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Question 1
Incorrect
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Which statement is true regarding the diaphragmatic openings:
Your Answer: The right gastric artery passes through the opening at T10
Correct Answer: The thoracic duct passes through the opening at T12
Explanation:The diaphragmatic openings are:
T8 – opening for the inferior vena cavaand the right phrenic nerve
T10 – opening for the oesophagusand the left gastric artery and vein
T12 – opening for the aorta, the thoracic duct and azygos vein.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 2
Incorrect
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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: Median cubital
Correct 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 3
Incorrect
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A 16 year-old boy was stabbed in the right supraclavicular fossa. The sharp object punctured the portion of the parietal pleura that extends above the first rib. What is the name of this portion of the parietal pleura?
Your Answer: Endothoracic fascia
Correct Answer: Cupola
Explanation:Endothoracic fascia: the connective tissue (fascia) that is between the costal parietal pleura and the inner wall of the chest wall.
Costomediastinal recess: the point where the costal pleura becomes mediastinal pleura.
Costodiaphragmatic recess: is the lowest point of the pleural sac where the costal pleura becomes diaphragmatic pleura.
Cupola: the part of the parietal pleura that extends above the first rib level into the root of the neck.
Costocervical recess: this is a made-up term.
Peritracheal fascia: a layer of connective tissue that invests the trachea.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 4
Incorrect
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Renin is secreted by pericytes in the vicinity of the afferent arterioles of the kidney from the juxtaglomerular cells. Plasma renin levels are decreased in patients with:
Your Answer: Upright posture
Correct Answer: Primary aldosteronism
Explanation:Primary aldosteronism, also known as primary hyperaldosteronism or Conn’s syndrome, is excess production of the hormone aldosterone by the adrenal glands resulting in low renin levels. Most patients with primary aldosteronism (Conn’s syndrome) have an adrenal adenoma. The increased plasma aldosterone concentration leads to increased renal Na+ reabsorption, which results in plasma volume expansion. The increase in plasma volume suppresses renin release from the juxtaglomerular apparatus and these patients usually have low plasma renin levels. Salt restriction and upright posture decrease renal perfusion pressure and therefore increases renin release from the juxtaglomerular apparatus. Secondary aldosteronism is due to elevated renin levels and may be caused by heart failure or renal artery stenosis.
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This question is part of the following fields:
- Physiology
- Renal
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Question 5
Correct
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The extent of cancer growth can be described through staging. What is taken into consideration when staging a cancer?
Your Answer: Local invasion
Explanation:Cancer stage is based on four characteristics: the size of cancer, whether the cancer is invasive or non-invasive, whether the cancer has spread to the lymph nodes, and whether the cancer has spread to other parts of the body, in this case beyond the breast. Staging is important as it is often a good predictor of outcomes and treatment is adjusted accordingly.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 6
Incorrect
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The most likely cause of a low p(O2) in arterial blood is:
Your Answer: Hyperaemic hypoxia
Correct Answer: Hypoxic hypoxia
Explanation:Hypoxia is when the whole body or a region is deprived of adequate oxygen supply. Different types of hypoxia include the following:
– Hypoxic hypoxia, which occurs due to poor oxygen supply, as a result of low partial pressure of oxygen in arterial blood. This could be due to low partial pressure of atmospheric oxygen (e.g., at high altitude), sleep apnoea, poor ventilation because of chronic obstructive pulmonary disease or respiratory arrest, or shunts. The other types of hypoxia have a normal partial pressure of oxygen.
– Anaemic hypoxia occurs due to low total oxygen content of the blood, with a normal arterial oxygen pressure.
– Hyperaemic hypoxia occurs due to poor delivery of oxygen to target tissues, such as in carbon monoxide poisoning or methemoglobinemia.
– Histotoxic hypoxia results due to inability of the cells to use the delivered oxygen due to disabled oxidative phosphorylation enzymes.
– Ischaemic (or stagnant) hypoxia occurs due to local flow restriction of well-oxygenated blood, seen in cases like cerebral ischaemia, ischaemic heart disease and intrauterine hypoxia.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 7
Incorrect
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A 7-year old child from a rural setting complains of recurrent abdominal pain. The child is found to have a heavy parasitic infestation and anaemia. Which type of anaemia is most likely seen in this patient?
Your Answer: Haemolytic anaemia
Correct Answer: Iron deficiency anaemia
Explanation:The most common cause of iron deficiency anaemia in children in developing countries is parasitic infection (hookworm, amoebiasis, schistosomiasis and whipworm).
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 8
Incorrect
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Regarding abduction of the digits of the hand, which of the following is correct?
Your Answer: The palmar interosseous muscles are the sole adductors of the digits
Correct Answer: All of the adductors of the digits take at least part of their attachments from metacarpal bones
Explanation:Lying on the palmer surfaces of the metacarpal bones are four palmar interossei which are smaller than the dorsal interossei. Arising from the entire length of the metacarpal bone of one finger, is a palmar interosseous, which is inserted into the side of the base of the first phalanx and the aponeurotic expansion of the extensor digitorum communis tendon to the same finger. All the interossei are innervated by the eighth cervical nerve, through the deep palmar branch of the ulnar nerve. The palmar interossei adducts the fingers to an imaginary line drawn longitudinally through the centre of the middle finger.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 9
Correct
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A 30-year-old woman feels thirsty. This thirst is probably due to:
Your Answer: Increased level of angiotensin II
Explanation:Thirst is the basic need or instinct to drink. It arises from a lack of fluids and/or an increase in the concentration of certain osmolites such as salt. If the water volume of the body falls below a certain threshold or the osmolite concentration becomes too high, the brain signals thirst. Excessive thirst, known as polydipsia, along with excessive urination, known as polyuria, may be an indication of diabetes. Angiotensin II is a hormone that is a powerful dipsogen (i.e. it stimulates thirst) that acts via the subfornical organ. It increases secretion of ADH in the posterior pituitary and secretion of ACTH in the anterior pituitary.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 10
Correct
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Two boys were playing when one of them brought the forearm of the other behind his back. This resulted in a stretching of the lateral rotator of the arm. Which of the following muscles was most likely to have been involved?
Your Answer: Infraspinatus
Explanation:There are two lateral rotators of the arm, the infraspinatus and the teres minor muscles. The infraspinatus muscle receives nerve supply from C5 and C6 via the suprascapular nerve, whilst the teres minor is supplied by C5 via the axillary nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 11
Incorrect
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The orbicularis oculi us a muscle that closes the eyelids. What is the motor innervation of this muscle?
Your Answer: A branch of the same nerve that innervates the temporalis muscle
Correct Answer: A branch of a nerve that exits through the stylomastoid foramen
Explanation:The orbicularis oculi is a muscle in the face that closes the eyelids. It is supplied by zygomatic branch of the facial nerve (cranial nerve VII), which exits through the stylomastoid foramen.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 12
Incorrect
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A 55 year old man presented with a 4 day history of cough and fever. His sputum culture showed the presence of Strep pneumoniae. Which of the following substances produced by the inflammatory cells will result in effective clearance of this organism from the lung parenchyma?
Your Answer: Prostaglandins
Correct Answer: Hydrogen peroxide
Explanation:Hydrogen peroxide is produced by myeloperoxidase to form a potent oxidant that eliminates bacteria, but is not effective in chronic granulomatous diseases.
Platelet activating factor will lead to the activation, adhesion and aggregation of platelets but will not directly kill bacteria.
Prostaglandins cause vasodilation but do not activate neutrophils.
Kallikrein promotes formation of bradykinin that leads to vasodilation.
Leukreines increase vascular permeability.
Cytokines are communicating molecules between immune cells but directly will not kill bacteria.
Interleukins will regulate the immune response.
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This question is part of the following fields:
- Inflammation & Immunology; Respiratory
- Pathology
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Question 13
Incorrect
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Injury to this nerve will result to the loss of general sensory innervation of the lacrimal gland:
Your Answer: Maxillary 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 14
Incorrect
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During gastrectomy, the operating surgeon ligates the short gastric arteries along the greater curvature of the stomach. Where do the short gastric arteries branch from?
Your Answer: Superior mesenteric artery
Correct Answer: Splenic artery
Explanation:Short gastric arteries arise from the splenic artery at the end or from its terminal divisions. They are about 5 or 7 in number, passing from the left to the right in between the layers of the gastrosplenic ligament to be distributed along 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 15
Incorrect
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Extracellular body fluid as compared with intracellular body fluid:
Your Answer: Has greater volume
Correct Answer: Is relatively rich in glucose
Explanation:The percentages of body water contained in various fluid compartments add up to total body water (TBW). This water makes up a significant fraction of the human body, both by weight and by volume. Ensuring the right amount of body water is part of fluid balance, an aspect of homeostasis. The extracellular fluid (ECF) includes all fluids outside the cells. This fluid can be divided into three fluid departments: interstitial (in the tissue spaces) fluid, blood plasma and lymph, and specialised compartments called transcellular fluid. The extracellular fluid surrounds all the cells in the body and is in equilibrium with the intracellular fluid. So, its composition must remain fairly constant even though substances are passing into and out of the cells. The interstitial fluid, though called a fluid, is in a reality a gel-like composition made up of: water, proteoglycan molecules and collagen. The extracellular fluid constitutes 40% of total body water, with intracellular fluid making up the remaining 60%. It is relatively rich in glucose.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 16
Incorrect
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On exploration of an axillary wound, a branch from the third part of the axillary artery was found to be transected. Which of the following arteries would have been likely injured?
Your Answer: Superior thoracic
Correct Answer: Anterior circumflex humeral
Explanation:The axillary artery gives off many branches from the first, second, or third parts along its course. The third part of the axillary artery gives off 3 branches: the subscapular, anterior and posterior circumflex humeral arteries.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 17
Incorrect
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A CT-scan of the lung shows a tumour crossing the minor (horizontal) fissure. This fissure separates:
Your Answer: The lower lobe from the lingula
Correct Answer: The middle lobe from the upper lobe
Explanation:The horizontal fissure separates the upper lobe from the middle lobe. The oblique fissure on the other hand separates the lower lobe from both the middle and upper lobes. The lingula is found only on the left lung.
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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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One sensitive indicator of heavy alcohol dependence is:
Your Answer: Decreased serum alkaline phosphatase
Correct Answer: Elevated serum gamma-glutamyl transpeptidase
Explanation:Elevated serum gamma-glutamyl transpeptidase (GGT) may be the only laboratory abnormality in patients who are dependent on alcohol. Heavy drinkers may also have an increased MCV.
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This question is part of the following fields:
- Hepatobiliary
- Physiology
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Question 19
Incorrect
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An 18 -year-old female is diagnosed with folliculitis in the left axilla. What is the most likely organism that could cause this condition?
Your Answer: Klebsiella species
Correct Answer: Staphylococcus aureus
Explanation:Folliculitis is the inflammation of the hair follicles. It is usually caused by Staphylococcus infection.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 20
Incorrect
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The fundus of the stomach receives blood supply from the same artery as the greater curvature of the stomach. Which of the following arteries when ligated will disrupt blood supply to the fundus of the stomach through this artery?
Your Answer: Superior mesenteric
Correct Answer: Splenic
Explanation:The fundus of the stomach along with the greater curvature of the stomach receive blood supply from the short gastric artery. The short gastric artery arises from the end of the splenic artery. The ligation of the splenic artery therefore would cause a disruption of blood supply to the fundus of the stomach.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 21
Incorrect
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A gymnast was admitted to hospital for investigation of a weakness in the extension and adduction of his arm. He had a previous penetrating wound in the area of the posterior axillary fold. Which of these muscles is the likely cause?
Your Answer: Rhomboideus major
Correct Answer: Latissimus dorsi
Explanation:All the criteria of this case points towards the latissimus dorsi. This muscle is greatly involved in extension, adduction and medial rotation of the arm and forms the posterior axillary fold which in this case was injured.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 22
Incorrect
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Different substances have different renal clearance rates. Which of the following substances should have the lowest renal clearance rate in a healthy patient?
Your Answer: Water
Correct Answer: Glucose
Explanation:Under normal conditions the renal clearance of glucose is zero, since glucose is completely reabsorbed in the renal tubules and not excreted. Glycosuria – the excretion of glucose into the urine- is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 23
Correct
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The thyroid gland is a large ductless gland located in which part of the neck?
Your Answer: Visceral space
Explanation:The thyroid gland is an endocrine gland in the neck, consisting of two lobes connected by an isthmus. It is situated at the front and sides of the neck in the visceral space.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 24
Incorrect
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Which of the given options best describes the metabolic changes which occur following a severe soft tissue injury sustained after a PVA?
Your Answer: Protein anabolism
Correct Answer: Mobilisation of fat stores
Explanation:The following metabolic responses occur following trauma as part of a coping mechanism for the additional stress. These include acid base changes (metabolic acidosis or alkalosis), decrease urine output and osmolality, reduced basal metabolic rate (BMR), gluconeogenesis with amino acid breakdown and shunting, hyponatraemia as a result of impaired functioning of sodium pumps, hypoxic injury, coagulopathies, decreased immunity, increase extracellular fluid and hypovolemic shock, increase permeability leading to oedema, break down and mobilization of fat reserves, pyrexia and reduced circulating levels of albumin.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 25
Correct
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A 48-year-old man smoker presented to the doctor complaining of a persistent cough and shortness of breath. A chest X-ray indicated the presence of a right upper lung mass. Biopsy of the mass revealed the presence of pink cells with large, irregular nuclei. What is the most probable diagnosis?
Your Answer: Squamous cell carcinoma
Explanation:Squamous cell carcinoma, is a type of non-small cell lung cancer that accounts for approximately 30% of all lung cancers. The presence of squamous cell carcinoma is often related with a long history of smoking and the presence of persistent respiratory symptoms. Chest radiography usually shows the presence of a proximal airway lesion. Histological findings include keratinisation that takes the form of keratin pearls with pink cytoplasm and cells with large, irregular nuclei.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 26
Incorrect
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A cerebellar tremor can be differentiated from a Parkinsonian tremor in that:
Your Answer: It is present at rest
Correct Answer: It only occurs during voluntary movements
Explanation:Cerebellar disease leads to intention tremors, which is absent at rest and appears at the onset of voluntary movements. In comparison, Parkinson’s tremor is present at rest. Frequency of tremor is a less reliable means to differentiate between the two as the oscillation amplitude of the tremor is not constant throughout a voluntary action.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 27
Incorrect
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A specialist registrar was performing the bi-lateral surgical removal of the adrenal glands. He first removed the left adrenal gland before moving on to the right one. However, the registrar noticed that the removal of the right adrenal gland would be a challenge because of an overlying structure. What was this structure that overlies the right suprarenal glad?
Your Answer: Right renal artery
Correct Answer: Inferior vena cava
Explanation:The adrenal glands or the suprarenal glands are small glands that are found on top of each of the kidneys. They are retroperitoneal glands. The right adrenal gland is found on top of the right kidney and is closely associated with the inferior vena cava as it directly drains into this large vein. In the case where the right adrenal gland is to be surgically removed, the inferior vena cava might prove a problem to manoeuvre as it overlies the right suprarenal gland. The other blood vessels such as the aorta, right renal, superior mesenteric, splenic artery and the hepatic vein as well as the right crus are not closely associated with either of the suprarenal glands.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 28
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 29
Incorrect
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What is the name of the cutaneous branch of the posterior primary ramus of C2?
Your Answer: Lesser occipital nerve
Correct Answer: Greater occipital nerve
Explanation:The dorsal primary ramus of the spinal nerve C2 is the greater occipital nerve which provides cutaneous innervation to the skin of the back of the head. The ventral primary ramus gives off the great auricular nerve, the lesser occipital nerve and the ansa cervicalis.
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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 cyclist fell and sustained a laceration to his elbow which was shortly sutured in the emergency department. Which of the following factors will aid in the wound healing process?
Your Answer:
Correct Answer: Presence of sutures
Explanation:Foreign bodies including sutures will delay wound healing, however due to the net affect being helpful they are used. Secondary wound infection will delay healing and is a potential post op complication. Corticosteroids depresses the wound healing ability of the body. Poor nutrition will also delay healing leading to decreased albumin, vit D and vit C. Diabetic patients with atherosclerosis with poor perfusion of tissues have notoriously delayed/poor healing.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
