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Question 1
Correct
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Which muscle in the neck divides the neck into two large triangles?
Your Answer: Sternocleidomastoid
Explanation:The sternocleidomastoid muscle is an important landmark in the neck as it divides the neck into two; anterior and posterior triangles. These triangles help in the location of the structures of the neck including the carotid artery, head and neck lymph nodes, accessory nerve and the brachial plexus. It originates from the manubrium and medial portion of the clavicle and inserts on the mastoid process of the temporal bone, superior nuchal line. The sternocleidomastoid receives blood supply from the occipital artery and the superior thyroid artery. It is innervated by the accessory nerve (motor) and cervical plexus (sensory).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 2
Correct
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A cell is classified on the basis of its regenerative ability. Which of the following cells represent a permanent cell?
Your Answer: Erythrocyte
Explanation:An erythrocyte is the last cell in the progeny of RBC cell division and is not capable of further division and regeneration. Hepatocytes, osteocytes and epithelium of kidney tubules are all stable cells. Colonic mucosa and pluripotent hematopoietic stem cells are all labile cells.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 3
Correct
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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).
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 4
Correct
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A chest x ray of a patient reveals loculated fluid in the right chest, which can be easily aspirated if the needle is inserted through the body wall just above the 9th rib in the midaxillary line. Where is this fluid located?
Your Answer: Costodiaphragmatic recess
Explanation:The costodiaphragmatic recess is the lowest point of the pleural sac where the costal pleura becomes the diaphragmatic pleura. At the midclavicular line, this is found between ribs 6 and 8; at the paravertebral lines, between ribs 10 and 12 and between ribs 8 and 10 at the midaxillary line.
The cardiac notch: is an indentation of the heart on the left lung, located on the anterior surface of the lung.
Cupola: part of the parietal pleura that extends above the first rib.
Oblique pericardial sinus: part of the pericardial sac located posterior to the heart behind the left atrium.
Costomediastinal recess: a reflection of the pleura from the costal surface to the mediastinal surface, is on the anterior surface of the chest.
The inferior mediastinum: is the space in the chest occupied by the heart.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 5
Correct
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A 40-year old gentleman underwent a computed tomographic scan for the abdomen to rule out blunt abdominal trauma, after a vehicular accident. The scan revealed no abnormal finding except for a 1 cm-sized cortical mass in the left adrenal gland. The doctor-on-call decided to not intervene for this mass because it was likely to be a:
Your Answer: Non-functioning adrenal adenoma
Explanation:Adrenal adenomas are common, benign lesions which are asymptomatic and seen in 10% of population. Usually detected incidentally on Computed tomography (‘incidentaloma’), only around 1 in 10,000 are malignant (adenocarcinoma). Adrenal adenomas rarely need to be investigated, especially if they are homogenous and less than 3 cm in diameter. Follow-up imaging can be done after an interval of 3-6 months to assess any change in size. Some adenomas can secrete cortisol (leading to Cushing syndrome), or aldosterone (leads to Conn syndrome) or androgens (leading to hyperandrogenism).
Haematomas and simple cysts are not usually seen in adrenal gland. Infection due to Histoplasma capsulatum is usually bilateral and leads to multiple granulomas. Adrenal metastasis will usually demonstrate a lung primary and the adrenal lesions will be often multiple and larger than 1 cm.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 6
Correct
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A 17-year-old boy, who had developed shortness of breath and a loss of appetite over the last month, was referred to a haematologist because he presented with easy bruising and petechiae. His prothrombin time, platelet count, partial thromboplastin and bleeding time were all normal. Which of the following would explain the presence of the petechiae and easy bruising tendency?
Your Answer: Scurvy
Explanation:Scurvy is a condition caused by a dietary deficiency of vitamin C, also known as ascorbic acid. Humans are unable to synthesize vitamin C, therefore the quantity of it that the body needs has to come from the diet. The presence of an adequate quantity of vitamin C is required for normal collagen synthesis. In scurvy bleeding tendency is due to capillary fragility and not coagulation defects, therefore blood tests are normal.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 7
Correct
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What class of drugs does buspirone belong to?
Your Answer: Anxiolytic
Explanation:Buspirone is an anxiolytic agent and a serotonin-receptor agonist that belongs to the azaspirodecanedione class of compounds. It shows no potential for addiction compared with other drugs commonly prescribed for anxiety, especially the benzodiazepines. The development of tolerance has not been noted. It is primarily used to treat generalized anxiety disorders. It is also commonly used to augment antidepressants in the treatment of major depressive disorder.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 8
Correct
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Which tumour marker is associated with medullary carcinoma of thyroid?
Your Answer: Calcitonin
Explanation:Medullary carcinoma of thyroid accounts for 3% of thyroid cancers. It arises from the parafollicular cells (C cells) of the thyroid gland that produce calcitonin. It is often familial and caused by mutation of ret proto-oncogene, but can occasionally be sporadic. The familial cases can also occur as part of MEN syndromes IIA and IIB. The high calcitonin leads to down-regulation of the receptors, which does not affect the calcium levels significantly. Medullary carcinoma of thyroid shows characteristic amyloid deposits that stain positively with Congo red. The initial presentation consists of an asymptomatic thyroid nodule. Many cases are diagnosed due to routine screening of relatives of patients with MEN IIA and IIB. Medullary carcinoma can also cause ectopic production of other hormones/peptides such as adrenocorticotrophic hormone, vasoactive intestinal polypeptide, kallikreins and serotonin.
Metastasis from medullary carcinoma spread via the lymphatics to cervical and mediastinal nodes, and can also affect the liver, lungs and bone. Diagnosis is by raised serum calcitonin levels. A provocative test with calcium (15 mg/kg intravenously over 4 hours) also aids in diagnosis by leading to excessive secretion of calcitonin. X-ray might also show dense, conglomerate calcification.
CA-125 is frequently elevated in ovarian carcinomas. CA 15-3 is often associated with breast carcinomas. Alpha-fetoprotein is seen raised in hepatomas and gonadal tumours. Elevated HCG is associated with normal pregnancies, gonadal tumours, and choriocarcinomas. Thyroglobulin is used for surveillance in papillary carcinoma of thyroid. CA 19-9 is used in the management of pancreatic cancer.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 9
Correct
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Blood investigations of a patient with vitamin K deficiency revealed a prolonged prothrombin time. This coagulation abnormality is most probably due to:
Your Answer: Factor VII deficiency
Explanation:Factor VII deficiency is a bleeding disorder caused by a deficiency or reduced activity of clotting factor VII. It may be inherited or acquired at some point during life. Inherited factor VII deficiency is an autosomal recessive disorder caused by mutations of the F7 gene. Factor VII is vitamin K-dependent, as are Factors II, IX and X and therefore lack of this vitamin can cause the development of acquired factor VII deficiency. Other causes of acquired deficiency of this factor include liver disease, sepsis and warfarin therapy.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 10
Correct
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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: 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 11
Correct
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Gastric acid secretion is stimulated by which of the following?
Your 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
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 12
Correct
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The tensor villi palatini muscle is a broad thin, ribbon-like muscle in the head that tenses the soft palate. Which of the following structures is associated with the tensor villi palatini muscle?
Your Answer: The hamulus of the medial pterygoid plate
Explanation:The pterygoid hamulus is a hook-like process at the lower extremity of the medial pterygoid plate of the sphenoid bone around which the tendon of the tensor veli palatini passes.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 13
Correct
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The nutcracker effect of the alimentary canal is described as a nutcracker-like compression caused by the aorta and the superior mesenteric arteries on a certain section of the alimentary canal leading to bowel obstruction. Which of the following parts of the alimentary canal is usually obstructed by this nutcracker compression of the two arteries?
Your Answer: Duodenum
Explanation:The ‘nutcracker effect’ is only seen in one part of the alimentary canal, and that is in the third part of the duodenum. This can happen when the superior mesenteric artery that passes across the duodenum and the aorta, posteriorly to the third part of the duodenum enlarges and starts compressing the duodenum. The result is an obstructed duodenum that inhibits passage of food.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 14
Correct
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A surgeon ligates the left superior suprarenal artery whilst preforming a left adrenalectomy. Where does the left superior suprarenal artery originate?
Your Answer: Left inferior phrenic artery
Explanation:The superior suprarenal arteries arises from the inferior phrenic artery on either side.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 15
Correct
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Pseudomonas aeruginosa is a multidrug resistant pathogen that causes hospital-acquired infections. It is usually treated with piperacillin or another antibiotic. Which of the following is the other antibiotic?
Your Answer: Azlocillin
Explanation:Azlocillin, like piperacillin, is an acylampicillin antibiotic with an extended spectrum of activity and greater in vitro potency than the carboxypenicillins. Azlocillin is similar to mezlocillin and piperacillin. It demonstrates antibacterial activity against a broad spectrum of bacteria, including Pseudomonas aeruginosa.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 16
Correct
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A medical officer was shown an X ray with barium contrast and was asked to distinguish the small from the large bowel. Which of the following features listed is CORRECT?
Your Answer: Circular folds of the mucosa
Explanation:Distinguishing features include:
1. Three strips of longitudinal muscle-taenia coli- on the wall instead of a continuous surrounding longitudinal muscle that is seen in the small intestine
2. The colon has bulges called haustra that are not on the small bowel.
3. The surface of the colon is covered with fatty omental appendages. Both the colon and the small intestine have similar circular smooth muscle layer, serosa. Peyer’s patches are lymphoid tissues that are not visible on X ray with barium contrast.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 17
Correct
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The superior rectal artery is a continuation of the:
Your Answer: Inferior mesenteric artery
Explanation:The superior rectal artery or superior haemorrhoidal artery is the continuation of the inferior mesenteric artery. It descends into the pelvis between the layers of the mesentery of the sigmoid colon, crossing the left common iliac artery and vein.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 18
Correct
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Which of the following will be affected by a lesion in the posterior column-medial lemniscus system?
Your Answer: Fine touch
Explanation:The posterior column–medial lemniscus (PCML) pathway is a sensory pathway that transmits fine touch and conscious proprioceptive information from the body to the brain. As the posterior columns are also known as dorsal columns, the pathway is also called the dorsal column–medial lemniscus system or DCML.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 19
Correct
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Gram positive bacteria differ from gram negative bacteria due to the presence of which of the following structures?
Your Answer: Outer membrane
Explanation:The reason bacteria are either Gram-positive or Gram-negative is due to the structure of their cell envelope (the cell envelope is defined as the cell membrane and cell wall plus an outer membrane, if one is present.) Gram-positive bacteria, for example, retain the crystal violet due to the amount of peptidoglycan in the cell wall. It can be said therefore that the Gram-stain procedure separates bacteria into two broad categories based on structural differences in the cell envelope.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 20
Correct
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A 40 year old woman, who is under anaesthesia for an elective procedure, received an antibiotic injection. She immediately developed a rash and her airway constricted raising the airway pressure. Which mechanism is responsible for this reaction?
Your Answer: Type I hypersensitivity
Explanation:Type I hypersensitivity reaction is an immediate reaction that occurs due to binding of the antigen with antibodies attached to mast cells in a previously sensitized person. It has an immediate phase, which is characterised by vasodilation, leakage of plasma, smooth muscle spasm, or glandular secretions. This manifests in about 5-30 min and usually resolves within 60 mins. The delayed phase follows after 24 hours and can persist up to several days. It is due to infiltration of eosinophils, neutrophils, basophils and CD4+ cells and leads to tissue destruction. The nature of the reaction varies according to the site. It can take the form of skin allergy, hives, allergic rhinitis, conjunctivitis, bronchial asthma or food allergy.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
