
Your Answer: Anterior tibial artery
Correct Answer: Tibial nerve
Explanation:The flexor retinaculum is immediately posterior to the medial malleolus. The structures that pass under the flexor retinaculum from anterior to posterior are: tendon of the tibialis posterior, flexor digitorum longus, posterior tibial artery (and vein), tibial nerve and tendon of flexor hallucis longus. The tibial nerve is the only one which lies behind the flexor retinaculum.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 29
Correct
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A 30 year-old male patient sustained a sharp blow to the right side of the head, over the temporal region during a vehicular accident. This resulted to the rupture of the principal artery that supplies the meninges. Which artery is affected?
Your Answer: Middle meningeal artery
Explanation:The middle meningeal artery is typically the third branch of the first part of the maxillary artery, one of the two terminal branches of the external carotid artery. After branching off the maxillary artery in the infratemporal fossa, it runs through the foramen spinosum to supply the dura mater and the calvaria. The middle meningeal artery is the largest of the three (paired) arteries that supply the meninges, the others being the anterior meningeal artery and the posterior meningeal artery. The anterior branch of the middle meningeal artery runs beneath the pterion. It is vulnerable to injury at this point, where the skull is thin. Rupture of the artery may give rise to an epidural hematoma .An injured middle meningeal artery is the most common cause of an epidural hematoma.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 30
Incorrect
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A 56 year old gentleman, who is a chronic smoker presents to the clinic with dyspnoea. His Chest X-ray shows intercostal space widening with increased blackening bilaterally. What is the most likely finding on his pulmonary function test?
Your Answer: Decreased residual volume
Correct Answer: Increased total lung capacity
Explanation:In patients suspected of having chronic obstructive pulmonary disease, pulmonary function testing (PFT) is useful to confirm airway obstruction, to quantify its severity and reversibility, for following disease progression and monitoring response to treatment. These tests include:
FEV1 – volume of air forcefully expired during the first second after a full breath
Forced vital capacity (FVC) – total volume of air expired with maximal force and flow-volume loops. The hallmark of airway obstruction is reduction of FEV1, FVC and the ratio of FEV1/FVC, with a concave pattern in expiratory tracing on the flow-volume loop. FEV1 and forced vital capacity (FVC) are easily measured with office spirometry and are useful to assess the severity of disease. Other parameters include increased total lung capacity, functional residual capacity and residual volume, which can help distinguish chronic obstructive pulmonary disease (COPD) from restrictive pulmonary disease where these values are lower than normal. Along with these, other tests are decreased vital capacity; and decreased diffusing capacity for carbon monoxide (DLCO). DLCO is non-specific and can be low in other disorders that affect the pulmonary vascular bed, such as interstitial lung disease. DLCO is however useful to distinguish COPD from asthma, in which DLCO is normal or elevated.
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This question is part of the following fields:
- Physiology
- Respiratory
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SESSION STATS - PERFORMANCE PER SPECIALTY
