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Question 1
Correct
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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: 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 2
Incorrect
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Which of the following structures carry part of the right bundle branch of the AV bundle?
Your Answer: Anterior papillary muscle of the left ventricle
Correct Answer: Moderator band (septomarginal trabecula)
Explanation:The moderator band extends from the base of the anterior papillary muscle to the ventricular septum. It is the structure which carries part of the right AV bundle. Its role it to prevent overdistention of the ventricle.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 3
Correct
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After a total colectomy and ileotomy, a 50-year old diabetic man who was a known case of diabetic nephropathy had persistent metabolic acidosis. The patient appeared well perfused, with normal vital signs and normal fluid balance. Investigations revealed:
Sodium = 132 mmol/l
Potassium = 6.6 mmol/l
Creatinine = 185 μmol/l (2.16 mg/dl)
Chloride = 109 μmol/l
8am cortisol = 500 nmol/l (18 μg/dl)
pH = 7.29, p(CO2) = 27 mmHg
p(O2) = 107 mmHg
standard bicarbonate = 12 mmol/l.
What is the likely causes of his acidosis?Your Answer: Renal tubular acidosis
Explanation:Acidosis here is due to low bicarbonate. The low p(CO2) is seen in compensation. The anion gap is normal, ruling out intra-abdominal ischaemia (which leads to metabolic acidosis). If it was a gastrointestinal aetiology, low potassium would be seen. The history of diabetic nephropathy predisposes to renal tubular acidosis. Type 4 (hyporeninaemic hypoaldosteronism) is associated with high potassium and is found in diabetic and hypertensive renal disease.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 4
Incorrect
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Regarding innervation to the peroneus brevis muscle:
Your Answer: Is by the same distal nerve that innervates the peroneus tertius muscle
Correct Answer: Could be damaged by a fracture of the neck of the fibula
Explanation:The peroneus brevis is supplied by the fourth and fifth lumbar and first sacral nerves through the superficial peroneal nerve which is one of the two terminal branches of the common peroneal nerve. The common peroneal nerve winds around the neck of the fibula and can be injured in cases of fractured neck of fibula.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 5
Correct
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Signals pass through neuromuscular junctions via the neurotransmitter acetylcholine. After release from the skeletal neuromuscular junction, acetylcholine:
Your Answer: Causes postsynaptic depolarisation
Explanation:Acetylcholine is released from the presynaptic membrane into the cleft where it binds to the ion gated channels on the post synaptic membrane, causing them to open. This results in sodium entering into the fibre and further depolarizing it, creating an action potential.
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This question is part of the following fields:
- General
- Physiology
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Question 6
Correct
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Which of the following structures is not easily palpable?
Your Answer: Styloid process of the temporal bone
Explanation:The styloid process is a thin, pointed process that projects antero-inferiorly from the base of the petrous temporal bone. It can vary in length from a short, stubby process to a slender, four to five centimetre rod. It forms from the cranial elements of the second pharyngeal arch. The tympanic plate of the temporal bone ensheathes the base of this process. The pointed, projecting portion of the process provides attachment to the stylohyoid and stylomandibular ligaments, and to three muscles – the styloglossus, stylohyoid, and stylopharyngeus. As the styloid process is covered by the various muscles, it is not easily palpable in live subjects.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 7
Incorrect
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Gastric acid secretion is stimulated by which of the following?
Your Answer: Secretin
Correct Answer: Gastrin
Explanation:Gastric acid secretion is stimulated by three factors:
– Acetylcholine, from parasympathetic neurones of the vagus nerve that innervate parietal cells directly
– Gastrin, produced by pyloric G-cells
– Histamine, produced by mast cells.
Gastric acid is inhibited by three factors:
– Somatostatin
– Secretin
– Cholecystokinin
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 8
Incorrect
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An elderly, diabetic man has firm, tender nodules at the base of his left middle and ring fingers, which he can't extend fully. What's the most likely diagnosis?
Your Answer: Dystrophic calcification
Correct Answer: Fibromatosis
Explanation:This case is suggestive of Dupuytren’s contracture due to palmar fibromatosis. Its incidence is higher in men over the age of 45 years, and it increases in patients with diabetes, alcoholism, or epilepsy. These nodules are benign, usually appearing as a tender nodule in the palm which becomes painless. The disease has an aggressive clinical behaviour and recurs frequently.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 9
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 10
Correct
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A glycogen storage disorder is characterised by increased liver glycogen with a normal structure and no increase in serum glucose after oral intake of a protein-rich diet. Deficiency of which of the following enzymes is responsible for this disorder?
Your Answer: Glucose-6-phosphatase
Explanation:The most common glycogen storage disorder is von Gierke’s disease or glycogen storage disease type I. It results from a deficiency of enzyme glucose-6-phosphatase which affects the ability of liver to produce free glucose from glycogen and gluconeogenesis; leading to severe hypoglycaemia. There is also increased glycogen storage in the liver and kidneys causing enlargement and various problems in their functioning. The disease also causes lactic acidosis and hyperlipidaemia. The main treatment includes frequent or continuous feedings of corn-starch or other carbohydrates.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 11
Incorrect
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During an inguinal hernia repair, an incision is made parallel to and 5cm above the inguinal ligament. The registrar is warned to look out for the inferior epigastric vessels to avoid damage. Between which layers of the abdominal wall is the registrar likely to find these vessels?
Your Answer: Transversalis fascia and peritoneum
Correct Answer: Transversus abdominis muscle and peritoneum
Explanation:The inferior epigastric vessels lie on the inner surface of the transversus abdominis muscle covered by the parietal peritoneum. This layer of peritoneum lies over the inferior epigastric vessels to make the lateral umbilical fold. Camper’s and Scarpa’s fascia are two layers of the superficial fascia, the fatty layer and the membranous layer respectively.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 12
Correct
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A 50 year old man was admitted to the surgical ICU following a hemicolectomy for carcinoma of the caecum. A full blood count revealed: haematocrit = 30%, erythrocytes = 4 × 106/μ, haemoglobin level = 8 g/dl. To determine the likely cause of his anaemia, red blood cell indices were calculated. Which RBC indices are correct?
Your Answer: MCHC = haemoglobin concentration/haematocrit
Explanation:Mean corpuscular haemoglobin concentration (MCHC) is calculated simply by dividing the haemoglobin concentration (8 g/dl) by the haematocrit (0.3). The normal range is 31–36 g/dl. This patient has a hypochromic anaemia (MCHC = 8/0.3 = 26.7 g/dl). Dividing the haemoglobin concentration × 10 by erythrocyte number yields mean corpuscular haemoglobin (MCH). Normal range is 25.4–34.6 pg/cell and this patient has a significantly reduced cellular haemoglobin content (MCH = 8 × 10/4 = 20 pg/cell). Mean corpuscular volume (MCV) is calculated by dividing haematocrit × 1000 by erythrocyte number (4 × 106/μl). Normal range is 80–100 fl and this patient has a microcytic anaemia (MCV = 0.3 × 1000/4 = 75 fl). Microcytic, hypochromic anaemia is characteristic for iron-deficiency.
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This question is part of the following fields:
- General
- Physiology
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Question 13
Correct
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A 90-year-old man is prescribed spironolactone after his family notices his legs are swollen. What class of drugs does spironolactone belong to?
Your Answer: Potassium-sparing diuretics
Explanation:Spironolactone is a renal competitive aldosterone antagonist in a class of drugs called ‘potassium-sparing diuretics’, that is primarily used to treat fluid build-up due to heart failure, liver scarring, or kidney disease. It is also used in the treatment of high blood pressure, low blood potassium, early-onset puberty, and acne and excessive hair growth in women. Spironolactone inhibits the effect of aldosterone by competing for intracellular aldosterone receptors in the distal tubule cells. This increases the secretion of water and sodium, while decreasing the excretion of potassium.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 14
Correct
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After severe injury of the upper limb following an accident. The humerus is injured as well as the nerve which innervates the muscles of the anterior compartment of the arm. Which nerve is injured?
Your Answer: Musculocutaneous
Explanation:The musculoskeletal nerve supplies the muscles of the anterior compartment of the arm including the coracobrachialis, biceps brachii and the greater part of the brachialis. This nerve derives its fibres from the fifth, sixth and seventh cervical nerves and arises from the lateral cord of the brachial plexus. It also provides a branch to the elbow joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 15
Incorrect
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A 54-year-old woman with amyotrophic lateral sclerosis is diagnosed with respiratory acidosis. The patient’s renal excretion of potassium would be expected to:
Your Answer: Rise, since acid and potassium excretion are coupled
Correct Answer: Fall, since tubular secretion of potassium is inversely coupled to acid secretion
Explanation:Respiratory acidosis is a medical emergency in which decreased ventilation (hypoventilation) increases the concentration of carbon dioxide in the blood and decreases the blood’s pH (a condition generally called acidosis). Secretion of acid and potassium by the renal tubule are inversely related. So, increased excretion of H+ during renal compensation for respiratory acidosis will result in decreased secretion (or increased retention) of potassium ions, with the result that the body’s potassium store rises. An increase in K+ excretion would be associated with renal compensation for respiratory alkalosis. The filtered load of K+depends only on K+ plasma concentration and glomerular filtration rate, not on plasma pH.
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This question is part of the following fields:
- Physiology
- Renal
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Question 16
Correct
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A 45-year old male, who was a chronic smoker presented to the clinic with backache and dry, incessant cough. On examination, he was found to have raised blood pressure, purplish striae on his abdomen, truncal obesity and tenderness over the lower thoracic spine. These findings are suggestive of which condition?
Your Answer: Small-cell anaplastic (oat cell) carcinoma
Explanation:The symptoms suggest Cushing syndrome due to increased glucocorticoid levels. One cause of Cushing syndrome is ectopic production of adrenocorticotrophic hormone from oat cell carcinoma. As oat cell carcinoma is known to be highly metastatic, the tenderness in lower back could represent metastatic involvement.
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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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Which of the following conditions is likely to result in splenomegaly, hypochromic anaemia and hemochromatosis in a young male?
Your Answer: Hereditary spherocytosis
Correct Answer: β-Thalassaemia
Explanation:Beta-thalassaemia is due to decreased production of β-polypeptide chains, with an autosomal inheritance pattern. Carrier patients (heterozygotes) are asymptomatic and have mild to moderate microcytic anaemia. This is known as thalassaemia minor. Homozygotes (β-thalassaemia major, or Cooley’s anaemia) develop severe anaemia and marrow hyperactivity. The disease presents at 1-2 years of age with severe anaemia and transfusional and absorptive iron overload. Patients also present with jaundice, leg ulcers, massive splenomegaly and cholelithiasis. The disease can also lead to splenic sequestration leading to faster destruction of transfused red blood cells. Increased marrow activity causes thickening of cranial bones. Involvement of long bones is also seen, which can cause pathological fractures and growth impairment. There is iron deposition in various organs, which can lead to heart failure or hepatic failure (leading to cirrhosis). Thalassaemias are suspected in presence of family history, or signs suggesting microcytic haemolytic anaemia. Further test and quantitative haemoglobin studies are useful. In beta-thalassaemia, there is an increase in serum bilirubin, iron and ferritin levels. There is severe anaemia, often with haemoglobin < 6 g/dl. There is an elevated red blood cell count, which are microcytic. Peripheral blood smear is diagnostic with nucleated erythroblasts, target cells, small pale red blood cells, and punctate basophilia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 18
Correct
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The physician suggested lifestyle modification for his patient because his present condition could increase his risk for the development of adenocarcinoma of the oesophagus. What is the most common predisposing factor for the development of adenocarcinoma of the oesophagus?
Your Answer: Gastro-oesophageal reflux disease
Explanation:Barret’s oesophagus is attributed primarily to gastro-oesophageal reflux disease. The chronic acidic environment damages the squamous epithelial lining of the oesophagus, and subsequently undifferentiated pluripotent stem cells develop into columnar epithelium, this is then known as Barret’s oesophagitis.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 19
Incorrect
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Which of the following will be a likely sequelae of complete ileal resection?
Your Answer: Deficiency of fat content of the stool
Correct Answer: Vitamin B12 deficiency
Explanation:The ileum is a part of the small intestine and has a pH of around 7-8 (neutral or slightly alkaline). Its main function is absorption of products of digestion. The ileal wall has multiple villi, which in turn have numerous microvilli. This increases the surface area available for absorption significantly. The cells lining the ileum contain multiple enzymes such as protease and carbohydrase, which aid in the final stages of digestion. Villi contain lacteals which absorb the products of fat digestion, fatty acids and glycerol. Thus, ileal resection will lead to their decreased absorption and increased fat content in the stool. The ileum is also responsible for absorption of vitamin B12.
Maximum water absorption occurs in the colon followed by the jejunum. Hence, ileal resection is less likely to lead to fluid volume deficiency. Also, most minerals (like calcium, iron etc.) are absorbed in the duodenum, and thus will not be affected by ileal resection.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 20
Incorrect
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Which of the following is a true statement regarding the pupil?
Your Answer: Pupil diameter is determined by the balance between parasympathetic tone to the radial fibres of the iris and sympathetic tone to the pupillary sphincter muscle.
Correct Answer: Phentolamine causes pupil constriction
Explanation:A balance between the sympathetic tone to the radial fibres of the iris and parasympathetic tone to the pupillary sphincter muscle determines the pupil size. Phentolamine (α-adrenergic receptor blocker) causes pupillary constriction. Dilatation of the pupil occurs with increased sympathetic activity, decreased parasympathetic activity during darkness or block of muscarinic receptors by atropine.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 21
Correct
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A 27-year old lady presented with dull, abdominal pain and some pain in her lower limbs. On enquiry, it was revealed that she has been suffering from depression for a few months. Physical examination and chest X-ray were normal. Further investigations revealed serum calcium 3.5 mmol/l, albumin 3.8 g/dl and phosphate 0.65 mmol/l. What is the diagnosis?
Your Answer: Parathyroid adenoma
Explanation:Hypercalcaemia with hypophosphatemia indicates parathyroid disorder and adenomas are more common than hyperplasia. In this young age group, metastatic disease is unlikely. Solitary adenomas are responsible for 80-85% cases of primary hyperparathyroidism. 10-15% cases are due to parathyroid hyperplasia and carcinomas account for 2-3% cases. Symptoms include bone pain (bones), nephrolithiasis (stones), muscular aches, peptic ulcer disease, pancreatitis (groans), depression (moans), anxiety and other mental disturbances.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 22
Correct
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A 60-year-old woman has had persistent diarrhoea for a week. A stool test reveals an infection by Clostridium difficile. Which of the following antibiotics could be used to treat the infection?
Your Answer: Oral vancomycin
Explanation:Three antibiotics are effective against Clostridium difficile:
Metronidazole 500 mg orally three times daily is the drug of choice, because of superior tolerability, lower price and comparable efficacy.
Oral vancomycin 125 mg four times daily is second-line therapy in particular cases of relapse or where the infection is unresponsive to metronidazole treatment.
Thirdly, the use of linezolid might also be considered.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 23
Correct
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A 57-year-old male smoker noted a lump on his inner lip. Upon physical examination the lump measured more than 2 cm but less than 4 cm in its greatest dimension. He is diagnosed with squamous cell carcinoma of the lip. What is the stage of the patient's cancer according to the TNM staging for head and neck cancers?
Your Answer: T2
Explanation:Head and neck cancer is a group of cancers that starts within the mouth, nose, throat, larynx, sinuses, or salivary glands. The TNM staging system used for head and neck cancers is a clinical staging system that allows physicians to compare results across patients, assess prognosis, and design appropriate treatment regimens. The staging is as follows; Primary tumour (T): Tis: pre-invasive cancer (carcinoma in situ), T0: no evidence of primary tumour, T1: tumour 2 cm or less in its greatest dimension, T2: tumour more than 2 cm but not more than 4 cm, T3: tumour larger than 4 cm, T4: tumour with extension to bone, muscle, skin, antrum, neck, etc and TX: minimum requirements to assess primary tumour cannot be met. Regional lymph node involvement (N): N0: no evidence of regional lymph node involvement, N1: evidence of involvement of movable homolateral regional lymph nodes, N2: evidence of involvement of movable contralateral or bilateral regional lymph nodes, N3: evidence of involvement of fixed regional lymph nodes and NX: Minimum requirements to assess the regional nodes cannot be met. Distant metastases (M): M0: no evidence of distant metastases, M1: evidence of distant metastases and MX: minimum requirements to assess the presence of distant metastases cannot be met. Staging: Stage I: T1 N0 M0, Stage II: T2 N0 M0, Stage III: T2NOMO and T3N1MO, Stage IV: T4N1M0, any TN2M0, any TN3M0, any T and any NM1. The depth of infiltration is predictive of the prognosis. With increasing depth of invasion of the primary tumour, the risk of nodal metastasis increases and survival decreases. The patient in this scenario therefore has a T2 tumour.
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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 patient in the recovery ward after cardiac surgery is noticed to have a small effusion in the lowest extent of the pleural cavity, into which no lung tissue extends. What is the name of this part of the pleural cavity?
Your Answer: Costodiaphragmatic recess
Explanation:The costodiaphragmatic recess is the part of the pleural cavity where the costal pleura is in continuity with the diaphragmatic pleura. It forms the lowest extent of the pleural cavity.
Costomediastinal recess: a tiny recess that is anteriorly located, where the costal pleura becomes continuous with the mediastinal pleura.
The cupola is the pleural cavity that extends above the first rib.
The inferior mediastinum refers to the posterior, middle and anterior mediastinal divisions together.
The pulmonary ligament on the other hand, is a pleural fold that is situated beneath the root of the lung on the medial aspect of the lung.
Oblique pericardial sinus is not part of the pleural cavity.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 25
Incorrect
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A 27-year-old HIV patient started on an antifungal agent. Which antifungal agent that inhibits the biosynthesis of fungal ergosterol was given to the patient?
Your Answer: Amphotericin
Correct Answer: Ketoconazole
Explanation:Ketoconazole is a synthetic imidazole antifungal drug used primarily to treat fungal infections. It inhibits the biosynthesis of ergosterol by blocking demethylation at the C14 site of the ergosterol precursor. Amphotericin B and Nystatin impair permeability of the cell membrane. Flucytosine interferes with DNA synthesis, while the target of griseofulvin is the microtubules
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 26
Incorrect
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Which of the following malignancies is likely to have the best prognosis?
Your Answer: Anaplastic carcinoma of the thyroid
Correct Answer: Papillary carcinoma of the thyroid
Explanation:Papillary carcinoma accounts for 70-80% of all thyroid cancers and is seen commonly in people aged 30-60 years. It is more aggressive in elderly patients. 10-20% cases may have recurrence or persistent disease. More common in females with a female to male ratio of 3:1. Papillary carcinomas can also contain follicular carcinomas. The common route of spread is through lymphatics to regional nodes in one-third cases and pulmonary metastasis can also occur. Papillary carcinomas of the thyroid have the best prognosis, especially in patients less than 45 years of age with small tumours confined to the thyroid gland.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 27
Correct
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A patient is brought to the accident and emergency department. He is said to have been involved in a mall explosion. Chest imaging reveals metal fragments in his thoracic cavity. He also has a pericardial effusion suggestive of a pericardial tear. An emergency thoracotomy is done which revealed a tear of the pericardium inferiorly. The surgeon began to explore for fragments in the pericardial sac with his hand from below the apex. He slips his fingers upward and to the right within the sac until they were stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart. His finger tips were now in the:
Your 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 sinus.
Coronary sinus: large vein that drains the heart into the right atrium. Located on the surface of the heart.
Coronary sulcus: groove on the heart demarcating the atria from the ventricles.
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 28
Incorrect
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A lady presents to the out patient clinic with a painful boil on the skin of her mons pubis. Which nerve supplies the skin of the mons pubis?
Your Answer: Femoral branch of the genitofemoral
Correct Answer: Anterior labial
Explanation:Anterior labial branch is the terminal branch of the ilioinguinal nerve that innervates the skin of the mons pubis in women and the skin of the anterior scrotum in men.
The femoral branch of genitofemoral nerve innervates the upper medial thigh.
The iliohypogastric innervates muscles of the abdominal wall.
The subcostal nerve innervates muscles of the abdominal wall and the skin of the lower abdominal wall.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 29
Correct
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A 50-year old gentleman who suffered a stroke was brought to the emergency department by his relatives. The patient however denied the presence of paralysis of his left upper and lower limbs. What is the most likely site of the lesion in this patient?
Your Answer: Right posterior parietal cortex
Explanation:A large injury to the non-dominant parietal cortex can make the patient neglect or refuse to acknowledge the presence of paralysis on the contralateral side. This can also involve the perception of the external world. Smaller injuries in this area which involve the precentral gyrus (primary motor cortex) or postcentral gyrus (primary sensory cortex) cause contralateral spastic paralysis or contralateral loss of tactile sensation respectively. A lesion in posterior inferior gyrus of the dominant frontal lobe results in motor aphasia. Involvement of the posterior superior gyrus of the dominant frontal lobe produces sensory aphasia.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 30
Correct
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Which of the following clinical signs will be demonstrated in a case of Brown-Séquard syndrome due to hemisection of the spinal cord at mid-thoracic level?
Your Answer: Ipsilateral spastic paralysis, ipsilateral loss of vibration and proprioception (position sense) and contralateral loss of pain and temperature sensation beginning one or two segments below the lesion
Explanation:Brown–Séquard syndrome results due to lateral hemisection of the spinal cord and results in a loss of motricity (paralysis and ataxia) and sensation. The hemisection of the cord results in a lesion of each of the three main neural systems: the principal upper motor neurone pathway of the corticospinal tract, one or both dorsal columns and the spinothalamic tract. As a result of the injury to these three main brain pathways the patient will present with three lesions. The corticospinal lesion produces spastic paralysis on the same side of the body (the loss of moderation by the upper motor neurons). The lesion to fasciculus gracilis or fasciculus cuneatus results in ipsilateral loss of vibration and proprioception (position sense). The loss of the spinothalamic tract leads to pain and temperature sensation being lost from the contralateral side beginning one or two segments below the lesion. At the lesion site, all sensory modalities are lost on the same side, and an ipsilateral flaccid paralysis.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 31
Correct
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A Jewish man was diagnosed with haemophilia C. Which of the following factors is deficient in this form of haemophilia?
Your Answer: Factor XI
Explanation:Haemophilia C, also known as plasma thromboplastin antecedent (PTA) deficiency or Rosenthal syndrome, is a condition caused by the deficiency of the coagulation factor XI. The condition is rare and it is usually found in Ashkenazi Jews.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 32
Correct
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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: 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 33
Incorrect
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A 35 year old man presented to the surgical OPD with a lump on his right forearm which appeared 3 weeks ago and was tender on examination. He gave a history was being in a car accident with pieces of glass from the windshield piercing his forearm removed manually and on further elective surgery. Which of these cells are characteristically found during inflammation in this situation?
Your Answer: Neutrophil
Correct Answer: Giant cell
Explanation:A foreign body reaction Is characteristic of giant cells. Glass being the foreign object initiates an inflammatory response in this condition.
Mast cells are involved in allergic reactions.
Eosinophils are characteristic of a parasitic infection and allergic inflammatory process but are not due to foreign bodies.
Plasma cells are typical of chronic inflammation.
Lymphocytes are involved in viral infections.
Macrophages combine together to form giant cells.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 34
Correct
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A 38-year old woman presents to the clinic with a 2 cm eczema-like lesion on the areolar region of her left breast, for 5 months. Biopsy of the lesion showed large cells at the dermal-epidermal junction with positive staining for mucin. What is the likely diagnosis?
Your Answer: Paget’s disease of the breast
Explanation:Paget’s disease of the breast or nipple resembles eczema in appearance with an underlying carcinoma typically. The disease is usually unilateral and presents with inflammation, oozing and crusting along with a non-healing ulcer. Treatment is often delayed due to the innocuous appearance but can be fatal. It results due to spread of neoplastic cells from the ducts of the mammary gland to the epithelium.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 35
Incorrect
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What is the normal glomerular filtration rate?
Your Answer: 100 mL/min
Correct Answer: 125 mL/min
Explanation:The normal glomerular filtration rate (GFR) in humans is 125 mL/min. After the age of 40, GFR decreases progressively by about 0.4–1.2 mL/min per year.
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This question is part of the following fields:
- Physiology
- Renal
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Question 36
Correct
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Glucose is the most important source of energy for cellular respiration. The transport of glucose in the renal tubular cells occurs via:
Your Answer: Secondary active transport with sodium
Explanation:In 1960, Robert K. Crane presented for the first time his discovery of the sodium-glucose cotransport as the mechanism for glucose absorption. Glucose transport through biological membranes requires specific transport proteins. Transport of glucose through the apical membrane of renal tubular as well as intestinal epithelial cells depends on the presence of secondary active Na+–glucose symporters, SGLT-1 and SGLT-2, which concentrate glucose inside the cells, using the energy provided by co-transport of Na+ ions down their electrochemical gradient.
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This question is part of the following fields:
- Physiology
- Renal
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Question 37
Correct
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A 30 year old male has a painless and transilluminant swelling at the upper pole of his left testi. There is a negative cough test. Which of the following is the likely diagnosis?
Your Answer: Spermatocoele
Explanation:Spermatocele, also known as a spermatic cyst is a cystic mass usually occurring at the upper pole of the testis. Differential diagnosis included hydrocele as both are cystic, painless and transilluminant. Ultrasound is a useful modality. If symptomatic or large, surgical excision can be done.
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This question is part of the following fields:
- Pathology
- Urology
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Question 38
Correct
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Which of these conditions causes haematuria, hypertension and proteinuria in children, usually after a streptococcal infection?
Your Answer: Acute nephritic syndrome
Explanation:Nephritic syndrome (or acute nephritic syndrome) is a syndrome comprising of signs of nephritis. Children between 2 and 12 are most commonly affected, but it may occur at any age. Predisposing factors/causes include:
Infections with group A streptococcal bacteria (acute post-streptococcal glomerulonephritis).
Primary renal diseases: immunoglobulin A nephropathy, membranoproliferative glomerulonephritis, idiopathic rapidly progressive crescentic glomerulonephritis.
Secondary renal diseases: subacute bacterial endocarditis, infected ventriculo–peritoneal shunt, glomerulonephritis with visceral abscess, glomerulonephritis with bacterial, viral or parasitic infections.
Multisystem diseases.
By contrast, nephrotic syndrome is characterized by only proteins moving into the urine.
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This question is part of the following fields:
- Physiology
- Renal
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Question 39
Correct
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A 60-year-old man complains of pain in his left thigh. An X-ray reveals bowing of the affected femur, increased bone density, bony enlargement, abnormal bone architecture with coarse cortical trabeculations, and stress microfractures. Which is the most likely diagnosis in this case?
Your Answer: Paget’s disease of bone
Explanation:Paget’s disease of bone is a chronic disorder of the adult skeleton in which bone turnover is accelerated in localised areas, replacing normal matrix with softened and enlarged bone and causing gradual pain and deformity in some cases. It is more predominant in men over the age of 40. Characteristic X-ray findings include increased bone density, abnormal architecture with coarse cortical trabeculation or cortical thickening, bowing and bony enlargement; there might also be stress microfractures of the tibia or femur.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 40
Correct
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During a splenectomy procedure of a 45-year old male patient with a bleeding ruptured spleen, the surgeon decided to clamp the splenic artery near the coeliac trunk to stop the bleeding. Which of the following organ/s parts will be least affected by the clamping?
Your Answer: Duodenum
Explanation:The duodenum is the only organ in the list that would not be affect by the clumping of the splenic artery as it is supplied by common hepatic artery (through the gastroduodenal artery) and the superior mesenteric artery (through the inferior pancreaticoduodenal artery). The splenic artery is the artery that supplies the spleen with oxygenated blood. The splenic artery before reaching the spleen also gives off branches that supply the stomach and the pancreas. The greater curvature and the fundus of the stomach is supplied the short gastric artery which branches off from the splenic artery. The left portion of the greater curvature of the stomach together with the greater omentum is supplied by the left gastro-omental artery of the splenic artery. The body and tail of the pancreas is supplied by branches of the splenic artery through the dorsal and superior pancreatic arteries and the caudal pancreatic arteries respectively.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 41
Correct
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Which of the following is a likely cause of jaundice?
Your Answer: Hepatic disease if plasma albumin is low and serum aminotransferase elevations > 500 units
Explanation:Jaundice can occur due to any of the possible causes and treatment depends upon diagnosing the correct condition. Mild hyperbilirubinemia with normal levels of aminotransferase and alkaline phosphatase is often unconjugated (e.g., due to haemolysis or Gilbert’s syndrome rather than hepatobiliary disease). Moderate or severe hyperbilirubinemia along with increased urinary bilirubin (bilirubinuria), high alkaline phosphatase or aminotransferase levels suggest hepatobiliary disease. Hyperbilirubinemia produced by any hepatobiliary disease is largely conjugated. In this case, other blood tests include hepatitis serology for suspected hepatitis, prothrombin time (PT) or international normalised ratio (INR), albumin and globulin levels, and antimitochondrial antibody levels (suspected primary biliary cirrhosis). Low albumin and high globulin levels suggest chronic rather than acute liver disease. In cases where there is only a an elevation of alkaline phosphatase, γ-glutamyl transpeptidase (GGT) levels should be checked – the levels of which will be found high in hepatobiliary disease, but not in bone disorder which can also lead to elevated alkaline phosphatase levels. In diseases of hepatobiliary origin, aminotransferase elevations > 500 units suggest a hepatocellular cause, whereas disproportionate increases of alkaline phosphatase (e.g., alkaline phosphatase > 3 times normal and aminotransferase < 200 units) suggest cholestasis. Because hepatobiliary disease alone rarely causes bilirubin levels > 30 mg/dl, higher levels are suggestive of a combination of severe hepatobiliary disease and haemolysis or renal dysfunction. Imaging is best for diagnosing infiltrative and cholestatic causes of jaundice. Liver biopsy is rarely needed, but can be of use in intrahepatic cholestasis and in some types of hepatitis.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 42
Correct
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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: 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.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 43
Correct
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A 55-year-old male chronic smoker is diagnosed with non-small-cell cancer. His right lung underwent complete atelectasis and he has a 7cm tumour involving the chest wall. What is the stage of the lung cancer of this patient?
Your Answer: T3
Explanation:Non-small-cell lung cancer is staged through TNM classification. The stage of this patient is T3 because based on the TNM classification the tumour is staged T3 if > 7 cm or one that directly invades any of the following: Chest wall (including superior sulcus tumours), diaphragm, phrenic nerve, mediastinal pleura, or parietal pericardium; or the tumour is in the main bronchus < 2 cm distal to the carina but without involvement of the carina, Or it is associated with atelectasis/obstructive pneumonitis of the entire lung or separate tumour nodule(s) in the same lobe.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 44
Correct
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A machine worker fractured the medial epicondyle of his right humerus resulting in damage to an artery running with the ulnar nerve posterior to the medial epicondyle. The artery injured is the?
Your Answer: Superior ulnar collateral
Explanation:The superior ulnar collateral artery runs posterior to the medial epicondyle of the humerus, accompanied by the ulnar nerve. This artery arises from the brachial artery near the middle of the arm and ends under the flexor carpi ulnaris muscle by anastomosing with two arteries: the posterior ulnar recurrent and inferior ulnar collateral.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 45
Correct
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During a normal respiratory exhalation, what is the recoil alveolar pressure?
Your Answer: +10 cmH2O
Explanation:To determine compliance of the respiratory system, changes in transmural pressures (in and out) immediately across the lung or chest cage (or both) are measured simultaneously with changes in lung or thoracic cavity volume. Changes in lung or thoracic cage volume are determined using a spirometer with transmural pressures measured by pressure transducers. For the lung alone, transmural pressure is calculated as the difference between alveolar (pA; inside) and intrapleural (ppl; outside) pressure. To calculate chest cage compliance, transmural pressure is ppl (inside) minus atmospheric pressure (pB; outside). For the combined lung–chest cage, transmural pressure or transpulmonary pressure is computed as pA – pB. pA pressure is determined by having the subject deeply inhale a measured volume of air from a spirometer. Under physiological conditions the transpulmonary or recoil pressure is always positive; intrapleural pressure is always negative and relatively large, while alveolar pressure moves from slightly negative to slightly positive as a person breathes.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 46
Correct
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Which of the following statements regarding the femoral artery is CORRECT?
Your Answer: It has the femoral nerve lying lateral to it
Explanation:The femoral artery begins immediately behind the inguinal ligament, midway between the anterior superior spine of the ilium and the symphysis pubis. The first 4 cm of the vessel is enclosed, together with the femoral vein, in a fibrous sheath (the femoral sheath). The femoral nerve lies lateral to this.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 47
Correct
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Abnormal breathing is noticed in a of victim of a road traffic accident, who sustained a head injury. The breathing pattern is characterised by alternate periods of waxing and waning tidal volumes with interspersed periods of apnoea. This breathing pattern is known as:
Your Answer: Cheyne–Stokes breathing
Explanation:Cheyne-Stokes breathing is an abnormal breathing pattern with breathing periods of gradually waxing and waning tidal volumes, with apnoeic periods interspersed. It is usually the first breathing pattern to be seen with a rise in intracranial pressure and is caused by failure of the respiratory centre in the brain to compensate quickly enough to changes in serum partial pressure of oxygen and carbon dioxide. The aetiology includes strokes, head injuries, brain tumours and congestive heart failure. It is also a sign of altitude sickness in normal people, a symptom of carbon monoxide poisoning or post-morphine administration. Biot’s respiration (cluster breathing) is characterized by cluster of quick, shallow inspirations followed by regular or irregular periods of apnoea. It is different from ataxic respiration, which has completely irregular breaths and pauses. It results due to damage to the medulla oblongata by any reason (stroke, uncal herniation, trauma) and is a poor prognostic indicator. Kussmaul breathing, also known as ‘air hunger’, is basically respiratory compensation for metabolic acidosis and is characterized by quick, deep and laboured breathing. It is most often seen in in diabetic ketoacidosis. Due to forced inspiratory rate, the patients will show a low p(CO2). Ondine’s curse is congenital central hypoventilation syndrome or primary alveolar hypoventilation, which can be fatal and leads to sleep apnoea. It involves an inborn failure to control breathing autonomically during sleep and in severe cases, can affect patients even while awake. It is known to occur in 1 in 200000 liveborn children. Treatment includes tracheostomies and life long mechanical ventilator support.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 48
Correct
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Which of the following coagulation factors is responsible for the formation of a complex with tissue factor to activate factors IX and X?
Your Answer: Factor VII
Explanation:Factor VII, also known as proconvertin or stable factor, is a vitamin K–dependent protein that plays a central role in haemostasis and coagulation. Tissue factor is a protein that is normally not exposed on the surface of intact blood vessels. Damage to the vascular lumen leads to tissue factor exposure. The exposed tissue factor binds to factor VII. This facilitates the activation of factor VII to factor VIIa.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 49
Correct
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Question 50
Correct
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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: 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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SESSION STATS - PERFORMANCE PER SPECIALTY
