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Question 1
Correct
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Muscles and tendons in the planter region of the foot mainly take blood supply from:
Your Answer: Posterior tibial artery
Explanation:The posterior tibial artery is the main source of blood supply to the posterior compartment of the leg.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 2
Incorrect
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Which part of the nephron would have to be damaged to stop the reabsorption of the majority of salt and water?
Your Answer: Collecting duct
Correct Answer: Proximal tubule
Explanation:The proximal tubule is the portion of the duct system of the nephron of the kidney which leads from Bowman’s capsule to the loop of Henle. It is conventionally divided into the proximal convoluted tubule (PCT) and the proximal straight tubule (PST). The proximal tubule reabsorbs the majority (about two-thirds) of filtered salt and water. This is done in an essentially iso-osmotic manner. Both the luminal salt concentration and the luminal osmolality remain constant (and equal to plasma values) along the entire length of the proximal tubule. Water and salt are reabsorbed proportionally because the water is dependent on and coupled with the active reabsorption of Na+. The water permeability of the proximal tubule is high and therefore a significant transepithelial osmotic gradient is not possible.
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This question is part of the following fields:
- Physiology
- Renal
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Question 3
Incorrect
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A 26-year-old female sought consultation due to excessive vaginal discharge. Vaginal smear showed numerous bacilli under the microscope. The organism was non-pathogenic. What is the most likely organism:
Your Answer: Pseudomonas species
Correct Answer: Lactobacillus species
Explanation:Lactobacillus is a Gram-positive facultative bacteria. It is commonly present in the vagina and the gastrointestinal tract. Colonization of Lactobacillus is usually benign and it makes up a small portion of the gastrointestinal flora.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 4
Incorrect
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A mechanic sustained a deep laceration to his right cubital fossa which resulted in him unable to move the proximal radioulnar joint of his right arm. Which muscles was affected?
Your Answer:
Correct Answer: Pronator teres
Explanation:The correct answer is the pronator teres muscle. This muscle arises from 2 heads of origin: the humerus and ulnar. Between the 2 heads is the site of entrance of median nerve to the forearm. This muscle acts on the proximal radio-ulnar joint to rotate the radius on the ulna, otherwise known as pronation. It also assists in forearm flexion if the radius is fixed.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 5
Incorrect
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Renal function is an indication of the state of the kidney, measured by glomerular filtration rate (GFR). In a healthy person, GFR would be greatly increased by:
Your Answer:
Correct Answer: Substantial increases in renal blood flow
Explanation:An increase in the rate of renal blood flow (RBF) greatly increases the glomerular filtration rate (GFR). The more plasma available (from increased RBF), the more filtrate is formed. Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. Central to the physiologic maintenance of GFR is the differential basal tone of the afferent and efferent arterioles.
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This question is part of the following fields:
- Physiology
- Renal
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Question 6
Incorrect
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A 25-year-old woman complains of generalised swelling and particularly puffiness around the eyes which is worst in the morning. Laboratory studies showed:
Blood urea nitrogen (BUN) = 30 mg/dl
Creatinine = 2. 8 mg/dl
Albumin = 2. 0 mg/dl
Alanine transaminase (ALT) = 25 U/l
Bilirubin = 1 mg/dl
Urine analysis shows 3+ albumin and no cells.
Which of the following is the most likely diagnosis?Your Answer:
Correct Answer: Nephrotic syndrome
Explanation:Nephrotic syndrome is a disorder in which the glomeruli have been damaged, characterized by:
– Proteinuria (>3.5 g per 1.73 m2 body surface area per day, or > 40 mg per square meter body surface area per hour in children)
– Hypoalbuminemia (< 2,5 g/dl) – Hyperlipidaemia, and oedema (generalized anasarca).
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This question is part of the following fields:
- Physiology
- Renal
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Question 7
Incorrect
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The bronchial circulation is a part of the circulatory system that supplies nutrients and oxygen to the pulmonary parenchyma. What percentage of cardiac output is received by bronchial circulation?
Your Answer:
Correct Answer: 2%
Explanation:The bronchial circulation is part of the systemic circulation and receives about 2% of the cardiac output from the left heart. Bronchial arteries arise from branches of the aorta, intercostal, subclavian or internal mammary arteries. The bronchial arteries supply the tracheobronchial tree with both nutrients and O2. It is complementary to the pulmonary circulation that brings deoxygenated blood to the lungs and carries oxygenated blood away from them in order to oxygenate the rest of the body.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 8
Incorrect
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Prostatectomy carries a risk of loss of penile erection due to injury to the prostatic plexus responsible for an erection. From which nerves do these fibres originate?
Your Answer:
Correct Answer: Pelvic splanchnics
Explanation:Erection is a function of the parasympathetic nerves. Of the nerves listed, only the pelvic splanchnic nerves have parasympathetic fibres that innervate the smooth muscles and glands of the pelvic viscera.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 9
Incorrect
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The thyroid gland is a large ductless gland located in which part of the neck?
Your Answer:
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 10
Incorrect
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A 66-year-old man complains of constant headaches. On physical examination, the only relevant sign is a dark brown mole located on left his arm which has grown in size over the years and is itchy and painful. A MRI of the brain revealed a solitary lesion at the grey-white junction in the right frontal lobe, without ring enhancement. This lesion is most likely to be:
Your Answer:
Correct Answer: Metastatic carcinoma
Explanation:The location of the mass at the grey–white junction is typical of a metastasis. The most frequent types of metastatic brain tumours originate in the lung, skin, kidney, breast and colon. These tumour cells reach the brain via the bloodstream. This patient is likely to have skin cancer, which caused the metastatic brain tumour.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 11
Incorrect
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The muscle that depresses the glenoid fossa directly is the:
Your Answer:
Correct Answer: Pectoralis minor
Explanation:Situated at the upper part of the thorax beneath the pectoralis major, is a thin pectoralis minor, triangular muscle. It originates from the third, fourth and fifth ribs, near the cartilage and from the aponeurosis which covers the intercostals. These fibres move upwards and laterally to join and form a flat tendon. This is inserted into the medial border and upper surface of the coracoid process of the scapula. Through this medial anterior thoracic nerve, fibres from the pectoralis minor are received from the eighth cervical and first thoracic nerves. This pectoralis minor pushes down on the point of the shoulder (glenoid fossa), drawing the scapula downward and medially towards the thorax which throws the inferior angle backwards.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
Incorrect
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What principal artery that supplies the meninges is susceptible to rupture following trauma to the side of the head over the temporal region:
Your Answer:
Correct Answer: Middle meningeal artery
Explanation:The middle meningeal artery normally arises from the first or mandibular segment of the maxillary artery. The artery runs in a groove on the inside of the cranium, this can clearly be seen on a lateral skull X-ray. An injured middle meningeal artery is the most common cause of an epidural hematoma.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 13
Incorrect
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Out of the following options, which malignancy has the highest potential for multicentricity?
Your Answer:
Correct Answer: Transitional cell carcinoma
Explanation:Transitional cell carcinomas can arise anywhere in the urothelium lining the urinary tract; and hence are known to be multicentric and recur commonly. Prostatic adenocarcinoma most commonly involves the posterior lobe of the prostate gland. Although renal cell carcinomas occasionally show multicentricity, it is not common. Penile carcinomas are usually locally infiltrative lesions. Wilm’s tumours are usually solitary, but can be bilateral or multicentric in 10% cases. Small cell carcinoma of lung and teratomas are usually solitary.
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This question is part of the following fields:
- Pathology
- Renal
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Question 14
Incorrect
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Inside the palatoglossal arch is a muscle. Which nerve innervates this muscle?
Your Answer:
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 15
Incorrect
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The uterine artery arises from the?
Your Answer:
Correct Answer: Internal iliac artery
Explanation:The uterine artery arises from the anterior division of the internal iliac artery and runs medially on the levator ani towards the uterine cervix.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 16
Incorrect
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The left lateral pterygoid muscle is one of the muscles of mastication. When acting alone, it will shift the mandible towards which direction?
Your Answer:
Correct Answer: Laterally, to the right
Explanation:The lateral pterygoid or external pterygoid is a muscle of mastication with two heads. It lies superiorly to the medial pterygoid. When acting alone, it will shift the mandible laterally and to the right.
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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 chest X-ray in a healthy, non-smoker, asymptomatic 48-year-old woman reveals a 2cm left lower lobe well-defined round opacity. Which of the following conditions is most probably responsible for this finding?
Your Answer:
Correct Answer: Pulmonary hamartoma
Explanation:An asymptomatic healthy patient with no history of smoking and a lesion of small size most probably has a benign lung lesion. Hamartomas are one of the most common benign tumours of the lung that accounts for approximately 6% of all solitary pulmonary nodules. Pulmonary hamartomas are usually asymptomatic and therefore are found incidentally when performing an imaging test for other reasons.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 18
Incorrect
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During a procedure to treat an ulcer in the first part of the duodenum, the most appropriate site to make the incision on the anterior abdominal wall to approach this ulcer would be the:
Your Answer:
Correct Answer: Epigastric region
Explanation:The abdomen is divided into nine regions for descriptive purposes. The epigastric region contains the first part of the duodenum, part of the stomach, part of the liver and pancreas. This would be the region that the surgeon would need to enter to access the ulcer.
Typically, a midline incision in the epigastric region, extending from just below the xiphoid process down to the umbilicus, provides excellent access to the first part of the duodenum.
The left inguinal region contains the sigmoid colon.
The left lumbar region contains the descending colon and kidney.
The right lumbar region contains the right kidney and descending colon.
The right hypochondrial region contains part of the liver and gall bladder.
The hypogastric region contains the urinary bladder and the rectum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 19
Incorrect
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Which of these antibiotics is the first choice treatment for infections caused by Pseudomonas aeruginosa?
Your Answer:
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.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 20
Incorrect
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A 37-year-old woman with a history of rheumatic heart disease presents with 10 days recurrent low fever. Patient underwent laboratory work up and was diagnosed with infective endocarditis. What is the most likely organism that caused the infective endocarditis in this patient?
Your Answer:
Correct Answer: Streptococcus viridans
Explanation:Subacute bacterial endocarditis is often due to streptococci of low virulence, mainly streptococcus viridans. It is a mild to moderate illness which progresses slowly over weeks and months (>2weeks) and has low propensity to hematogenously seed to extracardiac sites.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 21
Incorrect
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A computer tomography guided needle biopsy is done on a patient with a cystic swelling in the left chest. The radiologist inserted the biopsy needle into the 9th intercostal space along the mid axillary line to aspirate the swelling and obtain tissue for histological diagnosis. In which space is the swelling most likely to be?
Your Answer:
Correct Answer: Costodiaphragmatic recess
Explanation:The costodiaphragmatic recess is the lowest point of the pleural sac where the costal pleura becomes the diaphragmatic pleura. At the midclavicular line, this is found between ribs 6 and 8; at the paravertebral lines, between ribs 10 and 12 and between ribs 8 and 10 at the midaxillary line.
The cardiac notch: is an indentation of the heart on the left lung, located on the anterior surface of the lung.
Cupola: part of the parietal pleura that extends above the first rib.
Oblique pericardial sinus: part of the pericardial sac located posterior to the heart behind the left atrium.
Costomediastinal recess: a reflection of the pleura from the costal surface to the mediastinal surface, is on the anterior surface of the chest.
The inferior mediastinum: is the space in the chest occupied by the heart.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 22
Incorrect
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A 25-year-old female had a painful abdomen and several episodes of vomiting. She was severely dehydrated when she was brought to the hospital. Her ABG showed a pH 7.7, p(O2) 75 mmHg, p(CO2) 46 mmHg and bicarbonate 48 mmol/l. The most likely interpretation of this ABG report would be:
Your Answer:
Correct Answer: Metabolic alkalosis
Explanation:Metabolic alkalosis is a primary increase in bicarbonate (HCO3−) with or without compensatory increase in carbon dioxide partial pressure (Pco2); pH may be high or nearly normal. Metabolic alkalosis occurs as a consequence of a loss of H+ from the body or a gain in HCO3 -. In its pure form, it manifests as alkalemia (pH >7.40). As a compensatory mechanism, metabolic alkalosis leads to alveolar hypoventilation with a rise in arterial carbon dioxide tension p(CO2), which diminishes the change in pH that would otherwise occur. Normally, arterial p(CO2) increases by 0.5–0.7 mmHg for every 1 mmol/l increase in plasma bicarbonate concentration, a compensatory response that occurs very rapidly. If the change in p(CO2) is not within this range, then a mixed acid–base disturbance occurs. Likewise, if the increase in p(CO2) is less than the expected change, then a primary respiratory alkalosis is also present. However an elevated serum bicarbonate concentration can also occur due to a compensatory response to primary respiratory acidosis. A bicarbonate concentration greater than 35 mmol/l is almost always caused by metabolic alkalosis (as is the case in this clinical scenario). Calculation of the serum anion gap can also help to differentiate between primary metabolic alkalosis and the metabolic compensation for respiratory acidosis. The anion gap is frequently elevated to a modest degree in metabolic alkalosis because of the increase in the negative charge of albumin and the enhanced production of lactate. However, the only definitive way to diagnose metabolic alkalosis is by performing a simultaneous blood gases analysis, which reveals elevation of both pH and arterial p(CO2) and increased calculated bicarbonate.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 23
Incorrect
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A 40 year old man suffered severe trauma following an MVA. His BP is 70/33 mmhg, heart rate of 140 beats/mins and very feeble pulse. He was transfused 3 units of blood resulting in his BP returning to 100/70 and his heart rate to 90 beats/min. What decreased following transfusion?
Your Answer:
Correct Answer: Total peripheral resistance
Explanation:The patient is in hypovolemic shock, he is transfused with blood to replace the volume lost. It is important not only to replace fluids but stop active bleeding in resuscitation. Fluid replacement will result in a decreased sympathetic discharge and adequate ventricular filling thus reducing total peripheral resistance and increasing cardiac output and cardiac filling pressures.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 24
Incorrect
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A 56 year old gentleman, who is a chronic smoker presents to the clinic with dyspnoea. His Chest X-ray shows intercostal space widening with increased blackening bilaterally. What is the most likely finding on his pulmonary function test?
Your Answer:
Correct Answer: Increased total lung capacity
Explanation:In patients suspected of having chronic obstructive pulmonary disease, pulmonary function testing (PFT) is useful to confirm airway obstruction, to quantify its severity and reversibility, for following disease progression and monitoring response to treatment. These tests include:
FEV1 – volume of air forcefully expired during the first second after a full breath
Forced vital capacity (FVC) – total volume of air expired with maximal force and flow-volume loops. The hallmark of airway obstruction is reduction of FEV1, FVC and the ratio of FEV1/FVC, with a concave pattern in expiratory tracing on the flow-volume loop. FEV1 and forced vital capacity (FVC) are easily measured with office spirometry and are useful to assess the severity of disease. Other parameters include increased total lung capacity, functional residual capacity and residual volume, which can help distinguish chronic obstructive pulmonary disease (COPD) from restrictive pulmonary disease where these values are lower than normal. Along with these, other tests are decreased vital capacity; and decreased diffusing capacity for carbon monoxide (DLCO). DLCO is non-specific and can be low in other disorders that affect the pulmonary vascular bed, such as interstitial lung disease. DLCO is however useful to distinguish COPD from asthma, in which DLCO is normal or elevated.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 25
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:
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 26
Incorrect
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Atractyloside is an inhibitor of electron transport chain. It is expected to have little or no effect on the functioning of which of the following cell types?
Your Answer:
Correct Answer: Red blood cells
Explanation:Electron transport chain is a series of electron carriers that are embedded in the mitochondrial membrane. It is the place where ATP is made. Inhibiting the electron transport chain will stop production of ATP. Red blood cells are the only cell in the given option which do not contain ATP.
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This question is part of the following fields:
- General
- Physiology
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Question 27
Incorrect
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In which of the following situations will fat necrosis occur?
Your Answer:
Correct Answer: Trauma to the breast
Explanation:Fat necrosis is necrosis of adipose tissue with subsequent deposition of calcium, giving it a white chalky appearance. It is seen characteristically in trauma to the breast and the pancreas with subsequent involvement of the peripancreatic fat. In the breast it may present as a palpable mass with is usually painless or as an incidental finding on mammogram. Fatty acids are released from the traumatic tissue which combine with calcium in a process known as saponification, this is an example of dystrophic calcification in which calcium binds to dead tissue. The central focus is surrounded by macrophages and neutrophils initially, followed by proliferation of fibroblasts, neovascularization and lymphocytic migration to the site of the insult.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 28
Incorrect
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A 55-year-old woman complains of pain in the proximal and distal interphalangeal joins, and back pain which has increased over the last 4 years and worsens after activity. X-rays reveal Heberden’s and Bouchard’s nodes in her interphalangeal joints and the presence of osteophytes in her spine. What is the most likely diagnosis?
Your Answer:
Correct Answer: Osteoarthritis
Explanation:Osteoarthritis is most common in older adults, predominating in women between the ages of 40 and 70; after this age, men and women are affected equally. It affects an entire joint, with disruption and potential loss of joint cartilage, along with other joint changes, including bone hypertrophy (osteophyte formation). The pain is usually gradual and is worse after activity, with occasional joint swelling. X-ray findings include marginal osteophytes, narrowing of the joint space, increased density of the subchondral bone, subchondral cyst formation, bony remodelling and joint effusions.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 29
Incorrect
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A 70-year-old female who underwent coronary artery bypass graft developed post-operative acute renal failure. Her urinary catheter was left in place to monitor urine output. 6 days later she developed fever and chills. She also complained of suprapubic and left flank pain. She is found to have developed acute ascending pyelonephritis. Which of the following organism was most likely isolated during urine culture?
Your Answer:
Correct Answer: Escherichia coli with pili
Explanation:The most common cause of urinary tract infection is Escherichia coli. Pilated strains of E. coli ascend the urethra to infect the kidney and the bladder. Catheters have been associated with an increased risk of UTIs.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 30
Incorrect
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Which of the following conditions is characterized by generalised oedema due to effusion of fluid into the extracellular space?
Your Answer:
Correct Answer: Anasarca
Explanation:Anasarca (or ‘generalised oedema’) is a condition characterised by widespread swelling of the skin due to effusion of fluid into the extracellular space. It is usually caused by liver failure (cirrhosis of the liver), renal failure/disease, right-sided heart failure, as well as severe malnutrition/protein deficiency.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY
