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Question 1
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: Pulmonary artery pressure
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 2
Correct
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A 69 Year old lady presented to the emergency department following a massive myocardial infarction. She was found to be in hypotensive shock with focal neurological signs. Unfortunately the patient demised. What would be the expected findings on the brain biopsy?
Your Answer: Liquefactive necrosis
Explanation:Liquefactive necrosis is often associated with bacterial or fungal infections. However, hypoxic death of cells within the central nervous system can also result in liquefactive necrosis. The focal area is soft with a liquefied centre containing necrotic debris and dead white cells. This may later be enclosed by a cystic wall
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This question is part of the following fields:
- Cell Injury & Wound Healing; Neurology
- Pathology
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Question 3
Incorrect
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A neurotransmitter of the nigrostriatal pathway is:
Your Answer: Serotonin
Correct Answer: Dopamine
Explanation:Dopamine acts as a neurotransmitter in the brain, activating dopamine receptors. It is also a neurohormone released from the hypothalamus. It plays an important role in the reward system. It is believed that dopamine provides a teaching signal to parts of the brain responsible for acquiring new motor sequences (behaviours), by activation of dopamine neurons when an unexpected reward is presented. Loss of dopamine neurones in the nigrostriatal pathway causes Parkinson’s disease. In the frontal lobes, dopamine controls the flow of information from other areas of the brain, and thus, dopamine disorders in this region can cause a decline in neurocognitive functions, especially memory, attention and problem solving. Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention-deficit disorder and some symptoms of schizophrenia. Dopamine is also the primary neuroendocrine regulator of the secretion of prolactin from the anterior pituitary gland. Dopamine is also commonly associated with the pleasure system of the brain. This plays a key role in understanding the mechanism of action of drugs (such as cocaine and the amphetamines), which seem to be directly or indirectly related to the increase of dopamine.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 4
Correct
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After having donated a unit of blood. The blood bank will prefer to use which of the following anticoagulants to store the blood?
Your Answer: Citrate
Explanation:Calcium is necessary for coagulation to occur. Citrate being a chelator and combining with calcium ions to form un-ionised compound will prevent coagulation. Following transfusion the citrate is removed by the liver with in a few minutes. Oxalate also works on the same principle but it is toxic to the body.
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This question is part of the following fields:
- General
- Physiology
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Question 5
Correct
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A 34-year-old woman with severe burns, presented to casualty with a blood pressure of 75/40 mmHg and pulse of 172/minute. Obviously the patient is in shock. Which type of shock is it more likely to be?
Your Answer: Hypovolaemic shock
Explanation:Shock is a life-threatening condition that occurs when the organs and tissues of the body are not receiving a sufficient flow of blood. Lack of blood flow, oxygen and nutrients results in the inability to function properly and damage to many organs. Shock requires immediate treatment because, if left untreated the impaired tissue perfusion and cellular hypoxia can cause irreversible tissue injury, collapse, coma or even death. There are various types of physiological shock, including: cardiogenic (due to heart damage), hypovolaemic (due to low total volume of blood or plasma), neurogenic (due to nervous system damage), septic (due to infections) and anaphylactic shock (due to allergic reactions). Hypovolaemic shock can be caused by blood loss due to trauma, internal bleeding or other fluid loss due to severe burns, prolonged diarrhoea, vomiting and sweating.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 6
Incorrect
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Below which level of the spinal cord will the inferior gluteal nerve be unaffected?
Your Answer: S1
Correct Answer: S3
Explanation:The inferior gluteal nerve arises from the dorsal divisions of the fifth lumbar and first and second sacral nerves. According to this fact any lesion at or below the S3 will not affect the inferior gluteal nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 7
Correct
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An episiotomy is indicated for a woman during a difficult vaginal delivery. Whilst the registrar was performing this procedure she made a median cut too far through the perineal body cutting the structure immediately posterior. Which structure is this?
Your Answer: External anal sphincter
Explanation:An episiotomy is an incision that is made whenever there is a risk of a tear during vaginal deliver. A posterolateral incision, as opposed to a median incision is preferred. Of the options given, the external anal sphincter lies right posterior to the perineal body. The sacrospinous and the sacrotuberous ligaments are deep in the perineum that they should not be involved in this.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 8
Correct
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A 70-year-old man who was previously healthy develops a rapidly progressing neurological deficit. A MRI reveals a large, poorly defined mass with central necrosis in his left temporal lobe. What is the most likely diagnosis?
Your Answer: Glioblastoma multiforme
Explanation:Glioblastoma multiforme, or grade 4 astrocytoma, is the most common and aggressive primary brain tumour. They are formed by small areas of necrotising tissue surrounded by highly anaplastic cells. Most of them arise from the deep white matter of the brain and quickly infiltrate it, becoming very large before they are symptomatic. The most common symptom is progressive memory, personality or neurological deficit due to temporal and frontal lobe involvement. It is most common in men, and risk factors include: neurofibromatosis, tuberous sclerosis, Von Hippel-Lindau disease, Li-Fraumeni syndrome, and Turcot syndrome.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 9
Correct
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A 50-year-old man is diagnosed with emphysema and cirrhosis of the liver. Which of the following condition may be the cause of both cirrhosis and emphysema in this patient?
Your Answer: Alpha1-antitrypsin deficiency
Explanation:Alpha-1 antitrypsin (A1AT) deficiency is a condition characterised by the lack of a protein that protects the lungs and liver from damage, called alpha1-antytripsin. The main complications of this condition are liver diseases such as cirrhosis and chronic hepatitis, due to accumulation of abnormal alpha 1-antytripsin and emphysema due to loss of the proteolytic protection of the lungs.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 10
Incorrect
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Which of the following toxins most likely results in continuous cAMP production, which pumps H2O, sodium, potassium, chloride and bicarbonate into the lumen of the small intestine and results in rapid dehydration?
Your Answer: Diphtheria toxin
Correct Answer: Cholera toxin
Explanation:The cholera toxin (CTX or CT) is an oligomeric complex made up of six protein subunits: a single copy of the A subunit (part A), and five copies of the B subunit (part B), connected by a disulphide bond. The five B subunits form a five-membered ring that binds to GM1 gangliosides on the surface of the intestinal epithelium cells. The A1 portion of the A subunit is an enzyme that ADP-ribosylates G proteins, while the A2 chain fits into the central pore of the B subunit ring. Upon binding, the complex is taken into the cell via receptor-mediated endocytosis. Once inside the cell, the disulphide bond is reduced, and the A1 subunit is freed to bind with a human partner protein called ADP-ribosylation factor 6 (Arf6). Binding exposes its active site, allowing it to permanently ribosylate the Gs alpha subunit of the heterotrimeric G protein. This results in constitutive cAMP production, which in turn leads to secretion of H2O, Na+, K+, Cl−, and HCO3− into the lumen of the small intestine and rapid dehydration. The gene encoding the cholera toxin was introduced into V. cholerae by horizontal gene transfer.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 11
Correct
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What causes a reduction in pulmonary functional residual capacity?
Your Answer: Pulmonary fibrosis
Explanation:Pulmonary functional residual capacity (FRC) is = volume of air present in the lungs at the end of passive expiration.
Obstructive diseases (e.g. emphysema, chronic bronchitis, asthma) = an increase in FRC due to an increase in lung compliance and air trapping.
Restrictive diseases (e.g. pulmonary fibrosis) result in stiffer, less compliant lungs and a reduction in FRC.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 12
Correct
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In a splenectomy procedure, special care is emphasized on the preservation of the tail of the pancreas that is closely associated with the spleen to avoid post operative pancreatic fistula. As a general surgeon conducting a splenectomy where are you most likely to find the tail of the pancreas in the abdominal cavity?
Your Answer: Splenorenal ligament
Explanation:The tail of the pancreas is the only intraperitoneal part of the pancreas and is found contained in the splenorenal ligament of the peritoneal cavity. The splenorenal ligament is derived from the peritoneum where the wall of the general peritoneal cavity connects to the omental bursa between the spleen and the left kidney. This ligament contains the splenic vessels and the tail of the pancreas.
The gastrocolic ligament stretches from the greater curvature of the stomach to the transverse colon, connecting the two.
The gastrosplenic ligament is derived from the greater omentum and is the structure that connects the stomach to the hilum of the spleen. The gastrosplenic ligament continues from the splenic flexure of the colon to the diaphragm and acts as a support to the spleen.
The transverse colon is connected to the abdominal wall by the mesocolon ligament.
The falciform ligament on the other hand, attaches the liver to the ventral wall of the abdomen.
The hepatoduodenal ligament connects the porta hepatis of the liver to the superior part of the duodenum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 13
Incorrect
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Bile salt reuptake principally occurs where?
Your Answer: In the jejenum
Correct Answer: In the ileum
Explanation:90 – 95% of the bile salts are absorbed from the small intestine (mostly terminal ileum and then excreted again from the liver. This is known as the enterohepatic circulation. The entire pool recycles twice per meal and approximately 6 to 8 times per day.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 14
Incorrect
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In relation to the muscles of facial expression, It is true to say:
Your Answer: Some muscles of facial expression receive their motor supply via the zygomaticofacial nerve
Correct Answer: They are in the same subcutaneous plane as the platysma muscle
Explanation:The facial muscles generally originate from the facial bones and attach to the skin, in the same plane as the platysma muscle. They are all innervated by cranial nerve VII (the facial nerve). The occipitofrontalis muscle consists of two parts: The occipital belly, near the occipital bone, and the frontal belly, near the frontal bone.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 15
Correct
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If a patient takes long-term corticosteroid therapy, which of the following diseases is most likely to develop?
Your Answer: Osteoporosis
Explanation:One of the complications of long-term intake of corticosteroids is osteoporosis. Some guidelines recommend prophylactic calcium and vitamin D supplementation in patients who take more than 30 mg hydrocortisone or 7.5 mg of prednisolone daily.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 16
Incorrect
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A new-born was found to have an undeveloped spiral septum in the heart. This is characteristic of which of the following?
Your Answer: Atrioventricular septal defect
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.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 17
Incorrect
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If a catheter is placed in the main pulmonary artery of a healthy 30-year-old woman, which of the following will be its mean pulmonary arterial pressure?
Your Answer: 5 mmHg
Correct Answer: 15 mmHg
Explanation:The pulmonary artery pressure (PA pressure) is a measure of the blood pressure found in the main pulmonary artery. The hydrostatic pressure of the pulmonary circulation refers to the actual pressure inside pulmonary vessels relative to atmospheric pressure. Hydrostatic (blood pressure) in the pulmonary vascular bed is low compared with that of similar systemic vessels. The mean pulmonary arterial pressure is about 15 mmHg (ranging from about 13 to 19 mmHg) and is much lower than the average systemic arterial pressure of 90 mmHg.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 18
Incorrect
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Which nerve mediates the sensation to itch from the skin that is just over the base of the spine of your scapula?
Your Answer: Dorsal root of T2
Correct Answer: Dorsal primary ramus of C7
Explanation:The first branches off spinal nerves are called the dorsal and ventral rami. The dorsal rami mediate sensation of the skin over the back and motor supply to the true muscles of the back whilst the ventral rami gives sensation to the skin over the limbs and the skin that is over the ventral side of the trunk. It also gives motor supply to the skeletal muscles of the neck, the trunk and extremities. Hence, itchiness of the part of the skin that is over the spine of the scapula would be mediated by the primary ramus of C7. Accessory nerve doesn’t have any sensory innervation.
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This question is part of the following fields:
- Anatomy
- Neurology
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Question 19
Correct
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Which is the correct order of tendons passing from medial to lateral-posterior to the medial malleolus?
Your Answer: Posterior tibial, flexor digitorum longus, flexor hallucis longus
Explanation:The correct order of structures is the tendon of tibialis posterior, tendon of flexor digitorum longus, posterior tibial artery (and vein), tibial nerve and tendon of flexor hallucis longus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 20
Incorrect
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A patient gives a history of dull discomfort in her abdomen associated with pain that she points to be on her right shoulder and right scapula. The following organs are most likely to be source of her pain:
Your Answer: Stomach
Correct Answer: Liver, duodenum and gallbladder
Explanation:Referred pain is felt at a point away from the source of the pain or the unpleasant sensation. It arises when a nerve is damaged or compressed at a point but the pain is felt at another site that is the territory of that nerve. Common abdominal causes of referred pain to the shoulder and the shoulder blade are the liver, duodenum and gall bladder.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 21
Incorrect
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Calculate the resistance of the artery if the pressure at one end is 60 mmHg, pressure at the other end is 20 mm Hg and the flow rate in the artery is 200 ml/min.
Your Answer: 0.3
Correct Answer: 0.2
Explanation:Flow in any vessel = Effective perfusion pressure divided by resistance, where effective perfusion pressure is the mean intraluminal pressure at the arterial end minus the mean pressure at the venous end. Thus, in the given problem, resistance = (60 − 20)/200 = 0.2 mmHg/ml per min.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 22
Incorrect
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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: Neutrophil
Correct 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 23
Correct
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The extent of cancer growth can be described through staging. What is taken into consideration when staging a cancer?
Your Answer: Local invasion
Explanation:Cancer stage is based on four characteristics: the size of cancer, whether the cancer is invasive or non-invasive, whether the cancer has spread to the lymph nodes, and whether the cancer has spread to other parts of the body, in this case beyond the breast. Staging is important as it is often a good predictor of outcomes and treatment is adjusted accordingly.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 24
Correct
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A surgeon ligates the left middle suprarenal artery while carrying out a left adrenalectomy. Where does the left middle suprarenal artery originate?
Your Answer: Abdominal aorta
Explanation:Middle suprarenal arteries arise from either side of the abdominal aorta, opposite the superior mesenteric artery.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 25
Correct
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A cell is classified on the basis of its regenerative ability. Which of the following cells represent a permanent cell?
Your Answer: Erythrocyte
Explanation:An erythrocyte is the last cell in the progeny of RBC cell division and is not capable of further division and regeneration. Hepatocytes, osteocytes and epithelium of kidney tubules are all stable cells. Colonic mucosa and pluripotent hematopoietic stem cells are all labile cells.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 26
Incorrect
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A 45-year-old man complains of shortness of breath, cough and chest pain. Chest X ray revealed a perihilar mass with bronchiectasis in the left mid-lung. Which of the following is most probably associated with these findings?
Your Answer: Mesothelioma
Correct Answer: Bronchial carcinoid
Explanation:Bronchial carcinoids are neuroendocrine tumours that arise from Kulchitsky’s cells of the bronchial epithelium. Kulchitsky’s cells belong to the diffuse endocrine system. Patients affected by this tumour may be asymptomatic or may present with symptoms of airway obstruction, like dyspnoea, wheezing, and cough. Other common findings are recurrent pneumonia, haemoptysis, chest pain and paraneoplastic syndromes. Chest radiographs are abnormal in the majority of cases. Peripheral carcinoids usually present as a solitary pulmonary nodule. For central lesions common findings include hilar or perihilar masses with or without atelectasis, bronchiectasis, or consolidation. Bronchial carcinoids most commonly arise in the large bronchi causing obstruction.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 27
Incorrect
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While conducting a physical examination of a patient, the GP passed a finger down the edge of the medial crus of the superficial inguinal ring and felt a bony prominence deep to the lateral edge of the spermatic cord. What was this bony prominence?
Your Answer: Iliopubic eminence
Correct Answer: Pubic tubercle
Explanation:At the superficial inguinal ring, the pubic tubercle would be felt as a bony prominence lateral to the edge of the spermatic cord. This tubercle is the point of attachment of the inguinal ligament that makes up the floor of the inguinal canal.
Pecten pubis is the ridge on the superior surface of the superior pubic ramus and the point of attachment of the pectineal ligament.
The pubic symphysis is the joint between the two pubic bones and the iliopubic eminence is a bony process on the pubis found near the articulation of the pubis and the ilium.
The iliopectineal line is formed by the arcuate line of the ilium and the pectineal line of the pubis. It is the line that marks the transition between the abdominal and pelvic cavity.
The sacral promontory is found on the posterior wall of the pelvis and would not be felt through the inguinal ring.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 28
Correct
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Question 29
Correct
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Which of the following will be affected by a lesion in the posterior column-medial lemniscus system?
Your Answer: Fine touch
Explanation:The posterior column–medial lemniscus (PCML) pathway is a sensory pathway that transmits fine touch and conscious proprioceptive information from the body to the brain. As the posterior columns are also known as dorsal columns, the pathway is also called the dorsal column–medial lemniscus system or DCML.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 30
Incorrect
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In a study, breast lumps were analysed to determine the characteristic of malignant neoplasm on biopsy. What microscopic findings are suggestive of malignancy?
Your Answer: Anaplasia
Correct Answer: Invasion
Explanation:Invasion is suggestive of malignancy and an even better option would have been metastasis. Pleomorphism is found in both benign and malignant neoplasms along with atypia and anaplasia. A height nuclear/cytoplasmic ratio is suggestive of malignancy but not the best indicator. Malignant tumours are aggressive and growth rapidly. Necrosis can be seen in benign tumours if they deplete their blood supply.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 31
Incorrect
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A TRUE statement regarding abolition of the cephalic phase of pancreatic secretion is that it:
Your Answer: Will mainly affect enzymatic secretion
Correct Answer: Will result after vagotomy
Explanation:Recognition and integration of the sight, smell and taste of food triggers the cephalic phase of pancreatic secretion, causing an increase in pancreatic HCO3- and enzyme secretion. The degree of enzyme secretion in this phase is about 50% of the maximal response seen with exogenous CCK and secretin. The vagus nerve regulates the secretion through the cholinergic fibres innervating the acinar cells of the pancreas, and through peptidergic nerve fibres, which innervate ductal cells.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 32
Incorrect
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Regarding abduction of the digits of the hand, which of the following is correct?
Your Answer: The lumbrical muscles produce adduction of the digits
Correct Answer: All of the adductors of the digits take at least part of their attachments from metacarpal bones
Explanation:Lying on the palmer surfaces of the metacarpal bones are four palmar interossei which are smaller than the dorsal interossei. Arising from the entire length of the metacarpal bone of one finger, is a palmar interosseous, which is inserted into the side of the base of the first phalanx and the aponeurotic expansion of the extensor digitorum communis tendon to the same finger. All the interossei are innervated by the eighth cervical nerve, through the deep palmar branch of the ulnar nerve. The palmar interossei adducts the fingers to an imaginary line drawn longitudinally through the centre of the middle finger.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 33
Correct
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An enlarged lymph node which shows well-defined, prominent paracortical follicles with germinal centres is most likely from which of the following patients?
Your Answer: A 5-year-old boy with a sore throat and runny nose
Explanation:Lymphadenopathy is common in children and is usually reactive in nature. The description fits that of a benign, reactive lymph node.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 34
Incorrect
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A victim of mob justice was brought to the A & E with a stab wound in the anterior chest 2 cm lateral to the left sternal border. He underwent an emergency thoracotomy that revealed clots in the pericardium, with a puncture wound in the right ventricle. To evacuate the clots from the pericardial cavity the surgeon slipped his hand behind the heart at its apex. He extended his finger upwards until its tip was stopped by a line of pericardial reflection which forms the:
Your Answer: Sulcus terminalis
Correct 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 space.
Cardiac notch: indentation of the ‘of the heart’ on the superior lobe of the left lung.
Hilar reflection: the reflection of the pleura onto the root of the lung to continue as mediastinal pleura.
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 35
Correct
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A 45-year old gentleman presented to the emergency department at 5.00 AM with pain in his left flank. The pain began suddenly and presented in waves throughout the night. Urine examination was normal except for presence of blood and few white blood cells. The pH and specific gravity of the urine were also found to be within normal range. What is the likely diagnosis?
Your Answer: Ureteric calculus
Explanation:A calculus in the ureter, if less than 5mm in diameter is likely to pass spontaneously. However, a larger calculus irritates the ureter and may become lodged, leading to hydroureter and/or hydronephrosis. Likely sites where the calculus might get lodged, include pelviureteric junction, distal ureter at the level of iliac vessels and the vesicoureteric junction. An obstruction can result in reduced glomerular filtration. There can be deterioration in renal function due to hydronephrosis and a raised glomerular pressure, leading to poor renal blood flow. Permanent renal dysfunction usually takes about 4 weeks to occur. Secondary infection can also occur in chronic obstruction.
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This question is part of the following fields:
- Pathology
- Renal
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Question 36
Correct
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An explorative laparotomy is done on a 23 year old following a gunshot abdominal injury through the right iliac fossa. It is found that the ileocolic artery is severed and the bullet had perforated the caecum. From which branch does the ileocolic artery originate?
Your Answer: Superior mesenteric artery
Explanation:Ileocolic artery branches off from the superior mesenteric artery. It then divides to give a superior and inferior branch.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 37
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 38
Incorrect
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From which fascia of the pelvic wall muscle does the levator ani muscle arise?
Your Answer: Puborectalis
Correct Answer: Obturator internus
Explanation:The levator ani muscle arises from the posterior surface of the superior ramus of the pubis lateral to the symphysis, behind the inner surface of the spine of the ischium and between these points from the obturator internus fascia. It is attached to the inner surface of the side of the lesser pelvic cavity, supports the viscera in the cavity and surrounds the various structures that pass through it.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 39
Incorrect
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A histopathological analysis of a specimen showed loss of individual cell structure with karyorrhexis and fragmentation. The overall integrity of the tissue structure is preserved. This is typical of which of the following pathologies?
Your Answer: Renal transplant rejection
Correct Answer: Viral hepatitis
Explanation:Viral infections will cause necrosis of the hepatocytes with characteristic changes of karyorrhexis and cell fragmentation.
Brown atrophy of the heart is due to accumulation of lipofuscin in the myocardium.
Tissue destruction associated with transplant rejection leads to widespread loss of structural integrity.
Single cell necrosis is not characteristically seen in chronic alcoholic liver.
Barbiturate overdose will result in hypertrophy of the smooth endoplasmic reticulum.
Carcinoma insitu will cause dysplastic cells without the overall structural integrity being disrupted.
Atrophy is due to apoptosis with ordered cellular fragmentation and phagocytosis and will not induce an inflammatory process unlike necrosis.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 40
Correct
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A 47-year old-woman diagnosed with pancreatitis presented to the emergency department complaining of a worsening shortness of breath, fever, agitation and cough. Oxygen saturation was 67% in room air. Her respiratory status continued to deteriorate therefore she was intubated. She was admitted to the intensive care unit for management. Chest X-ray demonstrated bilateral perihilar opacities. The patient failed conventional treatment and died several days later. At autopsy, the lung shows growth of type 2 pneumocytes and thickened alveolar walls. What is the most probable diagnosis?
Your Answer: Adult respiratory distress syndrome
Explanation:Acute (or adult) respiratory distress syndrome (ARDS) is a life-threatening lung condition characterised by a non-cardiogenic pulmonary oedema that leads to acute respiratory failure. The most common risk factors for ARDS include trauma with direct lung injury, sepsis, pneumonia, pancreatitis, burns, drug overdose, massive blood transfusion and shock. Acute onset of dyspnoea with hypoxemia, anxiety and agitation is typical. Chest X ray most commonly demonstrates bilateral pulmonary infiltrates. Histological changes include the exudative, proliferative and fibrotic phase. ARDS is mainly a clinical diagnosis.
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This question is part of the following fields:
- Pathology
- Respiratory
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SESSION STATS - PERFORMANCE PER SPECIALTY
