-
Question 1
Correct
-
The histological exam of a tuberculous granuloma shows a periphery of multinuclear giant cells, with a central area of:
Your Answer: Caseous necrosis
Explanation:Granulomas with necrosis tend to have an infectious cause. The chronic infective lesion in this case typically presents with a central area of caseous (cheese-like) necrosis. Foam cells are the fat-laden M2 macrophages seen in atherosclerosis
-
This question is part of the following fields:
- Cell Injury & Wound Healing; Dermatology
- Pathology
-
-
Question 2
Correct
-
The following organs would be expected to lie within the right lower quadrant of the abdomen, assuming that the gastrointestinal tract is rotated normally:
Your Answer: Distal jejunum, caecum, vermiform appendix
Explanation:The abdomen is divided by theoretical anatomic lines into four quadrants. The median plane follows the linea alba and extends from the xiphoid process to the pubic symphysis and splits the abdomen in half. The transumbilical plane is a horizontal line that runs at the level of the umbilicus. This forms the upper right and left quadrants and the lower right and left quadrants. Structures in the right lower quadrant include: caecum, appendix, part of the small intestine, ascending colon, the right half of the female reproductive system, right ureter. Pain in this region is most commonly associated with appendicitis.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 3
Correct
-
A 24-year old patient diagnosed with a direct inguinal hernia was scheduled for surgery to have the hernia repaired. The hernia was discovered to be protruding through the Hesselbach's triangle (inguinal triangle). Which of the following blood vessels that is a branch of the external iliac artery forms the lateral border of this triangle?
Your Answer: Inferior epigastric
Explanation:The inguinal triangle is formed by the following structures; inguinal ligament at the base; inferior epigastric vessels laterally and the lateral border of the rectus sheath medially. This triangle (also known as Hesselebach’s triangle) is where direct inguinal hernias protrude. The inferior epigastric artery is this the branch of the external iliac artery being referred to. All the other blood vessels are branches of the internal iliac artery.
-
This question is part of the following fields:
- Anatomy
- Pelvis
-
-
Question 4
Correct
-
Which of the following is true regarding factor XI?
Your Answer: Deficiency causes haemophilia C
Explanation:Factor XI is also known as plasma thromboplastin and is one of the enzymes of the coagulation cascade. It is produced in the liver and is a serine protease. It is activated by factor XIIa, thrombin and by itself. Deficiency of factor XI causes the rare type of haemophilia C. Low levels of factor XI also occur in other disease states, including Noonan syndrome. High levels of factor XI have been seen in thrombosis.
-
This question is part of the following fields:
- General
- Physiology
-
-
Question 5
Incorrect
-
An 80 year-old quadriplegic man has been lying supine for 7 weeks in a critical care ward. He develops a right lung abscess that is draining by gravity to a particular region of the lung. Which is the most likely site of pus collection?
Your Answer: Lower lobe
Correct Answer: Superior segment of the lower lobe
Explanation:The superior segmental bronchus of the lower lobe of the right lung branches posteriorly off the intermediate bronchus or the inferior lobe bronchus. It is therefore more likely to receive fluid or foreign bodies that enter the right main bronchus especially when the patient is supine.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 6
Correct
-
Which structure holds the duodenojejunal flexure in place?
Your Answer: Suspensory ligament (of Treitz)
Explanation:The duodenum is connected to the diaphragm by the suspensory ligament called the ligament of Treitz. It is a slip of skeletal muscle from the right crus of the diaphragm and a fibromuscular band of smooth muscle from the 3rd and 4th parts of the duodenum. It is an important landmark, used to divide the gastrointestinal tract into the upper and lower parts. Contraction of this ‘ligament’ leads to opening of the duodenojejunal flexure allowing the flow of chyme.
-
This question is part of the following fields:
- Abdomen
- Anatomy
-
-
Question 7
Incorrect
-
Which of the following is the most likely cause of massive splenomegaly in a 35-year old gentleman?
Your Answer: Sickle cell anaemia
Correct Answer: Myelofibrosis
Explanation:Causes of massive splenomegaly include chronic myelogenous leukaemia, chronic lymphocytic leukaemia, lymphoma, hairy cell leukaemia, myelofibrosis, polycythaemia vera, sarcoidosis, Gaucher’s disease and malaria.
-
This question is part of the following fields:
- Haematology
- Pathology
-
-
Question 8
Incorrect
-
How much blood can the pulmonary vessels of a 45-year-old healthy man accommodate when he is at rest?
Your Answer: 150 ml
Correct Answer: 500 ml
Explanation:Pulmonary circulation is the portion of the cardiovascular system which carries deoxygenated blood away from the heart, to the lungs, and returns oxygenated blood back to the heart. The vessels of the pulmonary circulation are very compliant (easily distensible) and so typically accommodate about 500 ml of blood in an adult man. This large lung blood volume can serve as a reservoir for the left ventricle, particularly during periods when left ventricular output momentarily exceeds venous return.
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 9
Incorrect
-
A butcher accidentally cut himself on his right index finger. Which of the following substances when in contact with the basement membrane of the injured vasculature will activate the coagulation cascade as well as the kinin system in a first response to this injury?
Your Answer: Platelet activating factor
Correct Answer: Hageman factor
Explanation:Hageman factor/factor XII in the intrinsic pathway activates prekallikrein and factor XI. Deficiency will not cause excessive bleeding as other coagulation factors will be utilized but the PTT will be greater than 200 seconds.
Thromboxane promotes platelet aggregation and causes vasoconstriction.
Plasmin, which is cleaved from plasminogen acts as an anticoagulant which breaks down thrombi.
Platelet activating factor promotes platelet aggregation and is also chemotactic to neutrophils.
Histamine acts as a vasodilator.
Platelet inhibiting factor acts an anticoagulant.
Renin is a hormone released from the kidney that causes vasoconstriction and water retention.
-
This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
-
-
Question 10
Correct
-
Basal Metabolic Rate (BMR) will most likely be reduced by which of the following?
Your Answer: Decrease in body temperature
Explanation:The basal metabolic rate (BMR) is defined as the rate of calorie consumption after an overnight fast, in the absence of any muscular activity, with the patient in a restful state. Various factors affect the BMR including weight, body surface area and age. The BMR is 30 kcal/m2 per hour at birth; at age 2, the rate is 57 kcal/m2 per hour; and at age 20, 41 kcal/m2 per hour. After this, the BMR decreases by 10% between 20-60 years of age. Women are known to have a 10% lower BMR than men (due to higher fat content). A one-degree change in body temperature leads to a 10% change in BMR in the same direction. However, shivering and increasing ambient temperature brings about a rise in BMR, and so does stress, physical activity, caffeine, theophylline and hyperthyroidism. Also, thermogenesis induced by diet results in increased metabolic rate and hence, BMR should be ideally measured after overnight fasting.
-
This question is part of the following fields:
- Gastroenterology
- Physiology
-
-
Question 11
Correct
-
Which of these is secreted by both macrophages and muscle cells?
Your Answer: Interleukin-6
Explanation:IL-6 is secreted by the T cells and macrophages and is a pro inflammatory cytokine. It is secreted in response to trauma e.g. burns and tissue damage that leads to inflammation. Apart from this its is also a myokine and is elevated due to muscle contraction. Other functions include: stimulate osteoclast formation when secreted by osteoblasts, mediate fever in acute phase response and are responsible for energy metabolism in muscle and fatty tissues. Inhibitors of IL-6 e.g. oestrogen are used as a treatment for postmenopausal osteoporosis.
-
This question is part of the following fields:
- Inflammation & Immunology
- Pathology
-
-
Question 12
Incorrect
-
Arterial blood gas analysis of a man admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD) showed the following: pH = 7.28, p(CO2) = 65.5 mmHg, p(O2)= 60 mmHg and standard bicarbonate = 30.5 mmol/l. This patient had:
Your Answer: Mixed acidosis
Correct Answer: Respiratory acidosis
Explanation:Acidosis with high p(CO2) and normal standard bicarbonate indicates respiratory acidosis, commonly seen in acute worsening of COPD patients. Respiratory acidosis occurs due to alveolar hypoventilation which leads to increased arterial carbon dioxide concentration (p(CO2)). This in turn decreases the HCO3 –/p(CO2) and decreases pH. In acute respiratory acidosis, the p(CO2) is raised above the upper limit of normal (over 45 mm Hg) with a low pH. However, in chronic cases, the raised p(CO2) is accompanied with a normal or near-normal pH due to renal compensation and an increased serum bicarbonate (HCO3 – > 30 mmHg).
-
This question is part of the following fields:
- Physiology
- Respiratory
-
-
Question 13
Incorrect
-
Which of the following structures lying posterior to the ovary are at risk of injury in excision of a malignant tumour in the right ovary?
Your Answer: Uterine tube
Correct Answer: Ureter
Explanation:The ovaries are two nodular structures situated one on either side of the uterus in relation to the lateral wall of the pelvis and attached to the back of the broad ligament of the uterus, lying posteroinferiorly to the fallopian tubes. Each ovary has a lateral and medial surface. The ureter is at greater risk of iatrogenic injury at this location.
-
This question is part of the following fields:
- Anatomy
- Pelvis
-
-
Question 14
Correct
-
If a tumour is found in both lobes of the prostate, without nodal involvement or metastases, a histological grade of G2 and elevated PSA, what is the overall prostatic cancer stage?
Your Answer: Stage II
Explanation:The AJCC uses the TNM, Gleason score and PSA levels to determine the overall stage of prostatic cancer. This staging is as follows:
Stage I: T1, N0, M0, Gleason score 6 or less, PSA less than 10; or T2a, N0, M0, Gleason score 6 or less, PSA less than 10
Stage IIa: T1, N0, M0, Gleason score of 7, PSA less than 20; or T1, N0, M0, Gleason score of 6 or less, PSA at least 10 but less than 20; or T2a or T2b, N0, M0, Gleason score of 7 or less, PSA less than 20
Stage IIb: T2c, N0, M0, any Gleason score, any PSA; or T1 or T2, N0, M0, any Gleason score PSA of 20 or more; or T1 or T2, N0, M0, Gleason score of 8 or higher, any PSA
Stage III: T3, N0, M0, any Gleason score, any PSA Stage IV: T4, N0, M0,any Gleason score, any PSA; or any T, N1, M0,any Gleason score, any PSA; or Any T, any N, M1, any Gleason score, any PSA.
The patient in this case has a T2 N0 M0 G2 tumour, meaning it belongs in stage II
-
This question is part of the following fields:
- Pathology
- Urology
-
-
Question 15
Correct
-
Which of the following key features will be seen in an organ undergoing atrophy?
Your Answer: A greater number of autophagic vacuoles
Explanation:Atrophy is characterised by the breakdown of intracellular components along with organelles and packing them into vacuoles known as autophagic vacuoles. This is an adaptive response that separates the damaged cellular structures from the rest of the cells.
-
This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
-
-
Question 16
Correct
-
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.
-
This question is part of the following fields:
- Hepatobiliary
- Physiology
-
-
Question 17
Incorrect
-
A 40 year old man from Japan was diagnosed with cancer of the oesophagus. He is to undergo esophagectomy. While mobilizing the oesophagus in the neck, for resection and anastomosis with the stomach tube on the left side, the surgeon must be cautious not to injure a vital structure. Which of the following is it?
Your Answer: Azygos vein
Correct Answer: Thoracic duct
Explanation:The oesophagus is divided into 3 portions: cervical (part that is in the neck), thoracic portion and the abdominal portion. The cervical part is bordered by the trachea anteriorly and the prevertebral fascia covering the bodies of the 6,7 and 8th vertebra posteriorly. The thoracic duct lies on the left side at the level of the sixth cervical vertebra. The carotid sheath with its contents and lower poles of the lateral lobes of thyroid gland are lateral. The thoracic duct is the structure most likely to be injured.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 18
Incorrect
-
What intrinsic muscle of the larynx is responsible for the tensing of the vocal cords?
Your Answer: Arytenoid muscle
Correct Answer: Cricothyroid muscle
Explanation:The cricothyroid muscle is the only tensor muscle of the larynx aiding with phonation. It attaches to the anterolateral aspect of the cricoid and the inferior cornu and lower lamina of the thyroid cartilage. Its action tilts the thyroid forward to help tense the vocal cords.
-
This question is part of the following fields:
- Anatomy
- Head & Neck
-
-
Question 19
Correct
-
Which of the following is NOT true regarding malignant hyperpyrexia
Your Answer: It can be caused by nitrous oxide
Explanation:Malignant hyerpyrexia occurs in 1 in 150,000. All inhalational anaesthetic agents and suxamethonium, except nitrous oxide can cause malignant hyperpyrexia.
-
This question is part of the following fields:
- Pathology
- Pharmacology
-
-
Question 20
Incorrect
-
In the case of an injury to the sub sartorial canal, which of the following structures is most likely to be injured?
Your Answer: Nerve to sartorius
Correct Answer: Nerve to vastus medialis
Explanation:The adductor canal (sub sartorial canal) is situated in the middle third of the thigh.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 21
Incorrect
-
The transmembrane proteins responsible for resting membrane potential of vascular smooth muscle cells was blocked by a drug. Which of the following transmembrane proteins were blocked by this drug?
Your Answer: Ca2+ channels
Correct Answer: K+ channels
Explanation:The resting membrane potential is due to selective permeability of the membrane to potassium ions. The Na/K pump is responsible for the generation of a gradient across the membrane and it is due to the inherent ability of the K channels to allow diffusion back into the nerve at rest which charges the cells. In reality, the resting membrane potential is more positive because of small contributions by Na+ channels, Cl− channels and non-selective cation channels.
-
This question is part of the following fields:
- General
- Physiology
-
-
Question 22
Correct
-
What is expected from complete transection of the inferior gluteal nerve when it emerges from the greater sciatic foramen?
Your Answer: Extension of the thigh would be the action most affected
Explanation:As the inferior gluteal nerve emerges from the greater sciatic foramen below the piriformis muscle, it divides into branches and enters the gluteus maximus muscle which extends the femur and bends the thigh in line with the body.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 23
Incorrect
-
The specimen sent to the pathologist for examination was found to be benign. Which one of the following is most likely a benign tumour?
Your Answer: Haematoma
Correct Answer: Warthin’s tumour
Explanation:Warthin’s tumour is also known as papillary cystadenoma lymphomatosum. It is a benign cystic tumour of the salivary glands containing abundant lymphocytes and germinal centres. It has a slightly higher incidence in males and most likely occur in older adults aged between 60 to 70 years. This tumour is also associated with smoking. Smokers have an eight-fold greater risk in developing the tumour compared to non-smokers.
-
This question is part of the following fields:
- Neoplasia
- Pathology
-
-
Question 24
Incorrect
-
Mallory bodies are characteristic of which of the following conditions?
Your Answer: Cholangiocarcinoma
Correct Answer: Alcoholic hepatitis
Explanation:Mallory bodies (or ‘alcoholic hyaline’) are inclusion bodies in the cytoplasm of liver cells, seen in patients of alcoholic hepatitis; and also in Wilson’s disease. These pathological bodies are made of intermediate keratin filament proteins that are ubiquinated or bound by proteins like heat chock protein. Being highly eosinophilic, they appear pink on haematoxylin and eosin staining.
-
This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
-
-
Question 25
Incorrect
-
Below which level of the spinal cord will the inferior gluteal nerve be unaffected?
Your Answer: S2
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.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 26
Incorrect
-
A 26-year-old female patient had the following blood report: RBC count = 4. 0 × 106/μl, haematocrit = 27% and haemoglobin = 11 g/dl, mean corpuscular volume (MCV) = 90 fl, mean corpuscular haemoglobin concentration (MCHC) = 41 g/dl. Further examination of blood sample revealed increased osmotic fragility of the erythrocytes. Which of the following is the most likely cause of this patient’s findings?
Your Answer: Thalassaemia
Correct Answer: Spherocytosis
Explanation:Spherocytes are small rounded RBCs. It is due to an inherited defect of the RBC cytoskeleton membrane tethering proteins. Membrane blebs form that are lost over time and cells become round instead of biconcave. As it is a normochromic anaemia, the MCV is normal. it is diagnosed by osmotic fragility test which reveals increased fragility in a hypotonic solution.
-
This question is part of the following fields:
- General
- Physiology
-
-
Question 27
Correct
-
The likely cause of a tender and swollen breast in a lactating mother is:
Your Answer: Acute mastitis
Explanation:Acute mastitis results due to bacterial infection of the breast and results in signs of inflammation. It commonly occurs 2-3 weeks postpartum and common causative microorganisms are Staphylococcus aureus, Streptococcus species, and Escherichia coli. Complications like an abscess can be avoided by prompt treatment, which includes antibiotics and rest along with continued lactation.
-
This question is part of the following fields:
- Pathology
- Women's Health
-
-
Question 28
Incorrect
-
Bloody discharge from the nipple of a 40-year old woman with no obvious lump or abnormality on mammography is suggestive of:
Your Answer: Mastitis
Correct Answer: Intraductal papilloma
Explanation:A small benign tumour, namely intraductal papilloma is most common in women between 35-55 years of age. It is also the commonest cause of spontaneous discharge from a single duct. A lump below the nipple may be sometimes palpable. Ultrasound and ductography are useful investigations., along with cytology of discharge to assess the presence of malignant cells. Confirmation is by breast biopsy.
-
This question is part of the following fields:
- Pathology
- Women's Health
-
-
Question 29
Correct
-
A 42 year old man presents with end stage renal failure and is prepared to receive a kidney from his best friend. HLA testing showed that they are not a 100% match and he is given immunosuppressant therapy for this. Three months later when his renal function is assessed, he showed signs of deteriorating renal function, with decreased renal output, proteinuria of +++ and RBCs in the urine. He was given antilymphocyte globulins and his condition reversed. During the crisis period the patient is likely to be suffering from?
Your Answer: Acute rejection
Explanation:This patients is most likely experiencing an acute rejection. It is a cell mediated attack against the organ that has been transplanted. Antigens are either presented by blood borne cells with in the graft or antigen presenting cells in the body may be presenting class I and class II molecules that have been shed by the graft. Class I will activate CD8 and class II, CD4 cells, both of which will attack the graft.
Chronic rejection is a slow process which occurs months to years after the transplant. The exact mechanism is not very well understood but it probably involves a combination of Type III and Type IV hypersensitivity directed against the foreign MHC molecules which look like self-MHC presenting a foreign antigen.
Hyperacute Transplant Rejection occurs almost immediately and is often evident while you are still in surgery. It is caused by accidental ABO Blood type mismatching of the donor and recipient which almost never happens anymore. This means the host has preformed antibodies against the donated tissue.
-
This question is part of the following fields:
- Inflammation & Immunology; Renal
- Pathology
-
-
Question 30
Incorrect
-
A 46-year old lady presents with chief complaints of a large mass in the left breast. Histopathology of the mass revealed a stromal component with an epithelial component. What is the likely lesion?
Your Answer: Focal fat necrosis
Correct Answer: Phyllodes tumour
Explanation:Phyllodes tumours are large, quickly growing tumours which arise from the periductal stroma of the breast. These are fibroepithelial tumours and account for less than 1% of breast cancers. These tumours can be benign, borderline or malignant based on the histology. The tumour usually affects adult women, mostly between the age of 40 to 50 years. It can be confused with fibroadenoma, which however affects much younger patients.
-
This question is part of the following fields:
- Pathology
- Women's Health
-
SESSION STATS - PERFORMANCE PER SPECIALTY
