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  • Question 1 - The primary motor cortex is located in the: ...

    Incorrect

    • The primary motor cortex is located in the:

      Your Answer: Sylvian fissure

      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).

    • This question is part of the following fields:

      • Neurology
      • Physiology
      8.6
      Seconds

  • Question 2 - What is the arterial sequence for an analgesic to reach the latissimus dorsi...

    Incorrect

    • What is the arterial sequence for an analgesic to reach the latissimus dorsi muscle assuming that your starting point is at the subclavian vein?

      Your Answer:

      Correct Answer: Subclavian – axillary – subscapular – thoracodorsal

      Explanation:

      Assuming our starting point is the subclavian artery, the analgesic continues in the same vessel into the axillary artery, as it passes into the axilla. The axillary artery at the lower border of the subscapularis gives rise to the subcapsular artery which is considered the largest branch of the axillary artery. This circumflex scapular branch distributes a serratus branch before entering the substance of the muscle as the thoracodorsal artery.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 3 - An old woman complains of a lack of sensation halfway down the anterior...

    Incorrect

    • An old woman complains of a lack of sensation halfway down the anterior surface of the thigh. The cause of this:

      Your Answer:

      Correct Answer: Would result from damage to the nerve that innervates the pectineus muscle

      Explanation:

      The pectineus is supplied by the second, third and fourth lumbar nerves through the femoral nerve and by the third lumbar through the accessory obturator when it exists. The anterior surface of the thigh receives its innervation from the femoral nerve as well, thus this is the nerve most likely to be injured

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 4 - A suspected recreational drug user was brought to the Emergency department in an...

    Incorrect

    • A suspected recreational drug user was brought to the Emergency department in an unconscious state, and was found to be hypoventilating. Which of the following set of arterial blood gas analysis report is most consistent with hypoventilation as the primary cause? pH, pa(CO2) (mmHg), pa(O2) (mmHg).

      Your Answer:

      Correct Answer: 7.28, 55, 81

      Explanation:

      Hypoventilation (or respiratory depression) causes an increase in carbon dioxide (hypercapnia) and respiratory acidosis. It can result due to drugs such as alcohol, benzodiazepines, barbiturates, opiates, mechanical conditions or holding ones breath. Strong opioids such as heroin and fentanyl are commonly implicated and can lead to respiratory arrest. In recreational drug overdose, acute respiratory acidosis occurs with an increase in p(CO2) over 45 mm Hg and acidaemia (pH < 7.35)

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
      Seconds

  • Question 5 - After a car accident, a 30-year-old woman is alert and only has minor,...

    Incorrect

    • After a car accident, a 30-year-old woman is alert and only has minor, superficial injuries. 2 hours later, she becomes unconscious and a CT scan reveals a convex, lens-shaped haemorrhage over the right parietal region. The most likely diagnosis is:

      Your Answer:

      Correct Answer: Epidural haematoma

      Explanation:

      Epidural haematomas are usually caused by arterial bleeding, classically due to damage to the middle meningeal artery by a temporal bone fracture. Symptoms develop within minutes to several hours after the injury and consist of increasing headache, decreased level of consciousness, hemiparesis and pupillary dilation with loss of light reactivity. Around 15–20% of epidural hematomas are fatal.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      0
      Seconds

  • Question 6 - Renin is secreted by pericytes in the vicinity of the afferent arterioles of the...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Physiology
      • Renal
      0
      Seconds

  • Question 7 - Which statement is correct regarding coagulation? ...

    Incorrect

    • Which statement is correct regarding coagulation?

      Your Answer:

      Correct Answer: Thrombin converts fibrinogen to fibrin

      Explanation:

      Coagulation of blood is a complex process and an important part of haemostasis. There are two main pathways related to coagulation: the contact activation pathway/intrinsic pathway and tissue factor/extrinsic pathway. The extrinsic pathway is activated by external trauma that causes blood to escape from the vascular system. This pathway is quicker than the intrinsic pathway and involves factor VII. The intrinsic pathway is activated by trauma inside the vascular system, and initiated by platelets, exposed endothelium, chemicals, or collagen. This pathway is slower than the extrinsic pathway, but more important. It involves factors XII, XI, IX, VIII. Both pathways meet to finish the formation of a clot in what is known as the common pathway. The common pathway involves factors I, II, V, and X. They converge on the common pathway in which activation of prothrombin to thrombin leads to conversion of fibrinogen to fibrin and clot formation.

    • This question is part of the following fields:

      • General
      • Physiology
      0
      Seconds

  • Question 8 - A 55 year old lady underwent an uneventful appendicectomy. Two hours later, her...

    Incorrect

    • A 55 year old lady underwent an uneventful appendicectomy. Two hours later, her arterial blood gas analysis on room revealed pH: 7.30, p(CO2): 53 mmHg and p(O2): 79 mmHg. What is the most likely cause of these findings?

      Your Answer:

      Correct Answer: Alveolar hypoventilation

      Explanation:

      In the given problem, there is respiratory acidosis due to hypercapnia from a low respiratory rate and/or volume (hypoventilation). Causes of hypoventilation include conditions impairing the central nervous system (CNS) respiratory drive, impaired neuromuscular transmission and other causes of muscular weakness (drugs and sedatives), along with obstructive, restrictive and parenchymal pulmonary disorders. Hypoventilation leads to hypoxia and hypercapnia reduces the arterial pH. Severe acidosis leads to pulmonary arteriolar vasoconstriction, systemic vascular dilatation, reduced myocardial contractility, hyperkalaemia, hypotension and cardiac irritability resulting in arrhythmias. Raised carbon dioxide concentration also causes cerebral vasodilatation and raised intracranial pressure. Over time, buffering and renal compensation occurs. However, this might not be seen in acute scenarios where the rise in p(CO2) occurs rapidly.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
      Seconds

  • Question 9 - Which tumour occurs in young adults, affecting the epiphyses of the bones and...

    Incorrect

    • Which tumour occurs in young adults, affecting the epiphyses of the bones and sometimes extending to the soft tissues?

      Your Answer:

      Correct Answer: Benign giant-cell tumour

      Explanation:

      Benign giant-cell tumours tend to affect adults in their twenties and thirties, occur in the epiphyses and can erode the bone and extend into the soft tissues. These tumours have a strong tendency to recur.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      0
      Seconds

  • Question 10 - During gastrectomy, the operating surgeon ligates the short gastric arteries along the greater...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 11 - A 27-year-old woman has chronic low serum calcium levels. Which of the following...

    Incorrect

    • A 27-year-old woman has chronic low serum calcium levels. Which of the following conditions may be responsible for the hypocalcaemia in this patient?

      Your Answer:

      Correct Answer: Hypoparathyroidism

      Explanation:

      Chronic hypocalcaemia is mostly seen in patients with hypoparathyroidism as a result of accidental removal or damage to parathyroid glands during thyroidectomy.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Pathology
      0
      Seconds

  • Question 12 - A 47-year old-woman diagnosed with pancreatitis presented to the emergency department complaining of...

    Incorrect

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

      Your Answer:

      Correct Answer: Adult respiratory distress syndrome

      Explanation:

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

    • This question is part of the following fields:

      • Pathology
      • Respiratory
      0
      Seconds

  • Question 13 - Which of the following is a fact worth noting about the development of...

    Incorrect

    • Which of the following is a fact worth noting about the development of the spleen?

      Your Answer:

      Correct Answer: It develops in the dorsal mesogastrium

      Explanation:

      The spleen in the human embryo arises in week 5 of intrauterine life. It appears as a proliferating mesenchyme above the pancreas. The spleen is one the organs that develops in the dorsal mesogastrium. When the stomach changes its position during development, the spleen is made to move behind the stomach and stays in contact with the left kidney. The spleen is found within the peritoneum of the abdominal cavity thus it is an intraperitoneal organ.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 14 - Thalamic syndrome will most likely result in: ...

    Incorrect

    • Thalamic syndrome will most likely result in:

      Your Answer:

      Correct Answer: Hyperaesthesia

      Explanation:

      Signs and symptoms of thalamic syndrome include contralateral hemi anaesthesia, burning or aching sensation in one half of a body (hyperaesthesia), often accompanied by mood swings.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 15 - A young women following a road traffic accident suffered heavy blood loss and...

    Incorrect

    • A young women following a road traffic accident suffered heavy blood loss and developed subsequent anaemia. Which of the following is a consequence of this?

      Your Answer:

      Correct Answer: A high reticulocyte count

      Explanation:

      Anaemia refers to a decrease in the circulating levels of haemoglobin in the blood resulting in a reduced ability of the body to transport oxygen effectively. Anaemia from blood loss results in the body further compensating by releasing stored RBCs and immature RBCs from the bone marrow. Thus resulting in a high reticulocyte count.

    • This question is part of the following fields:

      • General
      • Physiology
      0
      Seconds

  • Question 16 - Where is the mental foramen located? ...

    Incorrect

    • Where is the mental foramen located?

      Your Answer:

      Correct Answer: In the mandible

      Explanation:

      The mental foramen is found bilaterally on the anterior surface of the mandible adjacent to the second premolar tooth. The mental nerve and terminal branches of the inferior alveolar nerve and mental artery leave the mandibular canal through it.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      0
      Seconds

  • Question 17 - Which of the following is true about a patient who has undergone total...

    Incorrect

    • Which of the following is true about a patient who has undergone total colectomy and ileostomy?

      Your Answer:

      Correct Answer: Following total colectomy and ileostomy, the volume and water content of ileal discharge decreases over time

      Explanation:

      After a patient has undergone total colectomy and ileostomy, the volume of ileal discharge, along with its water content gradually decreases over time. Post surgery, most patients can live a normal life. Iron and vitamin B12 absorption do not take place in the colon and hence are not affected significantly by a colectomy.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      0
      Seconds

  • Question 18 - The nutcracker effect of the alimentary canal is described as a nutcracker-like compression...

    Incorrect

    • The nutcracker effect of the alimentary canal is described as a nutcracker-like compression caused by the aorta and the superior mesenteric arteries on a certain section of the alimentary canal leading to bowel obstruction. Which of the following parts of the alimentary canal is usually obstructed by this nutcracker compression of the two arteries?

      Your Answer:

      Correct Answer: Duodenum

      Explanation:

      The ‘nutcracker effect’ is only seen in one part of the alimentary canal, and that is in the third part of the duodenum. This can happen when the superior mesenteric artery that passes across the duodenum and the aorta, posteriorly to the third part of the duodenum enlarges and starts compressing the duodenum. The result is an obstructed duodenum that inhibits passage of food.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 19 - Osteomyelitis is most commonly caused by which microbe in adults? ...

    Incorrect

    • Osteomyelitis is most commonly caused by which microbe in adults?

      Your Answer:

      Correct Answer: Staphylococcus aureus

      Explanation:

      Osteomyelitis is most commonly caused by S. aureus in all age groups.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      0
      Seconds

  • Question 20 - Which of the following is the most accurate test for the diagnosis of...

    Incorrect

    • Which of the following is the most accurate test for the diagnosis of primary syphilis?

      Your Answer:

      Correct Answer: Dark-field microscopy

      Explanation:

      Primary syphilis is transmitted via sexual contact. Lesions on genitalia, called a chancre occur after an asymptomatic incubation period of 10-90 days (average 21 days) after exposure. This chancre is a typically solitary (can be multiple), firm, painless, ulceration over the skin at the point of exposure to spirochete, seen on penis, vagina or rectum. It heals spontaneously after 4-6 weeks. Local lymphadenopathy can be seen.

      Diagnosis is made by microscopy of fluid from lesion using dark-field illumination, taking care to not confuse with other treponemal disease. Screening tests include rapid plasma regain (RPR) and Venereal Diseases Research Laboratory (VDRL) tests. False positives are known to occur with these tests and can be seen in viral infections like hepatitis, varicella, Epstein-Barr virus, tuberculosis, lymphoma, pregnancy and IV drug use. More specific tests should therefore be carried out in case these screening tests are positive.

      The Treponema pallidum hemagglutination assay (TPHA) and the fluorescent treponemal antibody absorption (FTAABS) test are based on monoclonal antibodies and immunofluorescence and are more specific. However, they can too show false positives with other treponemal diseases like yaws or pinta. Other confirmatory tests include those based on enzyme-linked immunoassays.

    • This question is part of the following fields:

      • Pathology
      • Urology
      0
      Seconds

  • Question 21 - Paracentesis of ascetic fluid in a 45-year old woman revealed the following :...

    Incorrect

    • Paracentesis of ascetic fluid in a 45-year old woman revealed the following : clear, yellow fluid with protein 2.0 g/dl and a few mesothelial and mononuclear cells seen. No malignant cells seen. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Cirrhosis

      Explanation:

      Ascites develops either from:

        • Increased  accumulation
          • Increased capillary permeability
          • Increased venous pressure
          • Decreased protein (oncotic pressure)
        • Decreased clearance
          • Increased lymphatic obstruction

      Cause

      • Transudate (<30g/L protein) (Systemic disease)
        • Liver (Cirrhosis)
        • Cardiac e.g. RHF, CCF, SBE right heart valve disease and constrictive Pericarditis
        • Renal failure
        • Hypoalbuminaemia (nephrosis)
      • Exudate (>30g/L protein) (Local disease)
        • Malignancy
        • Venous obstruction e.g. Budd-Chiari, Schistosomiasis
        • Pancreatitis
        • Lymphatic obstruction
        • Infection (especially TB)

      Cirrhosis is disease of the liver that is characterized by fibrosis leading to disorganization of the hepatic architecture. It shows the development of regenerative nodules surrounded by dense fibrotic tissue. Cirrhosis shows non-specific symptoms initially, which include fatigue, anorexia and weight loss. It can later progress to portal hypertension, ascites and liver failure.

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
      0
      Seconds

  • Question 22 - Rapid eye movement (REM) sleep is likely to be affected by a lesion...

    Incorrect

    • Rapid eye movement (REM) sleep is likely to be affected by a lesion in the:

      Your Answer:

      Correct Answer: Pons

      Explanation:

      Rapid eye movement (REM) sleep is also known as paradoxical sleep, as the summed activity of the brain’s neurons is quite similar to that during waking hours. Characterised by rapid movements of the eyes, most of the vividly recalled dreams occur during this stage of sleep. The total time of REM sleep for an adult is about 90–120 min per night.

      Certain neurones in the brainstem, known as REM sleep-on cells, which are located in the pontine tegmentum, are particularly active during REM sleep and are probably responsible for its occurrence. The eye movements associated with REM are generated by the pontine nucleus with projections to the superior colliculus and are associated with PGO (pons, geniculate, occipital) waves.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 23 - A 35 year-old female developed food poisoning 24H after eating canned food. She...

    Incorrect

    • A 35 year-old female developed food poisoning 24H after eating canned food. She complained of abdominal cramps, with nausea and vomiting. Shortly after she suddenly developed weakness, blurring of vision, difficulty in swallowing and breathing. Which of the following organisms is most likely associated with fatal food poisoning?

      Your Answer:

      Correct Answer: Clostridium botulinum

      Explanation:

      C. botulinum is a Gram-positive, rod-shaped, spore-forming bacterium. It is an obligate anaerobe, meaning that oxygen is poisonous to the cells. Only botulinum toxin types A, B, E, and F cause disease in humans. Types A, B, and E are associated with foodborne illness. Botulism poisoning can occur due to preserved or home-canned, low-acid food that was not processed using correct preservation times and/or pressure. Signs and symptoms of foodborne botulism typically begin between 18 and 36 hours after the toxin gets into the body, but can range from a few hours to several days, depending on the amount of toxin ingested. Botulinum that is produced by Clostridium botulinum can cause respiratory and muscular paralysis.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      0
      Seconds

  • Question 24 - Which of the following is the most common germ cell tumour of the...

    Incorrect

    • Which of the following is the most common germ cell tumour of the testis affecting an adult male?

      Your Answer:

      Correct Answer: Seminoma

      Explanation:

      Germ cell tumours represent 90% of primary tumours arising in the testis. They are broadly divided into seminomas and non-seminomas. Seminomas are the most common testicular germ cell tumour seen in 40% cases. The other non-seminomatous histological subtypes include embryonal (25%), teratocarcinoma (25%), teratoma (5%) and pure choriocarcinoma (1%).

    • This question is part of the following fields:

      • Pathology
      • Urology
      0
      Seconds

  • Question 25 - A 77-year-old woman's renal function is tested. The following results were obtained during...

    Incorrect

    • A 77-year-old woman's renal function is tested. The following results were obtained during a 24-h period:

      Urine flow rate: 2. 0 ml/min

      Urine inulin: 0.5 mg/ml

      Plasma inulin: 0.02 mg/ml

      Urine urea: 220 mmol/l

      Plasma urea: 5 mmol/l.

      What is the urea clearance?

      Your Answer:

      Correct Answer: 88 ml/min

      Explanation:

      Urea is reabsorbed in the inner medullary collecting ducts of the nephrons. The clearance (C) of any substance can be calculated as follows: C = (U × V)/P, where U and P are the urine and plasma concentrations of the substance, respectively and V is the urine flow rate. So, glomerular filtration rate = (0.220 × 2. 0)/0.005 = 88 ml/min.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      0
      Seconds

  • Question 26 - Coagulation in the body (in vivo) is a process in which several proteins...

    Incorrect

    • Coagulation in the body (in vivo) is a process in which several proteins known as coagulation factors are activated in a cascade effect to stop bleeding. Which of the following initiates this cascade effect?

      Your Answer:

      Correct Answer: Tissue factor

      Explanation:

      Tissue factor (TF), also known as ‘factor III’ or ‘thromboplastin’, is an anti-coagulation protein that initiates the extrinsic coagulation. TF acts as a transmembrane receptor for Factor VII/VIIa . It is expressed by endothelial cells but also certain tissues, such as the heart and brain.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      0
      Seconds

  • Question 27 - Routine evaluation of a 38 year old gentleman showed a slightly lower arterial...

    Incorrect

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

      Your Answer:

      Correct Answer: Is normal and due to shunted blood

      Explanation:

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

    • This question is part of the following fields:

      • Physiology
      • Respiratory
      0
      Seconds

  • Question 28 - A 27-year old lady presented with dull, abdominal pain and some pain in...

    Incorrect

    • A 27-year old lady presented with dull, abdominal pain and some pain in her lower limbs. On enquiry, it was revealed that she has been suffering from depression for a few months. Physical examination and chest X-ray were normal. Further investigations revealed serum calcium 3.5 mmol/l, albumin 3.8 g/dl and phosphate 0.65 mmol/l. What is the diagnosis?

      Your Answer:

      Correct Answer: Parathyroid adenoma

      Explanation:

      Hypercalcaemia with hypophosphatemia indicates parathyroid disorder and adenomas are more common than hyperplasia. In this young age group, metastatic disease is unlikely. Solitary adenomas are responsible for 80-85% cases of primary hyperparathyroidism. 10-15% cases are due to parathyroid hyperplasia and carcinomas account for 2-3% cases. Symptoms include bone pain (bones), nephrolithiasis (stones), muscular aches, peptic ulcer disease, pancreatitis (groans), depression (moans), anxiety and other mental disturbances.

    • This question is part of the following fields:

      • Endocrine
      • Pathology
      0
      Seconds

  • Question 29 - A 45 year old female had a stroke and was diagnosed with a...

    Incorrect

    • A 45 year old female had a stroke and was diagnosed with a homonymous hemianopsia. Which of the following structures was likely affected?

      Your Answer:

      Correct Answer: Optic radiation

      Explanation:

      Hemianopia or hemianopsia, is the loss of vision of half of the eye or loss of half the visual field. Homonymous hemianopia is the loss of vision or blindness on half of the same side of both eyes (visual field) – either both lefts of the eyes or both rights of the eyes. This condition is mainly caused by cerebrovascular accidents like a stroke that affects the optic radiation.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      0
      Seconds

  • Question 30 - Which of the following arteries branch from the deep femoral artery and course...

    Incorrect

    • Which of the following arteries branch from the deep femoral artery and course between the pectineus and iliopsoas muscles?

      Your Answer:

      Correct Answer: Medial femoral circumflex

      Explanation:

      The medial femoral circumflex artery is an artery in the upper thigh that supplies blood to the head and neck of the femur. It arises from the deep femoral artery and winds around the medial side of the femur. It passes first between pectineus and psoas major, and then between obturator externus and adductor brevis.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 31 - A 33-year old lady presented to the gynaecology clinic with amenorrhoea for 6...

    Incorrect

    • A 33-year old lady presented to the gynaecology clinic with amenorrhoea for 6 months and a recent-onset of milk discharge from her breasts. She was not pregnant or on any medication. On enquiry, she admitted to having frequent headaches the last 4 months. Which of the following findings would you expect to see in her condition?

      Your Answer:

      Correct Answer: Hyperprolactinaemia

      Explanation:

      Excessively high levels of prolactin in the blood is called hyperprolactinaemia. Normally, prolactin levels are less than 580 mIU/l in females and less than 450 mIU/l in men. The biologically inactive macroprolactin can lead to a false high reading. However, the patient remains asymptomatic. Dopamine down-regulates prolactin whereas oestrogen upregulates it. Hyperprolactinaemia can be caused due to lack of inhibition (compression of pituitary stalk or low dopamine levels), or increased production due to a pituitary adenoma (prolactinoma). Either of these causes can lead to a prolactin level of 1000-5000 mIU/l. However, levels more than 5000mIU/l are usually associated due to an adenoma and >100,000 mIU/l are seen in macroadenomas (tumours < 1cm in diameter). Increased prolactin causes increased dopamine release from the arcuate nucleus of hypothalamus. This increased dopamine in turn, inhibits the GnRH (Gonadotrophin Releasing Hormone) thus blocking gonadal steroidogenesis resulting in the symptoms of hyperprolactinaemia. In women, it includes hypoestrogenism, anovulatory infertility, decreased or irregular menstruation or complete amenorrhoea. It can even cause production of breast milk, loss of libido, vaginal dryness and osteoporosis. In men, the symptoms include impotence, decreased libido, erectile dysfunction and infertility. In men, treatment can be delayed due to late diagnosis as they have no reliable indicator such as menstruation that might indicate a problem. Most of the male patients seek help only when headaches and visual defects start to surface.

    • This question is part of the following fields:

      • Endocrine
      • Pathology
      0
      Seconds

  • Question 32 - An abnormal opening of the urethra on the under surface of the penis...

    Incorrect

    • An abnormal opening of the urethra on the under surface of the penis (ventral surface) is known as:

      Your Answer:

      Correct Answer: Hypospadias

      Explanation:

      Hypospadias is the condition where the urethra opens along the underside or ventral aspect of penile shaft. First-degree hypospadias is seen in 50-75% cases, where the urethra open on the glans penis. Second-degree hypospadias is seen in 20% cases where the urethra opens on the shaft, and third-degree in 30% cases with the urethra opening on the perineum. The severe cases are usually associated with undescended testis (cryptorchidism) or chordee, where the penis is tethered downwards and not completely separated from the perineum.

      It is a common male genital birth defect but varying incidences are noted in different countries. There is no obvious inheritance pattern noted. No exact cause has been determined, however several hypotheses include poor response to androgen, or interference by environmental factors.

    • This question is part of the following fields:

      • Pathology
      • Urology
      0
      Seconds

  • Question 33 - During an appendicectomy in a 16 year old girl, the registrar initially did...

    Incorrect

    • During an appendicectomy in a 16 year old girl, the registrar initially did not find the appendix on entering the peritoneal cavity. She, however, remained calm as she knew she could find it by:

      Your Answer:

      Correct Answer: Looking at the confluence of the taenia coli

      Explanation:

      The vermiform appendix arises from the apex of the caecum. Although it has a constant base, it can pass in one of several directions such as upward behind the caecum, to the left behind the ileum and mesentery or downward into the lesser pelvis. It is retained in place by a peritoneal fold, the mesoenteriole derived from the left leaf of the mesentery. Taenia coli meet at the appendix which is the terminal portion of the caecum. The appendix is below the ileocecal valve, not above. It is not near the right colic artery (which supplies the ascending colon). It would not be found by removing a layer of the jejuno-ileum and is not in the pelvic brim.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 34 - An elderly, diabetic man has firm, tender nodules at the base of his...

    Incorrect

    • An elderly, diabetic man has firm, tender nodules at the base of his left middle and ring fingers, which he can't extend fully. What's the most likely diagnosis?

      Your Answer:

      Correct Answer: Fibromatosis

      Explanation:

      This case is suggestive of Dupuytren’s contracture due to palmar fibromatosis. Its incidence is higher in men over the age of 45 years, and it increases in patients with diabetes, alcoholism, or epilepsy. These nodules are benign, usually appearing as a tender nodule in the palm which becomes painless. The disease has an aggressive clinical behaviour and recurs frequently.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      0
      Seconds

  • Question 35 - Which nodes are most likely to be enlarged in a patient complaining of...

    Incorrect

    • Which nodes are most likely to be enlarged in a patient complaining of a boil located on the labia majora?

      Your Answer:

      Correct Answer: Superficial inguinal

      Explanation:

      The perineum, external genitalia, the labia majora and scrotum drain to the superficial inguinal lymph nodes. In a man, the testes do not drain to the superficial inguinal lymph nodes but rather travel in the spermatic cord and drain into the lumbar nodes. The lumbar nodes drain the internal pelvic organs. The sacral nodes drain the prostrate gland, uterus, vagina, rectum and posterior pelvic wall and the external iliac nodes in turn drain the lower limb. The internal iliac nodes drain the pelvis and gluteal region.

    • This question is part of the following fields:

      • Anatomy
      • Pelvis
      0
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  • Question 36 - The renal tubule is the portion of the nephron that contains the fluid...

    Incorrect

    • The renal tubule is the portion of the nephron that contains the fluid that has been filtered by the glomerulus. Which of the following substances is actively secreted into the renal tubules?

      Your Answer:

      Correct Answer: Potassium

      Explanation:

      The renal corpuscle filters out solutes from the blood, delivering water and small solutes to the renal tubule for modification. In normal circumstances more than 90% of the filtered load of K is reabsorbed by the proximal tubules and loops of Henlé and almost all K appearing in the urine has been secreted by the late distal tubules and collecting tubules. So the rate of excretion is usually independent of the rate of filtration, but is closely tied to the rate of secretion and control of K excretion, largely accomplished by control of the secretion rate. Around 65–70% of the filtered potassium is reabsorbed along with water in the proximal tubule and the concentration of potassium in the tubular fluid varies little from that of the plasma.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      0
      Seconds

  • Question 37 - A 65-year-old man complains of headaches, weakness, cramps, and confusion; blood tests reveal...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      0
      Seconds

  • Question 38 - The muscle that forms the posterior wall of the axilla along with the...

    Incorrect

    • The muscle that forms the posterior wall of the axilla along with the scapula, subscapularis muscle and teres major muscle is the?

      Your Answer:

      Correct Answer: Latissimus dorsi

      Explanation:

      The latissimus dorsi forms the posterior wall of the axilla along with the scapula. It is responsible for extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and (medial) internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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      Seconds

  • Question 39 - A 60-year-old male who was admitted due to cerebrovascular disease on his 5th...

    Incorrect

    • A 60-year-old male who was admitted due to cerebrovascular disease on his 5th hospital stay developed pneumonia. The most likely organism that causes hospital acquired pneumonia is pseudomonas aeruginosa. What is the most likely mechanism for the pathogenesis on pseudomonas infection?

      Your Answer:

      Correct Answer: Exotoxin

      Explanation:

      Pseudomonas aeruginosa is a common Gram-negative, rod-shaped bacterium that can cause disease in plants and animals, including humans. It is citrate, catalase, and oxidase positive. P. aeruginosa uses the virulence factor exotoxin A to inactivate eukaryotic elongation factor 2 via ADP-ribosylation in the host cell, much the same as the diphtheria toxin does. Without elongation factor 2, eukaryotic cells cannot synthesize proteins and necrotise. The release of intracellular contents induces an immunologic response in immunocompetent patients.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      0
      Seconds

  • Question 40 - If a patient takes long-term corticosteroid therapy, which of the following diseases is...

    Incorrect

    • If a patient takes long-term corticosteroid therapy, which of the following diseases is most likely to develop?

      Your Answer:

      Correct Answer: Osteoporosis

      Explanation:

      One of the complications of long-term intake of corticosteroids is osteoporosis. Some guidelines recommend prophylactic calcium and vitamin D supplementation in patients who take more than 30 mg hydrocortisone or 7.5 mg of prednisolone daily.

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      0
      Seconds

  • Question 41 - When a penile tumour invades the subepithelial connective tissue of the penis, what...

    Incorrect

    • When a penile tumour invades the subepithelial connective tissue of the penis, what is its stage?

      Your Answer:

      Correct Answer: T1

      Explanation:

      The TNM staging used for penile cancer is as follows:

      TX: primary tumour cannot be assessed

      T0: primary tumour is not evident

      Tis: carcinoma in situ is present

      Ta: non-invasive verrucous carcinoma is present

      T1: tumour is invading subepithelial connective tissue

      T2: tumour is invading the corpora spongiosum or cavernosum

      T3: tumour invading the urethra or prostate

      T4: tumour invading other adjacent structures.

      In this case, the patient has a T1 tumour.

    • This question is part of the following fields:

      • Pathology
      • Urology
      0
      Seconds

  • Question 42 - A victim of road traffic accident presented to the emergency department with a...

    Incorrect

    • A victim of road traffic accident presented to the emergency department with a blood pressure of 120/90 mm Hg, with a drop in systolic pressure to 100 mm Hg on inhalation. This is known as:

      Your Answer:

      Correct Answer: Pulsus paradoxus

      Explanation:

      Weakening of pulse with inhalation and strengthening with exhalation is known as pulsus paradoxus. This represents an exaggeration of the normal variation of the pulse in relation to respiration. It indicates conditions such as cardiac tamponade and lung disease. The paradox refers to the auscultation of extra cardiac beats on inspiration, as compared to the pulse. Due to a decrease in blood pressure, the radial pulse becomes impalpable along with an increase in jugular venous pressure height (Kussmaul sign). Normal systolic blood pressure variation (with respiration) is considered to be >10 mmHg. It is >100 mmHg in Pulsus paradoxus. It is also predictive of the severity of cardiac tamponade.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 43 - A 26-year old man is brought to the A&E with a stab wound...

    Incorrect

    • A 26-year old man is brought to the A&E with a stab wound to the chest. The wound is in a part of the left lung that might partially fill the costomediastinal recess in full respiration. Where did the weapon strike this man?

      Your Answer:

      Correct Answer: Lingula

      Explanation:

      During full inspiration, the lingual-of the left lung partially fills the costomediastinal recess. If the apex of the lung is fully filled with air, it would occupy the copula (the part of the pleura that extends above the first rib). The hilum is part of the lung where the neurovascular structures that form the root of the lung enter and leave the lung and doesn’t expand on inspiration. The middle lobe can expand to fill the costomediastinal recess, however, the middle lobe is on the right lung. The inferior lobe, during full inspiration, might fill the costodiaphragmatic recess.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
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  • Question 44 - A 50 year old male point was diagnosed with tennis elbow that became...

    Incorrect

    • A 50 year old male point was diagnosed with tennis elbow that became worse after he started playing basket ball over the last three months. He was admitted to the orthopaedic ward to have elbow braces fitted. What type of synovial joint is the elbow joint?

      Your Answer:

      Correct Answer: Hinge

      Explanation:

      The elbow joint is one of the many synovial joints in the body. This joint is an example of the hinge joint as the humerus is received into the semilunar notch of the ulna and the capitulum of the humerus articulates with the fovea on the head of the radius, together acting as a hinge in one plane.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 45 - During cardiac catheterisation, if the blood sample from the catheter shows an oxygen...

    Incorrect

    • During cardiac catheterisation, if the blood sample from the catheter shows an oxygen saturation of 70%, and the pressure ranging from 12 to 24 mm Hg, it implies that the catheter tip is located in the:

      Your Answer:

      Correct Answer: Pulmonary artery

      Explanation:

      Normal values for various parameters are as follows:

      Systolic arterial blood pressure (SBP): 90–140 mmHg.

      Diastolic arterial blood pressure: 60–90 mmHg.

      Mean arterial blood pressure (MAP): SBP + (2 × DBP)/3 (normal range: 70-105 mmHg).

      Right atrial pressure (RAP): 2–6 mmHg.

      Systolic right ventricular pressure (RVSP): 15–25 mmHg.

      Diastolic right ventricular pressure (RVDP): 0–8 mmHg.

      Pulmonary artery pressure (PAP): Systolic (PASP) is 15-25 mmHg and Diastolic (PADP) is 8–15 mmHg.

      Pulmonary artery wedge pressure (PAWP): 6–12 mmHg.

      Left atrial pressure (LAP): 6–12 mmHg.

      Thus, the given value indicates that the position of catheter tip is likely to be in the pulmonary artery.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 46 - Which of the following proteins prevents red blood cells (RBCs) from bursting when...

    Incorrect

    • Which of the following proteins prevents red blood cells (RBCs) from bursting when they pass through capillaries?

      Your Answer:

      Correct Answer: Spectrin

      Explanation:

      Spectrin is a structural protein found in the cytoskeleton that lines the intercellular side of the membrane of cells which include RBCs. They maintain the integrity and structure of the cell. It is arranged into a hexagonal arrangement formed from tetramers of spectrin and associated with short actin filaments that form junctions allowing the RBC to distort its shape.

    • This question is part of the following fields:

      • General
      • Physiology
      0
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  • Question 47 - A neonate is diagnosed with cryptorchidism of the right side (undescended testis). Which...

    Incorrect

    • A neonate is diagnosed with cryptorchidism of the right side (undescended testis). Which is the LEAST likely place to find the testis?

      Your Answer:

      Correct Answer: Perineum

      Explanation:

      Embryologically the testes are retroperitoneal structures in the posterior abdominal wall, attached to the anterolateral abdominal wall by the gubernaculum. The gubernaculum ‘pulls’ the testes through the deep inguinal ring, inguinal canal and superficial inguinal ring and over the pelvic brim. The gubernaculum is preceded by the processus vaginalis that is derived from the peritoneum anterior to the testes. The processus vaginalis pushes the muscle and fascial layers. These eventually make up the canal and the spermatic cord, into the scrotum. The gubernaculum persists as the scrotal ligament while part of the processus vaginalis remains as a bursa-like sac i.e. the tunica vaginalis testes. The testes therefore could be caught in any one of these places along its path of descending. The testes are never in the perineum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 48 - A drug abuser developed an infection which spread from the dorsum of the...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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  • Question 49 - Painful erections along with deviation of the penis to one side when erect...

    Incorrect

    • Painful erections along with deviation of the penis to one side when erect are seen in which of the following conditions?

      Your Answer:

      Correct Answer: Peyronie’s disease

      Explanation:

      Peyronie’s disease leads to development of fibrous plaques in the penile soft tissue and occurs in 1% of men, most commonly affecting white males above 40 years age. It is a connective tissue disorder named after a French surgeon, François de la Peyronie who first described it. Symptoms include pain, hard lesions on the penis, abnormal curvature of erect penis, narrowing/shortening, painful sexual intercourse and in later stages, erectile dysfunction. 30% cases report fibrosis in other elastic tissues such as Dupuytren’s contractures of the hand. There is likely a genetic predisposition as increased incidence is noted among the male relatives of an affected individual.

    • This question is part of the following fields:

      • Pathology
      • Urology
      0
      Seconds

  • Question 50 - The bronchial circulation is a part of the circulatory system that supplies nutrients and oxygen to the pulmonary...

    Incorrect

    • The bronchial circulation is a part of the circulatory system that supplies nutrients and oxygen to the pulmonary parenchyma. What percentage of cardiac output is received by bronchial circulation?

      Your Answer:

      Correct Answer: 2%

      Explanation:

      The bronchial circulation is part of the systemic circulation and receives about 2% of the cardiac output from the left heart. Bronchial arteries arise from branches of the aorta, intercostal, subclavian or internal mammary arteries. The bronchial arteries supply the tracheobronchial tree with both nutrients and O2. It is complementary to the pulmonary circulation that brings deoxygenated blood to the lungs and carries oxygenated blood away from them in order to oxygenate the rest of the body.

    • This question is part of the following fields:

      • Physiology
      • Respiratory
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  • Question 51 - Which of these foramen is located at the base of the skull and...

    Incorrect

    • Which of these foramen is located at the base of the skull and transmits the accessory meningeal artery?

      Your Answer:

      Correct Answer: Foramen ovale

      Explanation:

      At the base of the skull the foramen ovale is one of the larger of the several holes that transmit nerves through the skull. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery, lesser petrosal nerve, a branch of the glossopharyngeal nerve, emissary vein connecting the cavernous sinus with the pterygoid plexus of veins and occasionally the anterior trunk of the middle meningeal vein.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
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  • Question 52 - A 45-year old gentleman presented to the emergency department at 5.00 AM with...

    Incorrect

    • A 45-year old gentleman presented to the emergency department at 5.00 AM with pain in his left flank. The pain began suddenly and presented in waves throughout the night. Urine examination was normal except for presence of blood and few white blood cells. The pH and specific gravity of the urine were also found to be within normal range. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Ureteric calculus

      Explanation:

      A calculus in the ureter, if less than 5mm in diameter is likely to pass spontaneously. However, a larger calculus irritates the ureter and may become lodged, leading to hydroureter and/or hydronephrosis. Likely sites where the calculus might get lodged, include pelviureteric junction, distal ureter at the level of iliac vessels and the vesicoureteric junction. An obstruction can result in reduced glomerular filtration. There can be deterioration in renal function due to hydronephrosis and a raised glomerular pressure, leading to poor renal blood flow. Permanent renal dysfunction usually takes about 4 weeks to occur. Secondary infection can also occur in chronic obstruction.

    • This question is part of the following fields:

      • Pathology
      • Renal
      0
      Seconds

  • Question 53 - Which of the following chemotherapy regimens is most likely to be used in...

    Incorrect

    • Which of the following chemotherapy regimens is most likely to be used in colorectal cancer?

      Your Answer:

      Correct Answer: FOLFOX

      Explanation:

      Chemotherapy regimens are often identified by acronyms, identifying the agents used in the drug combination. However, the letters used are not consistent across regimens. FOLFOX is a chemotherapy regimen used for the treatment of colorectal cancer, made up of the following drugs: • FOL: fluorouracil (5-fluorouracil or 5-FU) • F: folinic acid (leucovorin) • OX: oxaliplatin (Eloxatin®).

    • This question is part of the following fields:

      • Pathology
      • Pharmacology
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  • Question 54 - A 30-year-old woman is diagnosed with Hodgkin's lymphoma. Which of the following chemotherapy...

    Incorrect

    • A 30-year-old woman is diagnosed with Hodgkin's lymphoma. Which of the following chemotherapy regimens would be used in this case?

      Your Answer:

      Correct Answer: ABVD

      Explanation:

      ABVD is a chemotherapy regimen used in the first-line treatment of Hodgkin’s lymphoma. It consists of concurrent treatment with the chemotherapy drugs, adriamycin, bleomycin, vinblastine and dacarbazine. It supplanted the older MOPP protocol.

    • This question is part of the following fields:

      • Pathology
      • Pharmacology
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  • Question 55 - A 40-year old Caucasian male came to the hospital with complaints of fatigue...

    Incorrect

    • A 40-year old Caucasian male came to the hospital with complaints of fatigue and lethargy. On examination, he was found to have raised blood pressure. Urine examination showed >300 mg/dl proteinuria (4+) and 24-hour urine protein 3.5g. No glucose, blood, nitrites, urobilinogen or casts were present in urine. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Membranous glomerulonephritis

      Explanation:

      Membranous glomerulonephritis or nephropathy, is a renal disorder with insidious course and usually affects people aged 30-50 years. 85% cases are primary (or idiopathic). The other 15% are secondary to autoimmune conditions like SLE, infections like malaria or hepatitis B, drugs like captopril and NSAIDs, or malignancies (particularly lung or colonic carcinoma). This disease is caused due to circulating immune complexes which are said to form by binding of antibodies to antigens in glomerular basement membrane. This antigens could be endogenous or derived from systemic circulation. This immune complex triggers the complement system, resulting in formation of membrane attack complex (MAC) on glomerular epithelial cells. This further results in release of proteases and oxidants which damage the capillaries making them ‘leaky’. Moreover, the epithelial cells also secrete a mediator to reduce nephron synthesis and distribution.

    • This question is part of the following fields:

      • Pathology
      • Renal
      0
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  • Question 56 - In which of the following compartments of the femoral sheath is the femoral...

    Incorrect

    • In which of the following compartments of the femoral sheath is the femoral artery located?

      Your Answer:

      Correct Answer: Lateral compartment

      Explanation:

      The femoral sheath also known as the crural sheath is made up of three compartments; lateral, intermediate and the medial. The femoral artery is contained in the lateral compartment of the femoral sheath while the femoral vein is in the intermediate compartment.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 57 - A sudden loud sound is more likely to result in cochlear damage than...

    Incorrect

    • A sudden loud sound is more likely to result in cochlear damage than a slowly developing loud sound. This is because:

      Your Answer:

      Correct Answer: There is a latent period before the attenuation reflex can occur

      Explanation:

      On transmission of a loud sound into the central nervous system, an attenuation reflex occurs after a latent period of 40-80 ms. This reflex contracts the two muscles that pull malleus and stapes closer, developing a high degree of rigidity in the entire ossicular chain. This reduces the ossicular conduction of low frequency sounds to the cochlea by 30-40 decibels. In this way, the cochlea is protected from damage due to loud sounds (these are low frequency sounds) when they develop slowly.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
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  • Question 58 - Which of the given options best describes the metabolic changes which occur following...

    Incorrect

    • Which of the given options best describes the metabolic changes which occur following a severe soft tissue injury sustained after a PVA?

      Your Answer:

      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.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing
      • Pathology
      0
      Seconds

  • Question 59 - What is the linea aspera: ...

    Incorrect

    • What is the linea aspera:

      Your Answer:

      Correct Answer: Serves as an attachment for adductors of the thigh

      Explanation:

      The linea aspera is a prominent longitudinal ridge or crest on the middle third of the femur. It has a medial and a lateral lip and a narrow, rough, intermediate line. The vastus medialis arises from the medial lip of the linea aspera and has superior and inferior prolongations. The vastus lateralis takes origin from the lateral lip . The adductor magnus is inserted into the linea aspera. Two muscles are attached between the vastus lateralis and the adductor magnus: the gluteus maximus is inserted above and the short head of the biceps femoris arises below. Four muscles are inserted between the adductor magnus and the vastus medialis: the iliacus and pectineus superiorly, and the adductor brevis and adductor longus inferiorly.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
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      Seconds

  • Question 60 - A 25 year-old female medical student presents with fever, lack of appetite, rashes,...

    Incorrect

    • A 25 year-old female medical student presents with fever, lack of appetite, rashes, sore throat and lymphadenopathy. Peripheral smear shows atypical lymphocytes. Which is the most likely organism responsible for this patient's condition?

      Your Answer:

      Correct Answer: Epstein–Barr virus

      Explanation:

      Epstein-Barr virus is in the herpes family of viruses and most people will become infected with EBV sometime during their lives. EBV commonly causes infectious mononucleosis, or mono, a contagious viral illness that initially attacks the lymph nodes in the neck and throat. When these tissues become less effective in fighting infection, sore throats, swelling of the nodes and fever may result.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      0
      Seconds

  • Question 61 - Which of the following statements is true regarding the umbilical cord? ...

    Incorrect

    • Which of the following statements is true regarding the umbilical cord?

      Your Answer:

      Correct Answer: Is filled with jelly of Wharton

      Explanation:

      The umbilical cord that connects the fetus to the placenta is about 50cm long. This tissue consists of the body stalk and vitelline duct. The former containing the allantoic diverticulum and the umbilical vessels. The latter contains the connection linking the digestive tube and the yolk sac. This cord is wrapped by stratum of ectoderm and gelatinous tissue or jelly of Wharton. The right umbilical vein plus the vitelline vessels and ducts disappear and this at birth the cord has three vessels which are the umbilical vein and two umbilical arteries.

    • This question is part of the following fields:

      • Anatomy
      • Embryology
      0
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  • Question 62 - Following a bee sting, a women develops a 2cm red, raised, swollen lesion...

    Incorrect

    • Following a bee sting, a women develops a 2cm red, raised, swollen lesion at the site of the sting . Which of the following findings is likely to be seen in this lesion?

      Your Answer:

      Correct Answer: Vasodilation

      Explanation:

      Inflammation is the immediate response of the body towards infections or irritations. The cardinal signs of inflammation are 1. redness/rubor, 2. tumour/swelling, 3.dolar/pain, 4.calor/heat and organ dysfunction (function laesa). Inflammation has 2 components; vascular and cellular. Blood vessels dilate upstream of the inflamed area leading to the rubor and calor and constrict downstream, increasing pressure and causing fluid to leak out of the capillary, resulting in swelling. The cellular component includes infiltration by neutrophils. Leukocyte arrival and functions include; 1. margination: cells marginated 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 resulting in adhesion, 4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product and 5. phagocytosis: engulfing the offending substance/cell.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
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      Seconds

  • Question 63 - A patient with testicular seminoma has the following tumour markers: LDH 1.3 times...

    Incorrect

    • A patient with testicular seminoma has the following tumour markers: LDH 1.3 times the reference levels, β-hCG 4500 mIU/ml and AFP 875 ng/ml. What's the serum tumour marker stage in this case?

      Your Answer:

      Correct Answer: S1

      Explanation:

      According to AJCC guidelines, the serum tumour marker staging is the following:

      S0: marker studies within normal limits

      S1: lactate dehydrogenase (LDH) less than 1.5 times the reference range, beta-human chorionic gonadotrophin (β-hCG) <5000 mIU/ml, and alpha-fetoprotein (AFP) <1000 ng/ml S2: LDH 1.5–10 times the reference range, β-hCG 5000–50,000 mIU/ml or AFP 1000–10,000 ng/ml S3: LDH greater than 10 times the reference range, β-hCG >50,000 mIU/ml or AFP >10,000 ng/ml.

      According to this, the patient’s tumour belongs to the S1 stage.

    • This question is part of the following fields:

      • Pathology
      • Urology
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  • Question 64 - A 35 year-old woman is undergoing thyroidectomy. The external laryngeal nerve may be...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      0
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  • Question 65 - A diabetic 58-year-old man, after the injection of radiographic contrast, has a decreased...

    Incorrect

    • A diabetic 58-year-old man, after the injection of radiographic contrast, has a decreased urine output and decreased level of consciousness. Which of the following conditions has he most likely developed

      Your Answer:

      Correct Answer: Acute tubular necrosis

      Explanation:

      Acute tubular necrosis (ATN) involves damage to the tubule cells of the kidneys and is the most common cause of acute kidney injury. ATN in the majority of the cases is caused by ischaemia of the kidneys due to lack of perfusion and oxygenation but it may also occur due to poison or harmful substance. Contrast used for radiology may cause ATN in patients with several risk factors e.g. diabetic nephropathy. Symptoms may include oliguria, nausea, fluid retention, fatigue and decreased consciousness.

    • This question is part of the following fields:

      • Pathology
      • Renal
      0
      Seconds

  • Question 66 - Pseudomonas aeruginosa is a multidrug resistant pathogen that causes hospital-acquired infections. It is...

    Incorrect

    • Pseudomonas aeruginosa is a multidrug resistant pathogen that causes hospital-acquired infections. It is usually treated with piperacillin or another antibiotic. Which of the following is the other antibiotic?

      Your Answer:

      Correct Answer: Azlocillin

      Explanation:

      Azlocillin, like piperacillin, is an acylampicillin antibiotic with an extended spectrum of activity and greater in vitro potency than the carboxypenicillins. Azlocillin is similar to mezlocillin and piperacillin. It demonstrates antibacterial activity against a broad spectrum of bacteria, including Pseudomonas aeruginosa.

    • This question is part of the following fields:

      • Pathology
      • Pharmacology
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      Seconds

  • Question 67 - The chest X-ray of an 10-year-old boy, that presented with low-grade fever and...

    Incorrect

    • The chest X-ray of an 10-year-old boy, that presented with low-grade fever and cough, revealed hilar enlargement and parenchymal consolidation in the middle lobes. These X-ray findings are more typical for which of the following diagnoses?

      Your Answer:

      Correct Answer: Pulmonary tuberculosis

      Explanation:

      Primary pulmonary tuberculosis is seen in patients exposed to Mycobacterium tuberculosis for the firs time. The main radiographic findings in primary pulmonary tuberculosis include homogeneous parenchymal consolidation typically in the lower and middle lobes, lymphadenopathy, miliary opacities and pleural effusion.

    • This question is part of the following fields:

      • Pathology
      • Respiratory
      0
      Seconds

  • Question 68 - A 65-year-old smoker presents with painless haematuria, urinary frequency and urgency. He is...

    Incorrect

    • A 65-year-old smoker presents with painless haematuria, urinary frequency and urgency. He is diagnosed with bladder cancer. Which is the most likely type?

      Your Answer:

      Correct Answer: Transitional cell carcinoma

      Explanation:

      90% of bladder cancers are transitional cell carcinomas derived from the bladder urothelium. Risk factors include industrial chemicals, smoking and infection. Schistosomiasis and bladder stones predispose to the squamous cell variety.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      0
      Seconds

  • Question 69 - The surgical registrar is doing an exploratory laparotomy on a 35 year old...

    Incorrect

    • The surgical registrar is doing an exploratory laparotomy on a 35 year old lady of African descent with tuberculous of the abdomen and suspected perforation. The small bowel is matted due to adhesions and it is difficult to differentiate the ileum from the jejunum. Which of the following features is typical of the jejunum?

      Your Answer:

      Correct Answer: It has sparse aggregated lymph nodules

      Explanation:

      The jejunum has a wider diameter, is thicker and more vascularized, hence of a deeper colour compared to the ileum. The valvulae conniventes (circular folds) of its mucous membranes are large and thick and its villi are larger than those in the ileum. The jejunum also has sparse aggregates of lymph nodules and most of its part occupies the umbilical and left iliac regions whilst the ileum is mostly in the umbilical, hypogastric, right iliac and pelvic regions.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 70 - During work up for a 29 year-old lady who complained of chest pain,...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 71 - A lad involved in a road traffic accident is rushed to casualty where...

    Incorrect

    • A lad involved in a road traffic accident is rushed to casualty where physical examination reveals that he has limited extension of his right humerus. Which of the following nerves is most likely to have been injured?

      Your Answer:

      Correct Answer: Thoracodorsal nerve

      Explanation:

      Extension of the humerus is a function of the latissimus dorsi. This muscle is supplied by the thoracodorsal nerve which is a branch of the posterior cord of the plexus whose fibres are derived from cranial nerves V, VI and VII.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 72 - Calculate the total peripheral resistance for a patient with a blood pressure of...

    Incorrect

    • Calculate the total peripheral resistance for a patient with a blood pressure of 130/70 mm HG and cardiac output of 5 litres / min?

      Your Answer:

      Correct Answer: 18 mmHg × min/l

      Explanation:

      Total peripheral resistance = Mean arterial pressure/Cardiac output. And the mean arterial pressure = Diastolic pressure + 1/3 (Systolic pressure – Diastolic pressure), i.e., 70 + 1/3 (130-70) = 90 mmHg. Therefore, total peripheral resistance = 90 mmHg/5 l per min = 18 mmHg × min/l.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
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      Seconds

  • Question 73 - Which of the following will show decreased hearing when tested by air conduction...

    Incorrect

    • Which of the following will show decreased hearing when tested by air conduction but normal hearing when tested by bone conduction?

      Your Answer:

      Correct Answer: Fibrosis causing fixation of the ossicles

      Explanation:

      As the cochlea is embedded into bone, the vibrations from the bone are transmitted directly to the fluid in the cochlea. Hence, any damage to the ossicles or tympanic membrane will not show an abnormal result on bone conduction test.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      0
      Seconds

  • Question 74 - Infection to all of the following will lead to enlargement of the superficial...

    Incorrect

    • Infection to all of the following will lead to enlargement of the superficial inguinal lymph nodes, except for:

      Your Answer:

      Correct Answer: Ampulla of the rectum

      Explanation:

      The superficial inguinal lymph nodes form a chain immediately below the inguinal ligament. They receive lymphatic supply from the skin of the penis, scrotum, perineum, buttock and abdominal wall below the level of the umbilicus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
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  • Question 75 - A young female in the 15th week of pregnancy presented to the emergency...

    Incorrect

    • A young female in the 15th week of pregnancy presented to the emergency department with the passage of grape-like masses per vagina. Dilatation and curettage was done and microscopy revealed large avascular villi with trophoblastic proliferation. Which one of the following investigations is best recommended for her follow-up?

      Your Answer:

      Correct Answer: Serum β-hCG

      Explanation:

      Trophoblast is the layer of cells surrounding the blastocyst and that later develops into the chorion and amnion. Gestational trophoblastic disease is a tumour arising from this trophoblast. It can occur during or after either an intrauterine or ectopic pregnancy. If it occurs in a pregnant woman, it usually leads to spontaneous abortion, eclampsia or fetal death. It can be either malignant or benign.

      In suspected cases, investigations include measurement of serum beta subunit of human chorionic gonadotrophin (β-hCG) and pelvic ultrasound. Confirmatory test is a biopsy. Post-removal, the disease is classified clinically to assess further treatment. To assess the presence of metastases, further work-up includes computed tomography of the brain, chest, abdomen and pelvis. Chemotherapy is usually needed for persistent disease. If at least three consecutive, weekly serum β-hCG measurements are normal, treatment is considered successful. Follow-up is also done by measuring β-hCG.

    • This question is part of the following fields:

      • Pathology
      • Women's Health
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  • Question 76 - An old man was diagnosed with squamous cell carcinoma with axillary lymph node...

    Incorrect

    • An old man was diagnosed with squamous cell carcinoma with axillary lymph node metastasis. The doctor said he will excise the tumour and remove all axillary lymph nodes lateral to the edge of the pectoralis minor muscle. One of the following axillary lymph nodes won't be removed by this procedure. Which is it?

      Your Answer:

      Correct Answer: Apical

      Explanation:

      The apical lymph node group won’t be removed which include 20 to 30 lymph nodes.

      Axillary lymph nodes are grouped according to location. The lateral group, the anterior to pectoral group, the posterior or subscapular group, the central group, and the medial or apical group. The lateral, pectoral, and subscapular groups are found lateral to the pectoralis minor muscle. The central group is situated directly under that muscle. Thus, if all lymph nodes lateral to the medial edge of the pectoralis minor muscle are removed, all the above four groups will be removed. The apical group won’t be removed which is situated medial to the medial edge of the pectoralis minor muscle.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 77 - Which of the following conditions of the breast is most often associated with...

    Incorrect

    • Which of the following conditions of the breast is most often associated with use of oral contraceptives?

      Your Answer:

      Correct Answer: Cyst formation

      Explanation:

      Breast cysts are common and are smooth, firm, mobile lumps that can sometimes be tender. Cysts can also be bilateral and are known to recur in 10% of cases. They are more common in women in the third and fourth decades and most often disappear after menopause. Cysts are filled with fluid from the breast which occurs due to the normal menstrual cycle of a woman. The end of the menstrual cycle causes breast cells to swell. After the menses, the cells shrink and the released fluid disappears. However, in some cases this fluid forms a cyst. Incidence of cysts was also linked to use of oral contraceptives.

    • This question is part of the following fields:

      • Pathology
      • Women's Health
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      Seconds

  • Question 78 - Which of the following is a true statement regarding secretion of gastric acid?...

    Incorrect

    • Which of the following is a true statement regarding secretion of gastric acid?

      Your Answer:

      Correct Answer: Acetylcholine increases gastric acid secretion

      Explanation:

      Gastric acid secretion is increased by acetylcholine, histamine and gastrin, with the help of cAMP as a secondary messenger. They increase H+ and Cl- secretion by increasing the number of H+/K+ ATPase molecules and Cl- channels. In contrast, gastric acid secretion is decreased by somatostatin, epidermal growth factor and prostaglandins.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
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  • Question 79 - The anatomical course of the phrenic nerve passes over the following muscle in...

    Incorrect

    • The anatomical course of the phrenic nerve passes over the following muscle in the neck?

      Your Answer:

      Correct Answer: Anterior scalene

      Explanation:

      The phrenic nerve originates in the neck between C3-C5, mostly C4 spinal root. It enters the thoracic cavity past the heart and lungs to the diaphragm. In the neck, this nerve begins at the lateral border of the anterior scalene muscle, its course then continues inferiorly on the anterior aspect of the anterior scalene muscle as it moves towards the diaphragm.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
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  • Question 80 - A 20-year old gentleman was brought to the emergency department with headache and...

    Incorrect

    • A 20-year old gentleman was brought to the emergency department with headache and nausea for 2 days. He also complained of intolerance to bright light and loud sounds. Lumbar puncture showed glucose < 45 mg/dl, protein > 5 mg/dl and neutrophil leucocytosis. The likely diagnosis is:

      Your Answer:

      Correct Answer: Meningitis

      Explanation:

      Diagnosis of meningitis can be carried out with examination of cerebrospinal fluid (CSF) with a lumbar puncture (LP). In a case of bacterial meningitis, the CSF analysis will show:

      – Opening pressure: > 180 mmH2O

      – White blood cell count: 10–10 000/μl with neutrophil predominance

      – Glucose: < 40 mg/dl – CSF glucose to serum glucose ratio: < 0.4 – Protein: > 4.5 mg/dl

      – Gram stain: positive in > 60%

      – Culture: positive in > 80%

      – Latex agglutination: may be positive in meningitis due to Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Escherichia coli and group B streptococci

      – Limulus, lysates: positive in Gram-negative meningitis

    • This question is part of the following fields:

      • Neurology
      • Physiology
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  • Question 81 - From which fascia of the pelvic wall muscle does the levator ani muscle...

    Incorrect

    • From which fascia of the pelvic wall muscle does the levator ani muscle arise?

      Your Answer:

      Correct Answer: Obturator internus

      Explanation:

      The levator ani muscle arises from the posterior surface of the superior ramus of the pubis lateral to the symphysis, behind the inner surface of the spine of the ischium and between these points from the obturator internus fascia. It is attached to the inner surface of the side of the lesser pelvic cavity, supports the viscera in the cavity and surrounds the various structures that pass through it.

    • This question is part of the following fields:

      • Anatomy
      • Pelvis
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  • Question 82 - Whipple's procedure involves mobilizing the head of the pancreas. As the surgeon does...

    Incorrect

    • Whipple's procedure involves mobilizing the head of the pancreas. As the surgeon does this, he must be careful to avoid injury to a key structure that is found lying behind the head of the pancreas. Which vital structure is this?

      Your Answer:

      Correct Answer: Common bile duct

      Explanation:

      The posterior relations of the head of the pancreas include: the inferior vena cava, the common bile duct, the renal veins, the right crus of the diaphragm and the aorta.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
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  • Question 83 - During uterogrowth, the second pharyngeal arch gives rise to which structures? ...

    Incorrect

    • During uterogrowth, the second pharyngeal arch gives rise to which structures?

      Your Answer:

      Correct Answer: Stylohyoid muscle

      Explanation:

      The second pharyngeal arch or hyoid arch, is the second of six pharyngeal arches that develops in fetal life during the fourth week of development and assists in forming the side and front of the neck. Derivatives:

      Skeletal – From the cartilage of the second arch arises:

      Stapes,

      Temporal styloid process,

      Stylohyoid ligament, and

      Lesser cornu of the hyoid bone.

      Muscles:

      Muscles of face

      Occipitofrontalis muscle

      Platysma

      Stylohyoid muscle

      Posterior belly of Digastric

      Stapedius muscle

      Auricular muscles

      Nerve supply: Facial nerve

    • This question is part of the following fields:

      • Anatomy
      • Embryology
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  • Question 84 - The otic ganglion receives its preganglionic sympathetic fibres from which of the following...

    Incorrect

    • The otic ganglion receives its preganglionic sympathetic fibres from which of the following nerves?

      Your Answer:

      Correct Answer: Glossopharyngeal nerve

      Explanation:

      The otic ganglion is a small (2–3 mm), oval shaped, flattened parasympathetic ganglion of a reddish-grey colour, located immediately below the foramen ovale in the infratemporal fossa and on the medial surface of the mandibular nerve. The preganglionic parasympathetic fibres originate in the inferior salivatory nucleus of the glossopharyngeal nerve. They leave the glossopharyngeal nerve by its tympanic branch and then pass via the tympanic plexus and the lesser petrosal nerve to the otic ganglion. Here, the fibres synapse, and the postganglionic fibres pass by communicating branches to the auriculotemporal nerve, which conveys them to the parotid gland. They produce vasodilator and secretomotor effects.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
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      Seconds

  • Question 85 - Where do the seminal vesicles lie? ...

    Incorrect

    • Where do the seminal vesicles lie?

      Your Answer:

      Correct Answer: Base of the bladder and rectum

      Explanation:

      The seminal vesicles are two lobulated membranous pouches situated between the fundus of the bladder and rectum and act as a reservoir for the semen and secrete a fluid that is added to the seminal fluid. Each sac is pyramidal in shape but they all vary in size not only in different individuals but also in the same individuals. The anterior surface is in contact with the fundus of the bladder, extending from near the termination of the ureter to the base of the prostate. Each vesicle consist of single tube, which gives off several irregular caecal diverticula. These separate coils and the diverticula are connected by fibrous tissue.

    • This question is part of the following fields:

      • Anatomy
      • Pelvis
      0
      Seconds

  • Question 86 - A 45-year old man presents with sclerosing cholangitis, blood in his stools and...

    Incorrect

    • A 45-year old man presents with sclerosing cholangitis, blood in his stools and apparent iron deficiency anaemia. What will be the most likely finding on his colonic biopsy?

      Your Answer:

      Correct Answer: Pseudopolyps

      Explanation:

      Sclerosing cholangitis along with the passage of blood in stools suggests ulcerative colitis affecting the mucosa and submucosa of rectum and colon, with a sharp demarcation with the normal tissue. The musclaris layer is involved in severe cases. Initially, the mucosa is erythematous, friable with scattered haemorrhagic areas and loss of normal vascular pattern. Severe disease is indicated by presence of large mucosal ulcers with purulent exudate. There can be islands of normal mucosa between the ulcerated mucosa, along with few hyperplastic inflammatory mucosal lesions (pseudopolyps). Ulcerative colitis does not lead to development of fistulas or abscesses.

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
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  • Question 87 - In a hypertensive patient with secondary hyperaldosteronism, aldosterone is released mainly in response...

    Incorrect

    • In a hypertensive patient with secondary hyperaldosteronism, aldosterone is released mainly in response to:

      Your Answer:

      Correct Answer: Angiotensin II

      Explanation:

      Secondary hyperaldosteronism in hypertension is either due to primary renin overproduction by the kidneys or renin overproduction secondary to decreased renal blood flow. The main stimulus for aldosterone release are adrenocorticotrophic hormone (ACTH), angiotensin II and high plasma K+ levels. Low plasma Na+ might also stimulate the adrenal cortex. Fluid overload will reduce aldosterone secretion. Atrial natriuretic peptide is secreted under conditions of expanded extracellular volume and will not lead to aldosterone secretion.

    • This question is part of the following fields:

      • Endocrinology
      • Physiology
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  • Question 88 - In the case of an injury to the sub sartorial canal, which of...

    Incorrect

    • In the case of an injury to the sub sartorial canal, which of the following structures is most likely to be injured?

      Your Answer:

      Correct Answer: Nerve to vastus medialis

      Explanation:

      The adductor canal (sub sartorial canal) is situated in the middle third of the thigh.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
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      Seconds

  • Question 89 - Which of the following organelles have the capacity to regenerate and spontaneously replicate?...

    Incorrect

    • Which of the following organelles have the capacity to regenerate and spontaneously replicate?

      Your Answer:

      Correct Answer: Mitochondrion

      Explanation:

      A mitochondria is a membrane bound organelle found in eukaryotic cells. They are called the powerhouse of the cell and are the place where ATP is formed from energy generated through metabolism. They are capable of replication as well as repair and regeneration.

    • This question is part of the following fields:

      • General
      • Physiology
      0
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  • Question 90 - Mallory bodies are characteristic of which of the following conditions? ...

    Incorrect

    • Mallory bodies are characteristic of which of the following conditions?

      Your Answer:

      Correct Answer: Alcoholic hepatitis

      Explanation:

      Mallory bodies (or ‘alcoholic hyaline’) are inclusion bodies in the cytoplasm of liver cells, seen in patients of alcoholic hepatitis; and also in Wilson’s disease. These pathological bodies are made of intermediate keratin filament proteins that are ubiquinated or bound by proteins like heat chock protein. Being highly eosinophilic, they appear pink on haematoxylin and eosin staining.

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
      0
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  • Question 91 - Which of the following bones was most likely fractured following an injury in...

    Incorrect

    • Which of the following bones was most likely fractured following an injury in the medial side of the foot between the navicular behind and base of the first metatarsal in front?

      Your Answer:

      Correct Answer: First cuneiform

      Explanation:

      The first cuneiform bone is the largest of the three cuneiforms. It is situated at the medial side of the foot, between the navicular behind and the base of the first metatarsal in front.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
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  • Question 92 - A 27-year old lady is shot in the chest. The bullet enters superior...

    Incorrect

    • A 27-year old lady is shot in the chest. The bullet enters superior to the upper edge of the clavicle. She had difficulty in breathing which is interpreted by the A&E physician as a likely indicator of a collapsed lung. If that is the case, what portion of the pleura is most likely to have been punctured?

      Your Answer:

      Correct Answer: Cupola

      Explanation:

      The cupola is part of the pleura that extends above the first rib into the root of the lung. Most likely to injured in a stab above the level of the clavicle.

      Costodiaphragmatic recess: the lowest extent of the pleural sac.

      Pulmonary ligament: is a fold of pleura located below the root of the lung.

      Mediastinal pleura: part of the pleura that lines the mediastinal cavity.

      Hilar reflection is the part of the pleura where the visceral pleura of the lung reflects to become continuous with the parietal pleura.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
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  • Question 93 - A patient who complained of pain on the lower left side of the...

    Incorrect

    • A patient who complained of pain on the lower left side of the back had an x-ray done which confirmed a hernia passing posterolaterally, just superior to the iliac crest. Where is this hernia passing through?

      Your Answer:

      Correct Answer: Lumbar triangle

      Explanation:

      The lumber triangle is bound medially by the border of the latissimus dorsi, laterally by the external abdominal oblique and by the iliac crest inferiorly. This is exactly where the hernia that is described is located.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
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      Seconds

  • Question 94 - Which muscle extends to form the cremasteric muscle? ...

    Incorrect

    • Which muscle extends to form the cremasteric muscle?

      Your Answer:

      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.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 95 - A 31-year-old woman is diagnosed with adrenal hyperplasia, and laboratory samples are taken...

    Incorrect

    • A 31-year-old woman is diagnosed with adrenal hyperplasia, and laboratory samples are taken to measure serum aldosterone and another substance. Which is most likely to be the other test that was prescribed to this patient?

      Your Answer:

      Correct Answer: Plasma renin

      Explanation:

      The evaluation of a patient in whom hyperaldosteronism is first to determine that hyperaldosteronism is present (serum aldosterone) and, if it is present, to differentiate primary from secondary causes of hyperaldosteronism. The aldosterone-to-renin ratio (ARR) is the most sensitive means of differentiating primary from secondary causes of hyperaldosteronism as it is abnormally increased in primary hyperaldosteronism, and decreased or normal but with high renin levels in secondary hyperaldosteronism.

    • This question is part of the following fields:

      • Physiology
      • Renal
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  • Question 96 - A 60-year old patient presenting with squamous cell carcinoma of the anal canal...

    Incorrect

    • A 60-year old patient presenting with squamous cell carcinoma of the anal canal was brought in to the oncology ward for chemotherapy. In which of the following lymph nodes of this patient would you likely find metastases?

      Your Answer:

      Correct Answer: Internal iliac

      Explanation:

      The efferent lymphatics from the anal canal proceed to the internal iliac lymph nodes. This would most likely form the site of enlargement in the lymphatics.

    • This question is part of the following fields:

      • Anatomy
      • Pelvis
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  • Question 97 - Which of the following arteries, if ligated, will most likely affect blood supply...

    Incorrect

    • Which of the following arteries, if ligated, will most likely affect blood supply to the pancreas?

      Your Answer:

      Correct Answer: Superior mesenteric

      Explanation:

      The pancreas is a glandular organ in the body that produces important hormones such as insulin and glucagon. Its blood supply is from branches of the coeliac artery, superior mesenteric artery and the splenic artery. These are the arteries that if ligated, would affect blood supply to the pancreas.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 98 - A 44-year old man, who was euthyroid underwent thyroidectomy following neoplastic cells found...

    Incorrect

    • A 44-year old man, who was euthyroid underwent thyroidectomy following neoplastic cells found on fine-needle aspiration. Frozen section of multiple thyroid masses showed malignant neoplasm of polygonal cells in nests. The neoplasm also showed presence of amyloid which was positive with Congo-red staining. Immunoperoxidase staining for calcitonin was also positive. Chest X-ray revealed no abnormality. However, his blood pressure was found to be raised, and his serum ionised calcium was high. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Multiple endocrine neoplasia type IIA

      Explanation:

      MEN (Multiple Endocrine Neoplasia) syndromes are a group of three separate familial disease which consists of adenomatous hyperplasia and neoplasia in several endocrine glands. All three conditions are inherited as an autosomal dominant trait, with a single gene producing multiple effects. MEN IIA is characterized by medullary carcinoma of the thyroid, pheochromocytoma and hyperparathyroidism. It should be suspected in patients with bilateral pheochromocytoma, a familial history of MEN, or at least two characteristic endocrine manifestations. Genetic testing is used to confirm the diagnosis. Early diagnosis is crucial to aid in complete excision of the localized tumour. Pheochromocytomas can be detected by plasma free metanephrines and fractionated urinary catecholamines, particularly adrenaline (epinephrine).

      Imaging studies such as computed tomography or magnetic resonance imaging might also prove useful. Hyperparathyroidism is diagnosed by the standard finding of hypercalcaemia, hypophosphatemia and an increased parathyroid hormone level. Once MEN IIA syndrome is identified in any patient, it is recommended that his or her first-degree relatives and any other symptomatic also undergo genetic testing. Relatives should be subjected to annual screening for hyperparathyroidism and pheochromocytoma beginning in early childhood and continue indefinitely. Serum calcium levels help in screening for hyperparathyroidism. Similarly, screening for pheochromocytoma is by history, measurement of the blood pressure and laboratory testing.

    • This question is part of the following fields:

      • Endocrine
      • Pathology
      0
      Seconds

  • Question 99 - The mandibular nerve, which is the largest of the 3 divisions of the...

    Incorrect

    • The mandibular nerve, which is the largest of the 3 divisions of the trigeminal nerve, exits the cranial cavity through which foramen?

      Your Answer:

      Correct Answer: Foramen ovale

      Explanation:

      At the base of the skull the foramen ovale is one of the larger of the several holes that transmit nerves through the skull. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery, lesser petrosal nerve, a branch of the glossopharyngeal nerve, emissary vein connecting the cavernous sinus with the pterygoid plexus of veins and occasionally the anterior trunk of the middle meningeal vein.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      0
      Seconds

  • Question 100 - A 25 year old man presented with a history of headache and peripheral...

    Incorrect

    • A 25 year old man presented with a history of headache and peripheral cyanosis. He had been living in the Himalayas for 6 months prior to this. What is the reason for his condition?

      Your Answer:

      Correct Answer: Physiological polycythaemia

      Explanation:

      Polycythaemia is a condition that results in an increase in the total number of red blood cells (RBCs) in the blood. It can be due to myeloproliferative syndrome or due to chronically low oxygen levels or rarely malignancy. In primary polycythaemia/polycythaemia vera the increase is due to an abnormality in the bone marrow, resulting in increases RBCs, white blood cells (WBCs) and platelets. In secondary polycythaemia the increase occurs due to high levels of erythropoietin either artificially or naturally. The increase is about 6-8 million/cm3 of blood. A type of secondary polycythaemia is physiological polycythaemia where people living in high altitudes who are exposed to hypoxic conditions produce more erythropoietin as a compensatory mechanism for thin oxygen and low oxygen partial pressure.

    • This question is part of the following fields:

      • General
      • Physiology
      0
      Seconds

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