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  • Question 1 - A medical intern wanting to perform her first thoracentesis (remove fluid from the...

    Correct

    • A medical intern wanting to perform her first thoracentesis (remove fluid from the pleural cavity) wishes to be reminded where to insert the needle to aspirate in order to avoid injuring the lung or neurovascular elements. Where is this place?

      Your Answer: The bottom of interspace 9 in the midaxillary line

      Explanation:

      Thoracentesis is performed in the costodiaphragmatic recess. The needle needs to be inserted below the level of the lungs to avoid injury to the lungs. At the paravertebral line, is between ribs 10 and 12, at the midaxillary line between ribs 8 and 10 and at the midclavicular line between interspaces 6 and 8. The needle should be inserted at the top of the rib (or the bottom of the interspace) to avoid damage to the neurovascular structures found below the rib running in the costal groove.

      The recommended location for the needle insertion varies depending upon the source. It is critical that the patient hold his or her breath to avoid piercing of the lung.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      153.4
      Seconds

  • Question 2 - A 4-year-old child was brought to a paediatrician for consult due to a...

    Correct

    • 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.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      37.4
      Seconds

  • Question 3 - The gradual depolarization in-between action potentials in pacemaker tissue is a result of?...

    Correct

    • The gradual depolarization in-between action potentials in pacemaker tissue is a result of?

      Your Answer: A combination of gradual inactivation outward IK along with the presence of an inward ‘funny’ current (If) due to opening of channels permeable to both Na+ and K+ ions

      Explanation:

      One of the characteristic features of the pacemaker cell is the generation of a gradual diastolic depolarization also called the pacemaker potential. In phase 0, the upstroke of the action potential caused by an increase in the Ca2+ conductance, an influx of calcium occurs and a positive membrane potential is generated. The next is phase 3 which is repolarization caused by increased K+ conductance as a result of outwards K+ current. Phase 4 is a slow depolarization which accounts for the pacemaker activity, caused by increased conductance of Na+, inwards Na+ current called IF. it is turned on by repolarization.

    • This question is part of the following fields:

      • General
      • Physiology
      421.2
      Seconds

  • Question 4 - A 58-year-old woman has had a headache, fever, lethargy and nausea for the...

    Correct

    • A 58-year-old woman has had a headache, fever, lethargy and nausea for the last 10 days. He undergoes a CT scan which reveals a lesion in his frontal lobe, which, after a biopsy, is found to be formed by granulation tissue with collagenisation, gliosis and oedema. What's the most likely diagnosis?

      Your Answer: Chronic brain abscess

      Explanation:

      A cerebral abscess can result from direct extension of cranial infections, penetrating head trauma, haematogenous spread, or for unknown causes. An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts. Oedema around the abscess can increase the intracranial pressure. Symptoms result from increased intracranial pressure and mass effects. In a CT scan, an abscess appears as an oedematous mass with ring enhancement.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      297.8
      Seconds

  • Question 5 - The Henderson–Hasselbalch equation describes the derivation of pH as a measure of acidity. According to this equation,...

    Incorrect

    • The Henderson–Hasselbalch equation describes the derivation of pH as a measure of acidity. According to this equation, the buffering capacity of the system is at maximum when the number of free anions compared with undissociated acid is:

      Your Answer: Three times more

      Correct Answer: Equal

      Explanation:

      In 1908, Lawrence Joseph Henderson wrote an equation describing the use of carbonic acid as a buffer solution. Later, Karl Albert Hasselbalch re-expressed that formula in logarithmic terms, resulting in the Henderson–Hasselbalch equation. The equation is also useful for estimating the pH of a buffer solution and finding the equilibrium pH in acid–base reactions. Two equivalent forms of the equation are: pH = pKa + log10 [A–]/[HA] or pH = pKa + log10 [base]/[acid]. Here, pKa is − log10(Ka) where Ka is the acid dissociation constant, that is: pKa = –log10(Ka) = –log10 ([H3 O+][A–]/[HA]) for the reaction: HA + H2 O ≈ A– + H3 O+ In these equations, A– denotes the ionic form of the relevant acid. Bracketed quantities such as [base] and [acid] denote the molar concentration of the quantity enclosed. Maximum buffering capacity is found when pH = pKa or when the number of free anions to undissociated acid is equal and buffer range is considered to be at a pH = pKa ± 1.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      258.6
      Seconds

  • Question 6 - Which of the following tumours is very radiosensitive? ...

    Incorrect

    • Which of the following tumours is very radiosensitive?

      Your Answer: Chondrosarcoma

      Correct Answer: Seminoma

      Explanation:

      Seminoma is the most radiosensitive tumour and responds well to radiation therapy after unilateral orchidectomy. The ipsilateral inguinal areas are routinely not treated however, depending on the stage, the mediastinum and the left supraclavicular regions may also be irradiated.

    • This question is part of the following fields:

      • Neoplasia; Urology
      • Pathology
      77
      Seconds

  • Question 7 - A 42 year old man presents with end stage renal failure and is...

    Incorrect

    • 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: Graft-versus-host disease

      Correct 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.

    • This question is part of the following fields:

      • Inflammation & Immunology; Renal
      • Pathology
      108.1
      Seconds

  • Question 8 - The annular ligament in the forearm: ...

    Correct

    • The annular ligament in the forearm:

      Your Answer: Encircles the head of the radius

      Explanation:

      The annular ligament forms about four-fifths of the osseofibrous ring and is attached to the anterior and posterior margins of the radial notch. It is a strong band of fibres which encircles the head of the radius retaining it in contact with the radial notch of the ulna. When it comes to its upper border, it blends with the anterior and posterior ligament of the elbow.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      24.7
      Seconds

  • Question 9 - Which of these HLA alleles is most likely to be present in ankylosing...

    Correct

    • Which of these HLA alleles is most likely to be present in ankylosing spondylitis?

      Your Answer: HLA-B27

      Explanation:

      Ankylosing spondylitis usually appears between the ages of 20-40 years old and is more frequent in men. It is strongly associated with HLA-B27, along with other spondyloarthropathies, which can be remembered through the mnemonic PAIR (Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, and Reactive arthritis).

    • This question is part of the following fields:

      • Orthopaedics
      • Pathology
      10.8
      Seconds

  • Question 10 - A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect: ...

    Correct

    • A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect:

      Your Answer: Regulation of circadian rhythm

      Explanation:

      The suprachiasmatic nucleus (SCN) in the hypothalamus is responsible for controlling endogenous circadian rhythms and destruction of the SCN leads to a loss of circadian rhythm.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      16.3
      Seconds

  • Question 11 - Vincristine is a chemotherapy agent used to treat a number of types of...

    Incorrect

    • 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: Myelosuppression

      Correct 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.

    • This question is part of the following fields:

      • Pathology
      • Pharmacology
      18.6
      Seconds

  • Question 12 - The pterygoid plexus receives tributaries from which of the following veins? ...

    Incorrect

    • The pterygoid plexus receives tributaries from which of the following veins?

      Your Answer: Superficial temporal vein

      Correct Answer: Maxillary vein

      Explanation:

      The pterygoid plexus of veins is the main venous component associated with the infratemporal fossa. It receives tributaries corresponding to the branches of the internal maxillary artery. This plexus communicates freely with the anterior facial vein; it also communicates with the cavernous sinus, by branches through the foramen of Vesalius, foramen ovale and foramen lacerum. The (internal) maxillary vein is a short trunk which accompanies the first part of the (internal) maxillary artery. It is formed by a confluence of the veins of the pterygoid plexus and passes backward between the sphenomandibular ligament and the neck of the mandible and unites with the temporal vein to form the posterior facial vein. It carries blood away from the infratemporal fossa.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      43.6
      Seconds

  • Question 13 - A 38-year-old woman with end-stage renal disease, is undergoing haemodialysis. She has normocytic...

    Incorrect

    • A 38-year-old woman with end-stage renal disease, is undergoing haemodialysis. She has normocytic normochromic anaemia. What is the best treatment for her?

      Your Answer: Ferrous sulphate

      Correct Answer: Erythropoietin

      Explanation:

      E erythropoietin (EPO) is a hormone that is released by the kidney. It is responsible for the regulation of red blood cell production in the body. It can be made using recombinant technology and is used in the treatment of anaemia of chronic renal failure and in patients under going chemotherapy

    • This question is part of the following fields:

      • General
      • Physiology
      209.2
      Seconds

  • Question 14 - what is the cause of a prolonged PT(prothrombin time)? ...

    Incorrect

    • what is the cause of a prolonged PT(prothrombin time)?

      Your Answer: Haemophilia

      Correct Answer: Liver disease

      Explanation:

      PT measure the intrinsic pathway of coagulation. It determines the measure of the warfarin dose regime, liver disease and vit K deficiency status along with the clotting tendency of blood. PT measured factors are II,V,VII,X and fibrinogen. It is used along with aPTT which measure the intrinsic pathway.

    • This question is part of the following fields:

      • General
      • Physiology
      22
      Seconds

  • Question 15 - The glossopharyngeal nerve provides the parasympathetic innervation of the: ...

    Correct

    • The glossopharyngeal nerve provides the parasympathetic innervation of the:

      Your Answer: Parotid salivary gland

      Explanation:

      The glossopharyngeal nerve provides parasympathetic innervation for the parotid salivary gland via the auriculotemporal nerve. The facial nerve supplies the parasympathetic innervation of the lacrimal, nasal, sublingual and submandibular glands.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck; Neurology
      83.8
      Seconds

  • Question 16 - The muscles of the superficial posterior compartment of the leg insert into the:...

    Correct

    • The muscles of the superficial posterior compartment of the leg insert into the:

      Your Answer: Calcaneus

      Explanation:

      The muscles of the superficial posterior compartment of the leg form the characteristic ‘calf’ shape of the posterior leg and include the gastrocnemius, soleus and plantaris. The gastrocnemius and soleus together form a muscular mass which is occasionally described as the triceps surae; its tendon of insertion is the tendo calcaneus. The tendo calcaneus is the thickest and strongest in the body and together with the tendon of the plantaris muscle is inserted into the posterior part of the calcaneus.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      60.3
      Seconds

  • Question 17 - When a patient is standing erect, pleural fluid would tend to accumulate in...

    Correct

    • When a patient is standing erect, pleural fluid would tend to accumulate in which part of the pleural space?

      Your Answer: Costodiaphragmatic recess

      Explanation:

      The costo-diaphragmatic recess is the lowest extent of the pleural cavity or sac. Any fluid in the pleura will by gravity accumulate here when a patient is standing erect.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      27.3
      Seconds

  • Question 18 - Which of the following morphological features is most characteristic of hyaline degeneration? ...

    Correct

    • Which of the following morphological features is most characteristic of hyaline degeneration?

      Your Answer: Homogeneous, ground-glass, pink-staining appearance of cells

      Explanation:

      The characteristic morphological features of hyaline degeneration is ground-glass, pinking staining cytoplasm with an intact cell membrane. The accumulation of lipids, calcium salts, lipofuscin and an amorphous cytoplasm with an intact cell membrane are all characteristically found in different situations.

      Pyknotic nucleus and orphan Annie eye nucleus are not seen in hyaline degeneration.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing
      • Pathology
      235.9
      Seconds

  • Question 19 - Which of the following structures, is the area in which the superior cerebral...

    Correct

    • Which of the following structures, is the area in which the superior cerebral veins drain into?

      Your Answer: Superior sagittal sinus

      Explanation:

      The superior cerebral veins are predominantly located on the superior aspect of the brain. They are 8 to 12 in number and they drain the lateral, medial and superior aspects of the cerebral hemispheres.

      These veins drain into the superior sagittal sinus, also known as the superior longitudinal sinus – which is located along the attached margin of the falx cerebri.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      38.5
      Seconds

  • Question 20 - Regarding innervation to the peroneus brevis muscle: ...

    Correct

    • Regarding innervation to the peroneus brevis muscle:

      Your Answer: Could be damaged by a fracture of the neck of the fibula

      Explanation:

      The peroneus brevis is supplied by the fourth and fifth lumbar and first sacral nerves through the superficial peroneal nerve which is one of the two terminal branches of the common peroneal nerve. The common peroneal nerve winds around the neck of the fibula and can be injured in cases of fractured neck of fibula.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      443.6
      Seconds

  • Question 21 - What is the linea aspera: ...

    Incorrect

    • What is the linea aspera:

      Your Answer: Is a landmark on the tibia

      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
      37.7
      Seconds

  • Question 22 - Which of the following muscles attaches to the pterygomandibular raphe? ...

    Correct

    • Which of the following muscles attaches to the pterygomandibular raphe?

      Your Answer: Superior pharyngeal constrictor muscle

      Explanation:

      The pterygomandibular raphé (pterygomandibular ligament) provides attachment on its posterior border to the superior pharyngeal constrictor and on its anterior border to the buccinator muscle.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      10.7
      Seconds

  • Question 23 - During laparoscopic surgery to repair a direct inguinal hernia in a 68-year old...

    Correct

    • During laparoscopic surgery to repair a direct inguinal hernia in a 68-year old man, the surgeon asked the registrar to look at the medial inguinal fossa to identify the direct inguinal hernia. To do so, she would have to look at the area that is between the:

      Your Answer: Medial umbilical ligament and inferior epigastric artery

      Explanation:

      The medial umbilical fold is made by the medial umbilical ligament-which is the obliterated portion of the umbilical artery, while the lateral umbilical fold is a fold of peritoneum over the inferior epigastric vessels. The median umbilical fold is a midline structure made by the median umbilical ligament i.e. the obliterated urachus. The medial inguinal fossa is the space on the inner abdominal wall between the medial umbilical fold and the lateral umbilical fold. It is place in the abdominal wall where there is an area of weak fascia i.e. the inguinal triangle through which direct inguinal hernias break through. The lateral inguinal fossa on the other hand is a space lateral to the lateral umbilical fold. Indirect inguinal hernias push through this space.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      556.2
      Seconds

  • Question 24 - Gastric acid secretion is stimulated by which of the following? ...

    Incorrect

    • Gastric acid secretion is stimulated by which of the following?

      Your Answer: Cholecystokinin

      Correct Answer: Gastrin

      Explanation:

      Gastric acid secretion is stimulated by three factors:

      – Acetylcholine, from parasympathetic neurones of the vagus nerve that innervate parietal cells directly

      – Gastrin, produced by pyloric G-cells

      – Histamine, produced by mast cells.

      Gastric acid is inhibited by three factors:

      – Somatostatin

      – Secretin

      – Cholecystokinin

    • This question is part of the following fields:

      • Endocrine
      • Physiology
      23.3
      Seconds

  • Question 25 - A 39-year-old man, after radiological evaluation and thoracentesis, was found to have chylothorax....

    Correct

    • A 39-year-old man, after radiological evaluation and thoracentesis, was found to have chylothorax. What is the most probable cause of this diagnose?

      Your Answer: Mediastinal malignant lymphoma

      Explanation:

      Chylothorax is a potentially lethal condition characterized by fluid (chyle) accumulation in the pleural cavity, resulting from disruption of lymphatic drainage in the thoracic duct. Chyle is a fluid rich in triglycerides and chylomicrons and can originate from the thorax, the abdomen or both. Malignant tumours, especially lymphoma, are the most common causes of nontraumatic chylothorax. Bronchogenic carcinoma and trauma are the most common causes after lymphomas. Other rare causes of chylothorax are; granulomatous diseases, tuberculosis, congenital malformations, nephrotic syndrome, hypothyroidism, cirrhosis, decompensated heart failure and idiopathic chylothorax.

    • This question is part of the following fields:

      • Pathology
      • Respiratory
      229.8
      Seconds

  • Question 26 - Which of the following is a true statement regarding secretion of gastric acid?...

    Correct

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

      Your 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
      338.3
      Seconds

  • Question 27 - An organ transplant patient may be at risk of developing which type of...

    Incorrect

    • An organ transplant patient may be at risk of developing which type of cancer?

      Your Answer: Thyroid cancer

      Correct Answer: Skin cancer

      Explanation:

      The most common malignancies encountered in the post–solid organ transplant setting are non-melanoma skin cancers, post-transplant lymphoproliferative disorders and Kaposi’s sarcoma (KS). The pathogenesis of these tumours is likely related to the immunosuppressive drugs used post-transplantation and subsequent viral infection.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      429.8
      Seconds

  • Question 28 - The following organs would be expected to lie within the right lower quadrant...

    Correct

    • The following organs would be expected to lie within the right lower quadrant of the abdomen, assuming that the gastrointestinal tract is rotated normally:

      Your Answer: Distal jejunum, caecum, vermiform appendix

      Explanation:

      The abdomen is divided by theoretical anatomic lines into four quadrants. The median plane follows the linea alba and extends from the xiphoid process to the pubic symphysis and splits the abdomen in half. The transumbilical plane is a horizontal line that runs at the level of the umbilicus. This forms the upper right and left quadrants and the lower right and left quadrants. Structures in the right lower quadrant include: caecum, appendix, part of the small intestine, ascending colon, the right half of the female reproductive system, right ureter. Pain in this region is most commonly associated with appendicitis.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      111.2
      Seconds

  • Question 29 - A 35-year old lady presents to her GP with vague abdominal symptoms. Examination...

    Incorrect

    • A 35-year old lady presents to her GP with vague abdominal symptoms. Examination reveals a normal size spleen. Which of the following is the likely diagnosis?

      Your Answer: Myelofibrosis

      Correct Answer: Idiopathic thrombocytopenic purpura

      Explanation:

      Idiopathic thrombocytopenic purpura (ITP) is a disease caused due to development of an antibody against a platelet antigen (autoantibody). In childhood disease, the autoantibody gets triggered by binding of viral antigen to the megakaryocytes. Presentation includes unexplained thrombocytopenia, petechiae and bleeding from mucosal surfaces. The spleen usually does not enlarge in size. However, splenomegaly can occur due to coexisting viral infection. Marrow examination reveals normal or increased number of megakaryocytes. Diagnosis is by exclusion of other thrombocytopenic disorders.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      330.7
      Seconds

  • Question 30 - Which of the following brings about a reduction in gastric blood flow? ...

    Correct

    • Which of the following brings about a reduction in gastric blood flow?

      Your Answer: Vasopressin

      Explanation:

      Gastric blood flow is increased by vagal stimulation, gastrin, histamine and acetylcholine as they stimulate gastric section and the production of vasodilator metabolites. Acetylcholine and histamine also have a direct action on the gastric arterioles. Similarly, gastric blood flow is reduced by inhibitors of secretion – catecholamines, secretin and vasopressin.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      78.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (10/12) 83%
Thorax (2/2) 100%
Neoplasia (1/2) 50%
Pathology (5/10) 50%
General (1/3) 33%
Physiology (4/8) 50%
Neurology (2/2) 100%
Fluids & Electrolytes (0/1) 0%
Neoplasia; Urology (0/1) 0%
Inflammation & Immunology; Renal (0/1) 0%
Upper Limb (1/1) 100%
Orthopaedics (1/1) 100%
Pharmacology (0/1) 0%
Head & Neck (2/3) 67%
Head & Neck; Neurology (1/1) 100%
Lower Limb (2/3) 67%
Cell Injury & Wound Healing (1/1) 100%
Abdomen (2/2) 100%
Endocrine (0/1) 0%
Respiratory (1/1) 100%
Gastroenterology (2/2) 100%
Haematology (0/1) 0%
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