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Question 1
Correct
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A 45-year-old pregnant woman develops high blood pressure at 20 weeks. She complains of headaches and swollen feet, and a test reveals proteinuria (350 mg/day). Which of the following is the most likely diagnosis?
Your Answer: Pre-eclampsia
Explanation:Pre-eclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure (two separate readings taken at least 6 h apart of 140/90 or more) and often a significant amount of protein in the urine (>300 mg of protein in a 24-h urine sample). While blood pressure elevation is the most visible sign of the disease, it involves generalised damage to the maternal endothelium of the kidneys and liver, with the release of vasopressive factors only secondary to the original damage. Pre-eclampsia may develop at varying times within pregnancy and its progress differs among patients; most cases present pre-term. It has no known cure apart from ending the pregnancy (induction of labour or abortion). It may also present up to 6 weeks post partum. Risk factors for pre-eclampsia include obesity, prior hypertension, older age, and diabetes mellitus.
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This question is part of the following fields:
- Physiology
- Renal
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Question 2
Correct
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A 45 year old women has a 4 cm non tender mass in her right breast which is fixed to the chest wall. Another 2cm non-tender mass is palpable in the left axilla. Chest x ray reveals multiple nodules ranging from 0.5 - 0.2 cm in both the lungs. What is the stage of her disease?
Your Answer: T4 N1 M1
Explanation:This woman has an invasive primary tumour mass with axillary node and lung metastases, making this stage T4 N1 M1. Looking at the other stems, T1 N1 M0 signifies a small primary cancer with nodal metastases but no distant metastases; T1 N0 M1 signifies a small primary cancer with no lymph node metastases but with distant metastases; T2 N1 M0 signifies a larger primary cancer with nodal metastases but no distant metastases; and T3 N0 M0 indicates a larger primary cancer with no metastases to either lymph nodes or to distant sites.
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This question is part of the following fields:
- Neoplasia; Female Health
- Pathology
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Question 3
Correct
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What is the most likely condition a new born infant is likely to suffer from, if he/she was born with incomplete fusion of the embryonic endocardial cushions?
Your Answer: An atrioventricular septal defect
Explanation:The endocardial cushions in the heart are the mesenchymal tissue that make up the part of the atrioventricular valves, atrial septum and ventricular septum. An incomplete fusion of these mesenchymal cells can cause an atrioventricular septal defect. The terms endocardial cushion defect, atrioventricular septal defect and common atrioventricular canal defect can be used interchangeably with one another.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 4
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 5
Incorrect
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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: Thyroglossal duct cyst
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.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 6
Incorrect
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A histological examination of a lump showed an abnormal amount and arrangement of normal tissue in an otherwise normal area. This condition is known as?
Your Answer: Mixed tumour
Correct Answer: Hamartoma
Explanation:A hamartoma is a condition best described as tissue normally present in an area arranged haphazardly in an disorganized, abnormal fashion. They are never malignant and do not metastasis.
All the neoplastic, cancerous lesions comprise of a mixture of different cells that are not normal to that area.
Metaplasia is a change in the type of the epithelium.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 7
Incorrect
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In the glomerulus of the kidney, the mesangium is a structure associated with the capillaries. It has extraglomerular mesangial cells that:
Your Answer: Provide structural support for and regulate blood flow of the glomerular capillaries by their contractile activity
Correct Answer: Form the juxtaglomerular apparatus in combination with the macula densa and juxtaglomerular cells
Explanation:The mesangium is an inner layer of the glomerulus, within the basement membrane surrounding the glomerular capillaries. The mesangial cells are phagocytic and secrete the amorphous basement membrane-like material known as the mesangial matrix. They are typically separated from the lumen of the capillaries by endothelial cells. The other type of cells in the mesangium are the extraglomerular mesangial cells which form the juxtaglomerular apparatus in combination with two other types of cells: the macula densa of the distal convoluted tubule and juxtaglomerular cells of the afferent arteriole. This apparatus controls blood pressure through the renin–angiotensin–aldosterone system.
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This question is part of the following fields:
- Physiology
- Renal
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Question 8
Correct
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A 32-year-old man presented with a metabolic acidosis and increased anion gap. What is the most likely cause of the changes of the anion gap in this patient?
Your Answer: Lactic acidosis
Explanation:High anion gap in metabolic acidosis is caused generally by the elevation of the levels of acids like ketones, lactate, sulphates in the body, which consume the bicarbonate ions. Other causes of a high anion gap include overdosing on salicylates, uraemia, rhabdomyolysis, hypocalcaemia, hypomagnesaemia, or ingestion of toxins such as ethylene glycol, methanol, propyl alcohol, cyanide and iron.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 9
Incorrect
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A 65-year-old man complains of headaches, weakness, cramps, and confusion; blood tests reveal he has severe hyponatremia. The most likely cause is:
Your Answer: Muscular weakness
Correct Answer: Severe diarrhoea or vomiting
Explanation:Hyponatraemia occurs when the sodium level in the plasma falls below 135 mmol/l. Hyponatraemia is an abnormality that can occur in isolation or, more commonly as a complication of other medical illnesses. Severe hyponatraemia may cause osmotic shift of water from the plasma into the brain cells. Typical symptoms include nausea, vomiting, headache and malaise. As the hyponatraemia worsens, confusion, diminished reflexes, convulsions, stupor or coma may occur. The cause of hyponatremia is typically classified by a person’s fluid status into low volume, normal volume, and high volume. Low volume hyponatremia can occur from diarrhoea, vomiting, diuretics, and sweating.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 10
Incorrect
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During a laparoscopic surgery, the surgeon visualizes the medical umbilical folds on the deep surface of the anterior abdominal wall. What causes the medial umbilical folds?
Your Answer: Obliterated umbilical veins
Correct Answer: Obliterated umbilical arteries
Explanation:The medial umbilical ligament is a structure found on the deep surface of the anterior abdominal wall and is covered by the medial umbilical folds. It is a paired structure that represents the remnants of the fetal umbilical artery. They have no role in humans after birth other than to be used as a landmark for exploring the medial inguinal fossa during laparoscopic inguinal hernia repair.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 11
Incorrect
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Which of the following proteins prevents red blood cells (RBCs) from bursting when they pass through capillaries?
Your Answer: Myosin
Correct Answer: Spectrin
Explanation:Spectrin is a structural protein found in the cytoskeleton that lines the intercellular side of the membrane of cells which include RBCs. They maintain the integrity and structure of the cell. It is arranged into a hexagonal arrangement formed from tetramers of spectrin and associated with short actin filaments that form junctions allowing the RBC to distort its shape.
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This question is part of the following fields:
- General
- Physiology
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Question 12
Incorrect
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A 47 year-old woman was admitted for elective cholecystectomy, with a past history of easy bruising and heavy menstrual periods. The patient was also diagnosed with Willebrand's disease. Willebrand's disease is:
Your Answer: Characterised by decreased factor VII
Correct Answer: Autosomal dominant
Explanation:von Willebrand disease is an autosomal dominant disorder marked by the deficiency of vWF, a large protein synthesized by the endothelial cells and megakaryocytes. It mediates adhesion of platelets to the subendothelium at site of vascular injury. Disease characteristics include impaired platelet adhesion, prolonged bleeding time and a functional deficiency of factor VIII (vWF is its carrier protein).
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This question is part of the following fields:
- General
- Physiology
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Question 13
Incorrect
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A histology report of a cervical biopsy taken from a patient with tuberculosis revealed the presence of epithelioid cells. What are these cells formed from?
Your Answer: Neutrophils
Correct Answer: Macrophages
Explanation:Granulomas formed in tuberculosis are called tubercles and are made up polynuclear phagocytes, Langhans cells and epithelioid cells. Macrophages when enlarged, consist of abundant cytoplasm and have a tendency of arranging themselves very closely to each other representing epithelial cells. These enlarged macrophages are therefore termed as epithelioid cells.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 14
Incorrect
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A CT scan of 65 year old male patient at an outpatient clinic suggested a bone tumour at the stylomastoid foramen. Which of the following cranial nerves is likely to be affected with this tumour?
Your Answer: XII
Correct Answer: VII
Explanation:Cranial nerve VII, the facial nerve, is found in the internal acoustic canal and runs through this canal into the facial canal before exiting through the stylomastoid foramen. In the case of a bone tumour at the stylomastoid process, the facial nerve is the nerve that will most likely be affected.
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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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When a young boy falls on his outstretched hand, he fractures one of the bones at his wrist joint. The doctors told his parents that the fractured bone has special importance as it is that bone that articulates with the distal end of the radius. Which one of the following is it?
Your Answer: Scaphoid
Explanation:It is the scaphoid bone that articulates with the radius at this level. It is located at the radial side of the wrist and is considered the largest bone in the proximal row of carpal bones. It articulates with the radius via its superior surface. This bone also articulates with trapezium and trapezoid bones via the inferior surface, capitate and lunate medially.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 16
Incorrect
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A 65-year old man, known with Type 2 diabetes and chronic renal failure, is likely to eventually present with which of the following conditions?
Your Answer: Cushing syndrome
Correct Answer: Secondary hyperparathyroidism
Explanation:When the parathyroid glands secrete excess parathyroid hormone (PTH) in response to hypocalcaemia, it is known as Secondary hyperparathyroidism and is often seen in patients with renal failure. In chronic renal failure, the kidneys fail to excrete adequate phosphorus and also fail to convert enough vitamin D to its active form. This leads to formation of insoluble calcium phosphate in the body which ultimately causes hypocalcaemia. The glands then undergo hyperplasia and hypertrophy leading to secondary hyperparathyroidism. Symptoms include bone and joint pains, along with limb deformities. The raised PTH also results in pleiotropic effects on blood, the immune system and nervous system.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 17
Incorrect
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A 60 year old female patient who has suffered an embolic stroke that affected her middle cerebral artery as revealed by a CT scan is likely to exhibit which of the following neurologic conditions?
Your Answer: Ipsilateral hemiplegia
Correct Answer: Contralateral hemiplegia
Explanation:The middle cerebral artery is a major artery that supplies blood to the cerebrum. It continues from the internal carotid artery up into the lateral sulcus. The middle cerebral artery mainly supplies the lateral aspect of the cerebral cortex, anterior aspect of the temporal lobes and the insular cortices.
Functional areas supplied by this vein are as follows:
The motor and pre-motor areas
The somato-sensory
Auditory areas
Motor speech
Sensory speech
Pre-frontal area
Occlusion of the middle cerebral artery results in:
i) A severe contralateral hemiplegia, most marked in the upper extremity and face
ii) A contralateral sensory impairment worse in the upper part of the body.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 18
Incorrect
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A 45-year-old man presents to the emergency department with an irregular pulse and shortness of breath. Electrocardiography findings show no P waves, normal QRS complexes and an irregularly irregular rhythm. The patient most probably has:
Your Answer: Ventricular fibrillation
Correct Answer: Atrial fibrillation
Explanation:Atrial fibrillation is one of the most common arrhythmias, characterised by an irregular and rapid heart rate. Due to the decreased cardiac output, atrial fibrillation increases the risk of heart failure. It can also lead to thrombus formation which may lead to thromboembolic events. Clinical findings include palpitations, shortness of breath, fatigue, chest pain and confusion. The diagnosis is made by electrocardiographic findings which include absent P wave, fibrillatory (f) waves between QRS complexes and irregularly irregular R-R intervals.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 19
Incorrect
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A 30 year old lawyer presented with a history of pleural effusions, pericarditis, arthralgia without joint deformity and episodes of myalgia for the past 12 months. Blood tests reveal a normocytic anaemia. Which of the following tests should be performed to investigate this condition further?
Your Answer: Creatine phosphokinase
Correct Answer: Antinuclear antibody test
Explanation:These non specific findings are suggestive of autoimmune disease. Antinuclear antibody (ANA) is the first test that should be performed when autoimmune diseases are suspected and later on more specific tests should be performed. This tests aids in the diagnosis of SLE, scleroderma, Sjogren’s syndrome, Raynaud’s disease, juvenile chronic arthritis, rheumatoid arthritis and antiphospholipid antibody syndrome etc. To confirm the disease a history, physical examination along with specific tests are required.
CPK is more specific for acute conditions.
ESR is a non specific test for inflammation.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 20
Incorrect
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Normally, the O2 transfer in the lungs from alveolar to capillary is perfusion-limited. In which of the following situations does it become a diffusion-limited process?
Your Answer: Chronic obstructive lung disease
Correct Answer: Pulmonary oedema
Explanation:Normally, the transfer of oxygen from air spaces to blood takes place across the alveolar-capillary membrane by simple diffusion and depends entirely on the amount of blood flow (perfusion-limited process). Diseases that affect this diffusion will transform the normal process to a diffusion limited process. Thus, the diseases which cause a thickened barrier (such as pulmonary oedema due to increased extravascular lung water or asbestosis) will limit the diffusion of oxygen. Chronic obstructive lung diseases will have little effect on diffusion. Inhaling hyperbaric gas mixtures might overcome the diffusion limitation in patients with mild asbestosis or interstitial oedema, by increasing the driving force. Strenuous (not mild) exercise might also favour diffusion limitation and decrease passage time. Increasing the rate of ventilation will not have this affect but will only maintain a high oxygen gradient from air to blood.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 21
Incorrect
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Which of the following substances will enhance the activity of antithrombin III?
Your Answer: Aspirin
Correct Answer: Heparin
Explanation:Antithrombin III is a glycoprotein that inactivates multiple enzymes involved in the coagulation system. It inactivates factor X, factor IX, factor II, factor VII, factor XI and factor XII. Its activity is greatly increased by the action of heparin.
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This question is part of the following fields:
- General
- Physiology
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Question 22
Incorrect
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One of the following structures is contained in the anterior compartment of the lower leg. Which is it?
Your Answer: Peroneus brevis muscle
Correct Answer: Extensor hallucis muscle
Explanation:The lower leg is made up of four fascial compartments separated from one another by septa that contain the muscles of the lower leg. The four compartments are ; anterior, lateral, deep posterior and superficial posterior compartments.
These are the compartments and there contents:
i) Anterior compartment: Tibialis anterior muscle, extensor hallucis longus muscle, extensor digitorum longus muscle, peroneus tertius muscles, deep fibular nerve and anterior tibial blood vessels
ii) Lateral compartment: Fibularis longus muscle, brevis muscles and superficial fibular nerve
iii) Deep posterior compartment: Tibialis posterior m., flexor hallucis longus m., flexor digitorum longus m. ,popliteus m. , tibial nerve, posterior tibial artery and posterior tibial vessels such as the fibular artery.
iv) Superficial posterior compartment: Gastrocnemius m., soleus m., plantaris m., medial sural cutaneous nerve
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 23
Incorrect
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A 25 year-old male patient was brought to the hospital due to a vehicular accident. A skull x-ray was done which revealed a fracture along the base of the middle cranial fossa. The patient has no sense of touch over the skin over his cheek and chin. Injury to the maxillary and the mandibular nerves is suspected. In which foramina do these two affected sensory branches leave the cranial cavity.
Your Answer: Foramen ovale and foramen magnum
Correct Answer: Foramen rotundum and foramen ovale
Explanation:The patient’s clinical manifestations suggests an injury to the maxillary and mandibular nerves. The maxillary branch (V2) of the trigeminal nerve (CN V) passes through and exits the skull via the pterygopalatine fossa and the foramen rotundum. At the base of the skull the foramen ovale (Latin: oval window) is one of the larger of the several holes (the foramina) that transmit nerves through the skull. The foramen ovale is situated in the posterior part of the sphenoid bone, posterolateral to the foramen rotundum. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery (small meningeal or paradural branch, sometimes derived from the middle meningeal artery), lesser petrosal nerve, a branch of the glossopharyngeal nerve and an emissary vein connecting the cavernous sinus with the pterygoid plexus of veins. Occasionally it will also carry the anterior trunk of the middle meningeal vein.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 24
Correct
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Following a fracture in the fibula, an artery contained in a fibrous canal between tibialis posterior and flexor hallucis longus was lacerated. Which of the following arteries was injured?
Your Answer: Peroneal
Explanation:The peroneal artery is deeply seated at the back of the fibular side of the leg, contained in a fibrous canal between the tibialis posterior and the flexor hallucis longus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 25
Incorrect
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During cardiac catheterisation in a 20-year old man, the following data is obtained: Pressure (mmHg), O2 saturation (%) Right atrium 7 (N = 5) 90 (N = 75), Right ventricle 35/7 (N = 25/5) 90 (N = 75), Pulmonary artery 35/8 (N = 25/15), 90 (N = 75), Left atrium 7 (N = 9) 95 (N = 95), Left ventricle 110/7 (N = 110/9) 95 (N = 95), Aorta 110/75 (N = 110/75) 95 (N = 95) where N = Normal value. What is the likely diagnosis?
Your Answer: Pulmonary stenosis
Correct Answer: Atrial septal defect
Explanation:A congenital heart disease, ASD or atrial septal defect leads to a communication between the right and left atria due to a defect in the interatrial septum. This leads to mixing of arterial and venous blood from the right and left side of the heart. The hemodynamic significance of this defect depends on the presence of shunting of blood. Normally, the left side of the heart has higher pressure than the right as the left side has to pump blood throughout the body. A large ASD (> 9 mm) will result in a clinically significant left-to-right shunt, causing volume overload of the right atrium and ventricle, eventually leading to heart failure. Cardiac catheterization would reveal very high oxygen saturation in the right atrium, right ventricle and pulmonary artery. Eventually, the left-to-right shunt will lead to pulmonary hypertension and increased afterload in the right ventricle, along with the increased preload due to the shunted blood. This will either cause right ventricular failure, or raise the pressure in the right side of the heart to equal or more than that in the left. Elevation of right atrial pressure to that of left atrial pressure would thus lead to diminishing or complete cessation of the shunt. If left uncorrected, there will be reversal of the shunt, known as Eisenmenger syndrome, resulting in clinical signs of cyanosis as the oxygen-poor blood form right side of the heart will mix with the blood in left side and reach the peripheral vascular system.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 26
Incorrect
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Passing through the lesser sciatic foramen are the:
Your Answer: Nerve to quadratus femoris
Correct Answer: Pudendal nerve
Explanation:Structures that pass through the lesser sciatic foramen include:
– the pudendal nerve
– the nerve to obturator internus
– internal pudendal artery
– the tendon of obturator internus
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 27
Correct
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Regarding abduction of the digits of the hand, which of the following is correct?
Your 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 28
Incorrect
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A 55 year old lady underwent an uneventful appendicectomy. Two hours later, her arterial blood gas analysis on room revealed pH: 7.30, p(CO2): 53 mmHg and p(O2): 79 mmHg. What is the most likely cause of these findings?
Your Answer:
Correct Answer: Alveolar hypoventilation
Explanation:In the given problem, there is respiratory acidosis due to hypercapnia from a low respiratory rate and/or volume (hypoventilation). Causes of hypoventilation include conditions impairing the central nervous system (CNS) respiratory drive, impaired neuromuscular transmission and other causes of muscular weakness (drugs and sedatives), along with obstructive, restrictive and parenchymal pulmonary disorders. Hypoventilation leads to hypoxia and hypercapnia reduces the arterial pH. Severe acidosis leads to pulmonary arteriolar vasoconstriction, systemic vascular dilatation, reduced myocardial contractility, hyperkalaemia, hypotension and cardiac irritability resulting in arrhythmias. Raised carbon dioxide concentration also causes cerebral vasodilatation and raised intracranial pressure. Over time, buffering and renal compensation occurs. However, this might not be seen in acute scenarios where the rise in p(CO2) occurs rapidly.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 29
Incorrect
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The mechanism of action of streptokinase involves:
Your Answer:
Correct Answer: Direct conversion of plasminogen to plasmin
Explanation:Streptokinase is an enzyme that is produced by group A beta haemolytic streptococcus and is an effective and cost efficient method for the dissolution of a clot used in cases of MI and pulmonary embolism. It works by directly converting plasminogen to plasmin which breaks down the blood components in the clot and fibrin, dissolving the clot. Streptokinase is a bacterial product and thus the body will develop immunity against it.
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This question is part of the following fields:
- General
- Physiology
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Question 30
Incorrect
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Which of the following muscles winds around the pterygoid hamulus?
Your Answer:
Correct Answer: Tensor veli palatini
Explanation:The tensor veli palatini tenses the soft palate and by doing so, assists the levator veli palatini in elevating the palate to occlude and prevent entry of food into the nasopharynx during swallowing. It arises by a flat lamella from the scaphoid fossa at the base of the medial pterygoid plate, from the spina angularis of the sphenoid and from the lateral wall of the cartilage of the auditory tube. Descending vertically between the medial pterygoid plate and the medial pterygoid muscle, it ends in a tendon which winds around the pterygoid hamulus, being retained in this situation by some of the fibres of origin of the medial pterygoid muscle. Between the tendon and the hamulus is a small bursa. The tendon then passes medialward and is inserted onto the palatine aponeurosis and the surface behind the transverse ridge on the horizontal part of the palatine bone.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 31
Incorrect
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A 56-year-old woman weighs 75 kg. In this patient, total body water, intracellular fluid and extracellular fluid are respectively:
Your Answer:
Correct Answer: 45 l, 30 l, 15 l
Explanation:The percentages of body water contained in various fluid compartments add up to total body water (TBW). This water makes up a significant fraction of the human body, both by weight and by volume. The total body water (TBW) content of humans is approximately 60% of body weight. Two-thirds is located in the intracellular and one-third in the extracellular compartment. So, in a 75-kg individual, TBW = 60 × 75/100 = 45 l. Intracellular content = 2/3 × 45 = 30 l and extracellular content = 1/3 × 45 = 15 l.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 32
Incorrect
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What is the role of ICAM-1 and VCAM-1 in the inflammatory process?
Your Answer:
Correct Answer: Leukocyte adhesion
Explanation:Steps involved in leukocyte arrival and function include:
1. margination: cells migrate from the centre to the periphery of the vessel.
2. rolling: selectins are upregulated on the vessel walls.
3. adhesion: upregulation of the adhesion molecules ICAM and VCAM on the endothelium interact with integrins on the leukocytes. Interaction of these results in adhesion.
4. diapedesis and chemotaxis: diapedesis is the transmigration of the leukocyte across the endothelium of the capillary and towards a chemotactic product.
5. phagocytosis: engulfing the offending substance/cell.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 33
Incorrect
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Which organ is responsible for the secretion of enzymes that aid in digestion of complex starches?
Your Answer:
Correct Answer: Pancreas
Explanation:α-amylase is secreted by the pancreas, which is responsible for hydrolysis of starch, glycogen and other carbohydrates into simpler compounds.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 34
Incorrect
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An 80 year-old lady presents to the out patient clinic complaining of chest pain of 2 months' duration with a normal electrocardiogram and cardiac enzymes. A computed tomographic scan is done which reveals a mass lesion involving a structure in the middle mediastinum. Which among the following structures could be involved?
Your Answer:
Correct Answer: Ascending aorta
Explanation:The middle mediastinum is the broadest part of the mediastinal cavity containing the heart enclosed in the pericardium, ascending aorta, lower half of the superior vena cava with the azygos vein opening into it, the bifurcation of the trachea and the two bronchi, the pulmonary artery with its branches, pulmonary veins, phrenic nerves and bronchial lymph nodes. The most likely structure involved is the ascending aorta, perhaps with an aneurysm.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 35
Incorrect
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Which is the correct statement regarding gonadal venous drainage:
Your Answer:
Correct Answer: The left ovarian vein drains into the left renal vein
Explanation:Spermatic or testicular veins arise from the posterior aspect of the testis and receive tributaries from the epididymis. Upon uniting, they form the pampiniform plexus that makes up the greater mass of the spermatic cord. The vessels that make up this plexus rise up the spermatic cord in front of the ductus deferens. They then unite, below the superficial ring, to form three or four veins that traverse the inguinal canal and enter the abdomen through the deep inguinal ring. They further unite to form 2 veins that ascend up the psoas major muscle behind the peritoneum each lying on either side of the testicular artery. These further unite to form one vein that empties on the right side of the inferior vena cava at an acute angle and on the left side into the renal vein, at a right angle. The left testicular vein courses behind the iliac colon and is thus exposed to pressure from the contents of this part of the bowel. The ovarian vein is the equivalent of the testicular vein in women. They form a plexus in the broad ligament near the ovary and uterine tube and communicate with the uterine plexus. They drain into similar vessels as in a man.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 36
Incorrect
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Question 37
Incorrect
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A Monospot test in a 17-year old boy presenting with fever, multiple palpable lymph nodes and mild icterus was positive. His blood investigation is likely to show which of the following?
Your Answer:
Correct Answer: Atypical lymphocytosis
Explanation:Epstein-Barr virus is the causative agent for infectious mononucleosis leading to presence of atypical lymphocytes in blood. Usually symptomatic in older children and adults, the incubation period is 30-50 days. Symptoms include fatigue, followed by fever, adenopathy and pharyngitis. Fatigue can last for months and is maximum in first few weeks. Fever spikes in the afternoon or early evening, with temperature around 39.5 – 40.5 °C. The ‘typhoidal’ form where fatigue and fever predominate has a low onset and resolution. Pharyngitis resemble that due to streptococcus and can be severe and painful. Lymphadenopathy is bilaterally symmetrical and can involve any nodes, specially the cervical ones. Mild splenomegaly is seen in 50% cases, usually in 2-3rd week. Mild tender hepatomegaly can occur. Less common manifestations include maculopapular eruptions, jaundice, periorbital oedema and palatal enanthema. Diagnostic tests include full blood count and a heterophil antibody test. Morphologically abnormal lymphocytes account for 80% cells and are heterogenous, unlike leukaemia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 38
Incorrect
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What is the chief ligament preventing posterior sliding of the tibia on the femur ?
Your Answer:
Correct Answer: Posterior cruciate
Explanation:The posterior cruciate ligament is attached to the posterior intercondyloid fossa of the tibia and the lateral and front part of the medial condyle of the femur. It resists sliding of the tibia posteriorly.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 39
Incorrect
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Which of these nerves controls adduction of hand?
Your Answer:
Correct 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 40
Incorrect
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The posterior boundary of the carotid triangle is bounded by which of the following muscles?
Your Answer:
Correct Answer: Sternocleidomastoid
Explanation:The carotid triangle is a portion of the anterior triangle of the neck. It is bounded superiorly by the posterior belly of the digastric muscle, antero-inferiorly by the superior belly of omohyoid and posteriorly by the sternocleidomastoid. The floor is formed by the thyrohyoid, hyoglossus, middle and inferior pharyngeal constrictors and the roof is formed by the skin, superficial fascia, platysma and deep fascia.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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