-
Question 1
Correct
-
A 65 year old man with a history of diabetes and hypertension presented with a stroke a few months ago severely affecting his speech and movement in the right arm and leg. A cerebral angiogram revealed a middle cerebral artery occlusion. A recent CT scan was done which revealed a 5 cm cystic space in his left parietal lobe. This lesion is a result of which of the following forms of resolution?
Your Answer: Liquefactive necrosis
Explanation:Characteristically, the brain will undergo liquefactive necrosis following ischaemic injury. This leaves a cystic space in that region which would show up on a CT scan. Atrophy would result in a generalized decrease in the brain size. Coagulative necrosis typically occurs in parenchymal organs e.g. the spleen or kidney which have a lower lipid content. Caseous necrosis is typical in granulomatous tuberculosis infection. Apoptosis will not form a cystic area as it is programmed cell death involving a individual cells. Gangrenous necrosis is characteristic of ischaemic injury of the lower limb and GI tract. Fibrinous necrosis results from necrotic damage to the blood vessels with the leaking of proteins into the vessel, appearing bright pink on H & E staining.
-
This question is part of the following fields:
- Cell Injury & Wound Healing; Neurology
- Pathology
-
-
Question 2
Incorrect
-
A 30-year-old woman known with Von Willebrand disease (vWD) has to undergo surgery. Which of these complications is most unlikely in this patient?
Your Answer: Excessive bleeding
Correct Answer: Hemarthrosis
Explanation:Von Willebrand disease (vWD) is an inherited haemorrhagic disorder characterised by the impairment of primary haemostasis. It is caused by the deficiency or dysfunction of a protein named von Willebrand factor. The most common manifestation due to the condition is abnormal bleeding. Complications include easy bruising, hematomas, epistaxis, menorrhagia, prolonged bleeding and severe haemorrhage. Hemarthrosis is a complication that is more commonly found in haemophilia.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 3
Incorrect
-
Lung compliance is increased by:
Your Answer: Alveolar oedema
Correct Answer: Emphysema
Explanation:Lung compliance is increased by emphysema, acute asthma and increasing age and decreased by alveolar oedema, pulmonary hypertension, atelectasis and pulmonary fibrosis.
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 4
Correct
-
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: 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
-
-
Question 5
Correct
-
The anatomical course of the phrenic nerve passes over the following muscle in the neck?
Your Answer: Anterior scalene
Explanation:The phrenic nerve originates in the neck between C3-C5, mostly C4 spinal root. It enters the thoracic cavity past the heart and lungs to the diaphragm. In the neck, this nerve begins at the lateral border of the anterior scalene muscle, its course then continues inferiorly on the anterior aspect of the anterior scalene muscle as it moves towards the diaphragm.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 6
Correct
-
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.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 7
Correct
-
Which of the following substances brings about a dilatation of the gastrointestinal resistance vessels?
Your Answer: Vasoactive intestinal peptide
Explanation:Gastric vasoconstrictors include catecholamines, angiotensin II and vasopressin. Vasodilators include vasoactive intestinal peptide and the hormones; gastrin, cholecystokinin and glucagon.
-
This question is part of the following fields:
- Gastroenterology
- Physiology
-
-
Question 8
Incorrect
-
A 25 year old primi gravida lady was scheduled for a regular antenatal check up. During the vaginal exam of this lady, the registrar discovered a malignant growth on the anterior wall of her vagina. Which of the following structures, adjacent to the vagina, is likely to be involved as well?
Your Answer: Anal canal
Correct Answer: Fundus of the bladder
Explanation:The fundus of the bladder is related anatomically to the anterior surface of the vagina and the urethra as well. If there was a malignant growth in the anterior surface of the vagina, then most likely the fundus of the bladder would be involved as well aspotentially the urethra.
-
This question is part of the following fields:
- Anatomy
- Pelvis
-
-
Question 9
Incorrect
-
After surgery, a patient developed a stitch granuloma . Which leukocyte in the peripheral blood will become an activated macrophage in this granuloma?
Your Answer: Lymphocyte
Correct Answer: Monocyte
Explanation:Monocytes are leukocytes that protect the body against infections and move to the site of infection within 8-12 hours to deal with it. They are produced in the bone marrow and shortly after being produced are released into the blood stream where they circulate until an infection is detected. When called upon they leave the circulation and transform into macrophages within the tissue fluid and thus gain the capability to phagocytose the offending substance. Monocyte count is part of a complete blood picture. Monocytosis is the state of excess monocytes in the peripheral blood and may be indicative of various disease states. Examples of processes that can increase a monocyte count include: • chronic inflammation • stress response • hyperadrenocorticism • immune-mediated disease • pyogranulomatous disease • necrosis • red cell regeneration.
-
This question is part of the following fields:
- General
- Physiology
-
-
Question 10
Incorrect
-
What is the normal duration of the ST segment?
Your Answer: 0.4 s
Correct Answer: 0.08 s
Explanation:The ST segment lies between the QRS complex and the T-wave. The normal duration of the ST segment is 0.08 s. ST-segment elevation or depression may indicate myocardial ischaemia or infarction.
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 11
Correct
-
A 45 years old women was diagnosed with breast cancer. After a radical mastectomy to remove all axillary lymph nodes from her right breast, it was noticed that she had a winged scapula. Which nerve injury would explain this?
Your Answer: Long thoracic nerve
Explanation:The long thoracic nerve supplies the serratus anterior muscle. When this nerve is injured the muscle undergoes paralysis, which is seen clinically as winging of the scapula most apparent when the arm is lifted forward. The long thoracic nerve is greatly susceptible to injury during breast surgery because of its long and superficial course along the thorax from its origin, the brachial plexus, to the lower border of the serratus anterior muscle.
-
This question is part of the following fields:
- Anatomy
- Breast
-
-
Question 12
Incorrect
-
An old man was diagnosed with squamous cell carcinoma with axillary lymph node metastasis. The doctor said he will excise the tumour and remove all axillary lymph nodes lateral to the edge of the pectoralis minor muscle. One of the following axillary lymph nodes won't be removed by this procedure. Which is it?
Your Answer: Subscapular
Correct Answer: Apical
Explanation:The apical lymph node group won’t be removed which include 20 to 30 lymph nodes.
Axillary lymph nodes are grouped according to location. The lateral group, the anterior to pectoral group, the posterior or subscapular group, the central group, and the medial or apical group. The lateral, pectoral, and subscapular groups are found lateral to the pectoralis minor muscle. The central group is situated directly under that muscle. Thus, if all lymph nodes lateral to the medial edge of the pectoralis minor muscle are removed, all the above four groups will be removed. The apical group won’t be removed which is situated medial to the medial edge of the pectoralis minor muscle.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 13
Correct
-
Which cells are most commonly seen in a granulomatous lesion that suggests an underlying chronic inflammation?
Your Answer: Lymphocytes
Explanation:Lymphocytes and monocytes are commonly and characteristically recognised in a case of chronic inflammation.
Eosinophils and neutrophils are seen with acute inflammation.
Mast cells release histamine in early inflammation.
Basophils are seen with allergies.
Plasma cells are seen with viral infection.
Platelets are not characteristic of any type of inflammation.
-
This question is part of the following fields:
- Inflammation & Immunology
- Pathology
-
-
Question 14
Correct
-
A victim of assault in a domestic violence is stabbed in the left chest. The tip of the pen knife entered the pleural space just above the cardiac notch. Luckily the lung was spared as it would only occupy this space during deep inspiration. Which of these structures was pierced by the knife?
Your Answer: Costomediastinal recess
Explanation:The costomediastinal recess is located immediately next to the cardiac notch. The medial aspect of the superior lobe of the left lung, when fully inflated expands to this place. The lung wouldn’t enter the anterior or the posterior mediastinum which are found between the two pleural cavities.
The costodiaphragmatic recess is the lowest extent of the pleural cavity where the inferior lobes of the lungs would expand into in deep inhalation.
The cupola, is the part of the pleural cavity that extends above the first rib into the root of the neck. The superior most part of the superior lobe of the lung might extend into this part.
Pulmonary ligament: pleural fold that is located below the root of the lung where the visceral pleura and the mediastinal pleura are in continuity.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 15
Incorrect
-
A 30 year old gym coach presented to the surgical out patient clinic with a lump in the inguinal region. He was booked for surgery, during which, the surgeon opened the inguinal region and found a hernial sac with a small segment of intestine projecting through the abdominal wall. It was located just above the inguinal ligament and lateral to the inferior epigastric vessels. What type of hernia was this?
Your Answer: A direct inguinal hernia
Correct Answer: An indirect inguinal hernia
Explanation:An indirect inguinal hernia exits the abdominal cavity lateral to the inferior epigastric vessels and enters the inguinal canal through the deep inguinal ring. These are the most common types of hernias often caused by heavy weigh lifting. Direct inguinal hernias exit the abdominal cavity medial to the inferior epigastric vessels through weak fascia.
Congenital inguinal hernias are indirect hernias that occur due to persistence of the processus vaginalis.
Femoral hernias occur when abdominal viscera push through the femoral ring in the femoral canal.
Incisional hernia occurs after surgery when the omentum or organ protrudes through a previous site of incision.
Obturator hernia are a very rare type of hernia where the pelvic or abdominal contents protrude through the obturator foramen.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 16
Incorrect
-
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: T2
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.
-
This question is part of the following fields:
- Neoplasia
- Pathology
-
-
Question 17
Correct
-
The inferior palpebral nerve ascends behind the orbicularis oculi. What is the terminal branch of the inferior palpebral nerve?
Your 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.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 18
Incorrect
-
What is the arterial sequence for an analgesic to reach the latissimus dorsi muscle assuming that your starting point is at the subclavian vein?
Your Answer: Subclavian – axillary – thyrocervical trunk – suprascapular
Correct Answer: Subclavian – axillary – subscapular – thoracodorsal
Explanation:Assuming our starting point is the subclavian artery, the analgesic continues in the same vessel into the axillary artery, as it passes into the axilla. The axillary artery at the lower border of the subscapularis gives rise to the subcapsular artery which is considered the largest branch of the axillary artery. This circumflex scapular branch distributes a serratus branch before entering the substance of the muscle as the thoracodorsal artery.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 19
Incorrect
-
A textbook of cardiac surgery explains that while doing a left pneumonectomy, a surgeon must be careful to avoid injury to a vital structure that leaves an impression on the mediastinal surface of the left lung. Which structure is it referring to?
Your Answer: Azygos vein
Correct Answer: Aortic arch
Explanation:Structures that leave an impression on the mediastinal surface of the left lung include: the oesophagus, subclavian artery, brachiocephalic vein, first rib, thymus, the heart, the diaphragm, descending aorta and arch of the aorta. The other structures form an impression on the mediastinal aspect of the right lung.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 20
Correct
-
What is the primary function of the Kupffer cells found in the liver?
Your Answer: Recycling of old red blood cells
Explanation:Kupffer cells found in the liver are part of the monocyte-reticular system. They are specialised macrophages and primarily function to recycle old and damaged RBCs. The RBCs are phagocytosed and the haemoglobin is broken down into haem and globin. The haem is further broken down into iron that is recycled and bilirubin that is conjugated with glucuronic acid and excreted in the bile.
-
This question is part of the following fields:
- Inflammation & Immunology; Hepatobiliary
- Pathology
-
-
Question 21
Correct
-
A 59-year old gentleman admitted for elective cholecystectomy was found to have a haemoglobin 12.5 g/dl, haematocrit 37%, mean corpuscular volume 90 fl, platelet count 185 × 109/l, and white blood cell count 32 × 109/l; along with multiple, small mature lymphocytes on peripheral smear. The likely diagnosis is:
Your Answer: Chronic lymphocytic leukaemia
Explanation:CLL or chronic lymphocytic leukaemia is the most common leukaemia seen in the Western world. Twice more common in men than women, the incidence of CLL increases with age. About 75% cases are seen in patients aged more than 60 years. The blood, marrow, spleen and lymph nodes all undergo infiltration, eventually leading to haematopoiesis (anaemia, neutropenia, thrombocytopenia), hepatomegaly, splenomegaly and decreased production of immunoglobulin. In 98% cases, CD+5 B cells undergo malignant transformation.
Often diagnosed on blood tests while being evaluated for lymphadenopathy, CLL causes symptoms like fatigue, anorexia, weight loss, pallor, dyspnoea on exertion, abdominal fullness or distension. Findings include multiple lymphadenopathy with minimal-to- moderate hepatomegaly and splenomegaly. Increased susceptibility to infections is seen. Herpes Zoster is common. Diffuse or maculopapular skin infiltration can also be seen in T-cell CLL.
Diagnosis is by examination of peripheral blood smear and marrow: hallmark being a sustained, absolute leucocytosis (>5 ×109/l) and increased lymphocytes in the marrow (>30%). Other findings can include hypogammaglobulinemia (<15% of cases) and, rarely, raised lactate dehydrogenase (LDH). Only 10% cases demonstrate moderate anaemia and/or thrombocytopenia.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 22
Correct
-
A 38-year old woman presents to the clinic with a 2 cm eczema-like lesion on the areolar region of her left breast, for 5 months. Biopsy of the lesion showed large cells at the dermal-epidermal junction with positive staining for mucin. What is the likely diagnosis?
Your Answer: Paget’s disease of the breast
Explanation:Paget’s disease of the breast or nipple resembles eczema in appearance with an underlying carcinoma typically. The disease is usually unilateral and presents with inflammation, oozing and crusting along with a non-healing ulcer. Treatment is often delayed due to the innocuous appearance but can be fatal. It results due to spread of neoplastic cells from the ducts of the mammary gland to the epithelium.
-
This question is part of the following fields:
- Pathology
- Women's Health
-
-
Question 23
Correct
-
Which of the following statements is true regarding the umbilical cord?
Your Answer: Is filled with jelly of Wharton
Explanation:The umbilical cord that connects the fetus to the placenta is about 50cm long. This tissue consists of the body stalk and vitelline duct. The former containing the allantoic diverticulum and the umbilical vessels. The latter contains the connection linking the digestive tube and the yolk sac. This cord is wrapped by stratum of ectoderm and gelatinous tissue or jelly of Wharton. The right umbilical vein plus the vitelline vessels and ducts disappear and this at birth the cord has three vessels which are the umbilical vein and two umbilical arteries.
-
This question is part of the following fields:
- Anatomy
- Embryology
-
-
Question 24
Correct
-
The blood investigations of a 30-year old man with jaundice revealed the following : total bilirubin 6.5 mg/dl, direct bilirubin 1.1 mg/dl, indirect bilirubin 5.4 mg/dl and haemoglobin 7.3 mg/dl. What is the most likely diagnosis out of the following?
Your Answer: Haemolysis
Explanation:Hyperbilirubinemia can be caused due to increased bilirubin production, decreased liver uptake or conjugation, or decreased biliary excretion. Normal bilirubin level is less than 1.2 mg/dl (<20 μmol/l), with most of it unconjugated. Elevated unconjugated bilirubin (indirect bilirubin fraction >85%) can occur due to haemolysis (increased bilirubin production) or defective liver uptake/conjugation (Gilbert syndrome). Such increases are less than five-fold usually (<6 mg/dl or <100 μmol/l) unless there is coexistent liver disease.
-
This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
-
-
Question 25
Correct
-
What percentage of the cardiac output is delivered to the brain?
Your Answer: 15%
Explanation:Among all body organs, the brain is most susceptible to ischaemia. Comprising of only 2.5% of total body weight, the brain receives 15% of the cardiac output. Oxygen extraction is also higher with venous oxygen levels approximating 13 vol%, and arteriovenous oxygen difference of 7 vol%.
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 26
Incorrect
-
Injury to the supraspinatus muscle will affect:
Your Answer: Adduction of the humerus
Correct Answer: Initiation of abduction of the humerus
Explanation:This muscle arises from the medial two-thirds of the supraspinatus fossa and from the supraspinatus fascia. It is inserted into the highest impression on the greater tubercle of the humerus after passing over the upper part of the shoulder joint. It works with the deltoid to raise the arm from the side of the trunk and initiate abduction. It also assists in fixation of the head of the humerus in the glenoid cavity.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 27
Correct
-
Which nerve lies immediately medial to the psoas major muscle?
Your Answer: Obturator
Explanation:The obturator nerve is formed from the ventral divisions of the 2nd, 3rd and 4th lumbar nerves. It courses through the fibres of the psoas major and emerges from the medial border near the pelvic brim.
The iliohypogastric nerve comes from the first lumbar nerve and emerges from the upper part of the lateral border of psoas major.
The ilioinguinal nerve arises with the iliohypogastric nerve from the first lumbar nerve and also emerges from the lateral border of the psoas major muscle.
The lateral femoral cutaneous nerve comes from the posterior division of the 2nd and 3rd lumbar nerves to emerge from the lateral border of the psoas major muscle near its middle.
The femoral nerve also arises from the dorsal divisions, but of the 2nd, 3rd and 4th lumbar nerves and courses through the muscle fibres to emerge at the lower part of the lateral border.
The coccygeal nerve doesn’t arise from the lumbar plexus but from the sacral plexus.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 28
Correct
-
Which lymph nodes are most likely to enlarge due to the spread of infection through the lymphatic channels in a patient with a boil on his scrotum?
Your Answer: Superficial inguinal nodes
Explanation:The superficial inguinal nodes drain the perineum and the external genitalia which include the scrotum and the labia majora. The testes, however, drain to the lumbar nodes.
-
This question is part of the following fields:
- Anatomy
- Pelvis
-
-
Question 29
Correct
-
A 7-year-old boy is diagnosed with metabolic acidosis as a result of severe dehydration. Which of the following conditions is most likely to cause severe dehydration and metabolic acidosis?
Your Answer: Severe diarrhoea
Explanation:Diarrhoea is defined as having three or more loose or liquid stools per day, or as having more stools than is normal for that person. Severe diarrhoea, causing fluid loss and loss of bicarbonate, will result in marked dehydration and metabolic acidosis.
-
This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
-
-
Question 30
Incorrect
-
The glossopharyngeal nerve provides the parasympathetic innervation of the:
Your Answer: Lacrimal gland
Correct 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
-
SESSION STATS - PERFORMANCE PER SPECIALTY
