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Question 1
Incorrect
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Acute respiratory distress syndrome (ARDS) is a medical condition that occurs in critically ill patients, and can be triggered by events such as trauma and sepsis. Which of the following variables is most likely to be lower than normal in a patient with ARDS?
Your Answer: Work of breathing
Correct Answer: Lung compliance
Explanation:Acute (or Adult) respiratory distress syndrome (ARDS) is a medical condition occurring in critically ill patients characterized by widespread inflammation in the lungs. The development of acute respiratory distress syndrome (ARDS) starts with damage to the alveolar epithelium and vascular endothelium, resulting in increased permeability to plasma and inflammatory cells. These cells pass into the interstitium and alveolar space, resulting in pulmonary oedema. Damage to the surfactant-producing type II cells and the presence of protein-rich fluid in the alveolar space disrupt the production and function of pulmonary surfactant, leading to micro atelectasis and impaired gas exchange. The pathophysiological consequences of lung oedema in ARDS include a decrease in lung volumes, compliance and large intrapulmonary shunts. ARDS may be seen in the setting of pneumonia, sepsis, following trauma, multiple blood transfusions, severe burns, severe pancreatitis, near-drowning, drug reactions, or inhalation injuries.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 2
Incorrect
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A teacher had varicosities in the region of the small saphenous vein. Which of the following is true about that vein?
Your Answer: Is in close relation with the sural nerve in the upper two-thirds of the leg
Correct Answer: Has nine to twelve valves
Explanation:It is known that the small saphenous vein has nine to twelve valves along its course. This vein begins as a direct continuation of the lateral marginal vein posterior to the lateral malleolus. It is superficially situated but closer to its termination, perforates the deep fascia in the lower part of the popliteal fossa to end in the popliteal vein.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 3
Incorrect
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An operation to resect a tumour of the right lung was stopped as the chest surgeon said that the tumour was crossing the oblique fissure. Which structures are separated by the oblique fissure of the right lung?
Your Answer: Lower lobe from middle lobe only
Correct Answer: Lower lobe from both upper and middle lobes
Explanation:The oblique fissure on the right lung separates the lower lobe from both the middle and upper lobe. The lingual is only found on the left lung and is part of the upper lobe.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 4
Incorrect
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A week after a renal transplant the patient received antilymphocyte globulins. Shortly after she developed fever and hypotension. Which of the following mechanisms is involved in this response?
Your Answer: Type IV hypersensitivity
Correct Answer: Type III hypersensitivity
Explanation:Type III hypersensitivity is characterized by soluble immune complexes which are aggregations of IgG and IgM antibodies with antigens that deposit in different tissues e.g. the skin, joints, kidneys. They can then trigger an immune response by activating the complement cascade. This reaction can take hours to develop and examples include: immuno-complex glomerulonephritis, rheumatoid arthritis, SLE, subacute bacterial endocarditis, arthus reaction and serum sickness.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 5
Incorrect
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During hysterectomy, the ureter is most likely to be ligated when a surgeon is clamping the?
Your Answer: Ovarian ligaments
Correct Answer: Uterine arteries
Explanation:The ureter forms the posterior boundary of a shallow depression which lodges the ovary and then runs medially and forward on the lateral aspect of the uterine cervix and upper part of the vagina to reach the fundus of the bladder. It is also situated about 2cm from the side of the cervix of the uterus. The relationship of the ureters and uterine arteries is of clinical significance because the arteries are at risk of iatrogenic injury during hysterectomy.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 6
Correct
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The gynaecologist suspects that her patient has a cervical cancer. What particular test should be done on this patient to screen for cervical cancer?
Your Answer: Pap smear
Explanation:Worldwide, approximately 500,000 new cases of cervical cancer and 274,000 deaths are attributable to cervical cancer yearly. This makes cervical cancer the second most common cause of death from cancer in women. The mainstay of cervical cancer screening has been the Papanicolaou test (Pap smear).
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 7
Incorrect
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A 35 year old male patient sustained a traumatic head injury. The patient had loss of consciousness, woke up momentarily when he was in the emergency room but became drowsy and comatose a few hours after. CT scan of the brain showed accumulation of blood between the dura and the cranial bone on the left side of his head. What type of haemorrhage did the patient have?
Your Answer: Subdural
Correct Answer: Epidural
Explanation:Epidural hematoma, also known as epidural bleeding, is a type of traumatic brain injury (TBI) in which a build-up of blood occurs between the dura mater (the tough outer membrane of the central nervous system) and the skull. The spinal cord is also covered by a layer of dura mater, so epidural bleeds may also occur in the spinal column. Often due to trauma, the condition is potentially deadly because the build-up of blood may increase pressure in the intracranial space, compressing delicate brain tissue, and causing brain shift. The condition is present in one to three percent of head injuries. Around 15–20% of epidural hematomas are fatal.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 8
Correct
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A syndrome responsible for failure to absorb vitamin B12 from the GIT is called?
Your Answer: Pernicious anaemia
Explanation:Pernicious anaemia is a type of autoimmune disease in which antibodies form against the parietal cells or intrinsic factor. Intrinsic factor is required for the absorption of vitamin B12. Blood testing typically shows a macrocytic, normochromic anaemia and low levels of serum vitamin B12. A Schilling test can then be used to distinguish between pernicious anaemia, vitamin B12 malabsorption and vitamin B12 deficiency. Symptoms include shortness of breath, pallor and diarrhoea etc.
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This question is part of the following fields:
- General
- Physiology
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Question 9
Incorrect
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A blood sample of a 58 year old male patient, who underwent an abdominal aortic aneurysm repair, was sent to the laboratory. The laboratory technician said that the patient’s blood agglutinates with antisera anti-A and anti-D, while the patient’s serum agglutinates cells of blood group B. What is the blood group of this patient?
Your Answer: O negative
Correct Answer: A positive
Explanation:Group A – has only the A antigen on red cells (and B antibody in the plasma)
Group B – has only the B antigen on red cells (and A antibody in the plasma)
Group AB – has both A and B antigens on red cells (but neither A nor B antibody in the plasma)
Group O – has neither A nor B antigens on red cells (but both A and B antibody are in the plasma). Many people also have a so-called Rh factor on the red blood cell’s surface. This is also an antigen and those who have it are called Rh+. A person with Rh– blood does not have Rh antibodies naturally in the blood plasma (as one can have A or B antibodies, for instance) but they can develop Rh antibodies in the blood plasma if they receive blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies. A person with Rh+ blood can receive blood from a person with Rh– blood without any problems. In this scenario the person has blood group A+ as he has A antigen, anti B antibody and Rh antigen
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This question is part of the following fields:
- General
- Physiology
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Question 10
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 11
Correct
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A construction worker is brought to the A&E after a fall on site. The patient is conscious but complains of inability to feel his legs. A neurological examination reveals that he has no cutaneous sensation from his umbilicus to his toes. What is the likely level of the spinal cord that is injured?
Your Answer: T10
Explanation:The umbilicus has a relatively consistent position in humans and thus serves as an important land mark. The skin around the waist at the level of the umbilicus is supplied by the tenth thoracic spinal nerve (T10 dermatome).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 12
Correct
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Which of the following muscles winds around the pterygoid hamulus?
Your Answer: Tensor veli palatini
Explanation:The tensor veli palatini tenses the soft palate and by doing so, assists the levator veli palatini in elevating the palate to occlude and prevent entry of food into the nasopharynx during swallowing. It arises by a flat lamella from the scaphoid fossa at the base of the medial pterygoid plate, from the spina angularis of the sphenoid and from the lateral wall of the cartilage of the auditory tube. Descending vertically between the medial pterygoid plate and the medial pterygoid muscle, it ends in a tendon which winds around the pterygoid hamulus, being retained in this situation by some of the fibres of origin of the medial pterygoid muscle. Between the tendon and the hamulus is a small bursa. The tendon then passes medialward and is inserted onto the palatine aponeurosis and the surface behind the transverse ridge on the horizontal part of the palatine bone.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 13
Incorrect
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The sciatic nerve does NOT supply which of the following muscles?
Your Answer: Quadratus femoris
Correct Answer: Obturator externus
Explanation:The sciatic nerve supplies both gemellae, quadratus femoris, semitendinosus, semimembranosus, both heads of the biceps femoris, the hamstring half of abductor magnus and obturator internus. Obturator externus is supplied by the obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 14
Incorrect
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Which of these structures does NOT pass posterior to the medial malleolus?
Your Answer: Flexor hallucis longus tendon
Correct Answer: Saphenous vein
Explanation:The saphenous vein passes anterior to the medial malleolus. The structures passing posterior, from nearest to furthest include: tibial, posterior tendon, flexor digitorum longus tendon, posterior tibial artery, posterior tibial vein, posterior tibial nerve and the flexor hallucis longus tendon.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 15
Correct
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A 18-year old girl presents to her doctor with an excessively enlarged left breast as compared to the right breast since puberty. The most likely cause for this is:
Your Answer: Virginal breast hypertrophy
Explanation:Virginal breast hypertrophy’ is the term assigned to excessive growth of breasts during puberty and is a common phenomenon. It is also known as ‘juvenile macromastia’ or ‘ juvenile gigantomastia’. The breast hypertrophy often starts with menarche and occasionally occurs in growth spurts. These spurts can cause physical discomfort, red and itchy skin or pain in the breasts. The breasts can also grow continuously over several years and lead to overdevelopment of a normal breast. Nipples also undergo enlargement along with the breasts.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 16
Incorrect
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A 42-year old woman presents to the doctor with jaundice. Her investigations show conjugated hyperbilirubinemia, raised urine bilirubin levels and low urine urobilinogen levels. What is the likely cause of her jaundice?
Your Answer: Gilbert syndrome
Correct Answer: Blockage of the common bile duct
Explanation:The description of the patient here fits the diagnosis of obstructive jaundice or cholestasis, which results in conjugated hyperbilirubinemia. Cholestasis occurs due to impairment of bile flow, which can be anywhere from the liver cell canaliculus to the ampulla of Vater. Causes can be divided into intrahepatic and extrahepatic.
– Intrahepatic causes include hepatitis, drug toxicity, alcoholic liver disease, primary biliary cirrhosis, cholestasis of pregnancy and metastatic cancer.
– Extrahepatic causes include common duct stone, pancreatic cancer, benign stricture of the common duct, ductal carcinoma, pancreatitis and sclerosing cholangitis.
There is absence of bile constituents in the intestine, which causes spillage in the systemic circulation. Symptoms include pale stools, dark urine, pruritus, malabsorption leading to steatorrhea and deficiency of fat-soluble vitamins. Chronic cases can result in osteoporosis or osteomalacia due to vitamin D deficiency and Ca2+ malabsorption. Cholesterol and phospholipid retention produces hyperlipidaemia despite fat malabsorption (although increased liver synthesis and decreased plasma esterification of cholesterol also contribute); triglyceride levels are largely unaffected. The lipids circulate as a unique, low-density lipoprotein called lipoprotein X.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 17
Incorrect
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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: Coarctation of the aorta
Correct 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 18
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: T2
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 19
Incorrect
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A 38-year old lady presented to the hospital with abnormal passing of blood per vagina. On examination, she was found to have an endocervical polypoidal mass. On enquiry, she gave history of oral contraceptive usage for 3 years. What finding is expected on the histopathology report of biopsy of the mass?
Your Answer: Ectopic pregnancy
Correct Answer: Microglandular hyperplasia
Explanation:Endocervical polyps or microglandular hyperplasia are benign growths occurring in the endocervical canal, in about 2-5% women and occur secondary to use of oral contraceptives. They are usually < 1cm in size, friable and reddish-pink. Usually asymptomatic, they can cause bleeding or become infected, leading to leucorrhoea (purulent vaginal discharge). They are usually benign but need to be differentiated from adenocarcinomas by histology.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 20
Incorrect
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Post-total gastrectomy, there will be a decreased production of which of the following enzymes?
Your Answer: Chymotrypsin
Correct Answer: Pepsin
Explanation:Pepsin is a protease that is released from the gastric chief cells and acts to degrade proteins into peptides. Released as pepsinogen, it is activated by hydrochloric acid and into pepsin itself. Gastrin and the vagus nerve trigger the release of pepsinogen and HCl when a meal is ingested. Pepsin functions optimally in an acidic environment, especially at a pH of 2.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 21
Incorrect
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In a young, sexually active male, what is the most common cause of non-gonococcal urethritis?
Your Answer: Herpes simplex virus
Correct Answer: Chlamydia
Explanation:Non-gonococcal urethritis is most commonly caused by Chlamydia trachomatis (50% cases). Less common organisms include Mycoplasma genitalium, Urea urealyticum and Trichomonas vaginalis. Chlamydia is also the commonest cause of non-gonococcal cervicitis in women and proctitis in both sexes.
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This question is part of the following fields:
- Pathology
- Renal
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Question 22
Incorrect
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A woman that presented with dyspnoea, chest pain and cough was found to have a serous pleural effusion. This finding is most likely to be associated with which of the following conditions?
Your Answer: Metastatic carcinoma
Correct Answer: Congestive heart failure
Explanation:A pleural effusion is defined as an abnormal collection of fluid in the pleural space. Pleural effusion can result from excess fluid production or decreased absorption or both. Thoracentesis and laboratory testing help determine the origin of the accumulated fluid. Serous fluid accumulation in the pleural space indicates the presence of a hydrothorax and is most likely to develop secondary to congestive heart failure.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 23
Correct
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Question 24
Incorrect
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Carbachol is a cholinergic agonist. In which of these cases should carbachol be administered?
Your Answer: Angina
Correct Answer: Cataract surgery
Explanation:Carbachol (carbamylcholine) is a cholinergic agent, a choline ester and a positively charged quaternary ammonium compound. It is primarily used for various ophthalmic purposes, such as for treating glaucoma, or for use during ophthalmic surgery. It is usually administered topically to the eye or through intraocular injection. It is not well absorbed in the gastro-intestinal tract and does not cross the blood–brain barrier.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 25
Incorrect
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Choose the most correct answer regarding the common peroneal nerve.
Your Answer: While part of the sciatic nerve, it innervates nothing in the posterior thigh
Correct Answer: It gives rise to the nerve that supplies the anterior compartment leg muscles
Explanation:The common peroneal nerve divides beneath the peroneus longus muscle and gives off articular and lateral sural cutaneous nerves which supply muscular branches to the muscles of the anterior compartment of the leg which are the tibialis anterior, extensor digitorum, peroneus tertius and extensor hallucis longus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 26
Incorrect
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A 35-year-old woman in her 37th week of pregnancy complains of urinary incontinence. She is most likely to have:
Your Answer: Urge incontinence
Correct Answer: Stress incontinence
Explanation:Urinary incontinence is the involuntary excretion of urine from one’s body. It is often temporary and it almost always results from an underlying medical condition. Several types include:
– Stress incontinence is the voiding of urine following increased abdominal pressure e.g. laughing, coughing, pregnancy etc. It is the most common form of incontinence in women, most commonly due to pelvic floor muscle weakness, physical changes from pregnancy, childbirth and menopause. In men it is a common problem following a prostatectomy. Most lab results such as urine analysis, cystometry and postvoid residual volume are normal.
– Urge incontinence is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate. The most common cause of urge incontinence are involuntary and inappropriate detrusor muscle contractions.
– Functional incontinence – occurs when a person does not recognise the need to go to the toilet, recognise where the toilet is or get to the toilet in time. The urine loss may be large. Causes of functional incontinence include confusion, dementia, poor eyesight, poor mobility, poor dexterity or unwillingness. t
– Overflow incontinence – sometimes people find that they cannot stop their bladders from constantly dribbling or continuing to dribble for some time after they have passed urine.
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This question is part of the following fields:
- Physiology
- Renal
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Question 27
Incorrect
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A patient is diagnosed with a tumour of the parotid gland. During surgical removal of the gland, which artery is vulnerable to injury?
Your Answer: Main trunk of cranial nerve VIII
Correct Answer: External carotid artery
Explanation:The external carotid artery is a major artery of the head and neck. It arises from the common carotid artery when it splits into the external and internal carotid artery. It supplies blood to the face and neck. The external carotid artery begins opposite the upper border of the thyroid cartilage and, taking a slightly curved course, passes upward and forward and then inclines backward to the space behind the neck of the mandible, where it divides into the superficial temporal and internal maxillary arteries. It rapidly diminishes in size in its course up the neck, owing to the number and large size of the branches given off from it. At its origin, this artery is more superficial and placed nearer the midline than the internal carotid and is contained within the carotid triangle. The external carotid artery is covered by the skin, superficial fascia, platysma, deep fascia and anterior margin of the sternocleidomastoid. It is crossed by the hypoglossal nerve, by the lingual, ranine, common facial and superior thyroid veins; and by the digastric and stylohyoid; higher up it passes deeply into the substance of the parotid gland, where it lies deep to the facial nerve and the junction of the temporal and internal maxillary veins. It is here that it is in danger during surgery of the parotid gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 28
Incorrect
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Which one of the following muscles is innervated by the facial nerve?
Your Answer: Masseter
Correct Answer: Buccinator
Explanation:Buccinator is a muscle of facial expression and is therefore innervated by the facial nerve. The lateral pterygoid, masseter, anterior belly of digastric and temporalis are all muscles of mastication and therefore innervated by the mandibular division of the trigeminal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck; Neurology
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Question 29
Incorrect
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Which of the following is the most likely cause of massive splenomegaly in a 35-year old gentleman?
Your Answer: Portal hypertension
Correct Answer: Myelofibrosis
Explanation:Causes of massive splenomegaly include chronic myelogenous leukaemia, chronic lymphocytic leukaemia, lymphoma, hairy cell leukaemia, myelofibrosis, polycythaemia vera, sarcoidosis, Gaucher’s disease and malaria.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 30
Incorrect
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The wound healing process is documented in patients undergoing laparoscopic procedures. The port incisions are sutured closed and the wounds observed every few weeks for re-epithelialisation and tensile strength. Which substance is mostly likely to be found at a cellular level involved in wound healing?
Your Answer:
Correct Answer: Tyrosine kinase
Explanation:Cell surface growth factor receptors require intercellular proteins such as tyrosine kinase which are necessary to initiate a series of events that eventually lead to cell division and growth. Tyrosine kinase is an enzyme that transfers a phosphate group to the tyrosine residue in a protein. This phosphorylation will lead to an up regulation of the enzyme activity.
Fibronectin acts in the extracellular matrix to bind macromolecules (such as proteoglycans) via integrin receptors to aid attachment and migration of cells.
Laminin is an extracellular matrix component that is abundant in basement membranes.
Hyaluronic acid is one of the proteoglycans in the extracellular matrix.
Collagen fibres are part of the extracellular matrix that gives strength and stability to connective tissues.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
