-
Question 1
Correct
-
Evaluation of a 60-year old gentleman, who has been a coal miner all his life and is suspected to have pulmonary fibrosis reveals the following: normal FEV1, arterial oxygen saturation 92%, alveolar ventilation 6000 ml/min at a tidal volume of 600 ml and a breathing rate of 12 breaths/min. There are also pathological changes in lung compliance and residual volume. Which of the following is most accurate about his residual volume?
Your Answer: Cannot be measured directly with a spirometer
Explanation:Residual volume is the air left in the lungs after maximal expiration is done. Thus, this is not a part of vital capacity and cannot be measured with a spirometer directly. It can be measured by the methods such as body plethysmography or inert gas dilution. Expiratory reserve volume is vital capacity minus inspiratory capacity. Resting volume of lungs is he sum of residual volume and expiratory reserve volume. Lungs recoil inward until the recoil pressure becomes zero, which corresponds to a volume significantly lower than residual volume.
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 2
Correct
-
When inserting a chest drain anteriorly into the second intercostal space, one must identify the second costal cartilage by palpating which landmark?
Your Answer: Sternal angle
Explanation:The sternal angle is the site for identification of the second rib as the second rib is attached to the sternum at this point.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 3
Correct
-
In which of the following compartments of the femoral sheath is the femoral artery located?
Your Answer: Lateral compartment
Explanation:The femoral sheath also known as the crural sheath is made up of three compartments; lateral, intermediate and the medial. The femoral artery is contained in the lateral compartment of the femoral sheath while the femoral vein is in the intermediate compartment.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 4
Correct
-
A 45 year old women has a 4 cm non tender mass in her right breast which is fixed to the chest wall. Another 2cm non-tender mass is palpable in the left axilla. Chest x ray reveals multiple nodules ranging from 0.5 - 0.2 cm in both the lungs. What is the stage of her disease?
Your Answer: T4 N1 M1
Explanation:This woman has an invasive primary tumour mass with axillary node and lung metastases, making this stage T4 N1 M1. Looking at the other stems, T1 N1 M0 signifies a small primary cancer with nodal metastases but no distant metastases; T1 N0 M1 signifies a small primary cancer with no lymph node metastases but with distant metastases; T2 N1 M0 signifies a larger primary cancer with nodal metastases but no distant metastases; and T3 N0 M0 indicates a larger primary cancer with no metastases to either lymph nodes or to distant sites.
-
This question is part of the following fields:
- Neoplasia; Female Health
- Pathology
-
-
Question 5
Correct
-
A blood sample from a patient with polycythaemia vera will show which of the following abnormalities?
Your Answer: High platelet count
Explanation:Polycythaemia is a condition that results in an increase in the total number of red blood cells (RBCs) in the blood. It can be due to a myeloproliferative syndrome, chronically low oxygen levels or rarely malignancy. In primary polycythaemia/ polycythaemia vera the increase is due to an abnormality in the bone marrow, resulting in increased RBCs, white blood cells (WBCs) and platelets. In secondary polycythaemia the increase occurs due to high levels of erythropoietin either artificially or naturally. The increase is about 6-8 million/cm3 of blood. A type of secondary polycythaemia is physiological polycythaemia where people living in high altitudes who are exposed to hypoxic conditions produce more erythropoietin as a compensatory mechanism for thin oxygen and low oxygen partial pressure.
-
This question is part of the following fields:
- General
- Physiology
-
-
Question 6
Incorrect
-
During thyroidectomy, the recurrent laryngeal nerves are vulnerable to injury. Which of the following muscles will not be affected in cases where the recurrent laryngeal nerve is severed?
Your Answer: Thyroarytenoid
Correct Answer: Cricothyroid
Explanation:All muscles of the larynx are supplied by the recurrent laryngeal nerve except for the cricothyroid which is supplied by the vagus nerve.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 7
Incorrect
-
Which of the following compensatory parameters is responsible for causing an increase in the blood pressure in a 30 year old patient with a BP of 40 mmHg?
Your Answer: Ischaemic brain response
Correct Answer: Baroreceptor reflex
Explanation:The baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for regulating blood pressure. It provides a negative feedback response in which an elevated blood pressure will causes blood pressure to decrease; similarly, decreased blood pressure depresses the baroreflex, causing blood pressure to rise. The system relies on specialised neurones (baroreceptors) in the aortic arch, carotid sinuses and elsewhere to monitor changes in blood pressure and relay them to the brainstem. Subsequent changes in blood pressure are mediated by the autonomic nervous system. Baroreceptors include those in the auricles of the heart and vena cava, but the most sensitive baroreceptors are in the carotid sinuses and aortic arch. The carotid sinus baroreceptors are innervated by the glossopharyngeal nerve (CN IX); the aortic arch baroreceptors are innervated by the vagus nerve (CN X).
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 8
Correct
-
Which best describes the sartorius muscle?
Your Answer: Will flex the leg at the knee joint
Explanation:The sartorius muscle arises from tendinous fibres from the superior iliac spine. It passes obliquely across the thigh from lateral to medial and is inserted into the upper part of the medial side of the tibia. When the sartorius muscle contracts it will flex the leg at the knee joint.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 9
Correct
-
A 30-year-old woman known with Von Willebrand disease (vWD) has to undergo surgery. Which of these complications is most unlikely in this patient?
Your Answer: Hemarthrosis
Explanation:Von Willebrand disease (vWD) is an inherited haemorrhagic disorder characterised by the impairment of primary haemostasis. It is caused by the deficiency or dysfunction of a protein named von Willebrand factor. The most common manifestation due to the condition is abnormal bleeding. Complications include easy bruising, hematomas, epistaxis, menorrhagia, prolonged bleeding and severe haemorrhage. Hemarthrosis is a complication that is more commonly found in haemophilia.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 10
Correct
-
A 25 year-old female medical student presents with fever, lack of appetite, rashes, sore throat and lymphadenopathy. Peripheral smear shows atypical lymphocytes. Which is the most likely organism responsible for this patient's condition?
Your Answer: Epstein–Barr virus
Explanation:Epstein-Barr virus is in the herpes family of viruses and most people will become infected with EBV sometime during their lives. EBV commonly causes infectious mononucleosis, or mono, a contagious viral illness that initially attacks the lymph nodes in the neck and throat. When these tissues become less effective in fighting infection, sore throats, swelling of the nodes and fever may result.
-
This question is part of the following fields:
- Microbiology
- Pathology
-
-
Question 11
Correct
-
During a procedure in the mediastinum, the surgeon accidentally injured a key structure that lies immediately anterior to the thoracic duct. Which structure is likely to be injured?
Your Answer: Oesophagus
Explanation:In the mid-thorax, the azygos vein, thoracic duct and aorta (in this order from right to the left) are all located posterior to the oesophagus. The superior vena cava, left internal jugular vein and trachea are not found in the mid thorax.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 12
Correct
-
Which of the following features is indicative of poor prognosis in a case of breast carcinoma?
Your Answer: Axillary lymph node metastases
Explanation:Lymphatic spread indicates poor prognosis. Presence of family history is not a prognostic factor despite being linked to higher incidence. Aneuploidy is a poor prognostic factor. A breast tumour positive for oestrogen receptors is a good prognostic factor as it increases the responsiveness of the tumour to certain therapies. In-situ tumours carry the best prognosis.
-
This question is part of the following fields:
- Pathology
- Women's Health
-
-
Question 13
Incorrect
-
A new-born was found to have an undeveloped spiral septum in the heart. This is characteristic of which of the following?
Your Answer: Transposition of the great vessels
Correct Answer: Persistent truncus arteriosus
Explanation:Persistent truncus arteriosus is a congenital heart disease that occurs when the primitive truncus does not divide into the pulmonary artery and aorta, resulting in a single arterial trunk. The spiral septum is created by fusion of a truncal septum and the aorticopulmonary spiral septum. Incomplete development of these septa results in incomplete separation of the common tube of the truncus arteriosus and the aorticopulmonary trunk.
-
This question is part of the following fields:
- Cardiovascular
- Pathology
-
-
Question 14
Correct
-
A 63-year old lady presents with pain in multiple bones and renal failure. On enquiry, there is history of recurrent pneumonia in the past. What will be the likely finding on her bone marrow biopsy?
Your Answer: Plasma cells
Explanation:Multiple myeloma is a plasma cell malignancy that produce excessive monoclonal immunoglobulins. The disease presents with bone pains, renal dysfunction, increased calcium, anaemia and recurrent infections. Diagnosis is by demonstrating the presence of M-protein in urine or serum, lytic bone lesions, light chain proteinuria or excessive plasma cells on marrow biopsy.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 15
Correct
-
Which of the following structures is not easily palpable?
Your Answer: Styloid process of the temporal bone
Explanation:The styloid process is a thin, pointed process that projects antero-inferiorly from the base of the petrous temporal bone. It can vary in length from a short, stubby process to a slender, four to five centimetre rod. It forms from the cranial elements of the second pharyngeal arch. The tympanic plate of the temporal bone ensheathes the base of this process. The pointed, projecting portion of the process provides attachment to the stylohyoid and stylomandibular ligaments, and to three muscles – the styloglossus, stylohyoid, and stylopharyngeus. As the styloid process is covered by the various muscles, it is not easily palpable in live subjects.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 16
Incorrect
-
Which of these antibiotics is the first choice treatment for infections caused by Pseudomonas aeruginosa?
Your Answer: Ampicillin
Correct Answer: Piperacillin
Explanation:Piperacillin is an extended-spectrum beta-lactam antibiotic of the ureidopenicillin class. It is normally used with a beta-lactamase inhibitor such as tazobactam. The combination has activity against many Gram-positive and Gram-negative pathogens and anaerobes, including Pseudomonas aeruginosa. Piperacillin is sometimes referred to as an anti-pseudomonal penicillin.
-
This question is part of the following fields:
- Pathology
- Pharmacology
-
-
Question 17
Incorrect
-
Which of the following arteries, if ligated, will most likely affect blood supply to the pancreas?
Your Answer: Common hepatic
Correct Answer: Superior mesenteric
Explanation:The pancreas is a glandular organ in the body that produces important hormones such as insulin and glucagon. Its blood supply is from branches of the coeliac artery, superior mesenteric artery and the splenic artery. These are the arteries that if ligated, would affect blood supply to the pancreas.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 18
Correct
-
A 56-year-old woman complains of back pain, muscle spasms, weakness, and a burning sensation that radiates from her left hip to her toes. What's the most likely diagnosis?
Your Answer: Herniated nucleus pulposus
Explanation:A herniated disk will produce sensory disturbances, causing pain that radiates along the course of the sciatic nerve which is typically burning or stabbing, with or without back pain. The herniation is usually caused by age-related degeneration although trauma, injuries, or straining may also trigger it.
-
This question is part of the following fields:
- Orthopaedics
- Pathology
-
-
Question 19
Correct
-
In the kidney, the macula densa is an area of closely packed specialized cells lining the wall of the:
Your Answer: Distal convoluted tubule
Explanation:In the kidney, the macula densa is an area of closely packed specialised cells lining the region of the distal convoluted tubule (DCT) lying next to the glomerular vascular pole. The cells of the macula densa are sensitive to the ionic content and water volume of the fluid in the DCT, producing signals that promote renin secretion by other cells of the juxtaglomerular apparatus.
-
This question is part of the following fields:
- Physiology
- Renal
-
-
Question 20
Correct
-
Into which vein does the left and right inferior thyroid veins drain?
Your Answer: Brachiocephalic vein
Explanation:The brachiocephalic vein is formed by the confluence of the subclavian and internal jugular veins. In addition it receives drainage from: the left and right internal thoracic veins (also called internal mammary veins), left and right inferior thyroid veins and the left superior intercostal vein.
The superior thyroid veins and middle thyroid veins drain into the internal jugular vein. The right and left inferior thyroid veins to drain into their respective brachiocephalic veins (right and left). -
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 21
Correct
-
The orbicularis oculi us a muscle that closes the eyelids. What is the motor innervation of this muscle?
Your Answer: A branch of a nerve that exits through the stylomastoid foramen
Explanation:The orbicularis oculi is a muscle in the face that closes the eyelids. It is supplied by zygomatic branch of the facial nerve (cranial nerve VII), which exits through the stylomastoid foramen.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 22
Correct
-
A 45-year-old man with short bowel syndrome requires parenteral nutrition. The solution of choice for parenteral nutrition is:
Your Answer: Crystalline amino acids
Explanation:Total parenteral nutrition (TPN), is the practice of feeding a person intravenously, circumventing the gut. It is normally used in the following situations: surgery, when feeding by mouth is not possible, when a person’s digestive system cannot absorb nutrients due to chronic disease or if a person’s nutrient requirement cannot be met by enteral feeding and supplementation. A sterile bag of nutrient solution, between 500 ml and 4L, is provided. The pump infuses a small amount (0.1–10 ml/h) continuously to keep the vein open. The nutrient solution consists of water, glucose, salts, amino acids, vitamins and sometimes emulsified fats. Ideally each patient is assessed individually before commencing on parenteral nutrition, and a team consisting of doctors, nurses, clinical pharmacists and dietitians evaluate the patient’s individual data and decide what formula to use and at what rate.
-
This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
-
-
Question 23
Incorrect
-
The inferior palpebral nerve ascends behind the orbicularis oculi. What is the terminal branch of the inferior palpebral nerve?
Your Answer: Facial nerve
Correct Answer: Infraorbital nerve
Explanation:The inferior palpebral nerve is a branch of the maxillary nerve. It supplies the skin and conjunctiva of the lower eyelid.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 24
Incorrect
-
Regarding the venous drainage of the heart which of these is correct?
Your Answer: The middle and small cardiac veins drain most of the areas supplied by the left coronary artery
Correct Answer: The great cardiac vein is the largest tributary of the coronary sinus and this vein starts at the apex of the heart and ascends with the anterior ventricular branch of the left coronary artery
Explanation:Most of the veins of the heart open into the coronary sinus. This is a wide venous channel, about 2.25 cm in length, situated in the posterior part of the coronary sulcus and covered by muscular fibres from the left atrium. Its tributaries are the great, small and middle cardiac veins, the posterior vein of the left ventricle and the oblique vein of the left atrium. The great cardiac vein is the largest tributary of the coronary sinus.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 25
Incorrect
-
A 32-year-old man presented with a metabolic acidosis and increased anion gap. What is the most likely cause of the changes of the anion gap in this patient?
Your Answer: Lithium intoxication
Correct Answer: Lactic acidosis
Explanation:High anion gap in metabolic acidosis is caused generally by the elevation of the levels of acids like ketones, lactate, sulphates in the body, which consume the bicarbonate ions. Other causes of a high anion gap include overdosing on salicylates, uraemia, rhabdomyolysis, hypocalcaemia, hypomagnesaemia, or ingestion of toxins such as ethylene glycol, methanol, propyl alcohol, cyanide and iron.
-
This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
-
-
Question 26
Incorrect
-
A 55-years-old man presented to the emergency department complaining of a squeezing sensation in his chest that has spread to his neck with associated worsening shortness of breath. Which of these laboratory tests would you ask for in this patient:
Your Answer: Haematocrit
Correct Answer: Creatine kinase-MB
Explanation:Creatine kinase-MB is a test that usually is ordered when the patient has chest pain as a cardiac marker. When a heart attack is suspected and a troponin test (which is more specific for heart damage), is not available CK-MB is ordered. There are 3 forms of CK: CK-MM, CK-BB and CK-MB. CK-MB is commonly found in heart tissue, therefore injured heart muscle cells release CK-MB into the blood. Elevated CK-MB levels indicate that it is probable that a person has recently had a heart attack.
-
This question is part of the following fields:
- Cardiovascular
- Pathology
-
-
Question 27
Incorrect
-
An 8 year old boy presents with a history of repeated bacterial/pyogenic infections. He had a normal recovery from chickenpox and measles and shows normal antibody response. A decrease in which of the cell types can best explain this history of repeated pyogenic infections?
Your Answer: Macrophages
Correct Answer: Neutrophils
Explanation:A decrease in the number of granulocytes, particularly neutrophils is known as agranulocytosis and it increases the susceptibility of an individual towards recurrent infections. Neutropenia can be either due to decreased production or increased elimination of neutrophils.
Ineffective agranulopoiesis is seen in: 1. myeloid stem cell suppression, 2. disease conditions associated with granulopoiesis such as megaloblastic anaemia and myelodysplastic syndromes, 3. rare genetic diseases, 4. splenic sequestration and 5. increased peripheral utilization.
-
This question is part of the following fields:
- Inflammation & Immunology
- Pathology
-
-
Question 28
Incorrect
-
Which of the following is a landmark to identify the site of the 2nd costal cartilage?
Your Answer: Xiphoid process
Correct Answer: Sternal angle
Explanation:The sternal angle is an important part where the second costal cartilage attaches to the sternum. Finding the sternal angle will help in finding the second costal cartilage and intercostal space.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 29
Incorrect
-
A 40-year old lady presented to the hospital with fever and mental confusion for 1 week. On examination, she was found to have multiple petechiae all over her skin and mucosal surfaces. Blood investigations revealed low platelet count and raised urea and creatinine. A platelet transfusion was carried out, following which she succumbed to death. Autopsy revealed pink hyaline thrombi in myocardial arteries. What is the likely diagnosis?
Your Answer: Idiopathic thrombocytopenic purpura
Correct Answer: Thrombotic thrombocytopenic purpura
Explanation:Hyaline thrombi are typically associated with thrombotic thrombocytopenic purpura (TTP), which is caused by non-immunological destruction of platelets. Platelet transfusion is contraindicated in TTP. Platelets and red blood cells also get damaged by loose strands of fibrin deposited in small vessels. Multiple organs start developing platelet-fibrin thrombi (bland thrombi with no vasculitis) typically at arteriocapillary junctions. This is known as ‘thrombotic microangiopathy’. Treatment consists of plasma exchange.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 30
Incorrect
-
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: Hypertrophic pyloric stenosis
Correct 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).
-
This question is part of the following fields:
- Gastroenterology
- Physiology
-
SESSION STATS - PERFORMANCE PER SPECIALTY
