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Question 1
Correct
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In the adult heart, the sinus venosus gives rise to the:
Your Answer: Coronary sinus
Explanation:The sinus venosus is a large quadrangular cavity which precedes the atrium on the venous side of the chordate heart. It exists distinctly only in the embryonic heart (where it is found between the two venae cavae); however, the sinus venosus persists in the adult. In the adult, it is incorporated into the wall of the right atrium to form a smooth part called the sinus venarum, which is separated from the rest of the atrium by a ridge of fibres called the crista terminalis. The sinus venosus also forms the SA node and the coronary sinus.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 2
Correct
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A 45-year-old man complains of shortness of breath, cough and chest pain. Chest X ray revealed a perihilar mass with bronchiectasis in the left mid-lung. Which of the following is most probably associated with these findings?
Your Answer: Bronchial carcinoid
Explanation:Bronchial carcinoids are neuroendocrine tumours that arise from Kulchitsky’s cells of the bronchial epithelium. Kulchitsky’s cells belong to the diffuse endocrine system. Patients affected by this tumour may be asymptomatic or may present with symptoms of airway obstruction, like dyspnoea, wheezing, and cough. Other common findings are recurrent pneumonia, haemoptysis, chest pain and paraneoplastic syndromes. Chest radiographs are abnormal in the majority of cases. Peripheral carcinoids usually present as a solitary pulmonary nodule. For central lesions common findings include hilar or perihilar masses with or without atelectasis, bronchiectasis, or consolidation. Bronchial carcinoids most commonly arise in the large bronchi causing obstruction.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 3
Incorrect
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Which of the following statements is true regarding the umbilical cord?
Your Answer: Attaches the fetus to the allantois
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.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 4
Correct
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A gymnast was admitted to hospital for investigation of a weakness in the extension and adduction of his arm. He had a previous penetrating wound in the area of the posterior axillary fold. Which of these muscles is the likely cause?
Your Answer: Latissimus dorsi
Explanation:All the criteria of this case points towards the latissimus dorsi. This muscle is greatly involved in extension, adduction and medial rotation of the arm and forms the posterior axillary fold which in this case was injured.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 5
Incorrect
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From which source does the lingual artery originate?
Your Answer: Sphenopalatine
Correct Answer: External carotid
Explanation:The lingual artery arises from the external carotid between the superior thyroid artery and facial artery. It can be located easily on the lower surface of the tongue. The terminal branch of the lingual artery is the deep lingual artery. On its course the lingual artery gives off side branches: dorsal lingual branches that supply the dorsum of the tongue till the epiglottis; sublingual artery that supplies the sublingual gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 6
Correct
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What is the most likely condition a new born infant is likely to suffer from, if he/she was born with incomplete fusion of the embryonic endocardial cushions?
Your Answer: An atrioventricular septal defect
Explanation:The endocardial cushions in the heart are the mesenchymal tissue that make up the part of the atrioventricular valves, atrial septum and ventricular septum. An incomplete fusion of these mesenchymal cells can cause an atrioventricular septal defect. The terms endocardial cushion defect, atrioventricular septal defect and common atrioventricular canal defect can be used interchangeably with one another.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 7
Incorrect
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The line which divides the perineum into two triangles is connected to the?
Your Answer: Pubic tubercles
Correct Answer: Ischial tuberosities
Explanation:The perineum has it’s deep boundaries in front of the pubic arch and the arcuate ligament of the pubis, behind the tip of the coccyx and on either side of the inferior rami of the pubis and ischium and the sacrotuberous ligament. It also corresponds to the outlet of the pelvis. A line drawn transversely across, in front of the ischial tuberosities divides the space into two portions, the posterior contains the termination of the anal canal and the anterior, contains the external urogenital organs.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 8
Correct
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A 4-year-old child was brought to a paediatrician for consult due to a palpable mass in his abdomen. The child has poor appetite and regularly complains of abdominal pain. The child was worked up and diagnosed with a tumour. What is the most likely diagnosis ?
Your Answer: Nephroblastoma
Explanation:Nephroblastoma is also known as Wilms’ tumour. It is a cancer of the kidneys that typically occurs in children. The median age of diagnose is approximately 3.5 years. With the current treatment, approximately 80-90% of children with Wilms’ tumour survive.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 9
Correct
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A 42 year old man presents with end stage renal failure and is prepared to receive a kidney from his best friend. HLA testing showed that they are not a 100% match and he is given immunosuppressant therapy for this. Three months later when his renal function is assessed, he showed signs of deteriorating renal function, with decreased renal output, proteinuria of +++ and RBCs in the urine. He was given antilymphocyte globulins and his condition reversed. During the crisis period the patient is likely to be suffering from?
Your Answer: Acute rejection
Explanation:This patients is most likely experiencing an acute rejection. It is a cell mediated attack against the organ that has been transplanted. Antigens are either presented by blood borne cells with in the graft or antigen presenting cells in the body may be presenting class I and class II molecules that have been shed by the graft. Class I will activate CD8 and class II, CD4 cells, both of which will attack the graft.
Chronic rejection is a slow process which occurs months to years after the transplant. The exact mechanism is not very well understood but it probably involves a combination of Type III and Type IV hypersensitivity directed against the foreign MHC molecules which look like self-MHC presenting a foreign antigen.
Hyperacute Transplant Rejection occurs almost immediately and is often evident while you are still in surgery. It is caused by accidental ABO Blood type mismatching of the donor and recipient which almost never happens anymore. This means the host has preformed antibodies against the donated tissue.
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This question is part of the following fields:
- Inflammation & Immunology; Renal
- Pathology
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Question 10
Incorrect
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A 55-year-old male chronic smoker is diagnosed with non-small-cell cancer. His right lung underwent complete atelectasis and he has a 7cm tumour involving the chest wall. What is the stage of the lung cancer of this patient?
Your Answer: T4
Correct Answer: T3
Explanation:Non-small-cell lung cancer is staged through TNM classification. The stage of this patient is T3 because based on the TNM classification the tumour is staged T3 if > 7 cm or one that directly invades any of the following: Chest wall (including superior sulcus tumours), diaphragm, phrenic nerve, mediastinal pleura, or parietal pericardium; or the tumour is in the main bronchus < 2 cm distal to the carina but without involvement of the carina, Or it is associated with atelectasis/obstructive pneumonitis of the entire lung or separate tumour nodule(s) in the same lobe.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 11
Correct
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A 32-year-old man presented with a metabolic acidosis and increased anion gap. What is the most likely cause of the changes of the anion gap in this patient?
Your Answer: Lactic acidosis
Explanation:High anion gap in metabolic acidosis is caused generally by the elevation of the levels of acids like ketones, lactate, sulphates in the body, which consume the bicarbonate ions. Other causes of a high anion gap include overdosing on salicylates, uraemia, rhabdomyolysis, hypocalcaemia, hypomagnesaemia, or ingestion of toxins such as ethylene glycol, methanol, propyl alcohol, cyanide and iron.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 12
Correct
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During a laparoscopic inguinal hernia repair, the surgeon finds an artery in the extraperitoneal connective tissue (preperitoneal fat) that courses vertically and just medial to the bowel as the bowel passes through the abdominal wall. Which artery is this?
Your Answer: Inferior epigastric
Explanation:The inferior epigastric artery comes from the external iliac artery just above the inguinal ligament to curve forward in the subperitoneal tissue and then ascend obliquely along the medial margin of the deep inguinal ring. It continues to ascend between the rectus abdominis and the posterior lamella of its sheath after piercing the fascia transversalis and passing anterior to the linea semicircularis. Finally it gives off numerous branches that anastomose above the umbilicus with the superior epigastric branch of the internal mammary artery and with the lower intercostal arteries. As this artery ascends obliquely upwards from its origin it lies along the lower medial margins of the deep inguinal ring and posterior to the start of the spermatic cord. It is found in the preperitoneal fat of the abdomen lying just superficial to the peritoneum and forms the lateral umbilical fold. Hernias that pass lateral to this are indirect and medial to this, direct hernias.
The deep circumflex artery travels along the iliac crest on the inner surface of the abdominal wall. It is very lateral to the abdominal wall and hernias would pass medial to it.
The superficial circumflex iliac, superficial epigastric, superficial external pudendal arteries are all superficial arteries found in the superficial fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 13
Correct
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The following structures DO NOT lie between the layers of the mesosalpinx except for the?
Your Answer: Fallopian tube
Explanation:Mesosalpinx is the portion of the broad ligament that stretches from the fallopian tube to the ovary and contains the uterine tubes between it’s layers.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 14
Correct
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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: 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.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 15
Incorrect
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Which of the following diseases affects young adults, causing pain in any bone -particularly long bones- which worsens at night, and is typically relieved by common analgesics, such as aspirin?
Your Answer: Chondrosarcoma
Correct Answer: Osteoid osteoma
Explanation:Osteoid osteoma, which tends to affect young adults, can occur in any bone but is most common in long bones. It can cause pain (usually worse at night) that is typically relieved by mild analgesics, such as non-steroidal anti-inflammatory drugs. X-ray findings include a small radiolucent zone surrounded by a larger sclerotic zone.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 16
Correct
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The most likely cause of prominent U waves on the electrocardiogram (ECG) of a patient is:
Your Answer: Hypokalaemia
Explanation:The U-wave, not always visible in ECGs, is thought to represent repolarisation of papillary muscles or Purkinje fibres. When seen, it is very small and occurs after the T-wave. Inverted U-waves indicate myocardial ischaemia or left ventricular volume overload. Prominent U-waves are most commonly seen in hypokalaemia. Other causes include hypercalcaemia, thyrotoxicosis, digitalis exposure, adrenaline and class 1A and 3 anti-arrhythmic agents. It can also be seen in congenital long-QT syndrome and in intracranial haemorrhage.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 17
Incorrect
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Calculate the stroke volume in a patient admitted for coronary bypass surgery, with the following parameters pre-operatively:
Oxygen consumption = 300 ml/min
Arterial oxygen content = 20 ml/100 ml blood
Pulmonary arterial oxygen content = 15 ml/100 ml blood and Heart rate = 100 beats/min.Your Answer: 150 ml
Correct Answer: 60 ml
Explanation:By Fick’s principle, cardiac output can be calculated as follows: VO2 = CO × (CAO2– CVO2) where VO2= oxygen consumption, CO = cardiac output, CAO2 = arterial oxygen content and CvO2 = mixed venous oxygen content. Thus, in the given problem, 300 ml/min = CO × (20 – 15) ml/100 ml CO = 300 × 100/5 ml/min CO = 6000 ml/min. Also, cardiac output = stroke volume × heart rate. Thus, 6000 ml/min = stroke volume × 100 beats/min. Hence, stroke volume = 6000/100 ml/min which is 60 ml/min.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 18
Correct
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The otic ganglion receives its preganglionic sympathetic fibres from which of the following nerves?
Your 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.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 19
Incorrect
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A 65-year old patient with altered bowl movement experienced the worsening of shortness of breath and exertional chest pains over the course of 8 weeks. Examination shows pallor and jugular venous distension. Furthermore, a test of the stool for occult blood is positive. Laboratory studies show:
Haemoglobin 7.4 g/dl
Mean corpuscular volume 70 fl Leukocyte count 5400/mm3
Platelet count 580 000/mm3 Erythrocyte sedimentation 33 mm/h
A blood smear shows hypochromic, microcytic RBCs with moderate poikilocytosis. Which of the following is the most likely diagnosis?Your Answer: Anaemia of chronic disease
Correct Answer: Iron deficiency anaemia
Explanation:Iron deficiency anaemia is the most common type of anaemia. It can occur due to deficiency of iron due to decreased intake or due to faulty absorption. An MCV less than 80 will indicated iron deficiency anaemia. On the smear the RBC will be microcytic hypochromic and will also show piokilocytosis. iron profiles tests are important to make a diagnosis. Clinically the patient will be pale and lethargic.
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This question is part of the following fields:
- General
- Physiology
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Question 20
Incorrect
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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: Endotoxin
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.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 21
Correct
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Vincristine is a chemotherapy agent used to treat a number of types of cancer. Which of the following is a recognised major side-effect of vincristine?
Your Answer: Peripheral neuropathy
Explanation:Vincristine is an alkaloid chemotherapeutic agent. It is used to treat a number of types of cancer including acute lymphocytic leukaemia, acute myeloid leukaemia, Hodgkin’s disease, neuroblastoma, and small cell lung cancer among others. The main side-effects of vincristine are peripheral neuropathy and constipation.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 22
Correct
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During strenuous exercise, what else occurs besides tachycardia?
Your Answer: Increased stroke volume
Explanation:During strenuous exercise there is an increase in:
– Heart rate, stroke volume and therefore cardiac output. (CO = HR x SV)
– Respiratory rate (hyperventilation) which will lead to a reduction in Paco2.
– Oxygen demand of skeletal muscle, therefore leading to a reduction in mixed venous blood oxygen concentration.
Renal blood flow is autoregulated, so renal blood flow is preserved and will tend to remain the same. Mean arterial blood pressure is a function of cardiac output and total peripheral resistance and will increase with exercise, mainly as a result of the increase in cardiac output that occurs.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 23
Correct
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Which of the following muscles are involved in abduction of the wrist?
Your Answer: Extensor carpi radialis brevis and flexor carpi radialis
Explanation:The muscle of the wrist that cause abduction of the wrist otherwise also know as radial flexion of the wrist are the following:
-Abductor Pollicis Longus
-Flexor Carpi Radialis
-Extensor Carpi Radialis Longus
-Extensor Carpi Radialis Brevis
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 24
Incorrect
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Painful erections along with deviation of the penis to one side when erect are seen in which of the following conditions?
Your Answer: Priapism
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.
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This question is part of the following fields:
- Pathology
- Urology
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Question 25
Correct
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Which nuclei of the posterior grey column of the spinal cord are likely affected in a patient who has lost the sensation of pain and temperature?
Your Answer: Substantia gelatinosa
Explanation:Substantia gelatinosa is one of the nuclei in the posterior grey column along side other posterior grey column nuclei like the nucleus dorsalis, nucleus proprius, and posteromarginal nucleus. These nuclei are a collection of cells in the posterior grey area found in throughout the spinal cord. The substantia gelatinosa receives direct input from the dorsal nerve roots (sensory), especially from thermoreceptors and nociceptors (receptors for temperature and pain).
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This question is part of the following fields:
- Anatomy
- Neurology
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Question 26
Correct
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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: Hypoparathyroidism
Explanation:Chronic hypocalcaemia is mostly seen in patients with hypoparathyroidism as a result of accidental removal or damage to parathyroid glands during thyroidectomy.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 27
Incorrect
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Following a lacerating injury along the anterior border of the trapezius muscle in the neck, a man has the point of his shoulder (scapula) sagging and he has difficulty with full abduction of his arm. Which nerve is most likely injured?
Your Answer: Dorsal scapular
Correct Answer: Accessory (cranial nerve XI)
Explanation:Injury to the accessory nerve denervates the trapezius muscle so that the person will no longer be able to raise the acromion of the shoulder. The dorsal scapular nerve supplies the rhomboids i.e. major and minor and the levator scapulae so that injury to this nerve weakens retraction of the scapula. The greater occipital nerve is responsible for sensation of the posterior scalp. The axillary nerve innervates the deltoid muscle which is responsible for abduction of the arm and the suprascapular nerve is responsible for rotating the humerus laterally. Cutaneous nerves supply the skin.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 28
Correct
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QT interval in the electrocardiogram of a healthy individual is normally:
Your Answer: 0.40 s
Explanation:QT interval extends from beginning of the QRS complex till the end of he T-wave and normally lasts for 0.40 s. It is important in the diagnosis of long-QT and short-QT syndrome. The QT interval varies on the basis of heart rate and may need to be corrected.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 29
Correct
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Cervical intraepithelial neoplasia on Pap smear of a 34-year old lady is most likely associated with which of the following?
Your Answer: Human papillomavirus infection
Explanation:CIN (Cervical intraepithelial neoplasia) is considered a precursor of cervical cancer and is likely caused due to infection with human papillomavirus (HPV) types 16, 18, 31, 33, 35 or 39. The risk factors for cervical cancer include multiple sex partners, young age at the time of first intercourse, intercourse with men whose previous partners had cervical cancer. Also, smoking and immunodeficient states are considered contributory. CIN is graded as mild (grade I), moderate (grade II) and severe dysplasia or carcinoma in situ (grade III). CIN III rarely regresses spontaneously and can lead to invasive carcinoma by invading the basement membrane. Squamous cell carcinomas are the commonest cervical cancer seen in 80-85% of all cases. Others are commonly adenocarcinomas. Cervical cancer can spread by direct extension, lymphatic spread to pelvic and para-aortic nodes or by hematogenous route.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 30
Correct
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What is formed when the ductus deferens unites with the duct of the seminal vesicle?
Your Answer: Ejaculatory duct
Explanation:The deferens is a cylindrical structure​ with dense walls and an extremely small lumen It is joined at an acute angle by the duct of the seminal vesicles to form the ejaculatory duct, which traverses the prostate behind it’s middle lobe and opens into the prostatic portion of the urethra, close to the orifice of the prostatic utricle.
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This question is part of the following fields:
- Anatomy
- Pelvis
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SESSION STATS - PERFORMANCE PER SPECIALTY
