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Question 1
Correct
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With respect to far accommodation, which of the following is a TRUE statement?
Your Answer: The ciliary muscles are relaxed
Explanation:Myopia or near-sightedness is a disease due to elongated eyeballs or too strong a lens. For far accommodation (focus of a distant object onto the retina), the lens needs to decrease its refractive power, or in other words, increase its focal length. This is done by relaxation of ciliary muscles which tightens the zonular fibres and flattening of the lens. Relaxation of the zonular fibres, rounding of the lens, shortening of the focal length and constriction of the pupil occurs during near accommodation.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 2
Incorrect
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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 potassium
Correct 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 3
Incorrect
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The posterior boundary of the carotid triangle is bounded by which of the following muscles?
Your Answer: Anterior border of the trapezius muscle
Correct Answer: Sternocleidomastoid
Explanation:The carotid triangle is a portion of the anterior triangle of the neck. It is bounded superiorly by the posterior belly of the digastric muscle, antero-inferiorly by the superior belly of omohyoid and posteriorly by the sternocleidomastoid. The floor is formed by the thyrohyoid, hyoglossus, middle and inferior pharyngeal constrictors and the roof is formed by the skin, superficial fascia, platysma and deep fascia.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 4
Incorrect
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Most of the coagulation factors are serine proteases. Which of the following is not one of them?
Your Answer: Factor I
Correct Answer: Factor XIII
Explanation:Serine protease coagulation factors include: thrombin, plasmin, Factors X, XI and XII. Factor VIII and factor V are glycoproteins and factor XIII is a transglutaminase.
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This question is part of the following fields:
- General
- Physiology
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Question 5
Correct
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Which of the following conditions causes an elevation of the pH in the tissues with elevated arterial CO2 content?
Your Answer: Metabolic alkalosis
Explanation:Metabolic alkalosis is a metabolic condition in which the pH of tissue is elevated beyond the normal range (7.35-7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate, or alternatively a direct result of increased bicarbonate concentrations. Normally, arterial pa(CO2) increases by 0.5–0.7 mmHg for every 1 mEq/l increase in plasma bicarbonate concentration, a compensatory response that is very quick. If the change in pa(CO2) is not within this range, then a mixed acid–base disturbance occurs.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 6
Incorrect
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After being admitted to the hospital, a 60-year-old man is administered sodium nitroprusside. Which class of drugs does nitroprusside belong to?
Your Answer:
Correct Answer: Vasodilators
Explanation:Sodium nitroprusside is a potent peripheral vasodilator that affects both arterioles and venules. It is often administered intravenously to patients who are experiencing a hypertensive emergency. It reduces both total peripheral resistance as well as venous return, so decreasing both preload and afterload. For this reason it can be used in severe cardiogenic heart failure where this combination of effects can act to increase cardiac output. It is administered by intravenous infusion. Onset is typically immediate and effects last for up to ten minutes. The duration of treatment should not exceed 72 hours.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 7
Incorrect
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The middle meningeal artery is the largest among the arteries that supplies that dura mater of the brain. The middle meningeal artery is a branch of the?
Your Answer:
Correct Answer: Maxillary artery
Explanation:The middle meningeal artery is the largest of the three (paired) arteries that supply the meninges.
The middle meningeal artery is a large arterial branch of the maxillary artery which is a terminal branch of the external carotid artery. Upon originating, the middle meningeal artery passes through the foramen spinosum. In the skull, it courses in the middle cranial fossa where it provides several branches.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 8
Incorrect
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From which source does the lingual artery originate?
Your Answer:
Correct Answer: External carotid
Explanation:The lingual artery arises from the external carotid between the superior thyroid artery and facial artery. It can be located easily on the lower surface of the tongue. The terminal branch of the lingual artery is the deep lingual artery. On its course the lingual artery gives off side branches: dorsal lingual branches that supply the dorsum of the tongue till the epiglottis; sublingual artery that supplies the sublingual gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 9
Incorrect
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A 14 year old girl suffers from haemophilia A and chronic knee pain with progressive swelling and deformity over the last 4 years. Test results reveal a significantly reduced factor VIII activity. Which of the following is seen in the knee joint space after an acute painful episode?
Your Answer:
Correct Answer: Cholesterol crystals
Explanation:Due to breakdown of the red blood cell membrane in haemophilic patients, cholesterol crystals are formed by the lipids. On the other hand lipofuscin deposition does not occur in haemolysis or haemorrhage. Neutrophil accumulation suggests acute inflammation. Anthracotic pigment is an exogenous carbon pigment that deposits in the lung from dust. Russell bodies are intracellular accumulations of immunoglobins in plasma cells. Curschmann’s spirals and Charcot Leyden crystals are pathognomonic of asthma.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Haematology
- Pathology
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Question 10
Incorrect
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The uterine artery arises from the?
Your Answer:
Correct Answer: Internal iliac artery
Explanation:The uterine artery arises from the anterior division of the internal iliac artery and runs medially on the levator ani towards the uterine cervix.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 11
Incorrect
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What best describes the muscles of the posterior compartment of the leg?
Your Answer:
Correct Answer: One of the posterior compartment leg muscles laterally rotates the femur
Explanation:The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris and are the chief extensors of the foot at the ankle joint. Deep muscles include the tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 12
Incorrect
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Routine evaluation of a 38 year old gentleman showed a slightly lower arterial oxygen [pa(O2)] than the alveolar oxygen [pA(O2)]. This difference is:
Your Answer:
Correct Answer: Is normal and due to shunted blood
Explanation:Blood that bypasses the ventilated parts of lung and enters the arterial circulation directly is known as shunted blood. It happens in normal people due to mixing of arterial blood with bronchial and some myocardial venous blood (which drains into the left heart). Diffusion limitation and reaction velocity with haemoglobin are immeasurably small. CO2 unloading will not affect the difference between alveolar and arterial p(O2). A large VSD will result in much lower arterial O2 as compared to alveolar O2.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 13
Incorrect
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A 35 year old patient presenting with haematemesis, heart burn and bloody stool was diagnosed with a duodenal ulcer that had eroded the gastroduodenal artery. The patient was then rushed into theatre for an emergency procedure to control the haemorrhage. If the surgeon decided to ligate the gastroduodenal artery at its origin, which of the following arteries would most likely experience retrograde blood flow from collateral sources as a result of the ligation?
Your Answer:
Correct Answer: Right gastroepiploic
Explanation:In the stomach and around the duodenum, there are many arterial anastomoses. Ligation of the gastroduodenal artery would result in the retrograde flow of blood from the left gastroepiploic artery to the right gastroepiploic artery. The blood flows into the right gastroepiploic artery, a branch of the gastroduodenal artery from the left gastroepiploic artery that branches from the splenic artery. This retrograde blood flow is aimed at providing alternate blood flow to the greater curvature of the stomach.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 14
Incorrect
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Production of pain is most likely associated with:
Your Answer:
Correct Answer: Substance P
Explanation:Substance P is a short-chain polypeptide that functions as a neurotransmitter and as a neuromodulator, and is thus, a neuropeptide. It has been linked with pain regulation, mood disorders, stress, reinforcement, neurogenesis, respiratory rhythm, neurotoxicity, nausea and emesis. It is also a potent vasodilator as it brings about release of nitric oxide from the endothelium. Its release can also cause hypotension.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 15
Incorrect
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A 62-year-old man presented with a persistent cough and weight loss. Chest x-ray demonstrated widespread nodular opacities. After a bronchoalveolar lavage, atypical cells were detected. Which is the most probable diagnosis?
Your Answer:
Correct Answer: Bronchioalveolar carcinoma
Explanation:Bronchioloalveolar carcinoma (BAC) is a term used to define a particular subtype of adenocarcinoma which develops in cells near the alveoli, in the outer regions of the lungs. On a chest X-ray it can appear as a single peripheral spot or as scattered spots throughout the lungs. Symptoms include cough, haemoptysis, chest pain, dyspnoea and loss of weight.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 16
Incorrect
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What is the 5 year survival rate of a patient who is diagnosed with stage III colon cancer, who underwent successful resection and completed the prescribed session of adjuvant chemotherapy?
Your Answer:
Correct Answer: 30%–60%
Explanation:In this patient who has stage III colon cancer, the survival rate is 30-60%. For stage I or Dukes’ stage A disease, the 5-year survival rate after surgical resection exceeds 90%. For stage II or Dukes’ stage B disease, the 5-year survival rate is 70%–85% after resection, with or without adjuvant therapy. For stage III or Dukes’ stage C disease, the 5-year survival rate is 30%– 60% after resection and adjuvant chemotherapy and for stage IV or Dukes’ stage D disease, the 5-year survival rate is poor (approximately 5%).
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 17
Incorrect
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A 17-year-old female was given an antibiotic for a urinary tract infection. After taking the medication the patient developed Steven-Johnson syndrome. Which particular antibiotic usually causes Steven-Johnson syndrome?
Your Answer:
Correct Answer: Sulphonamides
Explanation:Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulphonamide antibiotics, and nevirapine.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 18
Incorrect
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In which of the following conditions will the oxygen-haemoglobin dissociation curve shift to the right?
Your Answer:
Correct Answer: Exercise
Explanation:The oxygen-haemoglobin dissociation curve plots saturated haemoglobin against the oxygen tension and is usually a sigmoid plot. Each molecule of haemoglobin can bind to four molecules of oxygen reversibly. Factors that can influence the binding include: pH, concentration of 2,3-diphosphoglycerate (2,3-DPG), temperature, type of haemoglobin molecules, and presence of toxins, especially carbon monoxide. Shape of the curve is due to interaction of bound oxygen molecules with the incoming molecules. The binding of first molecule is difficult, with easier binding of the second and third molecule and increase in difficulty with the fourth molecule – partly as a result of crowding and partly as a natural tendency of oxygen to dissociate.
Left shift of curve indicates haemoglobin’s increased affinity for oxygen (seen at lungs). Right shift indicates decreased affinity and is seen with an increase in body temperature, hydrogen ions, 2,3-diphosphoglycerate (DPG), carbon dioxide concentration and exercise. Under normal resting conditions in a healthy individual, the normal position of the curve is at a pH of 7.4. A shift in the position of the curve with a change in pH is called the Bohr effect. Left shift occurs in acute alkalosis, decrease in p(CO2), decrease in temperature and decrease in 2,3-DPG. The fetal haemoglobin curve is to the left of the adult haemoglobin to allow for oxygen diffusion across the placenta. The curve for myoglobin is even further to the left. Carbon monoxide has a much higher affinity for haemoglobin than oxygen does. Thus, carbon monoxide poisoning leads to hypoxia.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 19
Incorrect
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Which of the following physiological changes will you see in a young man who has been trekking in the Himalayas for 3 years?
Your Answer:
Correct Answer: Increased renal excretion of HCO3 –
Explanation:The atmospheric pressure is lower at high altitudes as compared with sea level. This leads to a decrease in the partial pressure of oxygen. Once 2100 m (7000 feet) of altitude is reached, there is a drop in saturation of oxyhaemoglobin. The oxygen saturation of haemoglobin determines the oxygen content in the blood. The body physiological tries to adapt to high altitude by acclimatization. Immediate effects include hyperventilation, fluid loss (due to a decreased thirst drive), increase in heart rate and slightly lowered stroke volume. Long term effects include lower lactate production, compensatory alkali loss in urine, decrease in plasma volume, increased erythropoietin release and red cell mass, increased haematocrit, higher concentration of capillaries in striated muscle tissue, increase in myoglobin, increase in mitochondria, increase in aerobic enzyme concentration such as 2,3-DPG and pulmonary vasoconstriction.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 20
Incorrect
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Electrophoresis is used to detect antibodies (immunoglobulins) in a blood sample from the umbilical artery of a new born. Which antibodies have the highest percentage in a new-born?
Your Answer:
Correct Answer: IgG
Explanation:IgG is a monomeric immunoglobulin. It is formed by two heavy chains and two light chains and has two binding sites. Its is the most abundant antibody that is equally distributed in the blood and the tissues. It is the only antibody that can pass through the placenta and thus the only antibody present in the baby after it is born. There are four subclasses: IgG1 (66%), IgG2 (23%), IgG3 (7%) and IgG4 (4%). IgG1, IgG3 and IgG4 cross the placenta easily
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This question is part of the following fields:
- General
- Physiology
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Question 21
Incorrect
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A patient is unable to move their mandible to the left. Which muscle is affected in this case?
Your Answer:
Correct Answer: Right lateral pterygoid muscle
Explanation:Patients with paralysis of the right pterygoid muscle are unable to move their mandible laterally to the left.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 22
Incorrect
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Which muscle in the neck divides the neck into two large triangles?
Your Answer:
Correct Answer: Sternocleidomastoid
Explanation:The sternocleidomastoid muscle is an important landmark in the neck as it divides the neck into two; anterior and posterior triangles. These triangles help in the location of the structures of the neck including the carotid artery, head and neck lymph nodes, accessory nerve and the brachial plexus. It originates from the manubrium and medial portion of the clavicle and inserts on the mastoid process of the temporal bone, superior nuchal line. The sternocleidomastoid receives blood supply from the occipital artery and the superior thyroid artery. It is innervated by the accessory nerve (motor) and cervical plexus (sensory).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 23
Incorrect
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During gastrectomy, the operating surgeon ligates the short gastric arteries along the greater curvature of the stomach. Where do the short gastric arteries branch from?
Your Answer:
Correct Answer: Splenic artery
Explanation:Short gastric arteries arise from the splenic artery at the end or from its terminal divisions. They are about 5 or 7 in number, passing from the left to the right in between the layers of the gastrosplenic ligament to be distributed along the greater curvature of the stomach.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 24
Incorrect
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Which is the correct superficial to deep order of structures that would be affected following a knife wound to the lateral aspect of the knee?
Your Answer:
Correct Answer: skin, fibular collateral ligament, popliteus muscle tendon, lateral meniscus
Explanation:Skin, fibular collateral ligament, popliteus muscle tendon and lateral meniscus is the correct order of structures covering the lateral aspect of the knee joint from a superficial to deep.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 25
Incorrect
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A 13-year-old girl has complained of pain in her left arm for 4 months. An X-ray reveals a mass along with erosion of the affected humerus. Histologically, the tumour is found to be formed by small, round, blue cells. What is the most likely diagnosis?
Your Answer:
Correct Answer: Ewing’s sarcoma
Explanation:Ewing’s sarcoma is formed by small, round, blue cells, and is common in children. The usually develop in limbs, and clinical findings include pain and inflammation, with lytic destruction showing up on X-rays.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 26
Incorrect
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The chest X-ray of an 10-year-old boy, that presented with low-grade fever and cough, revealed hilar enlargement and parenchymal consolidation in the middle lobes. These X-ray findings are more typical for which of the following diagnoses?
Your Answer:
Correct Answer: Pulmonary tuberculosis
Explanation:Primary pulmonary tuberculosis is seen in patients exposed to Mycobacterium tuberculosis for the firs time. The main radiographic findings in primary pulmonary tuberculosis include homogeneous parenchymal consolidation typically in the lower and middle lobes, lymphadenopathy, miliary opacities and pleural effusion.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 27
Incorrect
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C5a (a complement component) is a potent?
Your Answer:
Correct Answer: Anaphylotoxin
Explanation:C5a is a strong chemoattractant as well as an anaphylotoxin and is involved in the recruitment of inflammatory cells such as neutrophils, eosinophils, monocytes, and T lymphocytes. It is also involved in activation of phagocytic cells, release of granule-based enzymes and generation of oxidants. All of which contribute to innate immune functions.
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This question is part of the following fields:
- General
- Physiology
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Question 28
Incorrect
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A 65-year old gentleman presents to the clinic with chronic back pain and weight loss. His blood count shows a white blood cell count of 10 × 109/l, with a differential count of 66 polymorphonuclear leukocytes, 7 bands, 3 metamyelocytes, 3 myelocytes, 14 lymphocytes, 7 monocytes, and 5 nucleated red blood cells. The haemoglobin is 13 g/dl with a haematocrit of 38.1%, a mean corpuscular volume of 82 fl, and a platelet count of 126 × 109/l. What is the likely diagnosis?
Your Answer:
Correct Answer: Metastatic carcinoma
Explanation:The peripheral blood findings suggest a leucoerythroblastic picture, the common causes of which in a 65-year old gentleman includes prostatic or lung malignancy.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 29
Incorrect
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Which of the following compensatory parameters is responsible for causing an increase in the blood pressure in a 30 year old patient with a BP of 40 mmHg?
Your Answer:
Correct Answer: Baroreceptor reflex
Explanation:The baroreflex or baroreceptor reflex is one of the body’s homeostatic mechanisms for regulating blood pressure. It provides a negative feedback response in which an elevated blood pressure will causes blood pressure to decrease; similarly, decreased blood pressure depresses the baroreflex, causing blood pressure to rise. The system relies on specialised neurones (baroreceptors) in the aortic arch, carotid sinuses and elsewhere to monitor changes in blood pressure and relay them to the brainstem. Subsequent changes in blood pressure are mediated by the autonomic nervous system. Baroreceptors include those in the auricles of the heart and vena cava, but the most sensitive baroreceptors are in the carotid sinuses and aortic arch. The carotid sinus baroreceptors are innervated by the glossopharyngeal nerve (CN IX); the aortic arch baroreceptors are innervated by the vagus nerve (CN X).
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 30
Incorrect
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A 45 years old women was diagnosed with breast cancer. After a radical mastectomy to remove all axillary lymph nodes from her right breast, it was noticed that she had a winged scapula. Which nerve injury would explain this?
Your Answer:
Correct Answer: Long thoracic nerve
Explanation:The long thoracic nerve supplies the serratus anterior muscle. When this nerve is injured the muscle undergoes paralysis, which is seen clinically as winging of the scapula most apparent when the arm is lifted forward. The long thoracic nerve is greatly susceptible to injury during breast surgery because of its long and superficial course along the thorax from its origin, the brachial plexus, to the lower border of the serratus anterior muscle.
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This question is part of the following fields:
- Anatomy
- Breast
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Question 31
Incorrect
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Chest X-ray of a 45-year old gentleman with a week history of pleurisy showed a small pneumothorax with moderate-sized pleural effusion. Arterial blood gas analysis showed p(CO2) = 23 mmHg, p(O2) = 234.5 mmHg, standard bicarbonate = 16 mmol/l. What are we most likely dealing with?
Your Answer:
Correct Answer: Compensated respiratory alkalosis
Explanation:Normal pH with low p(CO2) and low standard bicarbonate could indicate either compensated respiratory alkalosis or a compensated metabolic acidosis. However, the history of hyperventilation for 5 days (pleurisy) favours compensated respiratory alkalosis. Compensated metabolic acidosis would have been likely in a diabetic patient with fever, vomiting and high glucose (diabetic ketoacidosis).
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 32
Incorrect
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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:
Correct 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 33
Incorrect
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Pain in the epigastric region occurring typically 2-3 hours after meals and causing the patient to wake up at night is characteristic of which of the following conditions?
Your Answer:
Correct Answer: Duodenal ulcer
Explanation:The description is typical for duodenal ulcers. There is no pain upon waking in the morning however it appears around mid-morning and is relieved by ingestion of food. The pain also often causes the patient to wake up at night.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 34
Incorrect
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To reach the oral vestibule, the parotid duct must pierce this muscle:
Your Answer:
Correct Answer: Buccinator muscle
Explanation:The parotid duct or Stensen duct is a duct and the route that saliva takes from the major salivary gland, the parotid gland into the mouth. The parotid duct is formed when several interlobular ducts—the largest ducts inside the parotid gland join. It emerges from the gland and runs forward along the lateral side of the masseter muscle. In this course, the duct is surrounded by the buccal fat pad. It takes a steep turn at the border of the masseter and passes through the buccinator muscle, opening into the vestibule of the mouth, between the cheek and the gums, at the parotid papilla, which lies across the second superior molar tooth.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 35
Incorrect
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Which of the following is found to be elevated in a case of hepatocellular carcinoma?
Your Answer:
Correct Answer: AFP
Explanation:Alpha-fetoprotein (AFP) is a glycoprotein that is normally produced by the yolk sac of the embryo, and then the fetal liver. It is elevated in the new-born and thus, also in the pregnant women. Eventually, it decreases in the first year of life to reach the adult normal value of < 20 ng/ml by 1 year of age. Markedly elevated levels (>500 ng/ml) in a high-risk patient is considered diagnostic for primary hepatocellular carcinoma (HCC). Moreover, due to smaller tumours secreting less quantities of AFP, rising levels can be a better indication. However, not all hepatocellular carcinomas produce AFP. Also, the level of AFP is not a prognostic factor. Populations where hepatitis B and HCC are common (e.g.: sub-Saharan Africans, ethnic Chinese) can see AFP levels as high as 100,000 ng/ml, whereas levels are low (about 3000 ng/ml) in regions with lesser incidences of HCC.
AFP can also be elevated up to 500 ng/ml in conditions like embryonic teratocarcinomas, hepatoblastomas, fulminant hepatitis, hepatic metastases from gastrointestinal tract cancers, some cholangiocarcinomas). Lesser values are seen in acute and chronic hepatitis.
Overall, the sensitivity of AFP value ≥20 ng/ml is 39-64% and the specificity is 76%–91%. Value of 500 ng/ml is considered as the diagnostic cut-off level for HCC.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 36
Incorrect
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Paracentesis of ascetic fluid in a 45-year old woman revealed the following : clear, yellow fluid with protein 2.0 g/dl and a few mesothelial and mononuclear cells seen. No malignant cells seen. What is the likely diagnosis?
Your Answer:
Correct Answer: Cirrhosis
Explanation:Ascites develops either from:
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- Increased accumulation
- Increased capillary permeability
- Increased venous pressure
- Decreased protein (oncotic pressure)
- Decreased clearance
- Increased lymphatic obstruction
- Increased accumulation
Cause
- Transudate (<30g/L protein) (Systemic disease)
- Liver (Cirrhosis)
- Cardiac e.g. RHF, CCF, SBE right heart valve disease and constrictive Pericarditis
- Renal failure
- Hypoalbuminaemia (nephrosis)
- Exudate (>30g/L protein) (Local disease)
- Malignancy
- Venous obstruction e.g. Budd-Chiari, Schistosomiasis
- Pancreatitis
- Lymphatic obstruction
- Infection (especially TB)
Cirrhosis is disease of the liver that is characterized by fibrosis leading to disorganization of the hepatic architecture. It shows the development of regenerative nodules surrounded by dense fibrotic tissue. Cirrhosis shows non-specific symptoms initially, which include fatigue, anorexia and weight loss. It can later progress to portal hypertension, ascites and liver failure.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 37
Incorrect
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Which of these conditions causes haematuria, hypertension and proteinuria in children, usually after a streptococcal infection?
Your Answer:
Correct 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 38
Incorrect
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Hyperplastic arteriosclerosis with fibrinoid necrosis, petechial haemorrhages, microinfarcts in the kidneys and elevated plasma renin are common findings in which of the following patients?
Your Answer:
Correct Answer: A 45-year-old woman with scleroderma
Explanation:Scleroderma, also known as systemic sclerosis, is a chronic disease of the connective tissue. Involvement of the kidneys occurs in patients with diffuse scleroderma, causing rapid onset of high blood pressure with hyperreninemia, thrombotic microangiopathy, and progressive renal failure.
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This question is part of the following fields:
- Pathology
- Renal
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Question 39
Incorrect
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A drug abuser developed an infection which spread from the dorsum of the hand to the medial side of the arm along the course of the large cutaneous vein. Which vein is involved?
Your Answer:
Correct Answer: Basilic
Explanation:The basilic vein is one of two veins found in the forearm, the other is the cephalic vein. These veins originate from the deep venous arch of the hand. The cephalic vein ascends along the lateral side of the forearm, and the basilic vein runs up the medial side of the forearm.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 40
Incorrect
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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:
Correct 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 41
Incorrect
-
From which of the following cells is heparin produced?
Your Answer:
Correct Answer: Mast cells
Explanation:Heparin is a natural highly-sulphated glycosaminoglycan that has anticoagulant functions. It is produced by the body basophils and mast cells.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 42
Incorrect
-
Which of the following coagulation factors cross-links fibrin?
Your Answer:
Correct Answer: Factor XIII
Explanation:Factor XIII, also known as fibrin stabilizing factor, is an enzyme of the coagulation cascade that crosslinks fibrin. Deficiency of FXIII may cause bleeding tendency but paradoxically, it may also predispose to thrombosis.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 43
Incorrect
-
A 29-year-old pregnant woman suffering from hyperemesis gravidarum is prescribed metoclopramide. What is the mechanism of action of metoclopramide?
Your Answer:
Correct Answer: Dopamine antagonist
Explanation:Metoclopramide is a potent dopamine-receptor antagonist with anti-emetic and prokinetic properties. It is therefore commonly used to treat nausea and vomiting, and to facilitate gastric emptying in patients with gastric stasis. The anti-emetic action of metoclopramide is due to its antagonist activity at D2 receptors in the chemoreceptor trigger zone (CTZ) in the central nervous system. Common adverse drug reactions associated with metoclopramide include restlessness (akathisia), and focal dystonia.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 44
Incorrect
-
Which of the following proteins acts as cofactor in the thrombin-induced activation of anticoagulant protein C?
Your Answer:
Correct Answer: Thrombomodulin
Explanation:Thrombomodulin is a protein cofactor expressed on the surface of endothelial cells. Thrombomodulin binds with thrombin forming a complex which activates protein C, initiating the anticoagulant pathway.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 45
Incorrect
-
An explorative laparotomy is done on a 23 year old following a gunshot abdominal injury through the right iliac fossa. It is found that the ileocolic artery is severed and the bullet had perforated the caecum. From which branch does the ileocolic artery originate?
Your Answer:
Correct Answer: Superior mesenteric artery
Explanation:Ileocolic artery branches off from the superior mesenteric artery. It then divides to give a superior and inferior branch.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 46
Incorrect
-
A brain tumour causing blockage of the hypophyseal portal system is likely to result in an increased secretion of which of the following hormones?
Your Answer:
Correct Answer: Prolactin
Explanation:The hypophyseal portal system links the hypothalamus and the anterior pituitary. With the help of this system, the anterior pituitary receives releasing and inhibitory hormones from the hypothalamus and regulates the action of other endocrine glands. One of the inhibitory hormones carried by this system is the prolactin-inhibitory hormone. In the absence of this hormone which might occur in case of a blockage of the system, prolactin secretion increases to about three times normal levels.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 47
Incorrect
-
The line which divides the perineum into two triangles is connected to the?
Your Answer:
Correct Answer: Ischial tuberosities
Explanation:The perineum has it’s deep boundaries in front of the pubic arch and the arcuate ligament of the pubis, behind the tip of the coccyx and on either side of the inferior rami of the pubis and ischium and the sacrotuberous ligament. It also corresponds to the outlet of the pelvis. A line drawn transversely across, in front of the ischial tuberosities divides the space into two portions, the posterior contains the termination of the anal canal and the anterior, contains the external urogenital organs.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 48
Incorrect
-
A 32-year-old man presented with a metabolic acidosis and increased anion gap. What is the most likely cause of the changes of the anion gap in this patient?
Your Answer:
Correct Answer: Lactic acidosis
Explanation:High anion gap in metabolic acidosis is caused generally by the elevation of the levels of acids like ketones, lactate, sulphates in the body, which consume the bicarbonate ions. Other causes of a high anion gap include overdosing on salicylates, uraemia, rhabdomyolysis, hypocalcaemia, hypomagnesaemia, or ingestion of toxins such as ethylene glycol, methanol, propyl alcohol, cyanide and iron.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 49
Incorrect
-
A 27-yeaar-old woman is diagnosed with candidiasis and prescribed fluconazole. What is the mechanism of action of fluconazole?
Your Answer:
Correct Answer: Inhibits cytochrome P450
Explanation:Fluconazole is a triazole antifungal drug used in the treatment and prevention of superficial and systemic fungal infections. Like other imidazole- and triazole-class antifungals, fluconazole inhibits the fungal cytochrome P450 enzyme, 14-demethylase. It is used to treat candidiasis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, dermatophytosis, and pityriasis versicolor.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 50
Incorrect
-
A patient with chronic renal disease, missed a day of his dialysis schedule., His serum potassium was 7.6 mmol/L when his electrolytes were checked. What is the ECG finding expected in this patient?
Your Answer:
Correct Answer: Tented T waves
Explanation:ECG characteristics of hyperkalaemia may show the following changes: P-waves are widened and of low amplitude due to slowing of conduction, widened QRS complex, QRS-T fusion, loss of ST segment and tall tented T waves.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 51
Incorrect
-
What is the mostly likely cause of prolonged activated partial thromboplastin time (aPPT) ?
Your Answer:
Correct Answer: Heparin therapy
Explanation:The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT) is an indicator for measuring the efficacy of both the intrinsic and common coagulation pathway. Prolonged aPTT may indicate: use of heparin, antiphospholipid antibody and coagulation factor deficiency (e.g., haemophilia). Deficiencies of factors VIII, IX, XI and XII and rarely von Willebrand factor (if causing a low factor VIII level) may lead to a prolonged aPTT correcting on mixing studies.
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This question is part of the following fields:
- General
- Physiology
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Question 52
Incorrect
-
Which of the following is true regarding factor XI?
Your Answer:
Correct Answer: Deficiency causes haemophilia C
Explanation:Factor XI is also known as plasma thromboplastin and is one of the enzymes of the coagulation cascade. It is produced in the liver and is a serine protease. It is activated by factor XIIa, thrombin and by itself. Deficiency of factor XI causes the rare type of haemophilia C. Low levels of factor XI also occur in other disease states, including Noonan syndrome. High levels of factor XI have been seen in thrombosis.
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This question is part of the following fields:
- General
- Physiology
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Question 53
Incorrect
-
A 17-year-old boy, who had developed shortness of breath and a loss of appetite over the last month, was referred to a haematologist because he presented with easy bruising and petechiae. His prothrombin time, platelet count, partial thromboplastin and bleeding time were all normal. Which of the following would explain the presence of the petechiae and easy bruising tendency?
Your Answer:
Correct Answer: Scurvy
Explanation:Scurvy is a condition caused by a dietary deficiency of vitamin C, also known as ascorbic acid. Humans are unable to synthesize vitamin C, therefore the quantity of it that the body needs has to come from the diet. The presence of an adequate quantity of vitamin C is required for normal collagen synthesis. In scurvy bleeding tendency is due to capillary fragility and not coagulation defects, therefore blood tests are normal.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 54
Incorrect
-
Pain in the right upper quadrant of the abdomen on ingestion of a fatty meal is seen in a condition which involves which of the following substances?
Your Answer:
Correct Answer: Cholecystokinin
Explanation:The clinical scenario described here favours the presence of gallstones. During food ingestion, vagal discharges stimulate gallbladder contraction. Moreover, presence of fat and amino acids in the intestinal lumen stimulates the release of cholecystokinin (CCK) in the duodenum. This causes sustained gallbladder contraction and relaxation of the sphincter of Oddi. If gallstones are present, there will be inflammation in the gallbladder and CCK will aggravate it due to contractions.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 55
Incorrect
-
Which cells are most commonly seen in a granulomatous lesion that suggests an underlying chronic inflammation?
Your Answer:
Correct Answer: Lymphocytes
Explanation:Lymphocytes and monocytes are commonly and characteristically recognised in a case of chronic inflammation.
Eosinophils and neutrophils are seen with acute inflammation.
Mast cells release histamine in early inflammation.
Basophils are seen with allergies.
Plasma cells are seen with viral infection.
Platelets are not characteristic of any type of inflammation.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
-
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Question 56
Incorrect
-
Severe abdominal pain radiating to the back, along with increased serum amylase levels, is seen in which of the following conditions?
Your Answer:
Correct Answer: Pancreatitis
Explanation:The primary test for diagnosis and monitoring of pancreatitis is amylase. Increased plasma levels of amylase can be found in: salivary trauma (including anaesthetic intubation), mumps, pancreatitis and renal failure. However, a rise in the total amylase levels over 10 times the upper limit of normal (ULN) is suggestive of pancreatitis; 5–10 times the ULN may indicate ileus or duodenal disease or renal failure. Lower levels are commonly found in salivary gland disease.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 57
Incorrect
-
A 76-year-old man with a urinary tract obstruction due to prostatic hyperplasia develops acute renal failure. Which of the following physiological abnormalities of acute renal failure will be most life threatening for this patient?
Your Answer:
Correct Answer: Acidosis
Explanation:Acute renal failure (ARF) is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. This accumulation may be accompanied by metabolic disturbances, such as metabolic acidosis and hyperkalaemia, changes in body fluid balance and effects on many other organ systems. Metabolic acidosis and hyperkalaemia are the two most serious biochemical manifestations of acute renal failure and may require medical treatment with sodium bicarbonate administration and antihyperkalaemic measures. If not appropriately treated these can be life-threatening. ARF is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient amounts of urine.
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This question is part of the following fields:
- Physiology
- Renal
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Question 58
Incorrect
-
In what form are fats primarily transported in the body?
Your Answer:
Correct Answer: Free fatty acids
Explanation:Fat is mainly transported in the body as free fatty acids. Once out of the adipose cell, the free fatty acids get ionized and combine with albumin.
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This question is part of the following fields:
- Gastroenterology
- Physiology
-
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Question 59
Incorrect
-
A man came to the hospital complaining of a sensation of pins and needles in the dorsum of the thumb and digits 1 and 2. On further examination they found that he had weakness in wrist dorsiflexion and finger extension. Which nerve do you think is injured in this case?
Your Answer:
Correct Answer: Radial
Explanation:The radial nerve can be injured in multiple sites along its course in the upper limb, and each site has its own presentation. The major complaint is wrist drop which if high above the elbow, can cause numbness of the forearm and hand. It can last for several days or weeks. The most common site of compression for the radial nerve is at the proximal forearm in the area of the supinator muscles.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 60
Incorrect
-
A 46-year old female patient experienced a stroke that affected her glossopharyngeal nerve. Damage to the glossopharyngeal nerve would most likely:
Your Answer:
Correct Answer: Result in general sensory deficit to the pharynx
Explanation:The glossopharyngeal nerve (CN IX) has many functions which include:
– Contributes to the pharyngeal plexus
– Receiving general somatic sensory fibres from the tonsils, pharynx, the middle ear and the posterior third of the tongue.
– supplies motor fibres to only one muscle; the stylopharyngeus muscle.
– provides parasympathetic fibres to the parotid gland via the otic ganglion.
– Receives visceral sensory fibres from the carotid bodies & carotid sinus.
– Receives special visceral sensory fibres from the posterior third of the tongue.
The above functions will directly be affected by the damage of the glossopharyngeal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 61
Incorrect
-
T lymphocytes that express the MCH type II antigen are most likely to produce which of the following cytokines?
Your Answer:
Correct Answer: Gamma interferon
Explanation:Interferon gamma is a soluble cytokine previously known as the macrophage activating factor. It is the only member belonging to the type II class of the interferons. It is secreted by a number of cells taking part in the immune reaction including: T-helper cells (CD-4), cells with immunological memory (CD45PA), killer cells (CD8), dendrite cells (CD23,35), natural killer cells (CD16) and B lymphocytes (CD22,CD23). It has both a defending as well as a pathological effect. It induces differentiation in the myeloid cell in the bone marrow. If macrophages are infected by parasites it activates the macrophages to destroy them. IFN-γ strengthens the anti-tumour activities of the cytotoxic lymphocytes. Together with CD4 or CD8 toxins, produced by lymphocytes, it suppresses the growth of the tumour cells. along with these functions it increases the non specific response of the natural killer cells, causing changes in the cell membrane surface to prevent adhesion and penetration of a virus. It can either increase or decrease B cell response and it activates osteoclasts which increases bone resorption.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 62
Incorrect
-
A 60-year-old female has sudden onset of high-grade fever associated with cough with productive rusty-coloured sputum. Chest x-ray showed left-sided consolidation. What is the most accurate test for the diagnosis of this patient?
Your Answer:
Correct Answer: Sputum culture
Explanation:Sputum culture is used to detect and identify the organism that are infecting the lungs or breathing passages.
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This question is part of the following fields:
- Microbiology
- Pathology
-
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Question 63
Incorrect
-
Which of the following tumours is very radiosensitive?
Your Answer:
Correct Answer: Seminoma
Explanation:Seminoma is the most radiosensitive tumour and responds well to radiation therapy after unilateral orchidectomy. The ipsilateral inguinal areas are routinely not treated however, depending on the stage, the mediastinum and the left supraclavicular regions may also be irradiated.
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This question is part of the following fields:
- Neoplasia; Urology
- Pathology
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Question 64
Incorrect
-
A 60-year old gentleman visited his general practitioner complaining of high grade fever for 7 days and a dull, aching pain in his left lumbar region. On enquiry, he admitted to having a burning sensation while passing urine. His blood results showed an elevated white blood cell count with a left shift. In his condition, which is the most characteristic finding on urine examination?
Your Answer:
Correct Answer: White blood cell casts
Explanation:Tubulointerstitial nephritis is the term given to primary injury to renal tubules and the renal interstitium, which ultimately results in a decline in renal function. Acute tubulointerstitial nephritis (acute pyelonephritis) is often seen as a result of infection or drug reactions. The most characteristic feature of this condition on urine analysis is the presence of white blood cell casts.
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This question is part of the following fields:
- Pathology
- Renal
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Question 65
Incorrect
-
Which of the following veins empties into the left renal vein?
Your Answer:
Correct Answer: Left suprarenal
Explanation:The left suprarenal vein empties into the left renal vein which crosses the vertebral column to reach the inferior vena cava. The left renal vein also receives the left gonadal vein.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 66
Incorrect
-
Which of the following arteries branch from the deep femoral artery and course between the pectineus and iliopsoas muscles?
Your Answer:
Correct Answer: Medial femoral circumflex
Explanation:The medial femoral circumflex artery is an artery in the upper thigh that supplies blood to the head and neck of the femur. It arises from the deep femoral artery and winds around the medial side of the femur. It passes first between pectineus and psoas major, and then between obturator externus and adductor brevis.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 67
Incorrect
-
During a procedure in the mediastinum, the surgeon accidentally injured a key structure that lies immediately anterior to the thoracic duct. Which structure is likely to be injured?
Your Answer:
Correct Answer: Oesophagus
Explanation:In the mid-thorax, the azygos vein, thoracic duct and aorta (in this order from right to the left) are all located posterior to the oesophagus. The superior vena cava, left internal jugular vein and trachea are not found in the mid thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 68
Incorrect
-
A patient underwent surgical excision of mass in the right carotid triangle. One day after the surgery patient complained of numbness of the skin over the right side of the neck. Injury to the cervical plexus of nerves is suspected. What is the possible nerve affected in this patient?
Your Answer:
Correct Answer: Transverse cervical
Explanation:The transverse cervical nerve (superficial cervical or cutaneous cervical) arises from the second and third spinal nerves, turns around the posterior border of the sternocleidomastoid and, passing obliquely forward beneath the external jugular vein to the anterior border of the muscle, it perforates the deep cervical fascia, and divides beneath the platysma into the ascending and descending branches. It provides cutaneous innervation to this area.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 69
Incorrect
-
A patient admitted for esophagectomy showed low levels of the lightest plasma protein in terms of weight. Which of the following is the lightest plasma protein:
Your Answer:
Correct Answer: Albumin
Explanation:Albumin is the most abundant and the lightest of all the plasma proteins. It maintains osmotic pressure, transports unconjugated bilirubin, thyroid hormones, fatty acids, drugs and acts as a buffer for pH.
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This question is part of the following fields:
- General
- Physiology
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Question 70
Incorrect
-
A 45-year old farmer was referred to the surgical clinic with complaints of pain in his right hypochondrium. Investigations confirmed the diagnosis of hepatocellular carcinoma with malignant ascites. According to you, what is the most likely cause of HCC in this patient?
Your Answer:
Correct Answer: Aflatoxin
Explanation:Aflatoxins are naturally occurring toxins produced by the Aspergillus fungus (most often, A. flavus and A. parasiticus). These organisms are common and their native habitat is soil, decaying vegetation and grains. They can contaminate the grain before harvest or after storage, more likely in high-humidity (at least 7%) or high temperature environment of after stressful conditions like drought. Aflatoxins are mycotoxins and also carcinogenic. They get metabolized in the liver to an epoxide, aflatoxin M1. High exposure can lead to acute necrosis, cirrhosis or liver carcinoma. These substances can cause haemorrhage, acute liver damage, oedema, and alteration in digestion, absorption and/or metabolism of nutrients. Although humans are susceptible to these toxins like all other animals, they have a high tolerance level and hence, rarely develop acute aflatoxicosis. However, children are particularly susceptible to exposure leading to growth impairment and delayed development. Chronic exposure carries a high risk of hepatic cancer, due to intercalation of its metabolite aflatoxin M1 into the DNA and alkylation of the bases because of its epoxide moiety.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 71
Incorrect
-
Which of these substances is secreted by pericytes in the juxtaglomerular cells?
Your Answer:
Correct Answer: Renin
Explanation:The juxtaglomerular cells synthesise, store and secrete the enzyme renin in the kidney. They are specialised smooth muscle cells in the wall of the afferent arteriole that delivers blood to the glomerulus and thus play a critical role in the renin– angiotensin system and so in renal autoregulation.
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This question is part of the following fields:
- Physiology
- Renal
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Question 72
Incorrect
-
In order to arrest sudden bleeding during pericardiectomy that started after accidental injury to a major vasculature in the pericardium; the surgeon inserted his left index finger through the transverse pericardial sinus, pulled forward on the two large vessels lying ventral to his finger, and compressed these vessels with his thumb to control the bleeding. Which vessels were these?
Your Answer:
Correct Answer: Pulmonary trunk and aorta
Explanation:Transverse pericardial sinus: located behind two great vessels (aorta and pulmonary trunk) and in front of the superior vena cava and is accessed from above as in this case. The brachiocephalic trunk is located above the pericardium and the right pulmonary artery is above the pericardial reflections.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 73
Incorrect
-
A ‘claw hand’ is usually associated with injury to which of the following nerves?
Your Answer:
Correct Answer: Ulnar nerve
Explanation:A ‘claw hand’ is associated with injury to the ulnar nerve at the wrist affecting the interossei, lumbricals and hypothenar muscles of the hand. It is characterized by hypothenar eminence wasting, hyperextended metacarpophalangeal joints and flexed interphalangeal joints.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 74
Incorrect
-
A 27-year-old female was admitted due to severe dehydration. The patient also complained of chest tightness, thus an ECG was requested. The ECG strip showed an isoelectric ST segment, upright T wave, with prominent U waves. What is the most likely electrolyte abnormality responsible for these ECG tracing?
Your Answer:
Correct Answer: Hypokalaemia
Explanation:U waves are prominent if it is >1-2mm or 25% of the height of the T wave. Abnormally prominent U waves are characteristically seen in severe hypokalaemia.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 75
Incorrect
-
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:
Correct 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 76
Incorrect
-
If a 55-year old gentleman who has suffered a stroke, develops a tremor in his fingers that worsens on reaching for an object, what part of his brain is likely to be involved?
Your Answer:
Correct Answer: Cerebellum
Explanation:The cerebellum plays an important role in the integration of sensory perception and motor output. Multiple neural pathways link the cerebellum with the motor cortex and the spinocerebellar tract. The cerebellum uses the constant feedback on body position to fine-tune the movements and integrates these pathways. The patient described here has a characteristic cerebellar tremor that is a slow, broad tremor of the extremities and occurs at the end of a purposeful movement.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 77
Incorrect
-
A 55-years-old man presented to the emergency department complaining of a squeezing sensation in his chest that has spread to his neck with associated worsening shortness of breath. Which of these laboratory tests would you ask for in this patient:
Your Answer:
Correct Answer: Creatine kinase-MB
Explanation:Creatine kinase-MB is a test that usually is ordered when the patient has chest pain as a cardiac marker. When a heart attack is suspected and a troponin test (which is more specific for heart damage), is not available CK-MB is ordered. There are 3 forms of CK: CK-MM, CK-BB and CK-MB. CK-MB is commonly found in heart tissue, therefore injured heart muscle cells release CK-MB into the blood. Elevated CK-MB levels indicate that it is probable that a person has recently had a heart attack.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 78
Incorrect
-
What is the linea aspera:
Your Answer:
Correct Answer: Serves as an attachment for adductors of the thigh
Explanation:The linea aspera is a prominent longitudinal ridge or crest on the middle third of the femur. It has a medial and a lateral lip and a narrow, rough, intermediate line. The vastus medialis arises from the medial lip of the linea aspera and has superior and inferior prolongations. The vastus lateralis takes origin from the lateral lip . The adductor magnus is inserted into the linea aspera. Two muscles are attached between the vastus lateralis and the adductor magnus: the gluteus maximus is inserted above and the short head of the biceps femoris arises below. Four muscles are inserted between the adductor magnus and the vastus medialis: the iliacus and pectineus superiorly, and the adductor brevis and adductor longus inferiorly.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 79
Incorrect
-
Question 80
Incorrect
-
Purkinje fibres in the heart conduct action potentials at the rate of:
Your Answer:
Correct Answer: 1.5–4.0 m/s
Explanation:Purkinje fibres control the heart rate along with the sinoatrial node (SA node) and the atrioventricular node (AV node). The QRS complex is associated with the impulse passing through the Purkinje fibres. These fibres conduct action potential about six times faster than the velocity in normal cardiac muscle.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 81
Incorrect
-
Which muscles are attached to the tibial tuberosity?
Your Answer:
Correct Answer: Vastus intermedius
Explanation:The tuberosity of the tibia is the site of attachment to the ligamentum patella (the tendon of the quadriceps femoris muscle which include four heads: rectus femoris, vastus medialis, intermedius and lateralis).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 82
Incorrect
-
Which of the following toxins most likely results in continuous cAMP production, which pumps H2O, sodium, potassium, chloride and bicarbonate into the lumen of the small intestine and results in rapid dehydration?
Your Answer:
Correct Answer: Cholera toxin
Explanation:The cholera toxin (CTX or CT) is an oligomeric complex made up of six protein subunits: a single copy of the A subunit (part A), and five copies of the B subunit (part B), connected by a disulphide bond. The five B subunits form a five-membered ring that binds to GM1 gangliosides on the surface of the intestinal epithelium cells. The A1 portion of the A subunit is an enzyme that ADP-ribosylates G proteins, while the A2 chain fits into the central pore of the B subunit ring. Upon binding, the complex is taken into the cell via receptor-mediated endocytosis. Once inside the cell, the disulphide bond is reduced, and the A1 subunit is freed to bind with a human partner protein called ADP-ribosylation factor 6 (Arf6). Binding exposes its active site, allowing it to permanently ribosylate the Gs alpha subunit of the heterotrimeric G protein. This results in constitutive cAMP production, which in turn leads to secretion of H2O, Na+, K+, Cl−, and HCO3− into the lumen of the small intestine and rapid dehydration. The gene encoding the cholera toxin was introduced into V. cholerae by horizontal gene transfer.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 83
Incorrect
-
A 45-year old with sarcoidosis has enlarged tracheobronchial lymph nodes. Which nerve is most likely to be irritated in this patient?
Your Answer:
Correct Answer: Left recurrent laryngeal
Explanation:Tracheobronchial lymph nodes are located at the bifurcation of the trachea and are in three groups i.e. the right superior, left superior and inferior. The aorta arches over the left bronchus near the point of tracheal bifurcation. Thus, the nerves that are closely associated with the aorta might be irritated if these nodes become inflamed. The left recurrent laryngeal nerve is such a nerve. The phrenic nerves, both the left and the right, are lateral and thus would not be affected. The right recurrent nerve loops around the right subclavian artery and is distant from this area. The right vagus artery is not associated with the aorta and the sympathetic chain is located in the posterior chest parallel to the vertebra, also not associated with the tracheobronchial tree.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 84
Incorrect
-
A 50-year old gentleman who was admitted for elective surgery was found to have haemoglobin 9.5 g/dl, white blood cell count of 1.4 × 109/l and a mean corpuscular volume (MCV) of 134 fl. Which of the following is the likely finding on his peripheral blood smear?
Your Answer:
Correct Answer: Hypersegmented neutrophils
Explanation:The likely diagnosis is megaloblastic anaemia, which also shows the presence of hypersegmented neutrophils.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 85
Incorrect
-
A 27 year old women works in a dry-cleaning shop. She was exposed to massive amounts of carbon tetrachloride on her skin as well as inhaled. Which of the following organs is most susceptible to damage?
Your Answer:
Correct Answer: Liver
Explanation:Carbon tetrachloride (CCl4) is a common agent used in the dry cleaning industry and is thought to cause the formation of free radicals. It causes rapid breakdown of the endoplasmic reticulum due to decomposition of lipids and severe liver cell injury. Within less than 30 mins, hepatic protein synthesis declines, lipid export is reduced due to lack of apoprotein and there is an influx of calcium and cell death.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 86
Incorrect
-
Enlargement of the spleen as seen in Gaucher's disease pushes the spleen downward and medially. What structure limits the straight-vertical-downward movement?
Your Answer:
Correct Answer: Left colic flexure
Explanation:The left colic flexure (also known as the splenic flexure), is the point where the colon takes a sharp turn downwards. It is the point where the transverse colon ends and the descending colon begins. It is located immediately inferior to the spleen so an enlarged spleen must move medially to avoid this colic flexure.
The left suprarenal gland is retroperitoneal.
The Ligament of Treitz suspends the fourth part of the duodenum from the posterior abdominal wall.
The stomach, pancreas and liver lie medial to the spleen and thus would not prevent a vertical downward movement.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 87
Incorrect
-
What is the percentage of bone calcium that is freely exchangeable with the extracellular fluid that is available for buffering changes in the calcium ion balance?
Your Answer:
Correct Answer: 1%
Explanation:Around 1% of calcium in the body is available for buffering changes in calcium ion balance. These are mainly derived from the bone that are freely exchangeable with extracellular fluid.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 88
Incorrect
-
A 45-year old man presents with sclerosing cholangitis, blood in his stools and apparent iron deficiency anaemia. What will be the most likely finding on his colonic biopsy?
Your Answer:
Correct Answer: Pseudopolyps
Explanation:Sclerosing cholangitis along with the passage of blood in stools suggests ulcerative colitis affecting the mucosa and submucosa of rectum and colon, with a sharp demarcation with the normal tissue. The musclaris layer is involved in severe cases. Initially, the mucosa is erythematous, friable with scattered haemorrhagic areas and loss of normal vascular pattern. Severe disease is indicated by presence of large mucosal ulcers with purulent exudate. There can be islands of normal mucosa between the ulcerated mucosa, along with few hyperplastic inflammatory mucosal lesions (pseudopolyps). Ulcerative colitis does not lead to development of fistulas or abscesses.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 89
Incorrect
-
What is correct regarding the obturator artery?
Your Answer:
Correct Answer: It is found in the medial compartment of the thigh
Explanation:The obturator artery is a branch of the internal iliac artery, which passes antero-inferiorly on the lateral wall of the pelvis, to the upper part of the obturator foramen. The posterior branch follows the posterior margin of the foramen and turns forward on the inferior ramus of the ischium. It also supplies an articular branch, which enters the hip joint through the acetabular notch, sending a branch along the ligamentum teres to the head of the femur. It is the main source of arterial supply to the medial compartment of the thigh
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 90
Incorrect
-
Which of the following organs is an ectoderm derivative?
Your Answer:
Correct Answer: Adrenal medulla
Explanation:Ectoderm derivatives include the adrenal medulla, posterior pituitary, the epidermis of the skin, nails, hair, sweat glands, mammary glands, sebaceous glands, the central nervous system, the peripheral nervous system, the retina and lens of eye, the pupillary muscle of the iris, melanocytes, Schwann cells and odontoblasts.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 91
Incorrect
-
A patient in the intensive care unit developed hyperphosphatemia. The phosphate level is 160 mmol/L. Which of the following is most likely responsible for this abnormality?
Your Answer:
Correct Answer: Renal insufficiency
Explanation:Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood. It is caused by conditions that impair renal phosphate excretion (ex: renal insufficiency, hypoparathyroidism, parathyroid suppression) and conditions with massive extracellular fluid phosphate loads (ex: rapid administration of exogenous phosphate, extensive cellular injury or necrosis, transcellular phosphate shifts).
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 92
Incorrect
-
What are some of the derivatives of the second pharyngeal arch?
Your Answer:
Correct Answer: Stylohyoid muscle
Explanation:Also known as the hyoid arch, it forms the side and front of the neck. From its cartilage develops the styloid process, stylohyoid ligament and lesser cornu of the hyoid bone. The muscular derivatives include the muscles of facial expression, stapedius, stylohyoid and the posterior belly of the digastric. All these are innervated by cranial nerve VII but migrate into the area of the mandibular arch.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 93
Incorrect
-
A 42 year old women presents with end stage renal failure and is prepared to receive a kidney from her husband. HLA testing showed that they are not a 100% match and she is given immunosuppressant therapy for this. Three months later when her renal function tests were performed she showed signs of deteriorating renal function, with decreased renal output, proteinuria of +++ and RBCs in the urine. She was given antilymphocyte globulins and her condition reversed. What type of graft did this patient receive?
Your Answer:
Correct Answer: Allograft
Explanation:Allograft describes a graft between two of the same species. As the donor and the recipients are history-incompatible, rejection of the graft is common and is controlled by immunosuppressive drug therapy. Isograft and syngraft are synonymous and referred to a graft transferred between genetically identical individuals e.g. identical twins. In this case rejection is rare as they are history-compatible.
Autograft refers to transfer of one part of the body to another location.
Xenograft is transfer of tissue from another species e.g. pig to human in valve replacement surgeries and rejection is very high.
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This question is part of the following fields:
- Inflammation & Immunology; Renal
- Pathology
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Question 94
Incorrect
-
A 54-year-old woman is re-admitted to the hospital with shortness of breath and sharp chest pain 2 weeks after surgical cholecystectomy. The most probable cause of these clinical findings is:
Your Answer:
Correct Answer: Pulmonary embolus
Explanation:Pulmonary embolism is caused by the sudden blockage of a major lung blood vessel, usually by a blood clot. Symptoms include sudden sharp chest pain, cough, dyspnoea, palpitations, tachycardia or loss of consciousness. Risk factors for developing pulmonary embolism include long periods of inactivity, recent surgery, trauma, pregnancy, oral contraceptives, oestrogen replacement, malignancies and venous stasis.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 95
Incorrect
-
A young man was thrown from a vehicle in a collision. He landed on his head and shoulder tip, stretching the left side of his neck. A neurological examination revealed that the fifth and sixth cervical nerves had been torn from the spinal cord. What is the most obvious clinical manifestation of this?
Your Answer:
Correct Answer: Abduction
Explanation:In the case of injuries to the upper roots of the brachial plexus there is complete loss of abduction. The muscle performing this movement is the supraspinatus. This initiates the movement, followed by the deltoid muscle, which allows for complete abduction. Both these muscles are innervated by nerves originating from C5 and C6. The injury to these roots results in a condition named Erb-Duchenne’s palsy.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 96
Incorrect
-
The renal cortex and medulla, if seen under the microscope, is lacking one of the following:
Your Answer:
Correct 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 97
Incorrect
-
A young women following a road traffic accident suffered heavy blood loss and developed subsequent anaemia. Which of the following is a consequence of this?
Your Answer:
Correct Answer: A high reticulocyte count
Explanation:Anaemia refers to a decrease in the circulating levels of haemoglobin in the blood resulting in a reduced ability of the body to transport oxygen effectively. Anaemia from blood loss results in the body further compensating by releasing stored RBCs and immature RBCs from the bone marrow. Thus resulting in a high reticulocyte count.
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This question is part of the following fields:
- General
- Physiology
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Question 98
Incorrect
-
Which of the following muscles may be affected by a fracture to the tuberosity on the medial surface of the right navicular bone?
Your Answer:
Correct Answer: Tibialis posterior
Explanation:The navicular bone is situated at the medial side of the tarsus, between the talus and the cuneiform bones. Its medial surface presents a rounded tuberosity, the lower part of which gives attachment to part of the tendon of the tibialis posterior.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 99
Incorrect
-
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:
Correct 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 100
Incorrect
-
A 31-year-old woman is diagnosed with adrenal hyperplasia, and laboratory samples are taken to measure serum aldosterone and another substance. Which is most likely to be the other test that was prescribed to this patient?
Your Answer:
Correct Answer: Plasma renin
Explanation:The evaluation of a patient in whom hyperaldosteronism is first to determine that hyperaldosteronism is present (serum aldosterone) and, if it is present, to differentiate primary from secondary causes of hyperaldosteronism. The aldosterone-to-renin ratio (ARR) is the most sensitive means of differentiating primary from secondary causes of hyperaldosteronism as it is abnormally increased in primary hyperaldosteronism, and decreased or normal but with high renin levels in secondary hyperaldosteronism.
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This question is part of the following fields:
- Physiology
- Renal
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Question 101
Incorrect
-
The patient who is diagnosed with bladder cancer asked his physician, what could have been the contributing factor in the development of his bladder cancer?
Your Answer:
Correct Answer: Smoking
Explanation:Tobacco smoking is the main known contributor to urinary bladder cancer. In most populations, smoking is associated with over half of bladder cancer cases in men and one-third of cases among women.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 102
Incorrect
-
The gradual depolarization in-between action potentials in pacemaker tissue is a result of?
Your Answer:
Correct Answer: A combination of gradual inactivation outward IK along with the presence of an inward ‘funny’ current (If) due to opening of channels permeable to both Na+ and K+ ions
Explanation:One of the characteristic features of the pacemaker cell is the generation of a gradual diastolic depolarization also called the pacemaker potential. In phase 0, the upstroke of the action potential caused by an increase in the Ca2+ conductance, an influx of calcium occurs and a positive membrane potential is generated. The next is phase 3 which is repolarization caused by increased K+ conductance as a result of outwards K+ current. Phase 4 is a slow depolarization which accounts for the pacemaker activity, caused by increased conductance of Na+, inwards Na+ current called IF. it is turned on by repolarization.
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This question is part of the following fields:
- General
- Physiology
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Question 103
Incorrect
-
Which of the following is a large artery that runs immediately posterior to the stomach?
Your Answer:
Correct Answer: Splenic
Explanation:The splenic artery is the large artery that would be found running off the posterior wall of the stomach. It is a branch of the coeliac trunk and sends off branches to the pancreas before reaching the spleen. The gastroduodenal artery on the other hand is found inferior to the stomach, posterior to the first portion of the duodenum. The left gastroepiploic artery runs from the left to the right of the greater curvature of the stomach. The common hepatic artery runs on the superior aspect of the lesser curvature of the stomach, and is a branch of the coeliac trunk. The superior mesenteric artery arises from the abdominal aorta just below the junction of the coeliac trunk.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 104
Incorrect
-
The occipital artery is accompanied by which nerve as it arises from the external carotid artery?
Your Answer:
Correct Answer: Hypoglossal nerve (CN XII)
Explanation:Three main types of variations in the relations of the occipital artery and the hypoglossal nerve are found according to the level at which the nerve crosses the external carotid artery and the point of origin of the occipital artery. In Type I, the hypoglossal nerve crosses the external carotid artery inferior to the origin of the occipital artery; in Type II, the nerve crosses the external carotid artery at the level of origin of the occipital artery; and in Type III, it crosses superior to that level. In Type III the occipital artery makes a loop around the hypoglossal nerve and is in a position to pull and exert pressure on the nerve. This possibility should be taken into consideration in the diagnosis of peripheral paresis or paralysis of the tongue and during surgery in this area.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 105
Incorrect
-
A 30 year-old male patient sustained a sharp blow to the right side of the head, over the temporal region during a vehicular accident. This resulted to the rupture of the principal artery that supplies the meninges. Which artery is affected?
Your Answer:
Correct Answer: Middle meningeal artery
Explanation:The middle meningeal artery is typically the third branch of the first part of the maxillary artery, one of the two terminal branches of the external carotid artery. After branching off the maxillary artery in the infratemporal fossa, it runs through the foramen spinosum to supply the dura mater and the calvaria. The middle meningeal artery is the largest of the three (paired) arteries that supply the meninges, the others being the anterior meningeal artery and the posterior meningeal artery. The anterior branch of the middle meningeal artery runs beneath the pterion. It is vulnerable to injury at this point, where the skull is thin. Rupture of the artery may give rise to an epidural hematoma .An injured middle meningeal artery is the most common cause of an epidural hematoma.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 106
Incorrect
-
Low molecular weight heparin (LMWH) has less side effects than heparin and is used in the prophylaxis and treatment of venous and arterial thrombotic disorders. Which of the following is LMWHs mechanism of action?
Your Answer:
Correct Answer: Inhibition of factor Xa
Explanation:Low molecular weight heparin (LMWH) is a anticoagulant that differs from normal heparin in that it has only short chains of polysaccharide. LMWH inhibits thrombin formation by converting antithrombin from a slow to a rapid inactivator of coagulation factor Xa.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 107
Incorrect
-
In multiple myeloma, which of these cell types confirms the diagnosis when found in a smear of bone marrow aspirate?
Your Answer:
Correct Answer: Plasma cells
Explanation:A bone marrow aspiration is the diagnostic test for multiple myeloma, which is a malignant bone tumour that usually affects older adults. The smear reveals clusters of plasma cells, while X-rays tend to show circumscribed lytic lesions or diffuse demineralisation.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 108
Incorrect
-
Which of the following is not seen as a complication of wound healing?
Your Answer:
Correct Answer: Malignancy
Explanation:Complications in wound healing can originate due to abnormalities in the repair process. These abnormalities are :
1) Deficient scar formation: insufficient granulation tissue can lead to wound dehiscence and ulceration. Dehiscence or wound rupture is seen most commonly in abdominal surgery due to increased intraabdominal pressure. Ulcerations are common in extremity wounds due to inadequate vascularization.
2) Excessive formation of repair components: collagen being laid down may begin normally however later lead to a raised scar also called a hypertrophic scar, which can extend beyond its boundaries to form a keloid and
3) Formation of contractures.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 109
Incorrect
-
Which of the following muscles is innervated by the inferior branch of the right recurrent laryngeal nerve?
Your Answer:
Correct Answer: Posterior cricoarytenoid
Explanation:The posterior cricoarytenoid muscle, which is the sole abductor of the vocal folds, receives its innervation from the inferior laryngeal nerve which is a continuation of the recurrent laryngeal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 110
Incorrect
-
During an operation to repair a hiatal hernia, the coeliac branch of the posterior vagal trunk is injured. This damage would affect muscular movements as well as some secretory activities of the gastrointestinal tract. Which gastrointestinal segment is LEAST likely to be affected?
Your Answer:
Correct Answer: Sigmoid colon
Explanation:The vagus nerve supplies the parasympathetic fibres to the abdominal structures that are receive arterial supply from the coeliac trunk or superior mesenteric artery i.e. up to the transverse colon. The end of the transverse colon and the gastrointestinal structures distal to this point receive parasympathetic innervation from the pelvic splanchnic nerves and blood from the inferior mesenteric artery(IMA). The ascending colon, caecum, jejunum and ileum would all, thus, be affected by this damage. Sigmoid colon would not be affected.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 111
Incorrect
-
A 40 year old man suffered severe trauma following a MVA. His BP is 72/30 mmhg, heart rate of 142 beats/mins and very feeble pulse. He was transfused 3 units of blood and his BP returned to 100/70 and his heart rate slowed to 90 beats/min. What decreased after transfusion?
Your Answer:
Correct Answer: Total peripheral resistance
Explanation:The patient is in hypovolemic shock, he is transfused with blood, this fluid resuscitation will result in a decreased sympathetic discharge and adequate ventricular filling which will result in the decreases TPR with an increased CO and cardiac filling pressures
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 112
Incorrect
-
what is the cause of a prolonged PT(prothrombin time)?
Your Answer:
Correct Answer: Liver disease
Explanation:PT measure the intrinsic pathway of coagulation. It determines the measure of the warfarin dose regime, liver disease and vit K deficiency status along with the clotting tendency of blood. PT measured factors are II,V,VII,X and fibrinogen. It is used along with aPTT which measure the intrinsic pathway.
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This question is part of the following fields:
- General
- Physiology
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Question 113
Incorrect
-
A 44-year old man, who was euthyroid underwent thyroidectomy following neoplastic cells found on fine-needle aspiration. Frozen section of multiple thyroid masses showed malignant neoplasm of polygonal cells in nests. The neoplasm also showed presence of amyloid which was positive with Congo-red staining. Immunoperoxidase staining for calcitonin was also positive. Chest X-ray revealed no abnormality. However, his blood pressure was found to be raised, and his serum ionised calcium was high. What is the likely diagnosis?
Your Answer:
Correct Answer: Multiple endocrine neoplasia type IIA
Explanation:MEN (Multiple Endocrine Neoplasia) syndromes are a group of three separate familial disease which consists of adenomatous hyperplasia and neoplasia in several endocrine glands. All three conditions are inherited as an autosomal dominant trait, with a single gene producing multiple effects. MEN IIA is characterized by medullary carcinoma of the thyroid, pheochromocytoma and hyperparathyroidism. It should be suspected in patients with bilateral pheochromocytoma, a familial history of MEN, or at least two characteristic endocrine manifestations. Genetic testing is used to confirm the diagnosis. Early diagnosis is crucial to aid in complete excision of the localized tumour. Pheochromocytomas can be detected by plasma free metanephrines and fractionated urinary catecholamines, particularly adrenaline (epinephrine).
Imaging studies such as computed tomography or magnetic resonance imaging might also prove useful. Hyperparathyroidism is diagnosed by the standard finding of hypercalcaemia, hypophosphatemia and an increased parathyroid hormone level. Once MEN IIA syndrome is identified in any patient, it is recommended that his or her first-degree relatives and any other symptomatic also undergo genetic testing. Relatives should be subjected to annual screening for hyperparathyroidism and pheochromocytoma beginning in early childhood and continue indefinitely. Serum calcium levels help in screening for hyperparathyroidism. Similarly, screening for pheochromocytoma is by history, measurement of the blood pressure and laboratory testing.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 114
Incorrect
-
A 70-year old man who is suspected to have a perforated colonic diverticulum is explored in theatre through a midline incision. This incision will be through the:
Your Answer:
Correct Answer: Linea alba
Explanation:The linea alba is the point where this incision was made. It is a tendinous raphe in the midline of the abdomen extending between the xiphoid process and the symphysis pubis. It is placed between the medial borders of the recti and is formed by the blending of the aponeuroses of the external and internal obliques and transversi.
The linea aspera is a vertical ridge on the posterior surface of the femur.
The arcuate line is the inferior border of the posterior rectus sheath behind the rectus abdominis muscle.
The semilunar line is the lateral margin of the rectus abdominis.
The iliopectineal line is a line on the pelvic bones formed by the arcuate line of the ilium and the pectineal line of the pubis.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 115
Incorrect
-
An organ transplant patient may be at risk of developing which type of cancer?
Your Answer:
Correct Answer: Skin cancer
Explanation:The most common malignancies encountered in the post–solid organ transplant setting are non-melanoma skin cancers, post-transplant lymphoproliferative disorders and Kaposi’s sarcoma (KS). The pathogenesis of these tumours is likely related to the immunosuppressive drugs used post-transplantation and subsequent viral infection.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 116
Incorrect
-
For calculation of cardiac output by Fick's principle, which of the following vessels is the best source of venous blood to determine the arterial-to-venous oxygen tension difference?
Your Answer:
Correct Answer: Pulmonary artery
Explanation:Fick’s principle states that the total uptake (or release) of a substance by peripheral tissues is equal to the product of the blood flow to the peripheral tissues and the arterial– venous concentration difference (gradient) of the substance. It is used to measure the cardiac output, and the formula is Cardiac output = oxygen consumption divided by arteriovenous oxygen difference. Assuming there are no shunts across the pulmonary system, the pulmonary blood flow equals the systemic blood flow. The arterial and venous blood oxygen content is measured by sampling from the pulmonary artery (low oxygen content) and pulmonary vein (high oxygen content). Peripheral arterial blood is used as a surrogate for the pulmonary vein.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 117
Incorrect
-
The vascular structure found on the right side of the fifth lumbar vertebra is?
Your Answer:
Correct Answer: Inferior vena cava
Explanation:The most likely vascular structure is the inferior vena cava. The inferior vena cava is formed by the joining of the two common iliac arteries, the right and the left iliac artery, at the level of the fifth lumbar vertebra( L5). The inferior vena cava passes along the right side of the vertebral column. It enters the thoracic cavity into the underside of the heart through the caval opening of the diaphragm at the level of the eight thoracic vertebra (T8).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 118
Incorrect
-
Cranial nerve XII, the hypoglossal nerve, innervates which one of the following muscles in the list?
Your Answer:
Correct 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 119
Incorrect
-
A patient presented with continuous bleeding several hours after dental extraction. Which of the following findings is most often associated with clinical bleeding?
Your Answer:
Correct Answer: Factor IX deficiency
Explanation:Factor IX deficiency, also called Haemophilia B or Christmas disease, is a disorder caused by missing or defective clotting factor IX. Deficiency of the factor IX causes irregular bleeding that can happen spontaneously or after mild trauma, surgery and dental extractions.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 120
Incorrect
-
A 40-year old Caucasian male came to the hospital with complaints of fatigue and lethargy. On examination, he was found to have raised blood pressure. Urine examination showed >300 mg/dl proteinuria (4+) and 24-hour urine protein 3.5g. No glucose, blood, nitrites, urobilinogen or casts were present in urine. What is the most likely diagnosis?
Your Answer:
Correct Answer: Membranous glomerulonephritis
Explanation:Membranous glomerulonephritis or nephropathy, is a renal disorder with insidious course and usually affects people aged 30-50 years. 85% cases are primary (or idiopathic). The other 15% are secondary to autoimmune conditions like SLE, infections like malaria or hepatitis B, drugs like captopril and NSAIDs, or malignancies (particularly lung or colonic carcinoma). This disease is caused due to circulating immune complexes which are said to form by binding of antibodies to antigens in glomerular basement membrane. This antigens could be endogenous or derived from systemic circulation. This immune complex triggers the complement system, resulting in formation of membrane attack complex (MAC) on glomerular epithelial cells. This further results in release of proteases and oxidants which damage the capillaries making them ‘leaky’. Moreover, the epithelial cells also secrete a mediator to reduce nephron synthesis and distribution.
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This question is part of the following fields:
- Pathology
- Renal
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SESSION STATS - PERFORMANCE PER SPECIALTY
