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Question 1
Correct
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Passing through the lesser sciatic foramen are the:
Your Answer: Pudendal nerve
Explanation:Structures that pass through the lesser sciatic foramen include:
– the pudendal nerve
– the nerve to obturator internus
– internal pudendal artery
– the tendon of obturator internus
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 2
Incorrect
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In a cardiac cycle, what event does the closing of atrioventricular (AV) valves coincide with?
Your Answer: Beginning of diastole
Correct Answer: First heart sound
Explanation:In the cardiac cycle, the closing of the atrioventricular (AV) valves coincides with the onset of ventricular systole. This event marks the beginning of the isovolumetric contraction phase, where the ventricles begin to contract, but the volume of blood in the ventricles remains the same because both the AV valves and the semilunar valves (aortic and pulmonary valves) are closed. The closing of the AV valves produces the first heart sound, known as “S1” or “lub.”
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 3
Correct
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A 45 year old man who complains of chronic post prandial, burning epigastric pain undergoes a gastrointestinal endoscopy. There is no apparent mass or haemorrhage and a biopsy is taken from the lower oesophageal mucosa just above the gastro-oesophageal junction. The results reveal the presence of columnar cells interspersed with goblet cells. Which change best explains the above mentioned histology?
Your Answer: Metaplasia
Explanation:Metaplasia is the transformation of one type of epithelium into another as a means to better cope with external stress on that epithelium. In this case metaplasia occurs due to the inflammation resulting from gastro-oesophageal reflux disease. Dysplasia is disordered cellular growth. Hyperplasia is an increase in cell number but not cell type i.e. transformation. Carcinoma is characterized by cellular atypia. Ischaemia would result in necrosis with ulceration. Carcinoma insitu involves dysplastic atypical cells with the basement membrane intact and atrophy would mean a decrease in number of cells.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Gastrointestinal
- Pathology
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Question 4
Incorrect
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Regarding abduction of the digits of the hand, which of the following is correct?
Your Answer: Adduction of the digits will be affected by carpal tunnel syndrome
Correct Answer: All of the adductors of the digits take at least part of their attachments from metacarpal bones
Explanation:Lying on the palmer surfaces of the metacarpal bones are four palmar interossei which are smaller than the dorsal interossei. Arising from the entire length of the metacarpal bone of one finger, is a palmar interosseous, which is inserted into the side of the base of the first phalanx and the aponeurotic expansion of the extensor digitorum communis tendon to the same finger. All the interossei are innervated by the eighth cervical nerve, through the deep palmar branch of the ulnar nerve. The palmar interossei adducts the fingers to an imaginary line drawn longitudinally through the centre of the middle finger.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 5
Incorrect
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The inferior palpebral nerve ascends behind the orbicularis oculi. What is the terminal branch of the inferior palpebral nerve?
Your Answer:
Correct Answer: Infraorbital nerve
Explanation:The inferior palpebral nerve is a branch of the maxillary nerve. It supplies the skin and conjunctiva of the lower eyelid.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 6
Incorrect
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The specimen sent to the pathologist for examination was found to be benign. Which one of the following is most likely a benign tumour?
Your Answer:
Correct Answer: Warthin’s tumour
Explanation:Warthin’s tumour is also known as papillary cystadenoma lymphomatosum. It is a benign cystic tumour of the salivary glands containing abundant lymphocytes and germinal centres. It has a slightly higher incidence in males and most likely occur in older adults aged between 60 to 70 years. This tumour is also associated with smoking. Smokers have an eight-fold greater risk in developing the tumour compared to non-smokers.
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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 29-year-old woman presents to the doctor complaining of cough, shortness of breath, fever and weight loss. Chest X-ray revealed bilateral hilar and mediastinal lymph node enlargement and bilateral pulmonary opacities. Non-caseating granulomas were found on histological examination. The most likely diagnosis is:
Your Answer:
Correct Answer: Sarcoidosis
Explanation:Sarcoidosis is an inflammatory disease of unknown aetiology that affects multiple organs but predominantly the lungs and intrathoracic lymph nodes. Systemic and pulmonary symptoms may both be present. Pulmonary involvement is confirmed by a chest X-ray and other imaging studies. The main histological finding is the presence of non-caseating granulomas.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 8
Incorrect
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If a 68-year-old man is diagnosed with a testicular seminoma that reaches the tunica albuginea and involves the tunica vaginalis, with retroperitoneal lymph nodes greater than 5cm, LDH 1.4 times the reference levels, β-hCG 4250 mIU/ml and AFP 780 ng/ml, what's the clinical stage in this case?
Your Answer:
Correct Answer: Stage IIC
Explanation:According to the AJCC, the clinical staging for testicular seminoma is:
Stage IA: T1 N0 M0 S0
Stage IB: T2/3/4 N0 M0 S0
Stage IC: any T N0 M0 S1/2/3
Stage IIA: any T N1 M0 S0/1
Stage IIB: any T N2 M0 S0/1
Stage IIC: any T N3 M0 S0/1
Stage IIIA: any T any N M1a S0/1
Stage IIIB: any T any N M0/1a S2
Stage IIIC: any T any N M1a/1b S3.
The patient in this case has IIC stage -
This question is part of the following fields:
- Pathology
- Urology
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Question 9
Incorrect
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In the emergency room, a nurse was introducing a catheter into the patients femoral vein for rapid fluid therapy. The femoral vein is situated inside the femoral sheath. Which of the following is true about that sheath?
Your Answer:
Correct Answer: The medial compartment is called the femoral canal
Explanation:The femoral sheath is situated ,4cm below the inguinal ligament. It is a prolongation of the abdominal fascia. The anterior wall is a prolongation of the transversalis fascia and the posterior wall, the iliac fascia. It is divided by two vertical septa into 3 compartments, lateral, intermediate, and medial. The medial compartment is known as the femoral canal and contains some lymphatic vessels. The lateral one contains the femoral artery and the intermediate one contains the femoral vein.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 10
Incorrect
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The absence of which of the following components characterizes the grey platelet syndrome (GPS)?
Your Answer:
Correct Answer: Alpha granules
Explanation:Grey platelet syndrome (GPS) is a rare inherited bleeding disorder associated with an almost total absence of α-granules and their contents. The syndrome is characterised by thrombocytopenia, enlarged platelets that have a grey appearance, myelofibrosis, and splenomegaly. Alpha granules store proteins and growth factors that promote platelet adhesiveness and wound healing. Patients with GPS develop symptoms and signs such as easy bruising, prolonged bleeding, and nose bleeds.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 11
Incorrect
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A cancer patient was found to have a radio resistant tumour. Which tumour does the patient most likely have?
Your Answer:
Correct Answer: Liposarcoma
Explanation:Liposarcoma is a cancer that arises in fat cells in deep soft tissue. Commonly it occurs inside the thigh or retroperitoneum. It usually affects middle-aged and older adults, over 40 years. Liposarcoma is the most common soft-tissue sarcoma. It is very radio resistant. Five-year survival rates vary from 100% to 56% based on histological subtype.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 12
Incorrect
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What is the result of maltase deficiency in the brush border of the small intestine?
Your Answer:
Correct Answer: Results in increased passage of maltose in stool
Explanation:Maltase is an enzyme produced from the surface cells of the villi, lining the small intestine and aids in hydrolysing the disaccharide maltose, which splits into two molecules of α-glucose. It is done by breaking the glycosidic bond between the ‘first’ carbon of one glucose and the ‘fourth’ carbon of the other (a 1–4 bond). Hence, a deficiency of enzyme maltase will result in the increased passage of maltose in the stool.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 13
Incorrect
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A 20-year-old woman had profuse watery diarrhoea for 2 days. She felt dizzy and weak, and thus decided to seek medical attention. At the emergency room her BP was 80/60 mmHg with a pulse of 118/min. What is the most appropriate intravenous treatment that should be given?
Your Answer:
Correct Answer: Isotonic saline
Explanation:Normal saline is typically the first fluid used when hypovolemia is severe enough to threaten the adequacy of blood circulation. It is isotonic and has long been believed to be the safest fluid to give quickly in large volumes.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 14
Incorrect
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An old man presented with atrophy of the thenar eminence despite the sensation over it still being intact. What is the injured nerve in this case?
Your Answer:
Correct Answer: Median nerve
Explanation:Atrophy of the thenar muscles means injury to the motor supply of these muscles. The nerve that sends innervation to it is the median nerve. But the median nerve does not provide sensory innervation to the overlying skin so sensation is spared.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 15
Incorrect
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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.
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This question is part of the following fields:
- Pathology
- Urology
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Question 16
Incorrect
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If a catheter is placed in the main pulmonary artery of a healthy 30-year-old woman, which of the following will be its mean pulmonary arterial pressure?
Your Answer:
Correct Answer: 15 mmHg
Explanation:The pulmonary artery pressure (PA pressure) is a measure of the blood pressure found in the main pulmonary artery. The hydrostatic pressure of the pulmonary circulation refers to the actual pressure inside pulmonary vessels relative to atmospheric pressure. Hydrostatic (blood pressure) in the pulmonary vascular bed is low compared with that of similar systemic vessels. The mean pulmonary arterial pressure is about 15 mmHg (ranging from about 13 to 19 mmHg) and is much lower than the average systemic arterial pressure of 90 mmHg.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 17
Incorrect
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A 50 year old man was admitted to the surgical ICU following a hemicolectomy for carcinoma of the caecum. A full blood count revealed: haematocrit = 30%, erythrocytes = 4 × 106/μ, haemoglobin level = 8 g/dl. To determine the likely cause of his anaemia, red blood cell indices were calculated. Which RBC indices are correct?
Your Answer:
Correct Answer: MCHC = haemoglobin concentration/haematocrit
Explanation:Mean corpuscular haemoglobin concentration (MCHC) is calculated simply by dividing the haemoglobin concentration (8 g/dl) by the haematocrit (0.3). The normal range is 31–36 g/dl. This patient has a hypochromic anaemia (MCHC = 8/0.3 = 26.7 g/dl). Dividing the haemoglobin concentration × 10 by erythrocyte number yields mean corpuscular haemoglobin (MCH). Normal range is 25.4–34.6 pg/cell and this patient has a significantly reduced cellular haemoglobin content (MCH = 8 × 10/4 = 20 pg/cell). Mean corpuscular volume (MCV) is calculated by dividing haematocrit × 1000 by erythrocyte number (4 × 106/μl). Normal range is 80–100 fl and this patient has a microcytic anaemia (MCV = 0.3 × 1000/4 = 75 fl). Microcytic, hypochromic anaemia is characteristic for iron-deficiency.
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This question is part of the following fields:
- General
- Physiology
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Question 18
Incorrect
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A 20 year old is brought to the A&E after he fell from a moving cart. The boy has sustained blunt abdominal injury, and the there is a possibility of internal bleeding as the boy is in shock. An urgent exploratory laparotomy is done in the A&E theatre. On opening the peritoneal cavity, the operating surgeon notices a torn gastrosplenic ligament with a large clot around the spleen. Which artery is most likely to have been injured in this case?
Your Answer:
Correct Answer: Short gastric
Explanation:The short gastric arteries branch from the splenic artery near the splenic hilum to travel back in the gastrosplenic ligament to supply the fundus of the stomach. Therefore, these may be injured in this case.
The splenic artery courses deep to the stomach to reach the hilum of the spleen. It doesn’t travel in the gastrosplenic ligament although it does give off branches that do.
The middle colic artery is a branch of the superior mesenteric artery that supplies the transverse colon.
Gastroepiploic artery is the largest branch of the splenic artery that courses between the layers of the greater omentum to anastomose with the right gastroepiploic.
Left gastric artery, a branch of the coeliac trunk. It supplies the left half of the lesser curvature.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 19
Incorrect
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A syndrome responsible for failure to absorb vitamin B12 from the GIT is called?
Your Answer:
Correct 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 20
Incorrect
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The majority of gallstones are mainly composed of:
Your Answer:
Correct Answer: Cholesterol
Explanation:Bile salts are formed out of cholesterol in the liver cells. Occasionally, precipitation of cholesterol occurs resulting into cholesterol stones developing in the gall bladder.
These cholesterol gallstones are the most common type and account for 80% of all gallstones. Another type, accounting for 20% gallstones is pigment stones which are composed of bilirubin and calcium salts. Occasionally, stones of mixed origin are also seen.
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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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Which of the following structures is not easily palpable?
Your Answer:
Correct Answer: Styloid process of the temporal bone
Explanation:The styloid process is a thin, pointed process that projects antero-inferiorly from the base of the petrous temporal bone. It can vary in length from a short, stubby process to a slender, four to five centimetre rod. It forms from the cranial elements of the second pharyngeal arch. The tympanic plate of the temporal bone ensheathes the base of this process. The pointed, projecting portion of the process provides attachment to the stylohyoid and stylomandibular ligaments, and to three muscles – the styloglossus, stylohyoid, and stylopharyngeus. As the styloid process is covered by the various muscles, it is not easily palpable in live subjects.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 22
Incorrect
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Which of the following changes in the histology of the cell is most likely to be accompanied by disruption of the cell membrane following an injury?
Your Answer:
Correct Answer: Coagulative necrosis
Explanation:The process of necrosis ends with the rupture of the cell membrane and the consequent release of the cellular components into the surrounding tissue. Apoptosis, pyknosis and karyorrhexis are not reversible events but the cell membrane remains intact. Cloudy swelling and hydropic changes are also reversible but again the cell membrane remains intact and they are therefore different and distinct from necrosis.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 23
Incorrect
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Regarding the long head of the biceps femoris, which of the following is correct?
Your Answer:
Correct Answer: It crosses two joints
Explanation:The long head of the biceps femoris arises from the lower and inner impression on the back of the tuberosity of the ischium. It inserts with the short head in an aponeurosis which becomes a tendon and this tendon is inserted into the lateral side of the head of the fibula and the lateral condyle of the tibia, thus crossing two joints.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 24
Incorrect
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Which is the correct order of tendons passing from medial to lateral-posterior to the medial malleolus?
Your Answer:
Correct Answer: Posterior tibial, flexor digitorum longus, flexor hallucis longus
Explanation:The correct order of structures is the tendon of tibialis posterior, tendon of flexor digitorum longus, posterior tibial artery (and vein), tibial nerve and tendon of flexor hallucis longus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 25
Incorrect
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A 45-year old male, who was a chronic smoker presented to the clinic with backache and dry, incessant cough. On examination, he was found to have raised blood pressure, purplish striae on his abdomen, truncal obesity and tenderness over the lower thoracic spine. These findings are suggestive of which condition?
Your Answer:
Correct Answer: Small-cell anaplastic (oat cell) carcinoma
Explanation:The symptoms suggest Cushing syndrome due to increased glucocorticoid levels. One cause of Cushing syndrome is ectopic production of adrenocorticotrophic hormone from oat cell carcinoma. As oat cell carcinoma is known to be highly metastatic, the tenderness in lower back could represent metastatic involvement.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 26
Incorrect
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A 13 year old girl presented with signs of shortness of breath, chest pain, non-productive cough, oedema of the lower extremities and cyanosis of the fingertips. She has a history of a ventricular septal defect not surgically corrected. The most probable cause of these symptoms is:
Your Answer:
Correct Answer: Shunt reversal
Explanation:A ventricular septal defect (VSD) is a common form of congenital heart defects and is characterised by the presence of a hole in the wall that separates the right from the left ventricle. Medium or large defects can cause many complications. One of these complication is Eisenmenger syndrome, characterised by reversal of the shunt (from left-to-right shunt into a right-to-left) ,cyanosis and pulmonary hypertension.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 27
Incorrect
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The parasympathetic fibres of the oculomotor nerve was impinged due to a growing tumour. The function of which of the following structures will be affected?
Your Answer:
Correct Answer: Ciliary muscle
Explanation:The oculomotor nerve is the third cranial nerve (CNIII). It offers motor and parasympathetic innervation to many of the ocular structures. The motor fibres innervate a number of the extraocular muscles. While the parasympathetic fibres supply the sphincter pupillae and the ciliary muscles of the eye, and the sympathetic fibres innervates the superior tarsal muscles.
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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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Laboratory findings in a patient with dark urine and yellowish skin revealed a prolonged prothrombin time. Which of the following is the most likely cause of this finding?
Your Answer:
Correct Answer: Liver damage
Explanation:Various conditions may prolong the prothrombin time (PT), including: warfarin use, vitamin K deficiency, liver disease, disseminated intravascular coagulopathy, hypofibrinogenemia, heparin infusion, massive blood transfusion and hypothermia. Liver disease causes prolonging of PT due to diminished synthesis of clotting factors. Dark urine colour and jaundice are indicators of the presence of a liver disease in this patient.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 29
Incorrect
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A 72-year-old male presents with dysuria and chronic haematuria. He was diagnosed with bladder cancer and tumour invasion of the perivesical fat. What is the stage of the patient's bladder cancer?
Your Answer:
Correct Answer: T3
Explanation:Bladder cancer is the growth of abnormal or cancerous cells on the inner lining of the bladder wall. The staging is as follows; stage 0is (Tis, N0, M0): Cancerous cells in the inner lining tissue of the bladder only, stage I (T1, N0, M0): tumour has spread onto the bladder wall, stage II (T2, N0, M0): tumour has penetrated the inner wall and is present in muscle of the bladder wall, stage III (T3, N0, M0): tumour has spread through the bladder to fat around the bladder and stage IV: (T4, N0, M0): tumour has grown through the bladder wall and into the pelvic or abdominal wall. The stage of cancer in the case presented is T3 because of the invasion of perivesical fat.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 30
Incorrect
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The normal location of the major duodenal papilla:
Your Answer:
Correct Answer: Descending part of the duodenum
Explanation:The major duodenal papilla is on the descending portion of the duodenum on the medial side, about 7-10cm from the pylorus. The pancreatic ducts and the common bile ducts unite and open by a common orifice on the summit of the duodenal papilla.
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This question is part of the following fields:
- Abdomen
- Anatomy
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