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Question 1
Incorrect
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What are some of the derivatives of the second pharyngeal arch?
Your Answer: Genioglossus muscle
Correct Answer: Stylohyoid muscle
Explanation:Also known as the hyoid arch, it forms the side and front of the neck. From its cartilage develops the styloid process, stylohyoid ligament and lesser cornu of the hyoid bone. The muscular derivatives include the muscles of facial expression, stapedius, stylohyoid and the posterior belly of the digastric. All these are innervated by cranial nerve VII but migrate into the area of the mandibular arch.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 2
Correct
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In which situation is a stretch reflex such as knee jerk likely to be exaggerated?
Your Answer: In upper motor neuron lesion
Explanation:A stretch reflex is a monosynaptic reflex that causes muscle contraction in response to stretching within that muscle. The sensory apparatus in a muscle that are sensitive to stretch are the muscle spindles. The patellar (knee jerk) reflex is an example. In upper motor neuron lesions, the stretch reflexes tend to be brisk due to loss of inhibitory signals on gamma neurons through the lateral reticulospinal tract.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 3
Incorrect
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Internal haemorrhoids are painless and only sensitive to stretch. They are formed from folds of the mucous membrane and the submucosa of the anal canal which contain varicose branches of the:
Your Answer: Inferior rectal vein
Correct Answer: Superior rectal vein
Explanation:Internal haemorrhoids are formed by varicosities of the branches of the superior rectal vein.
External haemorrhoids are formed by varicosities of the branches of the inferior rectal vein.
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This question is part of the following fields:
- Anatomy
- Colorectal
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Question 4
Incorrect
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Which of the following malignancies is associated with the development of Lambert-Eaton myasthenic syndrome?
Your Answer: Malignant melanoma
Correct Answer: Lung cancer
Explanation:Lambert–Eaton myasthenic syndrome is a rare disorder of the neuromuscular junction. It can occur as a solitary diagnosis but it can also occur as a paraneoplastic syndrome associated with lung cancer, particularly small-cell histology. It can also be associated with other cancers such as lymphoma, non-Hodgkin’s lymphoma, T-cell leukaemia, non-small-cell lung cancer, prostate cancer and thymoma.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 5
Correct
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A patient came into the emergency in a state of shock. His blood group is not known, but on testing it clotted when mixed with Type A antibodies. Which blood should be transfused?
Your Answer: B +ve
Explanation:There are two stages to determine the blood group, known as ABO typing. The first stage is called forward typing. In this method, RBCs are mixed with two separate solutions of type A or type B antibodies to see if they agglutinate. If this blood clumps, this indicates the presence of antigens within the blood sample. For example, a sample of type B blood will clump when tested with type A antibodies as it contains type B antigens. Group B – has only the B antigen on red cells (and A antibody in the plasma)
Group B – has only the B antigen on red cells (and A antibody in the plasma)
Group AB – has both A and B antigens on red cells (but neither A nor B antibody in the plasma)
Group O – has neither A nor B antigens on red cells (but both A and B antibody are in the plasma). Many people also have a Rh factor on the red blood cell’s surface. This is also an antigen and those who have it are called Rh+. Those who have not are called Rh–. A person with Rh– blood does not have Rh antibodies naturally in the blood plasma (as one can have A or B antibodies, for instance) but they can develop Rh antibodies in the blood plasma if they receive blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies. A person with Rh+ blood can receive blood from a person with Rh– blood without any problems. The patient’s blood group is B positive as he has antigen B, antibody A and Rh antigens.
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This question is part of the following fields:
- General
- Physiology
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Question 6
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 7
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 8
Incorrect
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A surgeon performing a thymectomy to remove a malignant thymoma is careful to avoid damaging an important nerve lying around the arch of the aorta. Which nerve is the surgeon trying to preserve?
Your Answer: Left phrenic
Correct Answer: Left Vagus
Explanation:The left vagus nerve lies on the lateral surface of the aortic arch. The left recurrent laryngeal nerve arises from the vagus and loops around the arch of the aorta. This nerve is at risk of injury during surgery.
The right and left phrenic nerves, being lateral to the vagus, do not loop around the arch of the aorta.
The sympathetic trunks, both right and left, are located in the posterior chest; not near the aortic arch.
The right vagus: not involved with the aortic arch.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 9
Correct
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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: 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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 10
Correct
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Langhans giant cells are characteristically seen in which type of inflammation?
Your Answer: Granulomatous inflammation
Explanation:Langhans giant cells are characteristically seen in granulomatous inflammation. They form when epithelioid cells fuse together. They usually contain a nuclei with a horseshoe-shaped pattern in the periphery of the cell.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 11
Correct
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A 50-year old, obese gentleman with a compression fracture of T11 vertebra was admitted in the hospital. Examination revealed a raised blood pressure 165/112 mmHg and blood glucose 8.5 mmol/l. His abdomen had the presence of purplish striae. What condition is he likely to be suffering from?
Your Answer: Adrenal cortical carcinoma
Explanation:Adrenocortical carcinomas are rare tumours with reported incidence being only two in a million. However, they have a poor prognosis. These are large tumours and range from 4-10 cm in diameter. They arise from the adrenal cortex and 10% cases are bilateral. 50-80% are known to be functional, leading to Cushing syndrome. Even though the tumour affects both sexes equally, functional tumours are slightly commoner in women and non-functional tumours are commoner in men. As compared to women, men also develop this tumour at an older age and seem to have a poorer prognosis.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 12
Correct
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A 15-day old baby was brought to the emergency department with constipation for 4 days. On examination, the abdomen of the baby was found to be distended and tender all over. No bowel sounds were heard. A sigmoid colon biopsy was carried out, which showed absent ganglion cells. What is the diagnosis?
Your Answer: Hirschsprung’s disease
Explanation:Hirschsprung’s disease is characterized by congenital absence of the autonomic plexus (Meissner’s and Auerbach’s plexus) in the intestinal wall. Usually limited to the distal colon, it can occasionally involve the entire colon or even the small bowel. There is abnormal or absent peristalsis in the affected segment, resulting in continuous spasm of smooth muscle and partial/complete obstruction. This causes accumulation of intestinal contents and dilatation of proximal segment. Skip lesions are highly uncommon. This disease is seen early in life with 15% patients presenting in first month, 60% by 1 year of age and 85% by the age of 4 years. Symptoms include severe and complete constipation, abdominal distension and vomiting. Patients with involvement of ultra-short segments might have mild constipation with intervening diarrhoea. In older children, symptoms include failure to thrive, anorexia, and lack of an urge to defecate. On examination, an empty rectum is revealed with stool palpable high up in the colon. If not diagnosed in time, it can lead to Hirschsprung’s enterocolitis (toxic megacolon), which can be fulminant and lead to death. Diagnosis involves a barium enema or a rectal suction biopsy. Barium enema shows a transition in diameter between the dilated, normal colon proximal to the narrowed, affected distal segment. It is to be noted that barium enema should be done without prior preparation, which can dilate the abnormal segment, leading to a false-negative result. A 24-hour post-evacuation film can be obtained in the neonatal period – if the colon is still filled with barium, there is a high likelihood of Hirschsprung’s disease. Full-thickness rectal biopsy is diagnostic by showing the absence of ganglion cells. Acetylcholinesterase staining can be done to highlight the enlarged nerve trunks. Abnormal innervation can also be demonstrated by rectal manometry.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 13
Correct
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What will the destruction of endoplasmic reticulum stop?
Your Answer: Synthesis of proteins
Explanation:The rough endoplasmic reticulum is the factory for the manufacturing of proteins. It contains ribosomes attached to it and transports proteins that are destined for membranes and secretions. The rough ER is connected to the nuclear envelope and to the cisternae of the Golgi apparatus by vesicles that shuttle between the two compartments.
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This question is part of the following fields:
- General
- Physiology
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Question 14
Correct
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A 5-year-old child diagnosed with nephrotic syndrome developed generalised oedema. What is the mechanism for the development of oedema in patients with nephrotic syndrome?
Your Answer: Decreased colloid osmotic pressure
Explanation:The development of oedema in nephrotic syndrome has traditionally been viewed as an underfill mechanism. According to this view, urinary loss of protein results in hypoalbuminemia and decreased plasma oncotic pressure. As a result, plasma water translocates out of the intravascular space and results in a decrease in intravascular volume. In response to the underfilled circulation, effector mechanisms are then activated that signal the kidney to secondarily retain salt and water. While an underfill mechanism may be responsible for oedema formation in a minority of patients, recent clinical and experimental findings would suggest that oedema formation in most nephrotic patients is the result of primary salt retention. Direct measurements of blood and plasma volume or measurement of neurohumoral markers that indirectly reflect effective circulatory volume are mostly consistent with either euvolemia or a volume expanded state. The ability to maintain plasma volume in the setting of a decreased plasma oncotic pressure is achieved by alterations in transcapillary exchange mechanisms known to occur in the setting of hypoalbuminemia that limit excessive capillary fluid filtration.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 15
Correct
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What is the chief ligament preventing posterior sliding of the tibia on the femur ?
Your Answer: Posterior cruciate
Explanation:The posterior cruciate ligament is attached to the posterior intercondyloid fossa of the tibia and the lateral and front part of the medial condyle of the femur. It resists sliding of the tibia posteriorly.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 16
Correct
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A 22-year old man presented with a mass in his left scrotum which was more prominent when standing and felt like a 'bag of worms'. Examination revealed a non-tender mass along the spermatic cord. Also, the right testis was larger than the left testis. What is the likely diagnosis?
Your Answer: Varicocele
Explanation:Varicocele refers to dilatation and increased tortuosity of the pampiniform plexus – which is a network of veins found in spermatic cord that drain the testicle. Defective valves or extrinsic compression can result in outflow obstruction and cause dilatation near the testis. Normal diameter of the small vessels ranges from 0.5 – 1.5mm. A varicocele is a dilatation more than 2mm.
The plexus travels from the posterior aspect of testis into the inguinal canal with other structures forming the spermatic cord. They then form the testicular veins out of which the right testicular vein drains into the inferior vena cava and the left into the left renal vein.
It affects 15-20% men, and 40% of infertile males. Usually diagnosed in 15-25 years of age, they are rarely seen after 40 years of age. Because of the vertical path taken by the left testicular vein to drain into left renal vein, 98% idiopathic varicoceles occur on the left side. It is bilateral in 70% cases. Right-sided varicoceles are rare.
Symptoms include pain or heaviness in the testis, infertility, testicular atrophy, a palpable mass, which is non-tender and along the spermatic cord (resembling a ‘bag of worms’). The testis on the affected side might be smaller.
Diagnosis can be made by ultrasound. Provocative measures such as Valsalva manoeuvre or making the patient stand up to increase the dilatation by increasing the intra-abdominal venous pressure.
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This question is part of the following fields:
- Pathology
- Urology
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Question 17
Correct
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An operation to resect a tumour of the right lung was stopped as the chest surgeon said that the tumour was crossing the oblique fissure. Which structures are separated by the oblique fissure of the right lung?
Your Answer: Lower lobe from both upper and middle lobes
Explanation:The oblique fissure on the right lung separates the lower lobe from both the middle and upper lobe. The lingual is only found on the left lung and is part of the upper lobe.
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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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Out of the following options, which malignancy has the highest potential for multicentricity?
Your Answer: Renal cell carcinoma
Correct Answer: Transitional cell carcinoma
Explanation:Transitional cell carcinomas can arise anywhere in the urothelium lining the urinary tract; and hence are known to be multicentric and recur commonly. Prostatic adenocarcinoma most commonly involves the posterior lobe of the prostate gland. Although renal cell carcinomas occasionally show multicentricity, it is not common. Penile carcinomas are usually locally infiltrative lesions. Wilm’s tumours are usually solitary, but can be bilateral or multicentric in 10% cases. Small cell carcinoma of lung and teratomas are usually solitary.
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This question is part of the following fields:
- Pathology
- Renal
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Question 19
Correct
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When you rest your elbows on a desk, what bony landmark of the upper limb are you resting on?
Your Answer: Olecranon process of the ulna
Explanation:At the upper and back part of the ulna, there exists a curved eminence which is the olecranon process. This process lodges in the olecranon fossa of the humerus. It’s posterior surface is subcutaneous and this triangular area is what you rest your elbow upon.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 20
Incorrect
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Loperamide is a drug used to treat diarrhoea. What is the mechanism of action of loperamide?
Your Answer: Competitively inhibits H2 receptors
Correct Answer: Opiate agonist
Explanation:Loperamide is an opioid-receptor agonist and acts on the mu opioid receptors in the myenteric plexus of large intestine. It works by decreasing the motility of the circular and longitudinal smooth muscles of the intestinal wall. It is often used for this purpose in gastroenteritis, inflammatory bowel disease, and short bowel syndrome.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 21
Correct
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A 65-year-old man complains of headaches, weakness, cramps, and confusion; blood tests reveal he has severe hyponatremia. The most likely cause is:
Your Answer: Severe diarrhoea or vomiting
Explanation:Hyponatraemia occurs when the sodium level in the plasma falls below 135 mmol/l. Hyponatraemia is an abnormality that can occur in isolation or, more commonly as a complication of other medical illnesses. Severe hyponatraemia may cause osmotic shift of water from the plasma into the brain cells. Typical symptoms include nausea, vomiting, headache and malaise. As the hyponatraemia worsens, confusion, diminished reflexes, convulsions, stupor or coma may occur. The cause of hyponatremia is typically classified by a person’s fluid status into low volume, normal volume, and high volume. Low volume hyponatremia can occur from diarrhoea, vomiting, diuretics, and sweating.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 22
Incorrect
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A 63-year old lady presents with pain in multiple bones and renal failure. On enquiry, there is history of recurrent pneumonia in the past. What will be the likely finding on her bone marrow biopsy?
Your Answer: Reed–Sternberg cells
Correct Answer: Plasma cells
Explanation:Multiple myeloma is a plasma cell malignancy that produce excessive monoclonal immunoglobulins. The disease presents with bone pains, renal dysfunction, increased calcium, anaemia and recurrent infections. Diagnosis is by demonstrating the presence of M-protein in urine or serum, lytic bone lesions, light chain proteinuria or excessive plasma cells on marrow biopsy.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 23
Correct
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The circle of Willis is an arterial anastomosis in the base of the brain and is one of the cerebrovascular safeguards in the brain. Where is the circle of Willis contained?
Your Answer: Cisterna basalis
Explanation:Cisterns refers to a system of intercommunicating pools formed by the subarachnoid space at the base of the brain and around the brainstem. Cisterna basalis/basal cistern (interpeduncular cistern) is found at the base of the brain between the two temporal lobes and it contains the arterial circle of Willis. The lumbar cistern is contained in the spinal canal while the foramen magna refers to the opening at the base of the skull though which the spinal cord enters into the skull.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 24
Correct
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During an anatomy revision session, medical students are told that the posterior wall of the rectus sheath ends in a thin curved margin whose concavity is directed downwards. What is the name of this inferior border of the rectus sheath?
Your Answer: Arcuate line
Explanation:The rectus sheath is a tendinous sheath that encloses the rectus abdominis muscle. It covers the entire anterior surface however on the posterior surface of the muscle the sheath is incomplete ending inferiorly at the arcuate line. Below the arcuate line, the rectus abdominis is covered by the transversalis fascia. The linea alba is a band of aponeurosis on the midline of the anterior abdominal wall, which extends from the xiphoid process to the pubic symphysis. It is formed by the combined abdominal muscle aponeuroses. This is a useful site for midline incision during abdominal surgery because it does not carry many blood vessels. All of the other answer choices are related to the inguinal canal.
The falx inguinalis (sometimes called the inguinal falx or conjoint tendon), is the inferomedial attachment of the transversus abdominis with some fibres of the internal abdominal oblique – it contributes to the posterior wall of the inguinal canal.
The inguinal ligament is the ligament that connects the anterior superior iliac spine with the pubic tubercle – it makes the floor of the inguinal canal.
The internal (deep) inguinal ring is the entrance to the inguinal canal, where the transversalis fascia pouches out and creates an opening through which structures can leave the abdominal cavity.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 25
Correct
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A 35 year old patient presenting with haematemesis, heart burn and bloody stool was diagnosed with a duodenal ulcer that had eroded the gastroduodenal artery. The patient was then rushed into theatre for an emergency procedure to control the haemorrhage. If the surgeon decided to ligate the gastroduodenal artery at its origin, which of the following arteries would most likely experience retrograde blood flow from collateral sources as a result of the ligation?
Your Answer: Right gastroepiploic
Explanation:In the stomach and around the duodenum, there are many arterial anastomoses. Ligation of the gastroduodenal artery would result in the retrograde flow of blood from the left gastroepiploic artery to the right gastroepiploic artery. The blood flows into the right gastroepiploic artery, a branch of the gastroduodenal artery from the left gastroepiploic artery that branches from the splenic artery. This retrograde blood flow is aimed at providing alternate blood flow to the greater curvature of the stomach.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 26
Correct
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A surgeon performing a Whipple's procedure, that involves mobilizing the head of the pancreases, accidentally injured a structure immediately posterior to the neck of the pancrease which bled out. Which structure is most likely to have been injured?
Your Answer: Superior mesenteric artery
Explanation:The structure immediately posterior to the neck of the pancreas is the superior mesenteric vein. The neck of the pancreas lies anterior to the superior mesenteric vein, which joins with the splenic vein to form the portal vein.
The superior mesenteric artery (SMA) is also located in proximity to the neck of the pancreas. Specifically, the SMA emerges from the abdominal aorta just below the level of the pancreas and passes posterior to the neck of the pancreas before it descends into the mesentery to supply the intestines. Thus, both the superior mesenteric vein and the superior mesenteric artery are key vascular structures related to the posterior aspect of the neck of the pancreas.
Bleeding out would suggest an arterial injury.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 27
Incorrect
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Perforin are present in the granules of which cell?
Your Answer: Mast cell
Correct Answer: Natural killer cell
Explanation:Perforins are characteristically found In the granules of CD8+ T cells and natural killer cells. They are cytolytic proteins that insert into the target plasma membrane forming a hole and resulting in lysis. They along with granzyme B induce apoptosis in the target cell.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 28
Correct
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A drug abuser developed an infection which spread from the dorsum of the hand to the medial side of the arm along the course of the large cutaneous vein. Which vein is involved?
Your Answer: Basilic
Explanation:The basilic vein is one of two veins found in the forearm, the other is the cephalic vein. These veins originate from the deep venous arch of the hand. The cephalic vein ascends along the lateral side of the forearm, and the basilic vein runs up the medial side of the forearm.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 29
Correct
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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: 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 30
Incorrect
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What is the role of ICAM-1 and VCAM-1 in the inflammatory process?
Your Answer: Leukocyte margination
Correct Answer: Leukocyte adhesion
Explanation:Steps involved in leukocyte arrival and function include:
1. margination: cells migrate from the centre to the periphery of the vessel.
2. rolling: selectins are upregulated on the vessel walls.
3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes. Interaction of these results in adhesion.
4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product.
5. phagocytosis: engulfing the offending substance/cell.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
