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Question 1
Incorrect
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Which of the following is the most likely cause of prolonged thrombin clotting time?
Your Answer: Warfarin therapy
Correct Answer: Hypofibrinogenemia
Explanation:Thrombin clotting time, also called thrombin time (TT), is test used for the investigation of possible bleeding or clotting disorders. TT reflects the conversion of fibrinogen to fibrin and it’s also very sensitive to the presence of the anticoagulant heparin. A prolonged thrombin time may indicate the presence of hypofibrinogenemia (decreased fibrinogen level ), dysfibrinogenaemia, disseminated intravascular coagulation (DIC), end stage liver disease or malnutrition.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 2
Correct
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The superior rectal artery is a continuation of the:
Your 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 3
Correct
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A blood sample of a 58 year old male patient, who underwent an abdominal aortic aneurysm repair, was sent to the laboratory. The laboratory technician said that the patient’s blood agglutinates with antisera anti-A and anti-D, while the patient’s serum agglutinates cells of blood group B. What is the blood group of this patient?
Your Answer: A positive
Explanation:Group A – has only the A antigen on red cells (and B antibody in the plasma)
Group B – has only the B antigen on red cells (and A antibody in the plasma)
Group AB – has both A and B antigens on red cells (but neither A nor B antibody in the plasma)
Group O – has neither A nor B antigens on red cells (but both A and B antibody are in the plasma). Many people also have a so-called Rh factor on the red blood cell’s surface. This is also an antigen and those who have it are called Rh+. A person with Rh– blood does not have Rh antibodies naturally in the blood plasma (as one can have A or B antibodies, for instance) but they can develop Rh antibodies in the blood plasma if they receive blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies. A person with Rh+ blood can receive blood from a person with Rh– blood without any problems. In this scenario the person has blood group A+ as he has A antigen, anti B antibody and Rh antigen
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This question is part of the following fields:
- General
- Physiology
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Question 4
Correct
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A 4-year-old child was brought to a paediatrician for consult due to a palpable mass in his abdomen. The child has poor appetite and regularly complains of abdominal pain. The child was worked up and diagnosed with a tumour. What is the most likely diagnosis ?
Your Answer: Nephroblastoma
Explanation:Nephroblastoma is also known as Wilms’ tumour. It is a cancer of the kidneys that typically occurs in children. The median age of diagnose is approximately 3.5 years. With the current treatment, approximately 80-90% of children with Wilms’ tumour survive.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 5
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 6
Correct
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A 70-year-old male who has smoked since his teens complains of progressive shortness of breath and a persistent cough. He is diagnosed with COPD. Which of the following abnormalities is most likely to be present in his pulmonary function tests?
Your Answer: Increased residual volume
Explanation:Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by long-term poor airflow. The main symptoms include shortness of breath and cough with sputum production. The best diagnostic test for evaluating patients with suspected chronic obstructive pulmonary disease (COPD) is lung function measured with spirometry. Key spirometrical measures may be obtained with a portable office spirometer and should include forced vital capacity (FVC) and the normal forced expiratory volume in the first second of expiration (FEV1). The ratio of FEV1 to forced vital capacity (FEV1/FVC) normally exceeds 0.75. Patients with COPD typically present with obstructive airflow. Complete pulmonary function testing may show increased total lung capacity, functional residual capacity and residual volume. A substantial loss of lung surface area available for effective oxygen exchange causes diminished carbon monoxide diffusion in the lung (DLco) in patients with emphysema. Tobacco smoking is the most common cause of COPD, with factors such as air pollution and genetics playing a smaller role.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 7
Correct
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Digital rectal examination of a 75-year old gentleman who presented to the surgical clinic with urinary retention revealed an enlarged, nodular prostate. PSA was found to be elevated, favouring the diagnosis of prostatic malignancy. Which of the given options is the most common malignant lesion affecting the prostate gland?
Your Answer: Adenocarcinoma
Explanation:Prostatic adenocarcinoma is the commonest solid malignancy and non-dermatological cancer in men above 50 years age. Increasing in incidence with age and the highest risk seen in the black population. About 75% of cases are seen in men over 65 years. Other tumours affecting the prostate include undifferentiated prostate cancer, squamous cell carcinoma, and ductal transitional carcinoma, but these occur less commonly. Sarcomas usually affect children. Hormones play a role in the aetiology of prostate adenocarcinoma unlike the other types. Intraepithelial neoplasia is considered a precursor of invasive malignancy.
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This question is part of the following fields:
- Pathology
- Urology
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Question 8
Correct
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After surgery, a patient developed a stitch granuloma . Which leukocyte in the peripheral blood will become an activated macrophage in this granuloma?
Your Answer: Monocyte
Explanation:Monocytes are leukocytes that protect the body against infections and move to the site of infection within 8-12 hours to deal with it. They are produced in the bone marrow and shortly after being produced are released into the blood stream where they circulate until an infection is detected. When called upon they leave the circulation and transform into macrophages within the tissue fluid and thus gain the capability to phagocytose the offending substance. Monocyte count is part of a complete blood picture. Monocytosis is the state of excess monocytes in the peripheral blood and may be indicative of various disease states. Examples of processes that can increase a monocyte count include: • chronic inflammation • stress response • hyperadrenocorticism • immune-mediated disease • pyogranulomatous disease • necrosis • red cell regeneration.
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This question is part of the following fields:
- General
- Physiology
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Question 9
Correct
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The absence of which of the following components characterizes the grey platelet syndrome (GPS)?
Your Answer: Alpha granules
Explanation:Grey platelet syndrome (GPS) is a rare inherited bleeding disorder associated with an almost total absence of α-granules and their contents. The syndrome is characterised by thrombocytopenia, enlarged platelets that have a grey appearance, myelofibrosis, and splenomegaly. Alpha granules store proteins and growth factors that promote platelet adhesiveness and wound healing. Patients with GPS develop symptoms and signs such as easy bruising, prolonged bleeding, and nose bleeds.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 10
Correct
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A 50 year old man on warfarin therapy following insertion of a pacemaker presented with epistaxis. Which of the following is true regarding blood coagulation?
Your Answer: Patients with haemophilia A usually have a normal bleeding time
Explanation:A prolonged bleeding time is seen in platelet disorders like thrombocytopenia. Patients with haemophilia A or B have a prolonged PTT but not a prolonged bleeding time.
Ca2+ is necessary for coagulation.
von Willebrand factor is an important part of the factor VIII complex and promotes platelet adhesion and aggregation.
DIC results in depleted coagulation factors and accumulation of fibrin.
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This question is part of the following fields:
- General
- Physiology
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Question 11
Correct
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Which of these nerves controls adduction of hand?
Your Answer: Ulnar nerve
Explanation:The adductors of the fingers are the palmer interossei. They are supplied by the ulnar nerve, which is a branch of the medical cord of the brachial plexus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
Correct
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A 42 year old women presents with end stage renal failure and is prepared to receive a kidney from her husband. HLA testing showed that they are not a 100% match and she is given immunosuppressant therapy for this. Three months later when her renal function tests were performed she showed signs of deteriorating renal function, with decreased renal output, proteinuria of +++ and RBCs in the urine. She was given antilymphocyte globulins and her condition reversed. What type of graft did this patient receive?
Your Answer: Allograft
Explanation:Allograft describes a graft between two of the same species. As the donor and the recipients are history-incompatible, rejection of the graft is common and is controlled by immunosuppressive drug therapy. Isograft and syngraft are synonymous and referred to a graft transferred between genetically identical individuals e.g. identical twins. In this case rejection is rare as they are history-compatible.
Autograft refers to transfer of one part of the body to another location.
Xenograft is transfer of tissue from another species e.g. pig to human in valve replacement surgeries and rejection is very high.
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This question is part of the following fields:
- Inflammation & Immunology; Renal
- Pathology
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Question 13
Correct
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Which one of the following is a derivative of the midgut?
Your Answer: Caecum
Explanation:The primary intestinal loop is formed from the midgut which gives rise to the distal half of the duodenum, the jejunum, ascending colon, proximal two thirds of the transverse colon and the ileum.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 14
Correct
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What is the innervation of the laryngeal mucosa inferior to the true vocal cord?
Your Answer: Recurrent laryngeal nerve
Explanation:Motor innervation to all other muscles of the larynx and sensory innervation to the subglottis is by the recurrent laryngeal nerve.
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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 7-year old child from a rural setting complains of recurrent abdominal pain. The child is found to have a heavy parasitic infestation and anaemia. Which type of anaemia is most likely seen in this patient?
Your Answer: Folic acid deficiency anaemia
Correct Answer: Iron deficiency anaemia
Explanation:The most common cause of iron deficiency anaemia in children in developing countries is parasitic infection (hookworm, amoebiasis, schistosomiasis and whipworm).
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 16
Correct
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A construction worker is brought to the A&E after a fall on site. The patient is conscious but complains of inability to feel his legs. A neurological examination reveals that he has no cutaneous sensation from his umbilicus to his toes. What is the likely level of the spinal cord that is injured?
Your Answer: T10
Explanation:The umbilicus has a relatively consistent position in humans and thus serves as an important land mark. The skin around the waist at the level of the umbilicus is supplied by the tenth thoracic spinal nerve (T10 dermatome).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 17
Incorrect
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A medical intern wanting to perform her first thoracentesis (remove fluid from the pleural cavity) wishes to be reminded where to insert the needle to aspirate in order to avoid injuring the lung or neurovascular elements. Where is this place?
Your Answer: The top of interspace 9 in the midaxillary line
Correct Answer: The bottom of interspace 9 in the midaxillary line
Explanation:Thoracentesis is performed in the costodiaphragmatic recess. The needle needs to be inserted below the level of the lungs to avoid injury to the lungs. At the paravertebral line, is between ribs 10 and 12, at the midaxillary line between ribs 8 and 10 and at the midclavicular line between interspaces 6 and 8. The needle should be inserted at the top of the rib (or the bottom of the interspace) to avoid damage to the neurovascular structures found below the rib running in the costal groove.
The recommended location for the needle insertion varies depending upon the source. It is critical that the patient hold his or her breath to avoid piercing of the lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 18
Correct
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Which of the following foramina will the ophthalmic artery pass through in order to reach the eye?
Your Answer: Optic canal
Explanation:The optic foramen is the opening to the optic canal. The canal is located in the sphenoid bone; it is bounded medially by the body of the sphenoid and laterally by the lesser wing of the sphenoid. The superior surface of the sphenoid bone is bounded behind by a ridge, which forms the anterior border of a narrow, transverse groove, the chiasmatic groove (optic groove). The groove ends on either side in the optic foramen, which transmits the optic nerve and ophthalmic artery into the orbital cavity. Compared to the optic nerve, the ophthalmic artery is located inferolaterally within the canal.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 19
Correct
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A woman that presented with dyspnoea, chest pain and cough was found to have a serous pleural effusion. This finding is most likely to be associated with which of the following conditions?
Your Answer: Congestive heart failure
Explanation:A pleural effusion is defined as an abnormal collection of fluid in the pleural space. Pleural effusion can result from excess fluid production or decreased absorption or both. Thoracentesis and laboratory testing help determine the origin of the accumulated fluid. Serous fluid accumulation in the pleural space indicates the presence of a hydrothorax and is most likely to develop secondary to congestive heart failure.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 20
Correct
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Which of the following tumours has the best prognosis following surgery?
Your Answer: Schwannoma
Explanation:Schwannomas are histologically benign neoplasms that arise from nerve sheaths, most commonly from sensory nerve roots. They are generally contained within a capsule, and so can be surgically removed without injuring the associated nerve root. They are histologically benign and less than 1% become malignant.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 21
Correct
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An organ transplant patient may be at risk of developing which type of cancer?
Your Answer: Skin cancer
Explanation:The most common malignancies encountered in the post–solid organ transplant setting are non-melanoma skin cancers, post-transplant lymphoproliferative disorders and Kaposi’s sarcoma (KS). The pathogenesis of these tumours is likely related to the immunosuppressive drugs used post-transplantation and subsequent viral infection.
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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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Which of the following muscles attaches to the pterygomandibular raphe?
Your 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 23
Correct
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Where do the cells belonging to the mononuclear phagocyte system originate?
Your Answer: Bone marrow
Explanation:The macrophage originates from a committed bone marrow stem cell. It is called the pluripotent hematopoietic stem cell. This differentiates into a monoblast and then into a promonocyte and finally matures into a monocyte. When called upon they leave the bone marrow and enter into the circulation. Upon entering the tissue they transform into macrophages. Tissue macrophages include: Kupffer cells (liver), alveolar macrophages (lung), osteoclasts (bone), Langerhans cells (skin), microglial cells (central nervous system), and possibly the dendritic immunocytes of the dermis, spleen and lymph nodes.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 24
Incorrect
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The surgical registrar is doing an exploratory laparotomy on a 35 year old lady of African descent with tuberculous of the abdomen and suspected perforation. The small bowel is matted due to adhesions and it is difficult to differentiate the ileum from the jejunum. Which of the following features is typical of the jejunum?
Your Answer: The circular folds of its mucous membrane are small
Correct Answer: It has sparse aggregated lymph nodules
Explanation:The jejunum has a wider diameter, is thicker and more vascularized, hence of a deeper colour compared to the ileum. The valvulae conniventes (circular folds) of its mucous membranes are large and thick and its villi are larger than those in the ileum. The jejunum also has sparse aggregates of lymph nodules and most of its part occupies the umbilical and left iliac regions whilst the ileum is mostly in the umbilical, hypogastric, right iliac and pelvic regions.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 25
Incorrect
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In a cardiac cycle, what event does the closing of atrioventricular (AV) valves coincide with?
Your Answer: Beginning of diastole
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 26
Correct
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A 66 year old male, was involved in a MVA. He sustained third degree burns to his abdomen and open bleeding wound to his left leg. The patient complains of dizziness. He is a known hypertensive but during examination was found to be hypotensive. His heart rate is 120/min, with regular rhythm. What is the possible cause of his hypotension?
Your Answer: Hypovolaemia
Explanation:Hypovolemia can be recognized by tachycardia, diminished blood pressure, and the absence of perfusion as assessed by skin signs (skin turning pale) and/or capillary refill time. The patient may feel dizzy, faint, nauseated, or very thirsty. Common causes of hypovolemia are loss of blood, loss of plasma which occurs in severe burns and lesions discharging fluid, loss of body sodium and consequent intravascular water which may occur in cases of diarrhoea and vomiting. In this case the cause of patients hypotension is due to hypovolemia from both loss of plasma and blood.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 27
Incorrect
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A 56-year-old man undergoes tests to determine his renal function. His results over a period of 24 hours were:
Urine flow rate: 2. 0 ml/min
Urine inulin: 1.0 mg/ml
Plasma inulin: 0.01 mg/ml
Urine urea: 260 mmol/l
Plasma urea: 7 mmol/l
What is the glomerular filtration rate?Your Answer: 300 ml/min
Correct Answer: 200 ml/min
Explanation:Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. GFR is equal to the inulin clearance because inulin is freely filtered into Bowman’s capsule but is not reabsorbed or secreted. The clearance (C) of any substance can be calculated as follows: C = (U × V)/P, where U and P are the urine and plasma concentrations of the substance, respectively and V is the urine flow rate. Thus, glomerular filtration rate = (1.0 × 2. 0)/0.01 = 200 ml/min.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 28
Correct
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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: 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 29
Correct
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A significantly elevated white cell count of 50 x 109/l with 5% blasts and raised leucocyte alkaline phosphatase is seen in which of the following conditions?
Your Answer: Leukaemoid reaction
Explanation:Non-neoplastic proliferation of leucocytes causes an increase in leukocyte alkaline phosphatase (LAP). This is referred to as ‘leukemoid reaction’ because of the similarity to leukaemia with an increased white cell count (>50 × 109/l) with immature forms. Causes of leukemoid reaction includes haemorrhage, drugs (glucocorticoids, all-trans retinoic acid etc), infections such as tuberculosis and pertussis, and as a paraneoplastic phenomenon. Leukemoid reaction can also be seen in infancy as a feature of trisomy 21. This is usually a benign condition, but can be a response to a disease state. Differential diagnosis include chronic myelogenous leukaemia (CML).
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This question is part of the following fields:
- Haematology
- Pathology
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Question 30
Correct
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Cranial nerve XII, the hypoglossal nerve, innervates which one of the following muscles in the list?
Your Answer: Hyoglossus
Explanation:The cranial nerve XII, hypoglossal nerve, innervates all the intrinsic and extrinsic muscles of the tongue except the palatoglossus. The muscles of the tongue innervated by this nerve include the extrinsic muscles; hyoglossus, styloglossus, genioglossus and the intrinsic muscles; superior longitudinal, inferior longitudinal, vertical and transverse muscles. The salpingopharyngeus, palatoglossus and the palatopharyngeus muscles are innervated by the vagus nerve. The stylopharyngeus muscle is innervated by the glossopharyngeal nerve (CN IX). The mylohyoid muscle is innervated by the inferior alveolar nerve, a branch of the mandibular nerve. Finally, the geniohyoid muscle is innervated by the olfactory nerve (CN I) via the hypoglossal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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SESSION STATS - PERFORMANCE PER SPECIALTY
