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Question 1
Correct
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A 5-year-old child presents with fever and otalgia. Greenish pustular discharge was seen in his left ear during physical examination. The patient is diagnosed with otitis externa. Which of the following organisms most likely caused the infection?
Your Answer: Pseudomonas aeruginosa
Explanation:P. aeruginosa is a multidrug resistant pathogen recognised for its ubiquity, its advanced antibiotic resistance mechanisms and its association with serious illnesses – especially hospital-acquired infections such as ventilator-associated pneumonia and various septic syndromes. The species name aeruginosa is a Latin word meaning verdigris (copper rust), referring to the blue-green colour of laboratory cultures of the species. This blue-green pigment is a combination of two metabolites of P. aeruginosa, pyocyanin (blue) and pyoverdine (green), which impart the blue-green characteristic colour of cultures.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 2
Incorrect
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The orbicularis oculi us a muscle that closes the eyelids. What is the motor innervation of this muscle?
Your Answer: A branch of a nerve that exits through the superior orbital foramen
Correct Answer: A branch of a nerve that exits through the stylomastoid foramen
Explanation:The orbicularis oculi is a muscle in the face that closes the eyelids. It is supplied by zygomatic branch of the facial nerve (cranial nerve VII), which exits through the stylomastoid foramen.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 3
Incorrect
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A 29-year-old woman presents to the doctor complaining of cough, shortness of breath, fever and weight loss. Chest X-ray revealed bilateral hilar and mediastinal lymph node enlargement and bilateral pulmonary opacities. Non-caseating granulomas were found on histological examination. The most likely diagnosis is:
Your Answer: Asbestosis
Correct Answer: Sarcoidosis
Explanation:Sarcoidosis is an inflammatory disease of unknown aetiology that affects multiple organs but predominantly the lungs and intrathoracic lymph nodes. Systemic and pulmonary symptoms may both be present. Pulmonary involvement is confirmed by a chest X-ray and other imaging studies. The main histological finding is the presence of non-caseating granulomas.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 4
Correct
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A 5-year-old child is rushed to the emergency department because of fever, erythema and neck stiffness. The child is also hypotensive upon physical examination. Which is the most likely toxin responsible for this child's condition?
Your Answer: Endotoxin
Explanation: An endotoxin is part of the bacterial outer membrane, and it is not released until the bacterium is killed by the immune system. The body’s response to an endotoxin can involve severe inflammation. In general, the inflammation process is usually considered beneficial to the infected host, but if the reaction is severe enough, it can lead to sepsis.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 5
Incorrect
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A 50-year old, obese gentleman with a compression fracture of T11 vertebra was admitted in the hospital. Examination revealed a raised blood pressure 165/112 mmHg and blood glucose 8.5 mmol/l. His abdomen had the presence of purplish striae. What condition is he likely to be suffering from?
Your Answer: Multinodular goitre
Correct Answer: Adrenal cortical carcinoma
Explanation:Adrenocortical carcinomas are rare tumours with reported incidence being only two in a million. However, they have a poor prognosis. These are large tumours and range from 4-10 cm in diameter. They arise from the adrenal cortex and 10% cases are bilateral. 50-80% are known to be functional, leading to Cushing syndrome. Even though the tumour affects both sexes equally, functional tumours are slightly commoner in women and non-functional tumours are commoner in men. As compared to women, men also develop this tumour at an older age and seem to have a poorer prognosis.
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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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Which of the following is a true statement regarding the pupil?
Your Answer: General increase in sympathetic tone during emotional excitement results in pupil constriction
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 7
Correct
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A 59-year old gentleman admitted for elective cholecystectomy was found to have a haemoglobin 12.5 g/dl, haematocrit 37%, mean corpuscular volume 90 fl, platelet count 185 × 109/l, and white blood cell count 32 × 109/l; along with multiple, small mature lymphocytes on peripheral smear. The likely diagnosis is:
Your Answer: Chronic lymphocytic leukaemia
Explanation:CLL or chronic lymphocytic leukaemia is the most common leukaemia seen in the Western world. Twice more common in men than women, the incidence of CLL increases with age. About 75% cases are seen in patients aged more than 60 years. The blood, marrow, spleen and lymph nodes all undergo infiltration, eventually leading to haematopoiesis (anaemia, neutropenia, thrombocytopenia), hepatomegaly, splenomegaly and decreased production of immunoglobulin. In 98% cases, CD+5 B cells undergo malignant transformation.
Often diagnosed on blood tests while being evaluated for lymphadenopathy, CLL causes symptoms like fatigue, anorexia, weight loss, pallor, dyspnoea on exertion, abdominal fullness or distension. Findings include multiple lymphadenopathy with minimal-to- moderate hepatomegaly and splenomegaly. Increased susceptibility to infections is seen. Herpes Zoster is common. Diffuse or maculopapular skin infiltration can also be seen in T-cell CLL.
Diagnosis is by examination of peripheral blood smear and marrow: hallmark being a sustained, absolute leucocytosis (>5 ×109/l) and increased lymphocytes in the marrow (>30%). Other findings can include hypogammaglobulinemia (<15% of cases) and, rarely, raised lactate dehydrogenase (LDH). Only 10% cases demonstrate moderate anaemia and/or thrombocytopenia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 8
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 9
Correct
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A 20 year old is brought to the A&E after he fell from a moving cart. The boy has sustained blunt abdominal injury, and the there is a possibility of internal bleeding as the boy is in shock. An urgent exploratory laparotomy is done in the A&E theatre. On opening the peritoneal cavity, the operating surgeon notices a torn gastrosplenic ligament with a large clot around the spleen. Which artery is most likely to have been injured in this case?
Your Answer: Short gastric
Explanation:The short gastric arteries branch from the splenic artery near the splenic hilum to travel back in the gastrosplenic ligament to supply the fundus of the stomach. Therefore, these may be injured in this case.
The splenic artery courses deep to the stomach to reach the hilum of the spleen. It doesn’t travel in the gastrosplenic ligament although it does give off branches that do.
The middle colic artery is a branch of the superior mesenteric artery that supplies the transverse colon.
Gastroepiploic artery is the largest branch of the splenic artery that courses between the layers of the greater omentum to anastomose with the right gastroepiploic.
Left gastric artery, a branch of the coeliac trunk. It supplies the left half of the lesser curvature.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 10
Correct
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A sexually active 21 year old man presents with the history of dysuria for the past 3 days. Urine culture confirmed Neisseria gonorrhoeae and smear showed abundant neutrophils. Which of the following mediators is responsible for causing diapedesis of the neutrophils to reach the site of infection?
Your Answer: Complement C5a
Explanation:C5a is part of the complement cascade and is released frim the complement C5. It acts as a chemotactic factor for neutrophils. Other chemotactic mediators are TNF, leukotrienes and bacterial products.
Bradykinin is associated with the production of pain and vasodilation.
Hageman factor is a clotting factor.
Histamine causes vasodilation.
C3B causes opsonisation.
IL-6 and IL-12 are inflammatory mediators causing B cell maturation and mediating inflammation and prostaglandins are involved with pain, increasing cell permeability and vasodilation.
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This question is part of the following fields:
- Inflammation & Immunology; Urology
- Pathology
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Question 11
Correct
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Which type of contractions are responsible for the propulsion of chyme along the small intestine?
Your Answer: Segmentation
Explanation:Two major types of intestinal contractions are segmentation and peristalsis:
Segmentation occurs most frequently and primarily involves circular muscle. It is essentially a contraction of 2- or 3-cm long intestinal segments while the muscle on either side of it relaxes. Chyme in the segment is displaced in both directions. As the contracted segment relaxes, the previously relaxed segments on either side may contract. This efficiently mixes the chyme with the digestive secretions and exposes the mucosal absorptive surface to the luminal contents. It also serves a propulsive function and contributes to the movement of chyme.
Peristalsis is a propulsive wave of contraction that is initiated by intestinal distension. It is short lived and travels only a few centimetres before dying out. The combined effects of intestinal peristalsis and segmentation provide for both adequate mixing of the intestinal contents and slow, steady movement of chyme.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 12
Correct
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Which of the following will be a likely sequelae of complete ileal resection?
Your 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 13
Correct
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A 34-year-old Asian male presents with cervical lymphadenopathy. The patient is suspected to have tuberculous lymphadenopathy. Excision biopsy of one of the nodes showed granulomatous inflammation. Which histopathologic feature is most likely consistent with the diagnosis of tuberculosis?
Your Answer: Caseation necrosis
Explanation:The granulomas of tuberculosis tend to contain necrosis (caseating tubercles), but non-necrotizing granulomas may also be present. Multinucleated giant cells with nuclei arranged like a horseshoe (Langhans giant cells) and foreign body giant cells are often present, but are not specific for tuberculosis. A definitive diagnosis of tuberculosis requires identification of the causative organism by microbiological cultures.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 14
Correct
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A 38 year-old man falls on an outstretched hand. X-rays indicate an anterior dislocation of one of the carpal bones. Which carpal bone is most commonly dislocated?
Your Answer: Lunate
Explanation:The scaphoid bone is the most commonly fractured carpal bone and has an increased risk of avascular necrosis.
The lunate is the most commonly dislocated carpal bone. The displaced bone may compress the median nerve in the carpal tunnel.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 15
Correct
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The majority of gallstones are mainly composed of:
Your Answer: Cholesterol
Explanation:Bile salts are formed out of cholesterol in the liver cells. Occasionally, precipitation of cholesterol occurs resulting into cholesterol stones developing in the gall bladder.
These cholesterol gallstones are the most common type and account for 80% of all gallstones. Another type, accounting for 20% gallstones is pigment stones which are composed of bilirubin and calcium salts. Occasionally, stones of mixed origin are also seen.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 16
Incorrect
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A 35 year-old woman is undergoing thyroidectomy. The external laryngeal nerve may be injured whilst ligating this artery during the procedure due to its close relationship?
Your Answer: Inferior thyroid artery
Correct Answer: Superior thyroid artery
Explanation:The superior thyroid artery arises from the external carotid artery just below the level of the greater cornu of the hyoid bone and ends in the thyroid gland. This artery must be ligated at the thyroid when conducting a thyroidectomy. If the artery is severed, but not ligated, it will bleed profusely. In order to gain control of the bleeding, the surgeon may need to extend the original incision laterally to ligate the artery at its origin at the external carotid artery. The external laryngeal branch of the superior laryngeal nerve courses in close proximity to the superior thyroid artery, making it at risk for injury during surgery.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 17
Correct
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Which is a feature of the action of insulin?
Your Answer: Promotes protein synthesis
Explanation:Insulin is produced by the beta-cells of the islets of Langerhans in the pancreas. Its actions include:
– promoting uptake of glucose into cells
– glycogen synthesis (glycogenesis)
– protein synthesis
– stimulation of lipogenesis (fat formation).
– driving potassium into cells – used to treat hyperkaelamia.
Parathyroid hormone and activated vitamin D are the principal hormones involved in calcium/phosphate metabolism, rather than insulin.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 18
Correct
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Which of the following is the most likely cause of prolonged thrombin clotting time?
Your Answer: Hypofibrinogenemia
Explanation:Thrombin clotting time, also called thrombin time (TT), is test used for the investigation of possible bleeding or clotting disorders. TT reflects the conversion of fibrinogen to fibrin and it’s also very sensitive to the presence of the anticoagulant heparin. A prolonged thrombin time may indicate the presence of hypofibrinogenemia (decreased fibrinogen level ), dysfibrinogenaemia, disseminated intravascular coagulation (DIC), end stage liver disease or malnutrition.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 19
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 20
Incorrect
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Multiple, non-tender lymphadenopathy with biopsy showing several crowded follicles of small, monomorphic lymphocytes and the absence of Reed-Sternberg cells is seen in which of the following?
Your Answer: Hodgkin’s disease, lymphocyte predominance type
Correct Answer: Poorly differentiated lymphocytic lymphoma
Explanation:Malignant lymphoma usually causes non-tender lymphadenopathy, unlike the tender lymphadenopathy caused by infections (including infectious mononucleosis caused by Epstein-Barr virus). Also, the lymphoid hyperplasia seen in infectious mononucleosis is benign and polyclonal.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 21
Correct
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A 30 year old female suffered from mismatched transfusion induced haemolysis. Which substance will be raised in the plasma of this patient?
Your Answer: Bilirubin
Explanation:Bilirubin is a yellow pigment that is formed due to the break down of RBCs. Haemolysis results in haemoglobin that is broken down into a haem portion and globin which is converted into amino acids and used again. Haem is converted into unconjugated bilirubin in the macrophages and shunted to the liver. In the liver it is conjugated with glucuronic acid making it water soluble and thus excreted in the urine. Its normal levels are from 0.2-1 mg/dl. Increased bilirubin causes jaundice and yellowish discoloration of the skin.
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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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Which muscle extends to form the cremasteric muscle?
Your Answer: Dartos muscle
Correct Answer: Internal abdominal oblique muscle
Explanation:The cremasteric muscle is a thin layer of muscle composed of several fasciculi that originate from the middle of the inguinal ligament. At its point of origin the fibres are continuous with the fibres of internal oblique and sometimes with the transversus abdominis. It then passes along the lateral side of the spermatic cord and descends with it through the superficial inguinal ring on the front and sides of the cord.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 23
Incorrect
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What is the 5-year survival rate of carcinoma of the pancreas?
Your Answer: 5 per cent
Correct Answer: 30 per cent
Explanation:Pancreatic cancer typically has a poor prognosis, partly because the cancer usually initially remains symptomless, leading to locally advanced or metastatic disease at the time of diagnosis. Median survival from diagnosis is around 3–6 months. Even in those suitable for resectional surgery, 5-year survival rates are still only 30 per cent.
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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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Which lymph nodes are most likely to enlarge due to the spread of infection through the lymphatic channels in a patient with a boil on his scrotum?
Your Answer: Superficial inguinal nodes
Explanation:The superficial inguinal nodes drain the perineum and the external genitalia which include the scrotum and the labia majora. The testes, however, drain to the lumbar nodes.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 25
Correct
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The sciatic nerve does NOT supply which of the following muscles?
Your Answer: Obturator externus
Explanation:The sciatic nerve supplies both gemellae, quadratus femoris, semitendinosus, semimembranosus, both heads of the biceps femoris, the hamstring half of abductor magnus and obturator internus. Obturator externus is supplied by the obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 26
Correct
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An experiment is carried out to observe engulfment and phagocytosis of microbes. Strep pneumoniae are added to a solution of leukocytes with a substance added to enhance the process of phagocytosis. What is this substance?
Your Answer: Complement C3b
Explanation:C3b is cleaved from C3 complement with the help of the enzyme C3- convertase. It binds to the cell surface of the offending substance and opsonizes it. This makes it easy for the phagocytes to detect and eliminate them.
IgM does not act as an opsonin but igG does.
Selectins aid leukocytes to bind to the endothelial surfaces.
C5a is a chemo-attractant and histamine a vasodilator.
NADPH oxidises offending substance after phagocytosis within the macrophage.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 27
Correct
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A medical student is asked to calculate the net pressure difference in a capillary wall, considering: Interstitial fluid hydrostatic pressure = –3 mmHg, Plasma colloid osmotic pressure = 28 mmHg, Capillary hydrostatic pressure = 17 mmHg, Interstitial fluid colloid osmotic pressure = 8 mmHg, and Filtration coefficient = 1. Which is the correct answer?
Your Answer: 0 mmHg
Explanation:The rate of filtration at any point along a capillary depends on a balance of forces sometimes called Starling’s forces after the physiologist who first described their operation in detail. The Starling principle of fluid exchange is key to understanding how plasma fluid (solvent) within the bloodstream (intravascular fluid) moves to the space outside the bloodstream (extravascular space). Fluid movement = k[(pc– pi)–(Πc– Πi)] where k = capillary filtration coefficient, pc = capillary hydrostatic pressure, pi= interstitial hydrostatic pressure, Πc = capillary colloid osmotic pressure, Πi = interstitial colloid osmotic pressure. Therefore: 1 × [capillary hydrostatic pressure (17) – interstitial fluid hydrostatic pressure (–3)] – [plasma colloid osmotic pressure (28) – interstitial fluid colloid osmotic pressure (8)] = 0 mmHg
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 28
Correct
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Which of the following arteries, if ligated, will most likely affect blood supply to the pancreas?
Your Answer: Superior mesenteric
Explanation:The pancreas is a glandular organ in the body that produces important hormones such as insulin and glucagon. Its blood supply is from branches of the coeliac artery, superior mesenteric artery and the splenic artery. These are the arteries that if ligated, would affect blood supply to the pancreas.
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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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Out of the following options, which malignancy has the highest potential for multicentricity?
Your Answer: Transitional cell carcinoma
Explanation:Transitional cell carcinomas can arise anywhere in the urothelium lining the urinary tract; and hence are known to be multicentric and recur commonly. Prostatic adenocarcinoma most commonly involves the posterior lobe of the prostate gland. Although renal cell carcinomas occasionally show multicentricity, it is not common. Penile carcinomas are usually locally infiltrative lesions. Wilm’s tumours are usually solitary, but can be bilateral or multicentric in 10% cases. Small cell carcinoma of lung and teratomas are usually solitary.
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This question is part of the following fields:
- Pathology
- Renal
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Question 30
Correct
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Evaluation of a 60-year old gentleman, who has been a coal miner all his life and is suspected to have pulmonary fibrosis reveals the following: FEV1 of 75% (normal > 65%), arterial oxygen saturation 92%, alveolar ventilation 6000 ml/min at a tidal volume of 600 ml and a breathing rate of 12 breaths/min. There are also pathological changes in lung compliance and residual volume. Calculate his anatomical dead space.
Your Answer: 100 ml
Explanation:Dead space refers to inhaled air that does not take part in gas exchange. Because of this dead space, taking deep breaths slowly is more effective for gas exchange than taking quick, shallow breaths where a large proportion is dead space. Use of a snorkel by a diver increases the dead space marginally. Anatomical dead space refers to the gas in conducting areas such as mouth and trachea, and is roughly 150 ml (2.2 ml/kg body weight). This corresponds to a third of the tidal volume (400-500 ml). It can be measured by Fowler’s method, a nitrogen wash-out technique. It is posture-dependent and increases with increase in tidal volume. Physiological dead space is equal to the anatomical dead space plus the alveolar dead space, where alveolar dead space is the area in the alveoli where no effective exchange takes place due to poor blood flow in capillaries. This physiological dead space is very small normally (< 5 ml) but can increase in lung diseases. Physiological dead space can be measured by Bohr’s method. Total ventilation per minute (minute ventilation) is given by the product of tidal volume and the breathing rate. Here, the total ventilation is 600 ml times 12 breaths/min = 7200 ml/min. The problem mentions alveolar ventilation to be 6000 ml/min. Thus, the difference between the alveolar ventilation and total ventilation is 7200 – 6000 ml/min = 1200 ml/min, or 100 ml per breath at 12 breaths per min. This 100 ml is the dead space volume.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 31
Correct
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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.
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This question is part of the following fields:
- Inflammation & Immunology; Renal
- Pathology
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Question 32
Correct
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Which of the following is a landmark to identify the site of the 2nd costal cartilage?
Your Answer: Sternal angle
Explanation:The sternal angle is an important part where the second costal cartilage attaches to the sternum. Finding the sternal angle will help in finding the second costal cartilage and intercostal space.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 33
Correct
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The following structures DO NOT lie between the layers of the mesosalpinx except for the?
Your Answer: Fallopian tube
Explanation:Mesosalpinx is the portion of the broad ligament that stretches from the fallopian tube to the ovary and contains the uterine tubes between it’s layers.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 34
Correct
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Which of the following accumulates within a cell due to the aging process?
Your Answer: Lipofuscin
Explanation:Lipofuscin , also known as lipochrome, is a wear and tear pigment or an aging pigment. It represents free radical injury or lipid peroxidation. On microscopic examination is appears as a yellowish brown pigment around the nucleus (perinuclear pigment). It is often seen in cells which are undergoing regressive changes, commonly in the liver and heart of old patients or patients with cancer, cachexia or severe malnutrition.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 35
Correct
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A 32-year old gentleman came to the emergency department, complaining of progressively increasing weakness in his arms and legs over 5 days. On examination, there is symmetrical weakness on both sides of his face, along with weakness of the proximal and distal muscles of all four limbs. No loss of sensation noted. Deep tendon reflexes could not be elicited and plantar responses were downward. On enquiry, it was revealed that he had an upper respiratory tract infection 10 days ago. The likely diagnosis is:
Your Answer: Guillain–Barré syndrome
Explanation:Guillain–Barré syndrome (GBS) is an acute, autoimmune polyradiculoneuropathy which affects the peripheral nervous system and is usually triggered by an acute infectious process. 75% patients have a history of acute infection within the past 1–4 weeks, usually respiratory or gastrointestinal. immunisations have also been implicated. The most common form is acute inflammatory demyelinating polyneuropathy. It results in an ascending paralysis with complete loss of deep tendon reflexes. Treatment includes immunoglobulins and supportive care. However, the disease may be fatal due to severe pulmonary complications and dysautonomia.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 36
Correct
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Which organ is most vulnerable to haemorrhagic shock?
Your Answer: Kidneys
Explanation:At rest, the brain receives 15% cardiac output, muscles 15%, gastrointestinal tract 30% and kidneys receive 20%. However, if normalised by weight, the largest specific blood flow is received by the kidneys at rest (400 ml/min x 100g), making them highly vulnerable in the case of a haemorrhagic shock.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 37
Correct
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A 27-year-old woman has chronic low serum calcium levels. Which of the following conditions may be responsible for the hypocalcaemia in this patient?
Your Answer: Hypoparathyroidism
Explanation:Chronic hypocalcaemia is mostly seen in patients with hypoparathyroidism as a result of accidental removal or damage to parathyroid glands during thyroidectomy.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 38
Correct
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Cranial nerve XII, the hypoglossal nerve, innervates which one of the following muscles in the list?
Your Answer: Hyoglossus
Explanation:The cranial nerve XII, hypoglossal nerve, innervates all the intrinsic and extrinsic muscles of the tongue except the palatoglossus. The muscles of the tongue innervated by this nerve include the extrinsic muscles; hyoglossus, styloglossus, genioglossus and the intrinsic muscles; superior longitudinal, inferior longitudinal, vertical and transverse muscles. The salpingopharyngeus, palatoglossus and the palatopharyngeus muscles are innervated by the vagus nerve. The stylopharyngeus muscle is innervated by the glossopharyngeal nerve (CN IX). The mylohyoid muscle is innervated by the inferior alveolar nerve, a branch of the mandibular nerve. Finally, the geniohyoid muscle is innervated by the olfactory nerve (CN I) via the hypoglossal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 39
Correct
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The primary motor cortex is located in the:
Your Answer: Precentral gyrus
Explanation:The primary motor cortex is located in the dorsal part of the precentral gyrus and the anterior bank of the central sulcus. The precentral gyrus lies anterior to the postcentral gyrus and is separated from it by a central sulcus. Its anterior border is the precentral sulcus, while inferiorly it borders to the lateral fissure (Sylvian fissure).
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This question is part of the following fields:
- Neurology
- Physiology
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Question 40
Correct
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A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and oliguria. She is diagnosed with chronic renal failure. Dipstick testing shows no protein, glucose, nitrite or ketones but a semi-quantitative sulphosalicylic acid test for urine protein is positive. Which of the following is the most probable cause of chronic renal failure in this patient.
Your Answer: Multiple myeloma
Explanation:Dipstick results are negative because the proteins found in the urine of this patient are not albumin but Bence Jones proteins. A Bence Jones protein is a monoclonal globulin protein commonly detected in patients affected by multiple myeloma. Multiple myeloma is a malignancy of plasma cells characterised by the production of monoclonal immunoglobulin. Symptoms include bone pain, bone fractures, bleeding, neurologic symptoms, fatigue, frequent infections and weight loss.
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This question is part of the following fields:
- Pathology
- Renal
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Question 41
Incorrect
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The petrous part of the internal carotid artery is located inside of which cranial bone?
Your Answer: Sphenoid
Correct Answer: Temporal
Explanation:The petrous segment, or C2, of the internal carotid is that which is inside the petrous part of the temporal bone. This segment extends until the foramen lacerum. The petrous portion classically has three sections: an ascending, or vertical portion; the genu, or bend; and the horizontal portion.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 42
Correct
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A 59-year-old man was brought to the emergency department by his family after complaining of sudden, severe upper back pain and a ripping sensation, that radiated to his neck. On arrival, his pulse was weak in one arm compared with the other however his ECG result was normal. Which of the following is most probably the cause of these findings and symptoms?
Your Answer: Acute aortic dissection
Explanation:Acute aortic dissection is a serious condition in which the inner layer of the aorta tears and the blood flows in between the inner and middle layers of the aorta causing their separation (dissection). Aortic dissection can lead to rupture or decreased blood flow to organs. Clinical manifestations most often include the sudden onset of severe, tearing or ripping chest pain that can radiate to the shoulder, back or neck; syncope; altered mental status; dyspnoea; pale skin; stroke symptoms etc. The diagnosis of acute aortic dissection is based on clinical findings, imaging studies, electrocardiography and laboratory analysis.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 43
Correct
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A 20-year-old woman had profuse watery diarrhoea for 2 days. She felt dizzy and weak, and thus decided to seek medical attention. At the emergency room her BP was 80/60 mmHg with a pulse of 118/min. What is the most appropriate intravenous treatment that should be given?
Your Answer: Isotonic saline
Explanation:Normal saline is typically the first fluid used when hypovolemia is severe enough to threaten the adequacy of blood circulation. It is isotonic and has long been believed to be the safest fluid to give quickly in large volumes.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 44
Correct
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The nutcracker effect of the alimentary canal is described as a nutcracker-like compression caused by the aorta and the superior mesenteric arteries on a certain section of the alimentary canal leading to bowel obstruction. Which of the following parts of the alimentary canal is usually obstructed by this nutcracker compression of the two arteries?
Your Answer: Duodenum
Explanation:The ‘nutcracker effect’ is only seen in one part of the alimentary canal, and that is in the third part of the duodenum. This can happen when the superior mesenteric artery that passes across the duodenum and the aorta, posteriorly to the third part of the duodenum enlarges and starts compressing the duodenum. The result is an obstructed duodenum that inhibits passage of food.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 45
Correct
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Congenital anomalies of genitourinary tract are more common than any other system. Which of the following anomalies carries the greatest risk of morbidity?
Your Answer: Bladder exstrophy
Explanation:Bladder exstrophy is the condition where the urinary bladder opens from the anterior aspect suprapubically. The mucosa of the bladder is continuous with the abdominal skin and there is separation of the pubic bones. The function of the upper urinary tract remains normal usually. Treatment consists of surgical reconstruction of the bladder and returning it to the pelvis. There can be a need for continent urinary diversion along with reconstruction of the genitals.
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This question is part of the following fields:
- Pathology
- Renal
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Question 46
Correct
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Under normal conditions, what is the major source of energy of cardiac muscles?
Your Answer: Fatty acids
Explanation:Under basal conditions, most of the energy needed by cardiac muscle for metabolism is derived from fats (60%), 35% by carbohydrates, and 5% by ketones and amino acids. However, after intake of large amounts of glucose, lactate and pyruvate are mainly used. During prolonged starvation, fat acts as the primary source. 50% of the used lipids are sourced from circulating fatty acids.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 47
Correct
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During cardiac catheterisation, if the blood sample from the catheter shows an oxygen saturation of 70%, and the pressure ranging from 12 to 24 mm Hg, it implies that the catheter tip is located in the:
Your Answer: Pulmonary artery
Explanation:Normal values for various parameters are as follows:
Systolic arterial blood pressure (SBP): 90–140 mmHg.
Diastolic arterial blood pressure: 60–90 mmHg.
Mean arterial blood pressure (MAP): SBP + (2 × DBP)/3 (normal range: 70-105 mmHg).
Right atrial pressure (RAP): 2–6 mmHg.
Systolic right ventricular pressure (RVSP): 15–25 mmHg.
Diastolic right ventricular pressure (RVDP): 0–8 mmHg.
Pulmonary artery pressure (PAP): Systolic (PASP) is 15-25 mmHg and Diastolic (PADP) is 8–15 mmHg.
Pulmonary artery wedge pressure (PAWP): 6–12 mmHg.
Left atrial pressure (LAP): 6–12 mmHg.
Thus, the given value indicates that the position of catheter tip is likely to be in the pulmonary artery.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 48
Correct
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Gastrocnemius, semimembranosus and semitendinosus together with which other muscle form the boundaries of the popliteal fossa?
Your Answer: Biceps femoris
Explanation:The popliteal fossa is located at the back of the knee. It is bounded laterally by the biceps femoris above and the plantaris and lateral head of the gastrocnemius below and medially by the semitendinosus and semimembranosus above and by the medial head of the gastrocnemius below.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 49
Correct
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Acute respiratory distress syndrome (ARDS) is a medical condition that occurs in critically ill patients, and can be triggered by events such as trauma and sepsis. Which of the following variables is most likely to be lower than normal in a patient with ARDS?
Your Answer: Lung compliance
Explanation:Acute (or Adult) respiratory distress syndrome (ARDS) is a medical condition occurring in critically ill patients characterized by widespread inflammation in the lungs. The development of acute respiratory distress syndrome (ARDS) starts with damage to the alveolar epithelium and vascular endothelium, resulting in increased permeability to plasma and inflammatory cells. These cells pass into the interstitium and alveolar space, resulting in pulmonary oedema. Damage to the surfactant-producing type II cells and the presence of protein-rich fluid in the alveolar space disrupt the production and function of pulmonary surfactant, leading to micro atelectasis and impaired gas exchange. The pathophysiological consequences of lung oedema in ARDS include a decrease in lung volumes, compliance and large intrapulmonary shunts. ARDS may be seen in the setting of pneumonia, sepsis, following trauma, multiple blood transfusions, severe burns, severe pancreatitis, near-drowning, drug reactions, or inhalation injuries.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 50
Correct
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Which of the following is the cause of flattened (notched) T waves on electrocardiogram (ECG)?
Your Answer: Hypokalaemia
Explanation:The T-wave is formed due to ventricular repolarisation. Normally, it is seen as a positive wave. It can be normally inverted (negative) in V1 (occasionally in V2-3 in African-Americans/Afro-Caribbeans). Hyperacute T-waves are the earliest ECG change of acute myocardial infarction. ECG findings of hyperkalaemia include high, tent-shaped T-waves, a small P-wave and a wide QRS complex. Hypokalaemia results in flattened (notched) T-waves, U-waves, ST-segment depression and prolonged QT interval.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 51
Correct
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A 27 year-old male patient was admitted to the hospital due to recurrent fever for the past 2 weeks. The patient claimed that he is an intravenous drug user. Following work up, the patient was diagnosed with infective endocarditis. Which is the most likely organism responsible for this diagnosis?
Your Answer: Staphylococcus aureus
Explanation:Acute bacterial endocarditis is a fulminant illness lasting over days to weeks (<2weeks). It is most likely due to Staphylococcus aureus especially in intravenous drug abusers.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 52
Incorrect
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A 45 -year-old female is recently diagnosed with breast cancer. She has a 8-cm-diameter mass in her left breast, with enlarged left axillary node. What is the most likely stage of her disease?
Your Answer: IIIB
Correct Answer: IIIA
Explanation:Stage IIIA breast cancer is T0–2 N2 M0 or T3 N1-2 M0 disease. It describes invasive breast cancer in which either: the tumour is smaller than 5 cm in diameter and has spread to 4 to 9 axillary lymph nodes; or it is found through imaging studies or clinical exam to have spread to internal mammary nodes (near the breastbone found during imaging tests or a physical exam); or the tumour is larger than 5 cm and has spread to 1 to 9 axillary nodes, or to internal mammary nodes. In this stage, the cancer has not metastasized (spread to distant sites).
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 53
Correct
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An experiment was conducted in which the skeletal muscle protein (not smooth muscle) involved in contraction was selectively inhibited. Which protein was inhibited?
Your Answer: Troponin
Explanation:The mechanism of contraction of smooth muscles is different from that of skeletal muscles in which the contractile protein is troponin whilst in smooth muscle contraction is a protein called calmodulin. Calmodulin reacts with calcium ions and stimulates the formation of myosin crossbridges.
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This question is part of the following fields:
- General
- Physiology
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Question 54
Incorrect
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A neonate is diagnosed with cryptorchidism of the right side (undescended testis). Which is the LEAST likely place to find the testis?
Your Answer: Pelvic brim
Correct Answer: Perineum
Explanation:Embryologically the testes are retroperitoneal structures in the posterior abdominal wall, attached to the anterolateral abdominal wall by the gubernaculum. The gubernaculum ‘pulls’ the testes through the deep inguinal ring, inguinal canal and superficial inguinal ring and over the pelvic brim. The gubernaculum is preceded by the processus vaginalis that is derived from the peritoneum anterior to the testes. The processus vaginalis pushes the muscle and fascial layers. These eventually make up the canal and the spermatic cord, into the scrotum. The gubernaculum persists as the scrotal ligament while part of the processus vaginalis remains as a bursa-like sac i.e. the tunica vaginalis testes. The testes therefore could be caught in any one of these places along its path of descending. The testes are never in the perineum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 55
Correct
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A TRUE statement regarding abolition of the cephalic phase of pancreatic secretion is that it:
Your Answer: Will result after vagotomy
Explanation:Recognition and integration of the sight, smell and taste of food triggers the cephalic phase of pancreatic secretion, causing an increase in pancreatic HCO3- and enzyme secretion. The degree of enzyme secretion in this phase is about 50% of the maximal response seen with exogenous CCK and secretin. The vagus nerve regulates the secretion through the cholinergic fibres innervating the acinar cells of the pancreas, and through peptidergic nerve fibres, which innervate ductal cells.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 56
Correct
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Which of these structures is most likely to be damaged if a patient loses consciousness days or weeks after an otherwise insignificant head trauma, especially in elderly patients?
Your Answer: Dural bridging vein
Explanation:A subdural haematoma is a type of hematoma, usually associated with traumatic brain injury, in which blood collects between the dura mater and the pia-arachnoid mater. Symptoms of subdural haemorrhage have a slower onset than those of epidural haemorrhages because the lower pressure veins bleed more slowly than arteries. These injuries are more common in elderly patients, especially those taking antiplatelet or anticoagulant drugs. Oedema and increased intracranial pressure are unusual.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 57
Correct
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A blood sample of a 58 year old male patient, who underwent an abdominal aortic aneurysm repair, was sent to the laboratory. The laboratory technician said that the patient’s blood agglutinates with antisera anti-A and anti-D, while the patient’s serum agglutinates cells of blood group B. What is the blood group of this patient?
Your Answer: A positive
Explanation:Group A – has only the A antigen on red cells (and B antibody in the plasma)
Group B – has only the B antigen on red cells (and A antibody in the plasma)
Group AB – has both A and B antigens on red cells (but neither A nor B antibody in the plasma)
Group O – has neither A nor B antigens on red cells (but both A and B antibody are in the plasma). Many people also have a so-called Rh factor on the red blood cell’s surface. This is also an antigen and those who have it are called Rh+. A person with Rh– blood does not have Rh antibodies naturally in the blood plasma (as one can have A or B antibodies, for instance) but they can develop Rh antibodies in the blood plasma if they receive blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies. A person with Rh+ blood can receive blood from a person with Rh– blood without any problems. In this scenario the person has blood group A+ as he has A antigen, anti B antibody and Rh antigen
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This question is part of the following fields:
- General
- Physiology
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Question 58
Correct
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The renal cortex and medulla, if seen under the microscope, is lacking one of the following:
Your Answer: Squamous epithelium
Explanation:Capillaries, Henle’s loop, collecting ducts, Bertin columns and type IV collagen in glomerular basement membrane are all structures present in the renal cortex or medulla. The squamous epithelium is the only one that is lacking in both the renal cortex and medulla, because normally it is not found above the outer urethra.
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This question is part of the following fields:
- Pathology
- Renal
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Question 59
Correct
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A 15-day old baby was brought to the emergency department with constipation for 4 days. On examination, the abdomen of the baby was found to be distended and tender all over. No bowel sounds were heard. A sigmoid colon biopsy was carried out, which showed absent ganglion cells. What is the diagnosis?
Your Answer: Hirschsprung’s disease
Explanation:Hirschsprung’s disease is characterized by congenital absence of the autonomic plexus (Meissner’s and Auerbach’s plexus) in the intestinal wall. Usually limited to the distal colon, it can occasionally involve the entire colon or even the small bowel. There is abnormal or absent peristalsis in the affected segment, resulting in continuous spasm of smooth muscle and partial/complete obstruction. This causes accumulation of intestinal contents and dilatation of proximal segment. Skip lesions are highly uncommon. This disease is seen early in life with 15% patients presenting in first month, 60% by 1 year of age and 85% by the age of 4 years. Symptoms include severe and complete constipation, abdominal distension and vomiting. Patients with involvement of ultra-short segments might have mild constipation with intervening diarrhoea. In older children, symptoms include failure to thrive, anorexia, and lack of an urge to defecate. On examination, an empty rectum is revealed with stool palpable high up in the colon. If not diagnosed in time, it can lead to Hirschsprung’s enterocolitis (toxic megacolon), which can be fulminant and lead to death. Diagnosis involves a barium enema or a rectal suction biopsy. Barium enema shows a transition in diameter between the dilated, normal colon proximal to the narrowed, affected distal segment. It is to be noted that barium enema should be done without prior preparation, which can dilate the abnormal segment, leading to a false-negative result. A 24-hour post-evacuation film can be obtained in the neonatal period – if the colon is still filled with barium, there is a high likelihood of Hirschsprung’s disease. Full-thickness rectal biopsy is diagnostic by showing the absence of ganglion cells. Acetylcholinesterase staining can be done to highlight the enlarged nerve trunks. Abnormal innervation can also be demonstrated by rectal manometry.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 60
Incorrect
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Bloody discharge from the nipple of a 40-year old woman with no obvious lump or abnormality on mammography is suggestive of:
Your Answer: Infiltrating ductal carcinoma
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.
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This question is part of the following fields:
- Pathology
- Women's Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
