-
Question 1
Correct
-
A surgeon performing a thymectomy to remove a malignant thymoma is careful to avoid damaging an important nerve lying around the arch of the aorta. Which nerve is the surgeon trying to preserve?
Your Answer: Left Vagus
Explanation:The left vagus nerve lies on the lateral surface of the aortic arch. The left recurrent laryngeal nerve arises from the vagus and loops around the arch of the aorta. This nerve is at risk of injury during surgery.
The right and left phrenic nerves, being lateral to the vagus, do not loop around the arch of the aorta.
The sympathetic trunks, both right and left, are located in the posterior chest; not near the aortic arch.
The right vagus: not involved with the aortic arch.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 2
Incorrect
-
Which of the deep fasciae located in the anterolateral abdominal wall form the inguinal ligament?
Your Answer: Transversalis fascia
Correct Answer: External abdominal oblique aponeurosis
Explanation:The inguinal ligament is the inferior border of the aponeurosis of the external oblique abdominis and extends from the anterior superior iliac spine to the pubic tubercle from whence it is reflected backward and laterally to attach to the pectineal line and form the lacunar ligament.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 3
Correct
-
The superior pancreaticoduodenal artery, the artery that supplies blood to the pancreas and the duodenum, is a branch of the:
Your Answer: Gastroduodenal artery
Explanation:The superior pancreaticoduodenal artery together with the right gastroepiploic artery form the two branches of the gastroduodenal artery which divides at the lower border of the duodenum.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 4
Correct
-
If your EEG shows waves with a frequency range of 8-12 Hz, the waves most likely to be seen are:
Your Answer: Alpha
Explanation:Electroencephalography (EEG) is the neurophysiological measurement of the electrical activity of the brain. It is done by placing electrodes on the scalp or subdurally. In reality, the electrical currents are not measured, but rather the voltage differences between different parts of the brain. Four major types of EEG activity are recognized, which are alpha, beta, delta and theta.
Alpha waves, also known as Berger’s waves ranges in frequency from 8-12 Hz. Best detected with eyes closed, alpha waves are characteristic of a relaxed, alert state of consciousness. An alpha-like normal variant called mu is sometimes seen over the motor cortex (central scalp) and attenuates with movement or, rather, with the intention to move.
-
This question is part of the following fields:
- Neurology
- Physiology
-
-
Question 5
Incorrect
-
A 44-year old man, who was euthyroid underwent thyroidectomy following neoplastic cells found on fine-needle aspiration. Frozen section of multiple thyroid masses showed malignant neoplasm of polygonal cells in nests. The neoplasm also showed presence of amyloid which was positive with Congo-red staining. Immunoperoxidase staining for calcitonin was also positive. Chest X-ray revealed no abnormality. However, his blood pressure was found to be raised, and his serum ionised calcium was high. What is the likely diagnosis?
Your Answer: Parathyroid carcinoma
Correct Answer: Multiple endocrine neoplasia type IIA
Explanation:MEN (Multiple Endocrine Neoplasia) syndromes are a group of three separate familial disease which consists of adenomatous hyperplasia and neoplasia in several endocrine glands. All three conditions are inherited as an autosomal dominant trait, with a single gene producing multiple effects. MEN IIA is characterized by medullary carcinoma of the thyroid, pheochromocytoma and hyperparathyroidism. It should be suspected in patients with bilateral pheochromocytoma, a familial history of MEN, or at least two characteristic endocrine manifestations. Genetic testing is used to confirm the diagnosis. Early diagnosis is crucial to aid in complete excision of the localized tumour. Pheochromocytomas can be detected by plasma free metanephrines and fractionated urinary catecholamines, particularly adrenaline (epinephrine).
Imaging studies such as computed tomography or magnetic resonance imaging might also prove useful. Hyperparathyroidism is diagnosed by the standard finding of hypercalcaemia, hypophosphatemia and an increased parathyroid hormone level. Once MEN IIA syndrome is identified in any patient, it is recommended that his or her first-degree relatives and any other symptomatic also undergo genetic testing. Relatives should be subjected to annual screening for hyperparathyroidism and pheochromocytoma beginning in early childhood and continue indefinitely. Serum calcium levels help in screening for hyperparathyroidism. Similarly, screening for pheochromocytoma is by history, measurement of the blood pressure and laboratory testing.
-
This question is part of the following fields:
- Endocrine
- Pathology
-
-
Question 6
Incorrect
-
Carbachol is a cholinergic agonist. In which of these cases should carbachol be administered?
Your Answer: Angina
Correct Answer: Cataract surgery
Explanation:Carbachol (carbamylcholine) is a cholinergic agent, a choline ester and a positively charged quaternary ammonium compound. It is primarily used for various ophthalmic purposes, such as for treating glaucoma, or for use during ophthalmic surgery. It is usually administered topically to the eye or through intraocular injection. It is not well absorbed in the gastro-intestinal tract and does not cross the blood–brain barrier.
-
This question is part of the following fields:
- Pathology
- Pharmacology
-
-
Question 7
Incorrect
-
Which of the following can lead to haemolytic anaemia?
Your Answer: Living at high altitude
Correct Answer: Presence of haemoglobin S
Explanation:Haemoglobin S is an abnormal type of haemoglobin seen in sickle cell anaemia. This allows for the haemoglobin to crystalize within the RBC upon exposure to low partial pressures of oxygen. This results in rupture of the RBCs as they pass through microcirculation, especially in the spleen. This can cause blockage of the vessel down stream and ischaemic death of tissues, accompanied by severe pain.
-
This question is part of the following fields:
- General
- Physiology
-
-
Question 8
Incorrect
-
A patient with this condition has extracellular fluid volume expansion:
Your Answer: Vomiting
Correct Answer: Nephrotic syndrome
Explanation:Nephrotic syndrome is a syndrome comprising of signs of nephrosis, including proteinuria, hypoalbuminemia, and oedema. It is a component of glomerulonephritis, in which different degrees of proteinuria occur. Essentially, loss of protein through the kidneys leads to low protein levels in the blood , which causes water to be drawn into soft tissues (oedema). Severe hypoalbuminemia can also cause a variety of secondary problems, such as water in the abdominal cavity (ascites), around the heart or lung (pericardial effusion, pleural effusion), high cholesterol, loss of molecules regulating coagulation (hence increased risk of thrombosis). The most common sign is excess fluid in the body due to the serum hypoalbuminemia. Lower serum oncotic pressure causes fluid to accumulate in the interstitial tissues. Sodium and water retention aggravates the oedema.
-
This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
-
-
Question 9
Incorrect
-
Pain in the epigastric region occurring typically 2-3 hours after meals and causing the patient to wake up at night is characteristic of which of the following conditions?
Your Answer: Pyloric stenosis
Correct Answer: Duodenal ulcer
Explanation:The description is typical for duodenal ulcers. There is no pain upon waking in the morning however it appears around mid-morning and is relieved by ingestion of food. The pain also often causes the patient to wake up at night.
-
This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
-
-
Question 10
Incorrect
-
If a 55-year old gentleman who has suffered a stroke, develops a tremor in his fingers that worsens on reaching for an object, what part of his brain is likely to be involved?
Your Answer: Cerebral cortex
Correct Answer: Cerebellum
Explanation:The cerebellum plays an important role in the integration of sensory perception and motor output. Multiple neural pathways link the cerebellum with the motor cortex and the spinocerebellar tract. The cerebellum uses the constant feedback on body position to fine-tune the movements and integrates these pathways. The patient described here has a characteristic cerebellar tremor that is a slow, broad tremor of the extremities and occurs at the end of a purposeful movement.
-
This question is part of the following fields:
- Neurology
- Physiology
-
-
Question 11
Incorrect
-
A 54-year-old woman is re-admitted to the hospital with shortness of breath and sharp chest pain 2 weeks after surgical cholecystectomy. The most probable cause of these clinical findings is:
Your Answer: Pulmonary oedema
Correct Answer: Pulmonary embolus
Explanation:Pulmonary embolism is caused by the sudden blockage of a major lung blood vessel, usually by a blood clot. Symptoms include sudden sharp chest pain, cough, dyspnoea, palpitations, tachycardia or loss of consciousness. Risk factors for developing pulmonary embolism include long periods of inactivity, recent surgery, trauma, pregnancy, oral contraceptives, oestrogen replacement, malignancies and venous stasis.
-
This question is part of the following fields:
- Pathology
- Respiratory
-
-
Question 12
Incorrect
-
Which of the following organs is most likely to have dendritic cells?
Your Answer: Spleen
Correct Answer: Skin
Explanation:Dendritic cells are part of the immune system and they function mainly as antigen presenting cells. They are present in small quantities in tissues which are in contact in the external environment. Mainly in the skin and to a lesser extent in the lining of the nose, lungs, stomach and intestines. In the skin they are known as Langerhans cells.
-
This question is part of the following fields:
- General
- Physiology
-
-
Question 13
Correct
-
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.
-
This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
-
-
Question 14
Incorrect
-
The vagus nerve passes through which of the following foramen?
Your Answer: Foramen magnum
Correct Answer: Jugular foramen
Explanation:The jugular foramen is a large foramen in the base of the skull. It is located behind the carotid canal and is formed in front by the petrous portion of the temporal bone, and behind by the occipital bone. Cranial nerves IX, X, and XI and the internal jugular vein pass through the jugular foramen.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 15
Correct
-
Which of the following structure contains the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle?
Your Answer: Edinger–Westphal nucleus
Explanation:The Edinger–Westphal nucleus (accessory oculomotor nucleus) is the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 16
Correct
-
A 27 year old women had developed a darker complexion following a vacation to India. She had no erythema or tenderness. Her skin colour returned to normal over a period of 1 month. Which of the these substances is related to the biochemical change mentioned above?
Your Answer: Tyrosine
Explanation:The tanning process can occur due to UV light exposure as a result of oxidation of tyrosine to dihydrophenylalanine with the help of the tyrosinase enzyme within the melanocytes. Hemosiderin can impart a brown colour due to breakdown of RBC but its usually due to a trauma and is known as haemochromatosis.
Lipofuscin gives a golden brown colour to the cell granules not the skin.
Homogentisic acid is part of a rare disease alkaptonuria, with characteristic black pigment deposition within the connective tissue.
Copper can impart a brown golden colour, but is not related to UV light exposure.
-
This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
-
-
Question 17
Incorrect
-
A 18-year old girl presents to her doctor with an excessively enlarged left breast as compared to the right breast since puberty. The most likely cause for this is:
Your Answer: Cystosarcoma phyllodes
Correct Answer: Virginal breast hypertrophy
Explanation:Virginal breast hypertrophy’ is the term assigned to excessive growth of breasts during puberty and is a common phenomenon. It is also known as ‘juvenile macromastia’ or ‘ juvenile gigantomastia’. The breast hypertrophy often starts with menarche and occasionally occurs in growth spurts. These spurts can cause physical discomfort, red and itchy skin or pain in the breasts. The breasts can also grow continuously over several years and lead to overdevelopment of a normal breast. Nipples also undergo enlargement along with the breasts.
-
This question is part of the following fields:
- Pathology
- Women's Health
-
-
Question 18
Incorrect
-
Diuretics that act on the ascending limb of the loop of Henle produce:
Your Answer: Reduced production of erythropoietin
Correct Answer: Reduced active transport of sodium
Explanation:The loop of Henlé leads from the proximal convoluted tubule to the distal convoluted tubule. Its primary function uses a counter current multiplier mechanism in the medulla to reabsorb water and ions from the urine. It can be divided into four parts:
1. Descending limb of loop of Henl̩ Рlow permeability to ions and urea, while being highly permeable to water
2. Thin ascending limb of loop of Henl̩ Рnot permeable to water, but it is permeable to ions
3. Medullary thick ascending limb of loop of Henlé – sodium (Na+), potassium (K+) and chloride (Cl–) ions are reabsorbed by active transport. K+ is passively transported along its concentration gradient through a K+ channel in the basolateral aspect of the cells, back into the lumen of the ascending limb.
4. The cortical thick ascending limb – the site of action where loop diuretics such as furosemide block the K+/Na+/2Cl− co-transporters = reduced active transport.
-
This question is part of the following fields:
- Physiology
- Renal
-
-
Question 19
Incorrect
-
A 46-year old female patient experienced a stroke that affected her glossopharyngeal nerve. Damage to the glossopharyngeal nerve would most likely:
Your Answer: Result in loss of motor innervation to the risorius muscle
Correct Answer: Result in general sensory deficit to the pharynx
Explanation:The glossopharyngeal nerve (CN IX) has many functions which include:
– Contributes to the pharyngeal plexus
– Receiving general somatic sensory fibres from the tonsils, pharynx, the middle ear and the posterior third of the tongue.
– supplies motor fibres to only one muscle; the stylopharyngeus muscle.
– provides parasympathetic fibres to the parotid gland via the otic ganglion.
– Receives visceral sensory fibres from the carotid bodies & carotid sinus.
– Receives special visceral sensory fibres from the posterior third of the tongue.
The above functions will directly be affected by the damage of the glossopharyngeal nerve.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 20
Incorrect
-
Calculate the pulmonary vascular resistance in an adult male with the following parameters:
Heart rate 70 beats/min
Arterial [O2] 0.24 ml O2/min
Venous [O2] 0.16 ml O2/mi
Whole body O2 consumption 500 ml/min
Pulmonary diastolic pressure 15 mmHg
Pulmonary systolic pressure 25 mmHg
Wedge pressure 5 mmHg.Your Answer: 1.5 resistance units (mmHg/l per min)
Correct Answer: 2.0 resistance units (mmHg/l per min)
Explanation:Pulmonary vascular resistance (PVR) = (Mean pulmonary artery pressure – Pulmonary capillary wedge pressure) divided by Cardiac output. To get cardiac output, Fick’s principle needs to be applied which states that VO2 = (CO × CAO2) – (CO × CVO2) where VO2 = oxygen consumption, CO = cardiac output, CA = oxygen concentration of arterial blood and CVO2 = oxygen concentration of venous blood. Thus, CO = VO2/CAO2– CVO2, CO = 500/0.24–0.16, CO = 500/0.8, CO = 6.25 l/min. To calculate mean pulmonary artery pressure, we use the formula: Mean pulmonary artery pressure = Diastolic pressure + 1/3(Systolic pressure – Diastolic pressure). Thus, Mean pulmonary artery pressure = 15 + 1/3(25 – 15) = 15 + 3. 33 = 18.33. Substituting these values in the first formula, PVR = 18.3–5/6.25 = 13.5/5.25 = 2.0 resistance units (mmHg/l per min) approximately.
-
This question is part of the following fields:
- Cardiovascular
- Physiology
-
-
Question 21
Incorrect
-
A 60-year-old female has sudden onset of high-grade fever associated with cough with productive rusty-coloured sputum. Chest x-ray showed left-sided consolidation. What is the most accurate test for the diagnosis of this patient?
Your Answer: CT scan of chest
Correct Answer: Sputum culture
Explanation:Sputum culture is used to detect and identify the organism that are infecting the lungs or breathing passages.
-
This question is part of the following fields:
- Microbiology
- Pathology
-
-
Question 22
Incorrect
-
In order to arrest sudden bleeding during pericardiectomy that started after accidental injury to a major vasculature in the pericardium; the surgeon inserted his left index finger through the transverse pericardial sinus, pulled forward on the two large vessels lying ventral to his finger, and compressed these vessels with his thumb to control the bleeding. Which vessels were these?
Your Answer: Superior vena cava and right pulmonary artery
Correct Answer: Pulmonary trunk and aorta
Explanation:Transverse pericardial sinus: located behind two great vessels (aorta and pulmonary trunk) and in front of the superior vena cava and is accessed from above as in this case. The brachiocephalic trunk is located above the pericardium and the right pulmonary artery is above the pericardial reflections.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 23
Incorrect
-
Out of the given options, which of the following is the most likely diagnosis in a 25-year old gentleman presenting with a testicular germ cell tumour?
Your Answer: Leydig cell tumour
Correct Answer: Embryonal carcinoma
Explanation:Embryonal carcinoma is a non-seminomatous germ cell tumour of the testis, accounting for 25% testicular tumours. Other germ cell tumours include seminoma, teratoma and choriocarcinoma. Embryonal carcinomas are known to occur in men aged 25-35 years, and occasionally in teens. They are rarely seen in ovaries of females. It can spread to the vas deferens and also to the aortic lymph nodes. Embryonal carcinomas are known to have elements of fetal origin such as cartilage. Usually, the main tumour is about 2.5cm long, with an extension of 8-9cm along the testicular cord. Contiguous spread to the testicle is seen in less than 1% cases.
-
This question is part of the following fields:
- Pathology
- Urology
-
-
Question 24
Incorrect
-
Which is the correct superficial to deep order of structures that would be affected following a knife wound to the lateral aspect of the knee?
Your Answer: Skin, anterior cruciate ligament, popliteus muscle tendon
Correct Answer: skin, fibular collateral ligament, popliteus muscle tendon, lateral meniscus
Explanation:Skin, fibular collateral ligament, popliteus muscle tendon and lateral meniscus is the correct order of structures covering the lateral aspect of the knee joint from a superficial to deep.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 25
Incorrect
-
Epstein-Barr virus (EBV) is known to be a carcinogen for:
Your Answer: Non-Hodgkin's lymphoma
Correct Answer: B-cell lymphoma
Explanation:EBV is known to be carcinogenic for B-cell lymphoma, nasopharyngel carcinoma and Hodgkin’s lymphoma.
-
This question is part of the following fields:
- Microbiology; Neoplasia
- Pathology
-
-
Question 26
Incorrect
-
Cyclophosphamide is used as a chemotherapy and immunosuppressant agent and is indicated in various diseases. One of the most severe complications of its use is cancer of the:
Your Answer: Colon
Correct Answer: Urinary bladder
Explanation:Cyclophosphamide is used to treat various types of cancer and autoimmune disorders. The main use of cyclophosphamide is in combination with other chemotherapy agents in the treatment of lymphomas, some forms of leukaemia and some solid tumours. Side-effects include nausea and vomiting, bone marrow suppression, stomach ache, diarrhoea, darkening of the skin/nails, alopecia, lethargy, and haemorrhagic cystitis. Cyclophosphamide is itself carcinogenic, potentially causing transitional cell carcinoma of the bladder as a long-term complication.
-
This question is part of the following fields:
- Pathology
- Pharmacology
-
-
Question 27
Incorrect
-
Which of the following over-the-counter drugs can cause a prolonged bleeding time?
Your Answer: Loratadine
Correct Answer: Acetylsalicylic acid
Explanation:Acetylsalicylic acid, or aspirin, is a nonsteroidal anti-inflammatory drug that is widely used as an analgesic and antipyretic. Aspirin is as a cyclo-oxygenase inhibitor that leads to decreased prostaglandin production. Decreased platelet aggregation is another effect of this drug, achieved by long-lasting use of aspirin.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 28
Incorrect
-
A 62-year-old male smoker, presented with shortness of breath, chronic cough and haemoptysis over the last three months. He has developed a fat pad in the base of his neck, rounded face, acne and osteoporosis. Which of the following is the most likely pulmonary disease that is causing these symptoms and findings?
Your Answer: Pulmonary adenocarcinoma
Correct Answer: Small-cell anaplastic carcinoma
Explanation:Small cell lung cancer is a highly aggressive form of lung cancer. It is thought to originate from neuroendocrine cells in the bronchus called Feyrter cells and is often associated to ectopic production of hormones like ADH and ACTH that result in paraneoplastic syndromes and Cushing’s syndrome.
-
This question is part of the following fields:
- Pathology
- Respiratory
-
-
Question 29
Incorrect
-
Pain in the right upper quadrant of the abdomen on ingestion of a fatty meal is seen in a condition which involves which of the following substances?
Your Answer:
Correct Answer: Cholecystokinin
Explanation:The clinical scenario described here favours the presence of gallstones. During food ingestion, vagal discharges stimulate gallbladder contraction. Moreover, presence of fat and amino acids in the intestinal lumen stimulates the release of cholecystokinin (CCK) in the duodenum. This causes sustained gallbladder contraction and relaxation of the sphincter of Oddi. If gallstones are present, there will be inflammation in the gallbladder and CCK will aggravate it due to contractions.
-
This question is part of the following fields:
- Gastroenterology
- Physiology
-
-
Question 30
Incorrect
-
Which of the following is the most likely cause of prolonged thrombin clotting time?
Your Answer:
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.
-
This question is part of the following fields:
- Haematology
- Pathology
-
SESSION STATS - PERFORMANCE PER SPECIALTY
