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Question 1
Correct
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After a prolonged coronary artery bypass surgery, a 60-year old gentleman was transfused 3 units of fresh-frozen plasma and 2 units of packed red cells. Two days later, the nurse noticed that he was tachypnoeic and chest X-ray showed signs consistent with adult respiratory distress syndrome. Which of the following variables will be low in this patient?
Your Answer: Compliance of the lung
Explanation:Acute or adult respiratory distress syndrome (ARDS) is a reaction to several forms of lung injuries and is commonly associated with sepsis and SIRS (systemic inflammatory response syndrome), severe traumatic injury, severe head injury, narcotics overdose, drowning, pulmonary contusion, and multiple blood transfusions. There is an increase in risk due to pre-existing liver disease or coagulation abnormalities. It results due to indirect toxic effects of neutrophil-derived inflammatory mediators in the lungs. ARDS is defined by the 1994 American–European Consensus Committee as the acute onset of bilateral infiltrates on chest X-ray, a partial pressure of arterial oxygen (pa(O2)) to fraction of inspired oxygen Fi(O2) ratio of less than 200 mmHg and a pulmonary artery occlusion pressure of less than 18 or the absence of clinical evidence of left arterial hypertension. ARDS is basically pulmonary oedema in the absence of volume overload or poor left ventricular function. This is different from acute lung injury, which shows a pa(O2)/Fi(O2) ratio of less than 300 mmHg. Pathogenesis of ARDS starts from damage to alveolar epithelium and vascular endothelium, causing increased permeability. Damage to surfactant-producing type II cells disrupts the production and function of pulmonary surfactant, causing micro atelectasis and poor gas exchange. There is a decrease in lung compliance and increase in work of breathing. Eventually, there is resorption of alveolar oedema, regeneration of epithelial cells, proliferation and differentiation of type II alveolar cells and alveolar remodelling. Some show resolution and some progress to fibrosing alveolitis, which involves the deposition of collagen in alveolar, vascular and interstitial spaces.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 2
Correct
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A 31-year-old woman is diagnosed with adrenal hyperplasia, and laboratory samples are taken to measure serum aldosterone and another substance. Which is most likely to be the other test that was prescribed to this patient?
Your Answer: Plasma renin
Explanation:The evaluation of a patient in whom hyperaldosteronism is first to determine that hyperaldosteronism is present (serum aldosterone) and, if it is present, to differentiate primary from secondary causes of hyperaldosteronism. The aldosterone-to-renin ratio (ARR) is the most sensitive means of differentiating primary from secondary causes of hyperaldosteronism as it is abnormally increased in primary hyperaldosteronism, and decreased or normal but with high renin levels in secondary hyperaldosteronism.
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This question is part of the following fields:
- Physiology
- Renal
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Question 3
Correct
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Normally, the O2 transfer in the lungs from alveolar to capillary is perfusion-limited. In which of the following situations does it become a diffusion-limited process?
Your Answer: Pulmonary oedema
Explanation:Normally, the transfer of oxygen from air spaces to blood takes place across the alveolar-capillary membrane by simple diffusion and depends entirely on the amount of blood flow (perfusion-limited process). Diseases that affect this diffusion will transform the normal process to a diffusion limited process. Thus, the diseases which cause a thickened barrier (such as pulmonary oedema due to increased extravascular lung water or asbestosis) will limit the diffusion of oxygen. Chronic obstructive lung diseases will have little effect on diffusion. Inhaling hyperbaric gas mixtures might overcome the diffusion limitation in patients with mild asbestosis or interstitial oedema, by increasing the driving force. Strenuous (not mild) exercise might also favour diffusion limitation and decrease passage time. Increasing the rate of ventilation will not have this affect but will only maintain a high oxygen gradient from air to blood.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 4
Incorrect
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What is correct regarding the obturator artery?
Your Answer: It exits through the greater sciatic foramen
Correct Answer: It is found in the medial compartment of the thigh
Explanation:The obturator artery is a branch of the internal iliac artery, which passes antero-inferiorly on the lateral wall of the pelvis, to the upper part of the obturator foramen. The posterior branch follows the posterior margin of the foramen and turns forward on the inferior ramus of the ischium. It also supplies an articular branch, which enters the hip joint through the acetabular notch, sending a branch along the ligamentum teres to the head of the femur. It is the main source of arterial supply to the medial compartment of the thigh
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 5
Correct
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After a cerebral infarction, which of these histopathogical findings is most likely to be found?
Your Answer: Liquefactive necrosis
Explanation:The brain has a high lipid content and typically undergoes liquefaction with ischaemic injury, because it contains little connective tissue but high amounts of digestive enzymes.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 6
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: MCHC = haemoglobin concentration × 10/erythrocyte number
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 7
Incorrect
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A 49-year-old woman with acute renal failure has a total plasma [Ca2+] = 2. 5 mmol/l and a glomerular filtration rate of 160 l/day. What is the estimated daily filtered load of calcium?
Your Answer: 120 mmol/day
Correct Answer: 240 mmol/day
Explanation:Calcium is the most abundant mineral in the human body. The average adult body contains in total approximately 1 kg of calcium of which 99% is in the skeleton in the form of calcium phosphate salts. The extracellular fluid (ECF) contains approximately 22 mmol, of which about 9 mmol is in the plasma. About 40% of total plasma Ca2+ is bound to proteins and not filtered at the glomerular basement membrane. Therefore, the estimated daily filtered load is 1.5 mmol/l × 160 l/day = 240 mmol/day. The exact amount of free versus total Ca2+ depends on the blood pH: free Ca2+ increases during acidosis and decreases during alkalosis.
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This question is part of the following fields:
- Physiology
- Renal
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Question 8
Correct
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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.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 9
Correct
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What is the result of maltase deficiency in the brush border of the small intestine?
Your 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 10
Incorrect
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Inside the palatoglossal arch is a muscle. Which nerve innervates this muscle?
Your Answer: XII
Correct Answer: X
Explanation:The palatoglossal arch contains the palatoglossal muscle which is innervated by the vagus nerve which is the tenth cranial nerve. So the correct answer is X
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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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A surgeon performing a laparoscopic repair of an inguinal hernia visualizes a loop of bowel protruding through the abdominal wall to form a direct inguinal hernia. When this is viewed from the side of the abdomen with a laparoscope, in which region would the hernial sac be?
Your Answer: Medial inguinal fossa
Explanation:In a direct inguinal hernia, visceral contents exit the abdomen through a weak point in the fascia in the medial inguinal fossa i.e. the area between the medial and lateral umbilical folds. Such a hernia doesn’t pass through the deep inguinal ring or the lateral inguinal fossa. Note that direct hernias can go through the superficial inguinal ring, although rarely. The supravesical fossa, between the median and medial umbilical folds, is formed by a peritoneal reflection from the anterior abdominal wall onto the bladder and the retrovesical fossa is the region behind the urinary bladder.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 12
Correct
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An anatomy instructor is giving a demonstration of the right lung. Which of the statements about the right lung made by the demonstrator is correct?
Your Answer: Its upper lobar bronchus lies behind and above the right pulmonary artery
Explanation:The root of the lungs on both sides are similar in that the pulmonary veins are anterior and inferior while the bronchus is posterior. However, on the right side, the pulmonary arteries are anterior to the bronchus while on the left side the pulmonary arteries are superior to the bronchus. The lingual is only found on the left lung. The mediastinum is the space in the thorax between the two pleural sacs and does not contain any lung. The right lung, having three lobes, is slightly larger than the left lung. On both sides, the phrenic nerves passes in front of the root of the lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 13
Incorrect
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Which of these infectious agents tends to affect people under 20 and over 40 years old, can cause acute encephalitis with cerebral oedema and petechial haemorrhages, along with haemorrhagic lesions of the temporal lobe. A lumbar puncture will reveal clear cerebrospinal fluid with an elevated lymphocyte count?
Your Answer: Neisseria meningitidis
Correct Answer: Herpes simplex virus
Explanation:Haemorrhagic lesions of the temporal lobe are typical of Herpes simplex encephalitis (HSE). It tends to affect patients aged under 20 or over 40 years, and is often fatal if left untreated. In acute encephalitis, cerebral oedema and petechial haemorrhages occur and direct viral invasion of the brain usually damages neurones. The majority of cases of herpes encephalitis are caused by herpes simplex virus-1 (HSV-1), and about 10% of cases of herpes encephalitis are due to HSV-2, which is typically spread through sexual contact.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 14
Incorrect
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Which of these foramen is located at the base of the skull and transmits the accessory meningeal artery?
Your Answer: Foramen spinosum
Correct Answer: Foramen ovale
Explanation:At the base of the skull the foramen ovale is one of the larger of the several holes that transmit nerves through the skull. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery, lesser petrosal nerve, a branch of the glossopharyngeal nerve, emissary vein connecting the cavernous sinus with the pterygoid plexus of veins and occasionally the anterior trunk of the middle meningeal vein.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 15
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: T4
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 16
Correct
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A 60-year-old woman has had persistent diarrhoea for a week. A stool test reveals an infection by Clostridium difficile. Which of the following antibiotics could be used to treat the infection?
Your Answer: Oral vancomycin
Explanation:Three antibiotics are effective against Clostridium difficile:
Metronidazole 500 mg orally three times daily is the drug of choice, because of superior tolerability, lower price and comparable efficacy.
Oral vancomycin 125 mg four times daily is second-line therapy in particular cases of relapse or where the infection is unresponsive to metronidazole treatment.
Thirdly, the use of linezolid might also be considered.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 17
Correct
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A 34-year-old Asian male presents with cervical lymphadenopathy. The patient is suspected to have tuberculous lymphadenopathy. Excision biopsy of one of the nodes showed granulomatous inflammation. Which histopathologic feature is most likely consistent with the diagnosis of tuberculosis?
Your Answer: Caseation necrosis
Explanation:The granulomas of tuberculosis tend to contain necrosis (caseating tubercles), but non-necrotizing granulomas may also be present. Multinucleated giant cells with nuclei arranged like a horseshoe (Langhans giant cells) and foreign body giant cells are often present, but are not specific for tuberculosis. A definitive diagnosis of tuberculosis requires identification of the causative organism by microbiological cultures.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 18
Incorrect
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Which lymph nodes are likely to be enlarged in a patient who has malignant growth involving the anus?
Your Answer: Internal iliac
Correct Answer: Superficial inguinal
Explanation:The lymphatics from the anus, skin of the perineum and the scrotum end in the superficial inguinal nodes. In case of a malignant growth of the anus, the superficial inguinal lymph nodes would most likely be enlarge.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 19
Correct
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A neonate with failure to pass meconium is being evaluated. His abdomen is distended and X-ray films of the abdomen show markedly dilated small bowel and colon loops. The likely diagnosis is:
Your Answer: Aganglionosis in the rectum
Explanation:Hirschsprung’s disease (also known as aganglionic megacolon) leads to colon enlargement due to bowel obstruction by an aganglionic section of bowel that starts at the anus. A blockage is created by a lack of ganglion cells needed for peristalsis that move the stool. 1 in 5000 children suffer from this disease, with boys affected four times more commonly than girls. It develops in the fetus in early stages of pregnancy. Symptoms include not having a first bowel movement (meconium) within 48 hours of birth, repeated vomiting and a swollen abdomen. Two-third of cases are diagnosed within 3 months of birth. Some children may present with delayed toilet training and some might not show symptoms till early childhood. Diagnosis is by barium enema and rectal biopsy (showing lack of ganglion cells).
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 20
Correct
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Which of the following organs is most likely to have dendritic cells?
Your Answer: Skin
Explanation:Dendritic cells are part of the immune system and they function mainly as antigen presenting cells. They are present in small quantities in tissues which are in contact in the external environment. Mainly in the skin and to a lesser extent in the lining of the nose, lungs, stomach and intestines. In the skin they are known as Langerhans cells.
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This question is part of the following fields:
- General
- Physiology
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Question 21
Correct
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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: 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 22
Correct
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While conducting a physical examination of a patient, the GP passed a finger down the edge of the medial crus of the superficial inguinal ring and felt a bony prominence deep to the lateral edge of the spermatic cord. What was this bony prominence?
Your Answer: Pubic tubercle
Explanation:At the superficial inguinal ring, the pubic tubercle would be felt as a bony prominence lateral to the edge of the spermatic cord. This tubercle is the point of attachment of the inguinal ligament that makes up the floor of the inguinal canal.
Pecten pubis is the ridge on the superior surface of the superior pubic ramus and the point of attachment of the pectineal ligament.
The pubic symphysis is the joint between the two pubic bones and the iliopubic eminence is a bony process on the pubis found near the articulation of the pubis and the ilium.
The iliopectineal line is formed by the arcuate line of the ilium and the pectineal line of the pubis. It is the line that marks the transition between the abdominal and pelvic cavity.
The sacral promontory is found on the posterior wall of the pelvis and would not be felt through the inguinal ring.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 23
Correct
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A 42 - year old male patient with an acute onset headache was brought in to the emergency department with suspicion of a subarachnoid haemorrhage (SAH). The SHO on call decided to have a diagnostic lumbar puncture after computed topography scan failed to support the suspicion. To perform a successful lumbar puncture without causing injury to the spine, which anatomical landmark should guide the SHO to locate the fourth vertebra for insertion of the spinal needle?
Your Answer: Iliac crest
Explanation:The safest spinal level for conducting a lumbar puncture, is at the level of the fourth lumbar vertebra. The anatomical landmark used to locate the fourth lumbar vertebra (L4), is the iliac crest. The needle can safely be inserted either above or below L4. The conus medullaris is at the level of the border of L1 and L2 so L4 is safely distant from it.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 24
Incorrect
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A 15 month old boy has a history of repeated bacterial pneumonia, failure to thrive and a sputum culture positive for H.influenzea and S.pneumoniae. There is no history of congenital anomalies. He is most likely suffering from?
Your Answer: DiGeorge syndrome
Correct Answer: X-linked agammaglobulinemia
Explanation:Recurrent bacterial infections may be due to lack of B-cell function, consequently resulting in a lack of gamma globulins production. Once the maternal antibodies have depleted, the disease manifests with greater severity and is called x-linked agammaglobulinemia also known as ‘X-linked hypogammaglobulinemia’, ‘XLA’ or ‘Bruton-type agammaglobulinemia. it is a rare x linked genetic disorder that compromises the bodies ability to fight infections.
Acute leukaemia causes immunodeficiency but not so specific.
DiGeorge syndrome is due to lack of T cell function.
Aplastic anaemia and EBV infection does not cause immunodeficiency.
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This question is part of the following fields:
- Inflammation & Immunology; Respiratory
- Pathology
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Question 25
Correct
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A 43-year-old diabetic man complains of headaches, palpitations, anxiety, abdominal pain and weakness. He is administered sodium bicarbonate used to treat:
Your Answer: Metabolic acidosis
Explanation:Sodium bicarbonate is indicated in the management of metabolic acidosis, which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis. Bicarbonate is given at 50-100 mmol at a time under scrupulous monitoring of the arterial blood gas readings. This intervention, however, has some serious complications including lactic acidosis, and in those cases, should be used with great care.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 26
Correct
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A CT-scan of the lung shows a tumour crossing the minor (horizontal) fissure. This fissure separates:
Your Answer: The middle lobe from the upper lobe
Explanation:The horizontal fissure separates the upper lobe from the middle lobe. The oblique fissure on the other hand separates the lower lobe from both the middle and upper lobes. The lingula is found only on the left lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 27
Correct
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During a clinical rotation in the ENT clinic, you observe a flexible bronchoscopy. As the scope is passed down the trachea, you see a cartilaginous structure that resembles a ship's keel and separates the right and the left main stem bronchi. This structure is the:
Your Answer: Carina
Explanation:The carina (a keel-like cartilage) is found at the bifurcation of the trachea separating the right from the left main stem bronchi. It is a little more to the left than to the right.
The cricoid cartilage is the inferior and posterior cartilage of the larynx.
The costal cartilage on the other hand elongates the ribs anteriorly and contribute to the elasticity of the thoracic cage.
The pulmonary ligament is a fold of pleura located below the root of the lung.
Tracheal rings are rings of cartilage that support the trachea.
Peritracheal fascia is a layer of connective tissue that invests the trachea from the outside and is not visible on bronchoscopy.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 28
Incorrect
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A football player sustained an injury to his ankle. The wound went through the skin, subcutaneous tissue and flexor retinaculum. Which other structure passing under the retinaculum may be injured?
Your Answer: Anterior tibial artery
Correct Answer: Tibial nerve
Explanation:The flexor retinaculum is immediately posterior to the medial malleolus. The structures that pass under the flexor retinaculum from anterior to posterior are: tendon of the tibialis posterior, flexor digitorum longus, posterior tibial artery (and vein), tibial nerve and tendon of flexor hallucis longus. The tibial nerve is the only one which lies behind the flexor retinaculum.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 29
Incorrect
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Gastric acid secretion is stimulated by which of the following?
Your Answer: The glossopharyngeal nerve
Correct 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 30
Correct
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A elderly patient with bulbar palsy is bed ridden. While swallowing he aspirates one of his tablets into his lungs. In which bronchopulmonary segments is it most likely to end up?
Your Answer: Superior segmental bronchus of the right inferior lobe
Explanation:Inhaled objects are more likely to enter the right lung for several reasons. First the right bronchus is shorter, wider and more vertical than the left bronchus. Also, the carina (a ridge-like structure at the point of tracheal bifurcation) is set a little towards the left. The superior segmental bronchus branches posteriorly off the intermediate bronchus or the inferior lobe bronchus and is thus more likely to receive the foreign body that enters the right main bronchus. The lingula is only found on the left lung. The terminal bronchiole is a very small space almost impossible for the tablet to lodge here.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 31
Correct
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Thalamic syndrome will most likely result in:
Your Answer: Hyperaesthesia
Explanation:Signs and symptoms of thalamic syndrome include contralateral hemi anaesthesia, burning or aching sensation in one half of a body (hyperaesthesia), often accompanied by mood swings.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 32
Incorrect
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The superior rectal artery is a continuation of the:
Your Answer: Sigmoid artery
Correct 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 33
Correct
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What will the destruction of endoplasmic reticulum stop?
Your 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.
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This question is part of the following fields:
- General
- Physiology
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Question 34
Correct
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A 7-month-old abandoned baby with congenital non-communicating hydrocephalus is hosted by a clinic at its new-born hostel. A CT scan of the baby's brain reveals what might be a blockage of the ventricular system between the third and the fourth ventricles. Which of the following is the most likely blocked structure?
Your Answer: Cerebral aqueduct
Explanation:The drainage of cerebral spinal fluid from the third ventricle to the fourth ventricle is carried out by the cerebral aqueduct. The cerebral aqueduct is the narrowest passageway in the entire ventricular system and thus forms the most common site of blockage of flow of cerebrospinal fluid. The interventricular foramen allows passage of CSF to the third ventricle. The foramen of Luschka and Magendie are located on the fourth ventricle and allow passage of CSF to the subarachnoid space from the ventricular system. The pontine cistern is a space located on the ventral aspect of the pons. The cisterna magna is an opening on the subarachnoid space between the pia matter and the arachnoid.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 35
Incorrect
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A patient with testicular seminoma has the following tumour markers: LDH 1.3 times the reference levels, β-hCG 4500 mIU/ml and AFP 875 ng/ml. What's the serum tumour marker stage in this case?
Your Answer: S2
Correct Answer: S1
Explanation:According to AJCC guidelines, the serum tumour marker staging is the following:
S0: marker studies within normal limits
S1: lactate dehydrogenase (LDH) less than 1.5 times the reference range, beta-human chorionic gonadotrophin (β-hCG) <5000 mIU/ml, and alpha-fetoprotein (AFP) <1000 ng/ml S2: LDH 1.5–10 times the reference range, β-hCG 5000–50,000 mIU/ml or AFP 1000–10,000 ng/ml S3: LDH greater than 10 times the reference range, β-hCG >50,000 mIU/ml or AFP >10,000 ng/ml.
According to this, the patient’s tumour belongs to the S1 stage.
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This question is part of the following fields:
- Pathology
- Urology
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Question 36
Correct
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A histopathological analysis of a specimen showed loss of individual cell structure with karyorrhexis and fragmentation. The overall integrity of the tissue structure is preserved. This is typical of which of the following pathologies?
Your Answer: Viral hepatitis
Explanation:Viral infections will cause necrosis of the hepatocytes with characteristic changes of karyorrhexis and cell fragmentation.
Brown atrophy of the heart is due to accumulation of lipofuscin in the myocardium.
Tissue destruction associated with transplant rejection leads to widespread loss of structural integrity.
Single cell necrosis is not characteristically seen in chronic alcoholic liver.
Barbiturate overdose will result in hypertrophy of the smooth endoplasmic reticulum.
Carcinoma insitu will cause dysplastic cells without the overall structural integrity being disrupted.
Atrophy is due to apoptosis with ordered cellular fragmentation and phagocytosis and will not induce an inflammatory process unlike necrosis.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 37
Correct
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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: 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 38
Correct
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In which situation is a stretch reflex such as knee jerk likely to be exaggerated?
Your Answer: In upper motor neuron lesion
Explanation:A stretch reflex is a monosynaptic reflex that causes muscle contraction in response to stretching within that muscle. The sensory apparatus in a muscle that are sensitive to stretch are the muscle spindles. The patellar (knee jerk) reflex is an example. In upper motor neuron lesions, the stretch reflexes tend to be brisk due to loss of inhibitory signals on gamma neurons through the lateral reticulospinal tract.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 39
Correct
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A 27-year-old female was admitted due to severe dehydration. The patient also complained of chest tightness, thus an ECG was requested. The ECG strip showed an isoelectric ST segment, upright T wave, with prominent U waves. What is the most likely electrolyte abnormality responsible for these ECG tracing?
Your Answer: Hypokalaemia
Explanation:U waves are prominent if it is >1-2mm or 25% of the height of the T wave. Abnormally prominent U waves are characteristically seen in severe hypokalaemia.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 40
Incorrect
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In a cardiac cycle, what event does the closing of atrioventricular (AV) valves coincide with?
Your Answer: Second heart sound
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 41
Incorrect
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The thyroid gland is a large ductless gland located in which part of the neck?
Your Answer: Submandibular triangle
Correct Answer: Visceral space
Explanation:The thyroid gland is an endocrine gland in the neck, consisting of two lobes connected by an isthmus. It is situated at the front and sides of the neck in the visceral space.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 42
Correct
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QT interval in the electrocardiogram of a healthy individual is normally:
Your Answer: 0.40 s
Explanation:QT interval extends from beginning of the QRS complex till the end of he T-wave and normally lasts for 0.40 s. It is important in the diagnosis of long-QT and short-QT syndrome. The QT interval varies on the basis of heart rate and may need to be corrected.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 43
Correct
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Which muscle would be affected most following injury to the transverse cervical artery?
Your Answer: Trapezius
Explanation:The latissimus dorsi receives blood from the thoracodorsal artery, the supraspinatus receives its blood from the suprascapular artery, the levator scapulae and the rhomboids are supplied by the dorsal scapular artery and the transverse cervical artery supplies blood to the trapezius.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 44
Correct
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Which of the following statements regarding aqueous humour is correct?
Your Answer: Is the only source of nutrients for the lens of the eye
Explanation:The aqueous humour is a transparent, watery fluid similar to plasma, but containing low protein concentrations. It is secreted from the ciliary epithelium and fills both the anterior and the posterior chambers of the eye. It maintains the intraocular pressure and inflates the globe of the eye. It is this hydrostatic pressure which keeps the eyeball in a roughly spherical shape and keeps the walls of the eyeball taut. It provides nutrition (e.g. amino acids and glucose) for the avascular ocular tissues; posterior cornea, trabecular meshwork, lens, and anterior vitreous. It may serve to transport ascorbate into the anterior segment to act as an antioxidant agent. The presence of immunoglobulins indicate its role in immune response to defend against pathogens.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 45
Correct
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A brain tumour causing blockage of the hypophyseal portal system is likely to result in an increased secretion of which of the following hormones?
Your Answer: Prolactin
Explanation:The hypophyseal portal system links the hypothalamus and the anterior pituitary. With the help of this system, the anterior pituitary receives releasing and inhibitory hormones from the hypothalamus and regulates the action of other endocrine glands. One of the inhibitory hormones carried by this system is the prolactin-inhibitory hormone. In the absence of this hormone which might occur in case of a blockage of the system, prolactin secretion increases to about three times normal levels.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 46
Incorrect
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Gastrocnemius, semimembranosus and semitendinosus together with which other muscle form the boundaries of the popliteal fossa?
Your Answer: Sartorius
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.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 47
Correct
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Which of the following malignancies is likely to have the best prognosis?
Your Answer: Papillary carcinoma of the thyroid
Explanation:Papillary carcinoma accounts for 70-80% of all thyroid cancers and is seen commonly in people aged 30-60 years. It is more aggressive in elderly patients. 10-20% cases may have recurrence or persistent disease. More common in females with a female to male ratio of 3:1. Papillary carcinomas can also contain follicular carcinomas. The common route of spread is through lymphatics to regional nodes in one-third cases and pulmonary metastasis can also occur. Papillary carcinomas of the thyroid have the best prognosis, especially in patients less than 45 years of age with small tumours confined to the thyroid gland.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 48
Correct
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Post-total gastrectomy, there will be a decreased production of which of the following enzymes?
Your Answer: Pepsin
Explanation:Pepsin is a protease that is released from the gastric chief cells and acts to degrade proteins into peptides. Released as pepsinogen, it is activated by hydrochloric acid and into pepsin itself. Gastrin and the vagus nerve trigger the release of pepsinogen and HCl when a meal is ingested. Pepsin functions optimally in an acidic environment, especially at a pH of 2.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 49
Incorrect
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A pedestrian sustained a left fibula fractured following a hit-and-run. X-rays showed that there was a transverse fracture of the upper end of the fibula. It was manifested clinically by inability to flex his foot at the ankle joint plus weak extension of the phalanges. What nerve is suspected to be injured in such a case?
Your Answer: Superficial peroneal
Correct Answer: Deep peroneal
Explanation:The deep peroneal nerve supplies the muscles allowing for flexion of the foot at the ankle joint, namely the tibialis anterior and peroneus tertius muscles. The peroneus tertius, peroneus brevis, and peroneus longus evert the foot, whereas the tibialis anterior and tibialis posterior invert the foot. Fibres of the deep peroneal nerve originate from L4, L5, and S1.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 50
Correct
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During an operation to repair an aortic coarctation in a neonate, a surgeon accidentally cuts the first aortic intercostal arteries as he mobilised the descending aorta. Which one of the following structure might be deprived of its primary source of blood supply following this injury?
Your Answer: Right bronchus
Explanation:The right bronchus is supplied by one right bronchial artery that may branch from one of the left bronchial arteries or from the right 3rd posterior intercostal artery (this is the first intercostal artery that arises from the aorta). Damage to this artery might stop blood supply to the main bronchus. Intercostal arteries that go to the first and the second interspaces originate from the highest intercostal artery such that blood supply to either of these spaces would not be interfered with.
The left bronchus receives blood from 2 left bronchial arteries which are direct branches from the descending aorta.
Fibrous pericardium is the sac that contains the heart. Its blood supply is not a major concern.
Visceral pericardium receives its blood supply from the coronary vessels.
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This question is part of the following fields:
- Anatomy
- Thorax
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SESSION STATS - PERFORMANCE PER SPECIALTY
