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  • Question 1 - A butcher accidentally cut himself on his right index finger. Which of the...

    Incorrect

    • A butcher accidentally cut himself on his right index finger. Which of the following substances when in contact with the basement membrane of the injured vasculature will activate the coagulation cascade as well as the kinin system in a first response to this injury?

      Your Answer: Plasmin

      Correct Answer: Hageman factor

      Explanation:

      Hageman factor/factor XII in the intrinsic pathway activates prekallikrein and factor XI. Deficiency will not cause excessive bleeding as other coagulation factors will be utilized but the PTT will be greater than 200 seconds.

      Thromboxane promotes platelet aggregation and causes vasoconstriction.

      Plasmin, which is cleaved from plasminogen acts as an anticoagulant which breaks down thrombi.

      Platelet activating factor promotes platelet aggregation and is also chemotactic to neutrophils.

      Histamine acts as a vasodilator.

      Platelet inhibiting factor acts an anticoagulant.

      Renin is a hormone released from the kidney that causes vasoconstriction and water retention.

    • This question is part of the following fields:

      • Cell Injury & Wound Healing
      • Pathology
      14.4
      Seconds

  • Question 2 - When you rest your elbows on a desk, what bony landmark of the...

    Correct

    • When you rest your elbows on a desk, what bony landmark of the upper limb are you resting on?

      Your Answer: Olecranon process of the ulna

      Explanation:

      At the upper and back part of the ulna, there exists a curved eminence which is the olecranon process. This process lodges in the olecranon fossa of the humerus. It’s posterior surface is subcutaneous and this triangular area is what you rest your elbow upon.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      14.4
      Seconds

  • Question 3 - What is the likely diagnosis in a 55-year old man presenting with jaundice,...

    Incorrect

    • What is the likely diagnosis in a 55-year old man presenting with jaundice, weight loss, pale coloured stools and elevated alkaline phosphatase?

      Your Answer: Cirrhosis of liver

      Correct Answer: Pancreatic carcinoma

      Explanation:

      Increased alkaline phosphatase is indicative of cholestasis, with a 4x or greater increase seen 1-2 days after biliary obstruction. Its level can remain elevated several days after the obstruction is resolved due to the long half life (7 days). Increase up to three times the normal level can be seen in hepatitis, cirrhosis, space-occupying lesions and infiltrative disorders. Raised alkaline phosphatase with other liver function tests being normal can occur in focal hepatic lesions like abscesses or tumours, or in partial/intermittent biliary obstruction. However, alkaline phosphatase has several isoenzymes, which originate in different organs, particularly bone. An isolated rise can also be seen in malignancies (bronchogenic carcinoma, Hodgkin’s lymphoma), post-fatty meals (from the small intestine), in pregnancy (from the placenta), in growing children (from bone growth) and in chronic renal failure (from intestine and bone). One can differentiate between hepatic and non-hepatic cause by measurement of enzymes specific to the liver e.g. gamma-glutamyl transferase (GGT).

      In an elderly, asymptomatic patient, isolated rise of alkaline phosphatase usually points to bone disease (like Paget’s disease). Presence of other symptoms such as jaundice, pale stools, weight loss suggests obstructive jaundice, most probably due to pancreatic carcinoma.

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
      21.1
      Seconds

  • Question 4 - Renal function is an indication of the state of the kidney, measured by glomerular...

    Correct

    • Renal function is an indication of the state of the kidney, measured by glomerular filtration rate (GFR). In a healthy person, GFR would be greatly increased by: 

      Your Answer: Substantial increases in renal blood flow

      Explanation:

      An increase in the rate of renal blood flow (RBF) greatly increases the glomerular filtration rate (GFR). The more plasma available (from increased RBF), the more filtrate is formed. Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. Central to the physiologic maintenance of GFR is the differential basal tone of the afferent and efferent arterioles.

    • This question is part of the following fields:

      • Physiology
      • Renal
      9.6
      Seconds

  • Question 5 - A 40-year-old woman is suspected to have an ovarian cancer. Which tumour marker...

    Correct

    • A 40-year-old woman is suspected to have an ovarian cancer. Which tumour marker should be requested to confirm the diagnosis?

      Your Answer: CA-125

      Explanation:

      CA-125 is a protein that is used as a tumour marker. This substance is found in high concentration in patients with ovarian cancer. It is the only tumour marker recommended for clinical use in the diagnosis and management of ovarian cancer.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      5.9
      Seconds

  • Question 6 - A 27 year-old male patient was admitted to the hospital due to recurrent...

    Correct

    • A 27 year-old male patient was admitted to the hospital due to recurrent fever for the past 2 weeks. The patient claimed that he is an intravenous drug user. Following work up, the patient was diagnosed with infective endocarditis. Which is the most likely organism responsible for this diagnosis?

      Your Answer: Staphylococcus aureus

      Explanation:

      Acute bacterial endocarditis is a fulminant illness lasting over days to weeks (<2weeks). It is most likely due to Staphylococcus aureus especially in intravenous drug abusers.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      16.8
      Seconds

  • Question 7 - What will the destruction of endoplasmic reticulum stop? ...

    Incorrect

    • What will the destruction of endoplasmic reticulum stop?

      Your Answer: Glycosylation of protein and carbohydrate moieties

      Correct Answer: Synthesis of proteins

      Explanation:

      The rough endoplasmic reticulum is the factory for the manufacturing of proteins. It contains ribosomes attached to it and transports proteins that are destined for membranes and secretions. The rough ER is connected to the nuclear envelope and to the cisternae of the Golgi apparatus by vesicles that shuttle between the two compartments.

    • This question is part of the following fields:

      • General
      • Physiology
      19.4
      Seconds

  • Question 8 - Risk factors for hepatocellular carcinoma do NOT include: ...

    Correct

    • Risk factors for hepatocellular carcinoma do NOT include:

      Your Answer: Heptitis E

      Explanation:

      Risk factors for hepatocellular carcinoma include hepatitis B and C, aflatoxin, anabolic steroids, alcohol cirrhosis and primary liver disease.

    • This question is part of the following fields:

      • Gastrointestinal; Hepatobiliary
      • Pathology
      6.1
      Seconds

  • Question 9 - A 7-year old child from a rural setting complains of recurrent abdominal pain....

    Correct

    • A 7-year old child from a rural setting complains of recurrent abdominal pain. The child is found to have a heavy parasitic infestation and anaemia. Which type of anaemia is most likely seen in this patient?

      Your Answer: Iron deficiency anaemia

      Explanation:

      The most common cause of iron deficiency anaemia in children in developing countries is parasitic infection (hookworm, amoebiasis, schistosomiasis and whipworm).

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      6.1
      Seconds

  • Question 10 - What is the basic chemical reaction that takes place in the breakdown of...

    Correct

    • What is the basic chemical reaction that takes place in the breakdown of complex foodstuffs?

      Your Answer: Hydrolysis

      Explanation:

      Breakdown of complex food into simpler compounds is achieved by hydrolysis, with the help of different enzymes specific for different compounds.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      5.6
      Seconds

  • Question 11 - The deep planter artery is a branch of the: ...

    Incorrect

    • The deep planter artery is a branch of the:

      Your Answer: Peroneal artery

      Correct Answer: Dorsalis pedis artery

      Explanation:

      The deep plantar artery is a branch of the dorsalis pedis artery.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      6.9
      Seconds

  • Question 12 - A 66-year-old man complains of constant headaches. On physical examination, the only relevant...

    Correct

    • A 66-year-old man complains of constant headaches. On physical examination, the only relevant sign is a dark brown mole located on left his arm which has grown in size over the years and is itchy and painful. A MRI of the brain revealed a solitary lesion at the grey-white junction in the right frontal lobe, without ring enhancement. This lesion is most likely to be:

      Your Answer: Metastatic carcinoma

      Explanation:

      The location of the mass at the grey–white junction is typical of a metastasis. The most frequent types of metastatic brain tumours originate in the lung, skin, kidney, breast and colon. These tumour cells reach the brain via the bloodstream. This patient is likely to have skin cancer, which caused the metastatic brain tumour.

    • This question is part of the following fields:

      • Neurology
      • Pathology
      54.2
      Seconds

  • Question 13 - Gastrocnemius, semimembranosus and semitendinosus together with which other muscle form the boundaries of...

    Incorrect

    • Gastrocnemius, semimembranosus and semitendinosus together with which other muscle form the boundaries of the popliteal fossa?

      Your Answer: Adductor magnus

      Correct Answer: Biceps femoris

      Explanation:

      The popliteal fossa is located at the back of the knee. It is bounded laterally by the biceps femoris above and the plantaris and lateral head of the gastrocnemius below and medially by the semitendinosus and semimembranosus above and by the medial head of the gastrocnemius below.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      14.3
      Seconds

  • Question 14 - During work up for a 29 year-old lady who complained of chest pain,...

    Incorrect

    • During work up for a 29 year-old lady who complained of chest pain, a computed tomography showed a large mass in the posterior mediastinum. Which among the following structures could be involved?

      Your Answer: Aortic arch

      Correct Answer: Lymph nodes

      Explanation:

      Boundaries of the posterior mediastinum include:

      Superior: a plane through the sternal angle and T4/5

      Inferior: the diaphragm

      Anterior: the middle mediastinal structures

      Posterior the spinal cord.

      Structures in the posterior mediastinum include the descending thoracic aorta, the azygos system, oesophagus, thoracic duct and lymph nodes. The great vessels and structures at the root of the lung are part of the middle mediastinum. In this case, the lymph nodes is the correct answer.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      13.2
      Seconds

  • Question 15 - Both the arytenoid muscles and the lateral cricoarytenoid muscles perform this action on...

    Incorrect

    • Both the arytenoid muscles and the lateral cricoarytenoid muscles perform this action on the glottis:

      Your Answer: Stretch

      Correct Answer: Adduction

      Explanation:

      Both the arytenoid and the cricoartenoid muscles close the glottis. The lateral cricoarytenoid muscles extend from the lateral cricoid cartilage to the muscular process of the arytenoid cartilage. By rotating the arytenoid cartilages medially, these muscles adduct the vocal cords and thereby close the rima glottidis. The arytenoid muscle adducts or approximates the arytenoid cartilages, and thus closes the aperture of the glottis.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      33.4
      Seconds

  • Question 16 - Which statement is true regarding the diaphragmatic openings: ...

    Correct

    • Which statement is true regarding the diaphragmatic openings:

      Your Answer: The thoracic duct passes through the opening at T12

      Explanation:

      The diaphragmatic openings are:

      T8 – opening for the inferior vena cavaand the right phrenic nerve

      T10 – opening for the oesophagusand the left gastric artery and vein

      T12 – opening for the aorta, the thoracic duct and azygos vein.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      14.1
      Seconds

  • Question 17 - An 18 year-old with an iron deficient diet was prescribed an iron supplement...

    Correct

    • An 18 year-old with an iron deficient diet was prescribed an iron supplement by her GP. Lack of iron often results in:

      Your Answer: Hypochromic anaemia

      Explanation:

      Iron deficiency anaemia is the most common type of anaemia. It can occur due to deficiency of iron from decreased intake, increased loss or inadequate absorption. An MCV less than 80 will indicated iron deficiency anaemia. On the smear the RBCs will be microcytic hypochromic and will also show poikilocytosis. Iron profile tests are important to make a diagnosis. Clinically the patient will be pale and lethargic.

    • This question is part of the following fields:

      • General
      • Physiology
      11.3
      Seconds

  • Question 18 - Which of these is secreted by both macrophages and muscle cells? ...

    Incorrect

    • Which of these is secreted by both macrophages and muscle cells?

      Your Answer: Interleukin-3

      Correct Answer: Interleukin-6

      Explanation:

      IL-6 is secreted by the T cells and macrophages and is a pro inflammatory cytokine. It is secreted in response to trauma e.g. burns and tissue damage that leads to inflammation. Apart from this its is also a myokine and is elevated due to muscle contraction. Other functions include: stimulate osteoclast formation when secreted by osteoblasts, mediate fever in acute phase response and are responsible for energy metabolism in muscle and fatty tissues. Inhibitors of IL-6 e.g. oestrogen are used as a treatment for postmenopausal osteoporosis.

    • This question is part of the following fields:

      • Inflammation & Immunology
      • Pathology
      7.1
      Seconds

  • Question 19 - A gymnast was admitted to hospital for investigation of a weakness in the...

    Correct

    • A gymnast was admitted to hospital for investigation of a weakness in the extension and adduction of his arm. He had a previous penetrating wound in the area of the posterior axillary fold. Which of these muscles is the likely cause?

      Your Answer: Latissimus dorsi

      Explanation:

      All the criteria of this case points towards the latissimus dorsi. This muscle is greatly involved in extension, adduction and medial rotation of the arm and forms the posterior axillary fold which in this case was injured.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      19.4
      Seconds

  • Question 20 - Which of the following muscle divide the posterior triangle of the neck into...

    Incorrect

    • Which of the following muscle divide the posterior triangle of the neck into the occipital and the subclavian triangle?

      Your Answer: Scalenus anterior muscle

      Correct Answer: Inferior belly of the omohyoid

      Explanation:

      The posterior triangle (or lateral cervical region) is a region of the neck bounded in front by the sternocleidomastoid; behind, by the anterior margin of the trapezius; inferiorly by the middle third of the clavicle and superiorly by the occipital bone. The posterior triangle is crossed, about 2.5 cm above the clavicle, by the inferior belly of the omohyoid muscle, which divides the space into two triangles: an upper or occipital triangle and a lower or subclavian triangle (or supraclavicular triangle).

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      32.8
      Seconds

  • Question 21 - A 45 year-old male, with behavioural changes developed euvolemic hyponatraemia. Which of the...

    Correct

    • A 45 year-old male, with behavioural changes developed euvolemic hyponatraemia. Which of the following conditions most likely predisposed the patient to develop euvolemic hyponatraemia?

      Your Answer: Psychosis

      Explanation:

      In euvolemic hyponatraemia, there is volume expansion in the body, there is no oedema, but hyponatremia occurs. Causes include: state of severe pain or nausea, psychosis, brain trauma, SIADH, hypothyroidism and glucocorticoid deficiency.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Pathology
      13.4
      Seconds

  • Question 22 - A 25-year old man presented to the clinic with swelling of the penis....

    Incorrect

    • A 25-year old man presented to the clinic with swelling of the penis. His uncircumcised penis was erythematous and oedematous. The foreskin could not be retracted over the glans. Which of the following agents is the likely cause of his condition?

      Your Answer: Chlamydia trachomatis

      Correct Answer: Staphylococcus aureus

      Explanation:

      Inflammation of the glans penis is known as balanitis. Associated involvement of the foreskin is then known as balanoposthitis. More likely to occur in men who have a tight foreskin that is difficult to pull back, or poor hygiene.

    • This question is part of the following fields:

      • Pathology
      • Urology
      14.5
      Seconds

  • Question 23 - A 50-year-old woman goes to the doctor complaining of myalgia, muscle cramps, and...

    Incorrect

    • A 50-year-old woman goes to the doctor complaining of myalgia, muscle cramps, and weakness; she is diagnosed with severe hypokalaemia. Which of the following is the most common cause of hypokalaemia?

      Your Answer: Diabetic ketoacidosis

      Correct Answer: Prolonged vomiting

      Explanation:

      Potassium is one of the body’s major ions. Nearly 98% of the body’s potassium is intracellular. The ratio of intracellular to extracellular potassium is important in determining the cellular membrane potential. Small changes in the extracellular potassium level can have profound effects on the function of the cardiovascular and neuromuscular systems. Hypokalaemia may result from conditions as varied as renal or gastrointestinal (GI) losses, inadequate diet, transcellular shift (movement of potassium from serum into cells) and medications. The important causes of hypokalaemia are:

      Renal losses: renal tubular acidosis, hyperaldosteronism, magnesium depletion, leukaemia (mechanism uncertain).

      GI losses: vomiting or nasogastric suctioning, diarrhoea, enemas or laxative use, ileal loop.

      Medication effects: diuretics (most common cause), β-adrenergic agonists, steroids, theophylline, aminoglycosides.

      Transcellular shift: insulin, alkalosis.

      Severe hypokalaemia, with serum potassium concentrations of 2.5–3 meq/l, may cause muscle weakness, myalgia, tremor, muscle cramps and constipation.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      25.3
      Seconds

  • Question 24 - Which of the following can lead to haemolytic anaemia? ...

    Incorrect

    • Which of the following can lead to haemolytic anaemia?

      Your Answer: Bone marrow aplasia

      Correct Answer: Presence of haemoglobin S

      Explanation:

      Haemoglobin S is an abnormal type of haemoglobin seen in sickle cell anaemia. This allows for the haemoglobin to crystalize within the RBC upon exposure to low partial pressures of oxygen. This results in rupture of the RBCs as they pass through microcirculation, especially in the spleen. This can cause blockage of the vessel down stream and ischaemic death of tissues, accompanied by severe pain.

    • This question is part of the following fields:

      • General
      • Physiology
      15.4
      Seconds

  • Question 25 - A man came to the hospital complaining of a sensation of pins and...

    Incorrect

    • A man came to the hospital complaining of a sensation of pins and needles in the dorsum of the thumb and digits 1 and 2. On further examination they found that he had weakness in wrist dorsiflexion and finger extension. Which nerve do you think is injured in this case?

      Your Answer: Median

      Correct Answer: Radial

      Explanation:

      The radial nerve can be injured in multiple sites along its course in the upper limb, and each site has its own presentation. The major complaint is wrist drop which if high above the elbow, can cause numbness of the forearm and hand. It can last for several days or weeks. The most common site of compression for the radial nerve is at the proximal forearm in the area of the supinator muscles.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      35.1
      Seconds

  • Question 26 - When does the heart rate decrease? ...

    Correct

    • When does the heart rate decrease?

      Your Answer: Pressure on the eyeball

      Explanation:

      Various vagotonic manoeuvres (e.g. Valsalva manoeuvre, carotid sinus massage, pressure on eyeballs, ice-water facial immersion, swallowing of ice-cold water) result in increased parasympathetic tone through the vagus nerve which results in a decrease in heart rate. These manoeuvres may be clinically useful in terminating supraventricular arrhythmias.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      5.3
      Seconds

  • Question 27 - A 35 year-old woman is undergoing thyroidectomy. The external laryngeal nerve may be...

    Incorrect

    • A 35 year-old woman is undergoing thyroidectomy. The external laryngeal nerve may be injured whilst ligating this artery during the procedure due to its close relationship?

      Your Answer: Inferior laryngeal artery

      Correct Answer: Superior thyroid artery

      Explanation:

      The superior thyroid artery arises from the external carotid artery just below the level of the greater cornu of the hyoid bone and ends in the thyroid gland. This artery must be ligated at the thyroid when conducting a thyroidectomy. If the artery is severed, but not ligated, it will bleed profusely. In order to gain control of the bleeding, the surgeon may need to extend the original incision laterally to ligate the artery at its origin at the external carotid artery. The external laryngeal branch of the superior laryngeal nerve courses in close proximity to the superior thyroid artery, making it at risk for injury during surgery.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      53
      Seconds

  • Question 28 - Skin infiltration by neoplastic T lymphocytes is seen in: ...

    Incorrect

    • Skin infiltration by neoplastic T lymphocytes is seen in:

      Your Answer: Hairy cell leukaemia

      Correct Answer: Mycosis fungoides

      Explanation:

      Mycosis fungoides is a chronic T-cell lymphoma that involves the skin and less commonly, the internal organs such as nodes, liver, spleen and lungs. It is usually diagnosed in patients above 50 years and the average life expectancy is 7-10 years. It is insidious in onset and presents as a chronic, itchy rash, eventually spreading to involve most of the skin. Lesions are commonly plaque-like, but can be nodular or ulcerated. Symptoms include fever, night sweats and weight loss. Skin biopsy is diagnostic. However, early cases may pose a challenge due to fewer lymphoma cells. The malignant cells are mature T cells (T4+, T11+, T12+). The epidermis shows presence of characteristic Pautrier’s micro abscesses are present in the epidermis.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      16
      Seconds

  • Question 29 - Internal haemorrhoids are painless and only sensitive to stretch. They are formed from...

    Correct

    • Internal haemorrhoids are painless and only sensitive to stretch. They are formed from folds of the mucous membrane and the submucosa of the anal canal which contain varicose branches of the:

      Your Answer: Superior rectal vein

      Explanation:

      Internal haemorrhoids are formed by varicosities of the branches of the superior rectal vein.

      External haemorrhoids are formed by varicosities of the branches of the inferior rectal vein.

    • This question is part of the following fields:

      • Anatomy
      • Colorectal
      21.2
      Seconds

  • Question 30 - During an exploratory laparotomy in a 22 year-old man shot in the abdomen,...

    Incorrect

    • During an exploratory laparotomy in a 22 year-old man shot in the abdomen, the operating doctor discovers the large bowel is perforated. Which of the following characteristics of the bowel enabled the surgeon to identify it as the large bowel?

      Your Answer:

      Correct Answer: Epiploic appendages

      Explanation:

      The large intestine doesn’t have a continuous layer of longitudinal muscle. Instead, it has three strips of longitudinal muscle called taenia coli. The large intestine is covered with omental appendages that are fat filled. It is also folded into sacculations called haustrations. Serosa is a general term for the outermost coat or serous layer of a visceral structure that lies in the body cavities of the abdomen or thorax.

      Complete circular folds are only found in the small intestine.

      Valvulae conniventes or valves of Kerckring are the circular folds which are large valvular flaps projecting into the lumen of the small bowel.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cell Injury & Wound Healing (0/1) 0%
Pathology (6/11) 55%
Anatomy (4/11) 36%
Upper Limb (2/3) 67%
Gastrointestinal; Hepatobiliary (1/2) 50%
Physiology (4/7) 57%
Renal (1/1) 100%
Neoplasia (1/1) 100%
Microbiology (2/2) 100%
General (1/3) 33%
Gastroenterology (1/1) 100%
Lower Limb (0/2) 0%
Neurology (1/1) 100%
Thorax (0/1) 0%
Head & Neck (0/3) 0%
Abdomen (1/1) 100%
Inflammation & Immunology (0/1) 0%
Fluids & Electrolytes (1/2) 50%
Urology (0/1) 0%
Cardiovascular (1/1) 100%
Haematology (0/1) 0%
Colorectal (1/1) 100%
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