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Question 1
Incorrect
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Which is a feature of the action of insulin?
Your Answer: Promotes phosphate release from bone
Correct Answer: Promotes protein synthesis
Explanation:Insulin is produced by the beta-cells of the islets of Langerhans in the pancreas. Its actions include:
– promoting uptake of glucose into cells
– glycogen synthesis (glycogenesis)
– protein synthesis
– stimulation of lipogenesis (fat formation).
– driving potassium into cells – used to treat hyperkaelamia.
Parathyroid hormone and activated vitamin D are the principal hormones involved in calcium/phosphate metabolism, rather than insulin.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 2
Incorrect
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Which of the following structure contains the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle?
Your Answer: Ciliary ganglion
Correct Answer: Edinger–Westphal nucleus
Explanation:The Edinger–Westphal nucleus (accessory oculomotor nucleus) is the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 3
Correct
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The basilar artery arises from the confluence of which two arteries?
Your Answer: Vertebral
Explanation:The basilar artery is part of the vertebrobasilar system. It is formed by the confluence of the two vertebral arteries which arise from the subclavian arteries. These two vertebral arteries merge at the level of cranial nerve VI at the junction between the pons and the medulla oblangata to form what is know as the basilar artery. This vertebrobasilar system supplies the upper spinal cord, brainstem, cerebellum, and posterior part of brain.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 4
Correct
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In the adult heart, the sinus venosus gives rise to the:
Your Answer: Coronary sinus
Explanation:The sinus venosus is a large quadrangular cavity which precedes the atrium on the venous side of the chordate heart. It exists distinctly only in the embryonic heart (where it is found between the two venae cavae); however, the sinus venosus persists in the adult. In the adult, it is incorporated into the wall of the right atrium to form a smooth part called the sinus venarum, which is separated from the rest of the atrium by a ridge of fibres called the crista terminalis. The sinus venosus also forms the SA node and the coronary sinus.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 5
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 6
Incorrect
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An 80 year-old lady presents to the out patient clinic complaining of chest pain of 2 months' duration with a normal electrocardiogram and cardiac enzymes. A computed tomographic scan is done which reveals a mass lesion involving a structure in the middle mediastinum. Which among the following structures could be involved?
Your Answer: Aortic arch
Correct Answer: Ascending aorta
Explanation:The middle mediastinum is the broadest part of the mediastinal cavity containing the heart enclosed in the pericardium, ascending aorta, lower half of the superior vena cava with the azygos vein opening into it, the bifurcation of the trachea and the two bronchi, the pulmonary artery with its branches, pulmonary veins, phrenic nerves and bronchial lymph nodes. The most likely structure involved is the ascending aorta, perhaps with an aneurysm.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 7
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 8
Correct
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Which of the following substances will enhance the activity of antithrombin III?
Your Answer: Heparin
Explanation:Antithrombin III is a glycoprotein that inactivates multiple enzymes involved in the coagulation system. It inactivates factor X, factor IX, factor II, factor VII, factor XI and factor XII. Its activity is greatly increased by the action of heparin.
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This question is part of the following fields:
- General
- Physiology
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Question 9
Correct
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A 59-year-old man was brought to the emergency department by his family after complaining of sudden, severe upper back pain and a ripping sensation, that radiated to his neck. On arrival, his pulse was weak in one arm compared with the other however his ECG result was normal. Which of the following is most probably the cause of these findings and symptoms?
Your Answer: Acute aortic dissection
Explanation:Acute aortic dissection is a serious condition in which the inner layer of the aorta tears and the blood flows in between the inner and middle layers of the aorta causing their separation (dissection). Aortic dissection can lead to rupture or decreased blood flow to organs. Clinical manifestations most often include the sudden onset of severe, tearing or ripping chest pain that can radiate to the shoulder, back or neck; syncope; altered mental status; dyspnoea; pale skin; stroke symptoms etc. The diagnosis of acute aortic dissection is based on clinical findings, imaging studies, electrocardiography and laboratory analysis.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 10
Incorrect
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The mechanism of action of streptokinase involves:
Your Answer: Proteolytic activation of fibrinogen
Correct Answer: Direct conversion of plasminogen to plasmin
Explanation:Streptokinase is an enzyme that is produced by group A beta haemolytic streptococcus and is an effective and cost efficient method for the dissolution of a clot used in cases of MI and pulmonary embolism. It works by directly converting plasminogen to plasmin which breaks down the blood components in the clot and fibrin, dissolving the clot. Streptokinase is a bacterial product and thus the body will develop immunity against it.
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This question is part of the following fields:
- General
- Physiology
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Question 11
Correct
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The following branch of the aorta is unpaired:
Your Answer: Coeliac artery
Explanation:Branches that stem from the abdominal aorta can be divided into three: the visceral branches, parietal branches and terminal branches. Of the visceral branches, the suprarenal, renal, testicular and ovarian arteries are paired while the coeliac artery and superior and inferior mesenteric arteries are unpaired. Of the parietal branches the inferior phrenic and lumbar arteries are paired while the middle sacral artery is unpaired. The terminal branches i.e. the common iliac arteries are paired.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 12
Correct
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A 60 year old female patient who has suffered an embolic stroke that affected her middle cerebral artery as revealed by a CT scan is likely to exhibit which of the following neurologic conditions?
Your Answer: Contralateral hemiplegia
Explanation:The middle cerebral artery is a major artery that supplies blood to the cerebrum. It continues from the internal carotid artery up into the lateral sulcus. The middle cerebral artery mainly supplies the lateral aspect of the cerebral cortex, anterior aspect of the temporal lobes and the insular cortices.
Functional areas supplied by this vein are as follows:
The motor and pre-motor areas
The somato-sensory
Auditory areas
Motor speech
Sensory speech
Pre-frontal area
Occlusion of the middle cerebral artery results in:
i) A severe contralateral hemiplegia, most marked in the upper extremity and face
ii) A contralateral sensory impairment worse in the upper part of the body.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 13
Incorrect
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Which of the following is the most likely cause of massive splenomegaly in a 35-year old gentleman?
Your Answer: Sickle cell anaemia
Correct Answer: Myelofibrosis
Explanation:Causes of massive splenomegaly include chronic myelogenous leukaemia, chronic lymphocytic leukaemia, lymphoma, hairy cell leukaemia, myelofibrosis, polycythaemia vera, sarcoidosis, Gaucher’s disease and malaria.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 14
Correct
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What is expected from complete transection of the inferior gluteal nerve when it emerges from the greater sciatic foramen?
Your Answer: Extension of the thigh would be the action most affected
Explanation:As the inferior gluteal nerve emerges from the greater sciatic foramen below the piriformis muscle, it divides into branches and enters the gluteus maximus muscle which extends the femur and bends the thigh in line with the body.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 15
Correct
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The dura mater is a thick membrane that is the outermost of the three layers of the meninges. Which of the following foramen transmits the dura mater?
Your Answer: Foramen magnum
Explanation:The foramen magnum is found in the most inferior part of the posterior cranial fossa . It is traversed by vital structures including the medulla oblongata . Its contents include the following: medulla oblongata, meninges (arachnoid, dura and pia mater), spinal root of the accessory nerve, vertebral arteries, anterior and posterior spinal arteries, tectorial membrane and alar ligaments .
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 16
Correct
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During work up for a 29 year-old lady who complained of chest pain, a computed tomography showed a large mass in the posterior mediastinum. Which among the following structures could be involved?
Your Answer: Lymph nodes
Explanation:Boundaries of the posterior mediastinum include:
Superior: a plane through the sternal angle and T4/5
Inferior: the diaphragm
Anterior: the middle mediastinal structures
Posterior the spinal cord.
Structures in the posterior mediastinum include the descending thoracic aorta, the azygos system, oesophagus, thoracic duct and lymph nodes. The great vessels and structures at the root of the lung are part of the middle mediastinum. In this case, the lymph nodes is the correct answer.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 17
Incorrect
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A TRUE statement regarding abolition of the cephalic phase of pancreatic secretion is that it:
Your Answer: Will mainly affect HCO3 – secretion
Correct Answer: Will result after vagotomy
Explanation:Recognition and integration of the sight, smell and taste of food triggers the cephalic phase of pancreatic secretion, causing an increase in pancreatic HCO3- and enzyme secretion. The degree of enzyme secretion in this phase is about 50% of the maximal response seen with exogenous CCK and secretin. The vagus nerve regulates the secretion through the cholinergic fibres innervating the acinar cells of the pancreas, and through peptidergic nerve fibres, which innervate ductal cells.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 18
Correct
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All the following statements are FALSE regarding the ophthalmic division of the trigeminal nerve, except:
Your Answer: The ophthalmic nerve is the smallest branch of the trigeminal nerve
Explanation:The ophthalmic nerve is the smallest of the three trigeminal divisions. The cutaneous branches of the ophthalmic nerve supply the conjunctiva, the skin over the forehead, the upper eyelid, and much of the external surface of the nose.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 19
Correct
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A 20-year old cyclist falls off a speeding bike and fractures a structure that articulates with the tubercle of the 7th rib. Which structure is fractured?
Your Answer: Transverse process of vertebra T7
Explanation:A rib tubercle is a projection that is postero-inferior and lateral to the neck of a rib which articulates with the transverse process of the corresponding vertebra i.e. of the same number. Therefore, the tubercle of rib 7 articulates with the transverse process of T7 vertebra. The head of the rib 7, on the other hand, articulates with the 6th vertebra superiorly and the 7th vertebra inferiorly.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 20
Incorrect
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The lateral thoracic artery:
Your Answer: Accompanies the thoracodorsal nerve to the serratus anterior muscle
Correct Answer: Accompanies the long thoracic nerve to the serratus anterior muscle
Explanation:The thoracic nerve, along with the lateral thoracic artery, follow the pectoralis minor to the side of the chest which supplies the serratus anterior and the pectoralis. It then sends branches across the axilla to the axillary glands and subscapularis. The pectoral branch of the thoraco-acromial anastomoses with the internal mammary, subscapular and intercostal arteries, which in women, supply an external mammary branch.
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This question is part of the following fields:
- Anatomy
- Breast
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Question 21
Correct
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A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect:
Your Answer: Regulation of circadian rhythm
Explanation:The suprachiasmatic nucleus (SCN) in the hypothalamus is responsible for controlling endogenous circadian rhythms and destruction of the SCN leads to a loss of circadian rhythm.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 22
Correct
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Digital rectal examination of a 75-year old gentleman who presented to the surgical clinic with urinary retention revealed an enlarged, nodular prostate. PSA was found to be elevated, favouring the diagnosis of prostatic malignancy. Which of the given options is the most common malignant lesion affecting the prostate gland?
Your Answer: Adenocarcinoma
Explanation:Prostatic adenocarcinoma is the commonest solid malignancy and non-dermatological cancer in men above 50 years age. Increasing in incidence with age and the highest risk seen in the black population. About 75% of cases are seen in men over 65 years. Other tumours affecting the prostate include undifferentiated prostate cancer, squamous cell carcinoma, and ductal transitional carcinoma, but these occur less commonly. Sarcomas usually affect children. Hormones play a role in the aetiology of prostate adenocarcinoma unlike the other types. Intraepithelial neoplasia is considered a precursor of invasive malignancy.
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This question is part of the following fields:
- Pathology
- Urology
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Question 23
Incorrect
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A 58-year-old woman has had a headache, fever, lethargy and nausea for the last 10 days. He undergoes a CT scan which reveals a lesion in his frontal lobe, which, after a biopsy, is found to be formed by granulation tissue with collagenisation, gliosis and oedema. What's the most likely diagnosis?
Your Answer: Aspergillosis
Correct Answer: Chronic brain abscess
Explanation:A cerebral abscess can result from direct extension of cranial infections, penetrating head trauma, haematogenous spread, or for unknown causes. An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts. Oedema around the abscess can increase the intracranial pressure. Symptoms result from increased intracranial pressure and mass effects. In a CT scan, an abscess appears as an oedematous mass with ring enhancement.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 24
Incorrect
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Injury to this nerve will result to the loss of general sensory innervation of the lacrimal gland:
Your Answer: Oculomotor nerve
Correct Answer: Ophthalmic nerve
Explanation:The lacrimal glands are paired, almond-shaped exocrine glands, that secrete the aqueous layer of the tear film. The lacrimal nerve, derived from the ophthalmic nerve, supplies the sensory component of the lacrimal gland. The greater petrosal nerve, derived from the facial nerve, supplies the parasympathetic autonomic component of the lacrimal gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 25
Correct
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Hepatomegaly with greatly increased serum alpha-fetoprotein is seen in which of the following conditions?
Your Answer: Hepatocellular carcinoma
Explanation:Hepatocellular carcinoma or hepatoma affects people with pre-existing cirrhosis and is more common in areas with higher prevalence of hepatitis B and C. Diagnosis include raise alpha-fetoprotein levels, imaging and liver biopsy if needed. Patients at high-risk for developing this disease can undergo screening by periodic AFP measurement and abdominal ultrasonography. The malignancy carries poor prognosis (see also Answer to 10.4).
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 26
Correct
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A victim of assault in a domestic violence is stabbed in the left chest. The tip of the pen knife entered the pleural space just above the cardiac notch. Luckily the lung was spared as it would only occupy this space during deep inspiration. Which of these structures was pierced by the knife?
Your Answer: Costomediastinal recess
Explanation:The costomediastinal recess is located immediately next to the cardiac notch. The medial aspect of the superior lobe of the left lung, when fully inflated expands to this place. The lung wouldn’t enter the anterior or the posterior mediastinum which are found between the two pleural cavities.
The costodiaphragmatic recess is the lowest extent of the pleural cavity where the inferior lobes of the lungs would expand into in deep inhalation.
The cupola, is the part of the pleural cavity that extends above the first rib into the root of the neck. The superior most part of the superior lobe of the lung might extend into this part.
Pulmonary ligament: pleural fold that is located below the root of the lung where the visceral pleura and the mediastinal pleura are in continuity.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 27
Incorrect
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A 78-year-old man who has been bedridden for a month is prescribed griseofulvin. What class of drugs does griseofulvin belong to?
Your Answer: Antimycobacterial
Correct Answer: Antifungal
Explanation:Griseofulvin is an antifungal drug. It is administered orally, and it is used to treat ringworm infections of the skin and nails. It binds to keratin in keratin precursor cells and makes them resistant to fungal infections. Griseofulvin works by interfering with fungal mitosis.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 28
Correct
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The Brunner glands secrete an alkaline product that helps maintain an optimal pH for pancreatic enzyme activity. Where are these glands located?
Your Answer: Submucosa of the duodeneum
Explanation:The Brunner glands are located in the submucosa of the duodenum. These glands are connected to the interstitial lumen by ducts that open into certain crypts. They secrete an alkaline product that protects the duodenal mucosa from the acidic chyme and helps achieve an optimal pH for the enzymes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 29
Incorrect
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A 13-year-old girl has complained of pain in her left arm for 4 months. An X-ray reveals a mass along with erosion of the affected humerus. Histologically, the tumour is found to be formed by small, round, blue cells. What is the most likely diagnosis?
Your Answer: Osteoblastoma
Correct Answer: Ewing’s sarcoma
Explanation:Ewing’s sarcoma is formed by small, round, blue cells, and is common in children. The usually develop in limbs, and clinical findings include pain and inflammation, with lytic destruction showing up on X-rays.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 30
Correct
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Which lymph nodes are most likely to enlarge due to the spread of infection through the lymphatic channels in a patient with a boil on his scrotum?
Your Answer: Superficial inguinal nodes
Explanation:The superficial inguinal nodes drain the perineum and the external genitalia which include the scrotum and the labia majora. The testes, however, drain to the lumbar nodes.
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This question is part of the following fields:
- Anatomy
- Pelvis
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