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Question 1
Correct
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Which of the cranial nerves is responsible for touch sensation on the skin over the maxilla region and the mandible?
Your Answer: Trigeminal
Explanation:The sensation of the face is provided by the trigeminal nerve which is cranial nerve V. It is also responsible for other motor functions such as biting and chewing. The trigeminal nerve has three branches; the ophthalmic nerve (V1), the maxillary nerve((V2) and the mandibular nerve (V3). These three branches exit the skull through separate foramina, namely; the superior orbital fissure, the foramen rotundum and the foramen ovale respectively. The mnemonic for this is ‘Standing room only’. The sensory fibres of the maxillary nerve are distributed to the lower eyelid and cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa, the palate and roof of the pharynx, the maxillary, ethmoid and sphenoid sinuses, and parts of the meninges. The sensory fibres of the mandibular nerve are distributed to the lower lip, the lower teeth and gums, the floor of the mouth, the anterior two-thirds of the tongue, the chin and jaw (except the angle of the jaw, which is supplied by C2–C3), parts of the external ear, and parts of the meninges. The mandibular nerve carries touch/ position and pain/temperature sensation from the mouth. The sensory fibres of the ophthalmic nerve are distributed to the scalp and forehead, the upper eyelid, the conjunctiva and cornea of the eye, the nose (including the tip of the nose), the nasal mucosa, the frontal sinuses and parts of the meninges (the dura and blood vessels). The sensory fibres of the maxillary nerve are distributed to the lower eyelid and cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa, the palate and roof of the pharynx, the maxillary, ethmoid and sphenoid sinuses, and parts of the meninges.
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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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Which antibiotic acts by inhibiting protein synthesis?
Your Answer: Erythromycin
Explanation:Penicillins and cephalosporins (e.g. cefuroxime, cefotaxime, ceftriaxone) inhibit bacterial cell wall synthesis through the inhibition of peptidoglycan cross-linking.
Macrolides (e.g. erythromycin), tetracyclines, aminoglycosides and chloramphenicol act by interfering with bacterial protein synthesis.
Sulphonamides (e.g. trimethoprim, co-trimoxazole) work by inhibiting the synthesis of nucleic acid
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This question is part of the following fields:
- Pharmacology; Microbiology
- Physiology
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Question 3
Correct
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Basal Metabolic Rate (BMR) will most likely be reduced by which of the following?
Your Answer: Decrease in body temperature
Explanation:The basal metabolic rate (BMR) is defined as the rate of calorie consumption after an overnight fast, in the absence of any muscular activity, with the patient in a restful state. Various factors affect the BMR including weight, body surface area and age. The BMR is 30 kcal/m2 per hour at birth; at age 2, the rate is 57 kcal/m2 per hour; and at age 20, 41 kcal/m2 per hour. After this, the BMR decreases by 10% between 20-60 years of age. Women are known to have a 10% lower BMR than men (due to higher fat content). A one-degree change in body temperature leads to a 10% change in BMR in the same direction. However, shivering and increasing ambient temperature brings about a rise in BMR, and so does stress, physical activity, caffeine, theophylline and hyperthyroidism. Also, thermogenesis induced by diet results in increased metabolic rate and hence, BMR should be ideally measured after overnight fasting.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 4
Incorrect
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The superior pancreaticoduodenal artery, the artery that supplies blood to the pancreas and the duodenum, is a branch of the:
Your Answer: Superior mesenteric artery
Correct Answer: Gastroduodenal artery
Explanation:The superior pancreaticoduodenal artery together with the right gastroepiploic artery form the two branches of the gastroduodenal artery which divides at the lower border of the duodenum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 5
Correct
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The pterion is clinically significant as it marks an area of weakness on the skull. What structure lies beneath it?
Your Answer: Anterior branches of the middle meningeal artery
Explanation:The pterion is the area where four bones, the parietal, frontal, greater wing of sphenoid and the squamous part of the temporal bone meet. It overlies the anterior branch of the middle meningeal artery on the internal aspect of the skull. The pterion is the weakest part of the skull. Slight trauma to this region can cause extradural hematoma.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 6
Incorrect
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Lateral medullary syndrome, also known as Wallenberg's syndrome is a neurological condition caused by ischaemia in the lateral part of the medulla oblongata and is commonly associated with numerous neurological symptoms. Which of the following arteries when occluded leads to this condition?
Your Answer: Superior cerebellar
Correct Answer: Posterior inferior cerebellar
Explanation:The lateral medullary syndrome or Wallenberg’s disease is also known as posterior inferior cerebellar artery syndrome (PICA). This syndrome is a clinical manifestation of the occlusion of the posterior cerebellar artery that results in symptoms of infarction of the lateral medullary oblongata. Other arteries that contribute to blood flow in to this region such are the vertebral artery, superior middle cerebellar and inferior medullary arteries can also result to this syndrome when occluded.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 7
Incorrect
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Which is the site of action of the drug omeprazole?
Your Answer: Cl–/HCO3 – exchange
Correct Answer: H+/K+ ATPase
Explanation:H+/K+-ATPase or ‘proton pump’ located in the canalicular membrane plays a major role in acid secretion. The ATPase here is magnesium-dependent. Omeprazole is a proton pump inhibitor and blocks H+/K+- ATPase.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 8
Correct
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One sensitive indicator of heavy alcohol dependence is:
Your Answer: Elevated serum gamma-glutamyl transpeptidase
Explanation:Elevated serum gamma-glutamyl transpeptidase (GGT) may be the only laboratory abnormality in patients who are dependent on alcohol. Heavy drinkers may also have an increased MCV.
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This question is part of the following fields:
- Hepatobiliary
- Physiology
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Question 9
Incorrect
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Regarding the coagulation cascade, Factor VII:
Your Answer: Is mainly synthesised by the vascular endothelium
Correct Answer: Is a serine protease
Explanation:Factor VII (FVII) is a zymogen for a vitamin K-dependent serine protease essential for the initiation of blood coagulation. It is synthesized primarily in the liver and circulates in plasma. Within the liver, hepatocytes are involved in the synthesis of most blood coagulation factors, such as fibrinogen, prothrombin, factor V, VII, IX, X, XI, XII, as well as protein C and S, and antithrombin, whereas liver sinusoidal endothelial cells produce factor VIII and von Willebrand factor.
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This question is part of the following fields:
- General
- Physiology
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Question 10
Incorrect
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Cancer of the testis most likely metastases to which set of lymph nodes?
Your Answer: Superficial inguinal
Correct Answer: Aortic
Explanation:The lymphatic drainage of an organ is related to its blood supply. The lymphatic drainage of the testis drains along the testicular artery to reach the lymph nodes along the aorta.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 11
Correct
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What occurs during cellular atrophy?
Your Answer: Cell size decreases
Explanation:Atrophy is the decrease in the size of cells, tissues, or organs. There are several causes including inadequate nutrition, poor circulation, loss of hormonal support or nerve supply, disuse, lack of exercise, or disease. An increase in cell size is termed hypertrophy which is distinguished from hyperplasia, in which the cells remain approximately the same size but increase in number.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Urology
- Pathology
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Question 12
Correct
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One of the following structures is contained in the anterior compartment of the lower leg. Which is it?
Your Answer: Extensor hallucis muscle
Explanation:The lower leg is made up of four fascial compartments separated from one another by septa that contain the muscles of the lower leg. The four compartments are ; anterior, lateral, deep posterior and superficial posterior compartments.
These are the compartments and there contents:
i) Anterior compartment: Tibialis anterior muscle, extensor hallucis longus muscle, extensor digitorum longus muscle, peroneus tertius muscles, deep fibular nerve and anterior tibial blood vessels
ii) Lateral compartment: Fibularis longus muscle, brevis muscles and superficial fibular nerve
iii) Deep posterior compartment: Tibialis posterior m., flexor hallucis longus m., flexor digitorum longus m. ,popliteus m. , tibial nerve, posterior tibial artery and posterior tibial vessels such as the fibular artery.
iv) Superficial posterior compartment: Gastrocnemius m., soleus m., plantaris m., medial sural cutaneous nerve
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 13
Correct
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Dysarthria, nystagmus and a tremor worsening with directed movement are likely to be seen in:
Your Answer: Cerebellar disease
Explanation:The given symptoms are seen in diseases affecting the cerebellum. A cerebellar tremor is a slow tremor that occurs at the end of a purposeful movement. It is seen in cerebellar disease, such as multiple sclerosis or some inherited degenerative disorders and chronic alcoholism. Classically, tremors are produced in the same side of the body as a one-sided lesion. Cerebellar disease can also result in a wing-beating’ type of tremor called rubral or Holmes’ tremor – a combination of rest, action and postural tremors. Other signs of cerebellar disease include dysarthria (speech problems), nystagmus (rapid, involuntary rolling of the eyes), gait problems and postural tremor of the trunk and neck.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 14
Correct
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The rotator cuff surrounds the shoulder joint and consists of the supraspinatus, infraspinatus, subscapularis and which one other muscle?
Your Answer: Teres minor
Explanation:The correct answer is the teres minor muscle. These group of muscles play an important role in protecting the shoulder joint and keeping the head of the humerus in the glenoid fossa of the scapula. This fossa is somehow shallow and needs support to allow for the full mobility that the shoulder joint has.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 15
Correct
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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.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 16
Incorrect
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Which of the following muscles attaches to the pterygomandibular raphe?
Your Answer: Middle pharyngeal constrictor muscle
Correct Answer: Superior pharyngeal constrictor muscle
Explanation:The pterygomandibular raphé (pterygomandibular ligament) provides attachment on its posterior border to the superior pharyngeal constrictor and on its anterior border to the buccinator muscle.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 17
Incorrect
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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: Amoxicillin
Correct 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 18
Correct
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When you rest your elbows on a desk, what bony landmark of the upper limb are you resting on?
Your Answer: Olecranon process of the ulna
Explanation:At the upper and back part of the ulna, there exists a curved eminence which is the olecranon process. This process lodges in the olecranon fossa of the humerus. It’s posterior surface is subcutaneous and this triangular area is what you rest your elbow upon.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
Correct
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A patient is brought to the accident and emergency department. He is said to have been involved in a mall explosion. Chest imaging reveals metal fragments in his thoracic cavity. He also has a pericardial effusion suggestive of a pericardial tear. An emergency thoracotomy is done which revealed a tear of the pericardium inferiorly. The surgeon began to explore for fragments in the pericardial sac with his hand from below the apex. He slips his fingers upward and to the right within the sac until they were stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart. His finger tips were now in the:
Your Answer: Oblique pericardial sinus
Explanation:Transverse sinus: part of pericardial cavity that is behind the aorta and pulmonary trunk and in front of the superior vena cava separating the outflow vessels from the inflow vessels.
Oblique pericardial sinus: is behind the left atrium where the visceral pericardium reflects onto the pulmonary veins and the inferior vena cava. Sliding a finger under the heart will take you to this sinus.
Coronary sinus: large vein that drains the heart into the right atrium. Located on the surface of the heart.
Coronary sulcus: groove on the heart demarcating the atria from the ventricles.
Costomediastinal recess: part of the pleural sac where the costal pleura transitions to become the mediastinal pleura.
Sulcus terminalis: a groove between the right atrium and the vena cava.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 20
Incorrect
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Which of the following organs is an ectoderm derivative?
Your Answer: Adrenal cortex
Correct Answer: Adrenal medulla
Explanation:Ectoderm derivatives include the adrenal medulla, posterior pituitary, the epidermis of the skin, nails, hair, sweat glands, mammary glands, sebaceous glands, the central nervous system, the peripheral nervous system, the retina and lens of eye, the pupillary muscle of the iris, melanocytes, Schwann cells and odontoblasts.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 21
Incorrect
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Which of the following has the least malignant potential?
Your Answer: Tubular adenoma
Correct Answer: Hyperplastic polyp
Explanation:Non-neoplastic (non-adenomatous) colonic polyps include hyperplastic polyps, hamartomas, juvenile polyps, pseudopolyps, lipomas, leiomyomas and others.
An autosomal dominant condition, Peutz–Jeghers syndrome is a disease that is characterized by multiple hamartomatous polyps in the stomach, small bowel and colon. Symptoms of this syndrome include hyperpigmentation of the skin and mucous membranes, especially of the lips and gums.
Juvenile polyps develop in children, and once they outgrow their blood supply, they autoamputate around puberty. In cases of uncontrolled bleeding or intussusception, treatment is needed.
Inflammatory polyps and pseudopolyps occur in chronic ulcerative colitis and Crohn’s disease. There is an increased risk of cancer with multiple juvenile polyps (not with sporadic polyps).
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 22
Incorrect
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Different portions of the renal tubule have varying degrees of water permeability. Which of the following renal sites is characterised by low water permeability under normal circumstances?
Your Answer: Proximal tubule
Correct Answer: Thick ascending limb of the loop of Henlé
Explanation:Within the nephron of the kidney, the ascending limb of the loop of Henle is a segment of the loop of Henle downstream of the descending limb, after the sharp bend of the loop. Both the thin and the thick ascending limbs of the loop of Henlé have very low permeability to water. Since there are no regulatory mechanisms to alter its permeability, it remains poorly permeable to water under all circumstances. Sodium and chloride are transported out of the luminal fluid into the surrounding interstitial spaces, where they are reabsorbed. Water must remain behind because it is not reabsorbed, so the solute concentration becomes less and less (the luminal fluid becomes more dilute). This is one of the principal mechanisms (along with diminution of ADH secretion) for the production of a dilute, hypo-osmotic urine (water diuresis).
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This question is part of the following fields:
- Physiology
- Renal
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Question 23
Incorrect
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A patient with this condition has extracellular fluid volume expansion:
Your Answer: Burns
Correct Answer: Nephrotic syndrome
Explanation:Nephrotic syndrome is a syndrome comprising of signs of nephrosis, including proteinuria, hypoalbuminemia, and oedema. It is a component of glomerulonephritis, in which different degrees of proteinuria occur. Essentially, loss of protein through the kidneys leads to low protein levels in the blood , which causes water to be drawn into soft tissues (oedema). Severe hypoalbuminemia can also cause a variety of secondary problems, such as water in the abdominal cavity (ascites), around the heart or lung (pericardial effusion, pleural effusion), high cholesterol, loss of molecules regulating coagulation (hence increased risk of thrombosis). The most common sign is excess fluid in the body due to the serum hypoalbuminemia. Lower serum oncotic pressure causes fluid to accumulate in the interstitial tissues. Sodium and water retention aggravates the oedema.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 24
Correct
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Where is factor VIII predominantly synthesised?
Your Answer: Vascular endothelium
Explanation:Factor VIII is an important part of the coagulation cascade. Deficiency causes haemophilia A. It is synthesised predominantly by the vascular endothelium and is not affected by liver disease. In the circulation it is bound to von Willebrand factor and it forms a stable complex with it. It is activated by thrombin or factor Xa and acts as a co factor to factor IXa to activate factor X which is a co factor to factor Va. Thrombin cleaves fibrinogen in fibrin and forms a meshwork to trap RBC and platelets to form a clot.
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This question is part of the following fields:
- General
- Physiology
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Question 25
Correct
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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.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 26
Incorrect
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For which of the following is NOT screened for in blood for transfusion?
Your Answer: Hepatitis C
Correct Answer: EBV
Explanation:Blood for transfusion is routinely screened for hepatitis B and C, HIV, CMV and syphilis.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 27
Correct
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In the emergency room, a nurse was introducing a catheter into the patients femoral vein for rapid fluid therapy. The femoral vein is situated inside the femoral sheath. Which of the following is true about that sheath?
Your Answer: The medial compartment is called the femoral canal
Explanation:The femoral sheath is situated ,4cm below the inguinal ligament. It is a prolongation of the abdominal fascia. The anterior wall is a prolongation of the transversalis fascia and the posterior wall, the iliac fascia. It is divided by two vertical septa into 3 compartments, lateral, intermediate, and medial. The medial compartment is known as the femoral canal and contains some lymphatic vessels. The lateral one contains the femoral artery and the intermediate one contains the femoral vein.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 28
Incorrect
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Where do the seminal vesicles lie?
Your Answer:
Correct Answer: Base of the bladder and rectum
Explanation:The seminal vesicles are two lobulated membranous pouches situated between the fundus of the bladder and rectum and act as a reservoir for the semen and secrete a fluid that is added to the seminal fluid. Each sac is pyramidal in shape but they all vary in size not only in different individuals but also in the same individuals. The anterior surface is in contact with the fundus of the bladder, extending from near the termination of the ureter to the base of the prostate. Each vesicle consist of single tube, which gives off several irregular caecal diverticula. These separate coils and the diverticula are connected by fibrous tissue.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 29
Incorrect
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A 60-year old patient presenting with squamous cell carcinoma of the anal canal was brought in to the oncology ward for chemotherapy. In which of the following lymph nodes of this patient would you likely find metastases?
Your Answer:
Correct Answer: Internal iliac
Explanation:The efferent lymphatics from the anal canal proceed to the internal iliac lymph nodes. This would most likely form the site of enlargement in the lymphatics.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 30
Incorrect
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A 58-year-old woman presents with signs of inflammation in the first metatarsophalangeal joint: redness, swelling and pain. The analysis of synovial fluid reveals needle-shaped, strongly negatively birefringent crystals. What's the most likely diagnosis in this case?
Your Answer:
Correct Answer: Gout
Explanation:Gout is a rheumatic disease caused by the precipitation of monosodium urate crystals into tissues, usually joints. This causes acute or chronic pain; the acute illness initially affects only one joint, often the first metatarsophalangeal joint. The diagnosis of the disease requires the identification of crystal in the synovial fluid. These crystals are needle-shaped and strongly negatively birefringent.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
