-
Question 1
Correct
-
On exploration of an axillary wound, a branch from the third part of the axillary artery was found to be transected. Which of the following arteries would have been likely injured?
Your Answer: Anterior circumflex humeral
Explanation:The axillary artery gives off many branches from the first, second, or third parts along its course. The third part of the axillary artery gives off 3 branches: the subscapular, anterior and posterior circumflex humeral arteries.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 2
Correct
-
Which foramen contains the vertebral artery?
Your Answer: Foramen magnum
Explanation:The foramen magnum is found in the most inferior part of the posterior cranial fossa. It is traversed by vital structures including the medulla oblongata. Its contents include the following: medulla oblongata, meninges, spinal root of the accessory nerve, vertebral arteries, anterior and posterior spinal arteries, tectorial membrane and alar ligaments.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 3
Incorrect
-
A surgical registrar performing an adrenalectomy procedure on the left suprarenal gland of a 25 - year old male patient, accidentally jabbed and injured a vital structure that lies anterior to the left suprarenal organ. Which of the following was the structure most likely injured?
Your Answer: Colon
Correct Answer: Pancreas
Explanation:The adrenal (suprarenal) glands are organs of the endocrine system located on top of each of the kidneys. The left suprarenal gland, in question, is crescent in shape and slightly larger than the right suprarenal gland. It is posteriorly located to the lateral aspect of the head of the pancreas which is thus the most likely to be injured. The other organs like the duodenum, liver and the inferior vena cava are related to the right suprarenal gland. The spleen and the colon are not in close proximity with the left suprarenal gland and are not likely to be the organs injured.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 4
Incorrect
-
A 5-year-old child presents with fever and otalgia. Greenish pustular discharge was seen in his left ear during physical examination. The patient is diagnosed with otitis externa. Which of the following organisms most likely caused the infection?
Your Answer: Moraxella catarrhalis
Correct Answer: Pseudomonas aeruginosa
Explanation:P. aeruginosa is a multidrug resistant pathogen recognised for its ubiquity, its advanced antibiotic resistance mechanisms and its association with serious illnesses – especially hospital-acquired infections such as ventilator-associated pneumonia and various septic syndromes. The species name aeruginosa is a Latin word meaning verdigris (copper rust), referring to the blue-green colour of laboratory cultures of the species. This blue-green pigment is a combination of two metabolites of P. aeruginosa, pyocyanin (blue) and pyoverdine (green), which impart the blue-green characteristic colour of cultures.
-
This question is part of the following fields:
- Microbiology
- Pathology
-
-
Question 5
Correct
-
The operating surgeon notices a structure lying alongside a herniated mass whilst repairing an indirect inguinal hernia in a female patient. Which structure could this be?
Your Answer: Round ligament of the uterus
Explanation:The main structure traversing the inguinal canal in women is the round ligament. In men, it is the spermatic cord.
The iliohypogastric nerve innervates the abdominal wall and runs between the transversus abdominis and internal oblique muscles before piercing the internal oblique at the anterior superior iliac spine to run between the internal and external obliques.
The inferior epigastric artery is between the peritoneum and the transversus abdominis creating the lateral umbilical fold.
The ovarian artery and the ovarian vein are branches from the descending aorta and inferior vena cava that supply the ovary in the pelvic cavity.
The pectineal ligament is a thick fascial layer over the pectineal line of the pubis. It doesn’t traverse the canal.
The broad ligament if found on the lateral sides of the uterus.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 6
Correct
-
A syndrome responsible for failure to absorb vitamin B12 from the GIT is called?
Your 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.
-
This question is part of the following fields:
- General
- Physiology
-
-
Question 7
Incorrect
-
Acute respiratory distress syndrome (ARDS) is a medical condition that occurs in critically ill patients, and can be triggered by events such as trauma and sepsis. Which of the following variables is most likely to be lower than normal in a patient with ARDS?
Your Answer: Alveolar–arterial pressure difference
Correct Answer: Lung compliance
Explanation:Acute (or Adult) respiratory distress syndrome (ARDS) is a medical condition occurring in critically ill patients characterized by widespread inflammation in the lungs. The development of acute respiratory distress syndrome (ARDS) starts with damage to the alveolar epithelium and vascular endothelium, resulting in increased permeability to plasma and inflammatory cells. These cells pass into the interstitium and alveolar space, resulting in pulmonary oedema. Damage to the surfactant-producing type II cells and the presence of protein-rich fluid in the alveolar space disrupt the production and function of pulmonary surfactant, leading to micro atelectasis and impaired gas exchange. The pathophysiological consequences of lung oedema in ARDS include a decrease in lung volumes, compliance and large intrapulmonary shunts. ARDS may be seen in the setting of pneumonia, sepsis, following trauma, multiple blood transfusions, severe burns, severe pancreatitis, near-drowning, drug reactions, or inhalation injuries.
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 8
Incorrect
-
If your EEG shows waves with a frequency range of 8-12 Hz, the waves most likely to be seen are:
Your Answer: Beta
Correct Answer: Alpha
Explanation:Electroencephalography (EEG) is the neurophysiological measurement of the electrical activity of the brain. It is done by placing electrodes on the scalp or subdurally. In reality, the electrical currents are not measured, but rather the voltage differences between different parts of the brain. Four major types of EEG activity are recognized, which are alpha, beta, delta and theta.
Alpha waves, also known as Berger’s waves ranges in frequency from 8-12 Hz. Best detected with eyes closed, alpha waves are characteristic of a relaxed, alert state of consciousness. An alpha-like normal variant called mu is sometimes seen over the motor cortex (central scalp) and attenuates with movement or, rather, with the intention to move.
-
This question is part of the following fields:
- Neurology
- Physiology
-
-
Question 9
Incorrect
-
What is the likely course of a pulmonary embolism arising from the leg veins and ending in the apical segmental pulmonary artery that supplies the superior lobe of left lung?.
Your Answer: Inferior vena cava – right atrium – tricuspid valve – right ventricle – pulmonary trunk – left pulmonary artery – left bronchial artery – left apical segmental artery
Correct Answer: Inferior vena cava – right atrium – tricuspid valve – right ventricle – pulmonary trunk – left pulmonary artery – left superior lobar artery – left apical segmental artery
Explanation:A clot originating in the leg vein will go to the inferior vena cava, into the right atrium, through the tricuspid valve, into the right ventricle, through the pulmonary trunk, into the left pulmonary artery, into the left superior lobar artery and then finally reach the left apical segmental artery.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 10
Correct
-
A 30 year old male has a painless and transilluminant swelling at the upper pole of his left testi. There is a negative cough test. Which of the following is the likely diagnosis?
Your Answer: Spermatocoele
Explanation:Spermatocele, also known as a spermatic cyst is a cystic mass usually occurring at the upper pole of the testis. Differential diagnosis included hydrocele as both are cystic, painless and transilluminant. Ultrasound is a useful modality. If symptomatic or large, surgical excision can be done.
-
This question is part of the following fields:
- Pathology
- Urology
-
-
Question 11
Correct
-
Which nerve mediates the sensation to itch from the skin that is just over the base of the spine of your scapula?
Your Answer: Dorsal primary ramus of C7
Explanation:The first branches off spinal nerves are called the dorsal and ventral rami. The dorsal rami mediate sensation of the skin over the back and motor supply to the true muscles of the back whilst the ventral rami gives sensation to the skin over the limbs and the skin that is over the ventral side of the trunk. It also gives motor supply to the skeletal muscles of the neck, the trunk and extremities. Hence, itchiness of the part of the skin that is over the spine of the scapula would be mediated by the primary ramus of C7. Accessory nerve doesn’t have any sensory innervation.
-
This question is part of the following fields:
- Anatomy
- Neurology
-
-
Question 12
Correct
-
What is the normal duration of PR interval on an electrocardiogram of a healthy individual?
Your Answer: 0.12–0.20 s
Explanation:PR interval extends from the beginning of the P-wave until the beginning of the QRS complex. The normal duration of the PR interval is 0.12-0.20 s. It can be prolonged in first degree heart block, and reduced in Wolff-Parkinson-White syndrome.
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 13
Correct
-
An X ray of a 60 year old male brought to the accident and emergency following a fall down stairs shows a fractured olecranon process of the right ulna with the line of fracture passing through the superior surface, disrupting a muscle. Which among the following muscles was most likely injured?
Your Answer: Triceps brachii
Explanation:The superior surface of the olecranon process forms an attachment for the insertion of the triceps brachii on the posterior aspect. It also has a minor transverse groove for the attachment of part of the posterior ligament of the elbow on the anterior aspect.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 14
Incorrect
-
A 45-year old lady underwent biopsy of a soft, fleshy mass involving her left breast. The biopsy showed lymphoid stroma with minimal fibrosis, surrounding sheets of large vesicular cells with frequent mitoses. Which condition is she most likely suffering from?
Your Answer: Cystosarcoma phyllodes
Correct Answer: Medullary carcinoma of breast
Explanation:Medullary carcinoma is a malignant tumour of the breast with well-defined boundaries and accounts for 5% of all breast cancers. Other special features include a larger size of the neoplastic cells and presence of lymphoid cells at tumour edge. Differential diagnosis includes invasive ductal carcinoma. Prognosis is usually good.
-
This question is part of the following fields:
- Pathology
- Women's Health
-
-
Question 15
Correct
-
A construction worker is brought to the A&E after a fall on site. The patient is conscious but complains of inability to feel his legs. A neurological examination reveals that he has no cutaneous sensation from his umbilicus to his toes. What is the likely level of the spinal cord that is injured?
Your Answer: T10
Explanation:The umbilicus has a relatively consistent position in humans and thus serves as an important land mark. The skin around the waist at the level of the umbilicus is supplied by the tenth thoracic spinal nerve (T10 dermatome).
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 16
Correct
-
During a radical mastectomy for advanced breast cancer, the surgeon injured the long thoracic nerve. Which among the following muscles is likely to be affected?
Your Answer: Serratus anterior
Explanation:The long thoracic nerve innervates the serratus anterior muscle which holds the scapula forward and balances the rhomboids and the trapezius muscles which retract the scapula. Injury to this nerve results in a ‘winged scapula’ with a posterior protrusion.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 17
Correct
-
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: 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
-
-
Question 18
Incorrect
-
A 26-year old man is brought to the A&E with a stab wound to the chest. The wound is in a part of the left lung that might partially fill the costomediastinal recess in full respiration. Where did the weapon strike this man?
Your Answer: Hilum
Correct Answer: Lingula
Explanation:During full inspiration, the lingual-of the left lung partially fills the costomediastinal recess. If the apex of the lung is fully filled with air, it would occupy the copula (the part of the pleura that extends above the first rib). The hilum is part of the lung where the neurovascular structures that form the root of the lung enter and leave the lung and doesn’t expand on inspiration. The middle lobe can expand to fill the costomediastinal recess, however, the middle lobe is on the right lung. The inferior lobe, during full inspiration, might fill the costodiaphragmatic recess.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 19
Correct
-
Injury to the supraspinatus muscle will affect:
Your 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 20
Incorrect
-
During thymectomy the surgeon accidentally nicks a vein that lies just posterior to the thymus. Which of the following vessels is likely to be injured?
Your Answer: Right brachiocephalic vein
Correct Answer: Left brachiocephalic vein
Explanation:The thymus is located superficially in the anterior mediastinum. The left brachiocephalic vein courses through the mediastinum to join the right brachiocephalic vein and form the superior vena cava on the right side of the thorax. The left brachiocephalic vein, being superficial, courses just deep to the thymus so that it may be susceptible to compression by an adjacent tumour. The left pulmonary vein, left bronchial vein and right pulmonary artery are deep, and enter and exit the lung at its root, thus are not near the thymus. The right superior intercostal vein drains the 2nd to the 4th intercostal spaces and drains into the arch of the azygos vein. It is not, therefore, closely related with the thymus.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
SESSION STATS - PERFORMANCE PER SPECIALTY
