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Question 1
Incorrect
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An old man fell and fractured a carpal bone articulating with the pisiform bone. Which bone was most likely fractured?
Your Answer: Capitate
Correct Answer: Triquetral
Explanation:The pisiform bone has an oval facet for articulation with the triquetral bone. The pisiform bone is a sesamoid bone, and is anterior to the other carpal bones.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 2
Incorrect
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Dicloxacillin is an antibiotic; the subclass that dicloxacillin belongs to is:
Your Answer: Macrolide
Correct Answer: Penicillin
Explanation:Dicloxacillin is a narrow-spectrum beta-lactam antibiotic. It is used to treat infections caused by susceptible Gram-positive bacteria and most effective against beta-lactamase-producing organisms such as Staphylococcus aureus. To decrease the development of resistance, dicloxacillin is recommended to treat infections that are suspected or proven to be caused by beta-lactamase-producing bacteria.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 3
Correct
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A 28 years old women presents with a history of chronic cough with fever for the past 2 months. A chest x ray revealed a diffuse bilateral reticulonodular pattern. A transbronchial biopsy was performed and histological examination showed focal areas of inflammation with epithelioid macrophages, Langhans cells and lymphocytes. Which of the immune reaction is responsible for this?
Your Answer: Type IV hypersensitivity
Explanation:A reactivated tuberculosis with granuloma formation is characteristic of type IV reaction. It is also called a delayed type of hypersensitivity reaction and takes around 2-8 days to deliver. It is a cell mediated response with the involvement of CD8 and CD4 cells and the release of IL-1 from macrophages that further activate these CD cells.
Granulomatous reactions are mostly cell-mediated.
Type I reactions are allergic and anaphylactic reactions and type II are complement-mediated immune reactions.
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This question is part of the following fields:
- Inflammation & Immunology; Respiratory
- Pathology
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Question 4
Correct
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You are asked to help a junior medical student studying anatomy to identify the left lung. Which of the following features found only in the left lung will you use the identify it?
Your Answer: Cardiac notch
Explanation:Oblique fissure: is found on both the left and the right lungs. It separates the upper from the lower lobes in both lungs and the middle lobe from the lower lobe in the right lung(which has three lobes.)
The superior lobar bronchus is found in both lungs.
Cardiac notch: found only on the left lung.
Horizontal fissure: a deep groove separating the middle lobe from the upper lobe of the right lung is absent on the left lung.
Diaphragmatic surface: refers to the part of the lung, both the left and the right, that is in contact with the diaphragm.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 5
Incorrect
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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: von Willebrand’s disease
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 6
Correct
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A 39-year old female patient was diagnosed with a tumour of the left adrenal gland. The tumour, which is metastasizing to the adjacent tissues, has already extended to the left suprarenal vein. If the tumour is still spreading, which of the following veins will most likely be affected after the involvement of the left suprarenal vein?
Your Answer: Left renal vein
Explanation:The suprarenal veins or also known as the veins of Warshaw, are the veins that receive blood from the suprarenal glands. These veins receive blood from the medullary venous plexus and the cortex of the adrenal glands (suprarenal glands). They are two in number – the left and the right suprarenal veins. The right suprarenal vein drains into the inferior vena cava while the left suprarenal vein drains into the left renal vein. This therefore means that in the case of a metastasizing tumour involving the left suprarenal vein, the tumour will most likely extend from the left suprarenal vein to the left renal vein into which it drains.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 7
Correct
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A 72-year-old male presents with dysuria and chronic haematuria. He was diagnosed with bladder cancer and tumour invasion of the perivesical fat. What is the stage of the patient's bladder cancer?
Your Answer: T3
Explanation:Bladder cancer is the growth of abnormal or cancerous cells on the inner lining of the bladder wall. The staging is as follows; stage 0is (Tis, N0, M0): Cancerous cells in the inner lining tissue of the bladder only, stage I (T1, N0, M0): tumour has spread onto the bladder wall, stage II (T2, N0, M0): tumour has penetrated the inner wall and is present in muscle of the bladder wall, stage III (T3, N0, M0): tumour has spread through the bladder to fat around the bladder and stage IV: (T4, N0, M0): tumour has grown through the bladder wall and into the pelvic or abdominal wall. The stage of cancer in the case presented is T3 because of the invasion of perivesical fat.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 8
Correct
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The physician suggested lifestyle modification for his patient because his present condition could increase his risk for the development of adenocarcinoma of the oesophagus. What is the most common predisposing factor for the development of adenocarcinoma of the oesophagus?
Your Answer: Gastro-oesophageal reflux disease
Explanation:Barret’s oesophagus is attributed primarily to gastro-oesophageal reflux disease. The chronic acidic environment damages the squamous epithelial lining of the oesophagus, and subsequently undifferentiated pluripotent stem cells develop into columnar epithelium, this is then known as Barret’s oesophagitis.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 9
Correct
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Linezolid is an antibiotic used for the treatment of infections caused by bacteria that are resistant to other antibiotics. Which of the following organisms is most likely to be effectively treated by linezolid?
Your Answer: Methicillin-resistant Staphylococcus aureus
Explanation:Linezolid is a synthetic antibiotic used for the treatment of infections caused by multiresistant bacteria, including streptococci and methicillin-resistant Staphylococcus aureus (MRSA). Linezolid is effective against Gram-positive pathogens, notably Enterococcus faecium, S. aureus, Streptococcus agalactiae, Streptococcus pneumoniae and Streptococcus pyogenes. It has almost no effect on Gram-negative bacteria and is only bacteriostatic against most enterococci.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 10
Correct
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Which foramen contains the vertebral artery?
Your Answer: Foramen magnum
Explanation:The foramen magnum is found in the most inferior part of the posterior cranial fossa. It is traversed by vital structures including the medulla oblongata. Its contents include the following: medulla oblongata, meninges, spinal root of the accessory nerve, vertebral arteries, anterior and posterior spinal arteries, tectorial membrane and alar ligaments.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 11
Correct
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Into which vein does the left and right inferior thyroid veins drain?
Your Answer: Brachiocephalic vein
Explanation:The brachiocephalic vein is formed by the confluence of the subclavian and internal jugular veins. In addition it receives drainage from: the left and right internal thoracic veins (also called internal mammary veins), left and right inferior thyroid veins and the left superior intercostal vein.
The superior thyroid veins and middle thyroid veins drain into the internal jugular vein. The right and left inferior thyroid veins to drain into their respective brachiocephalic veins (right and left). -
This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 12
Incorrect
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A 40-year old lady presented to the hospital with fever and mental confusion for 1 week. On examination, she was found to have multiple petechiae all over her skin and mucosal surfaces. Blood investigations revealed low platelet count and raised urea and creatinine. A platelet transfusion was carried out, following which she succumbed to death. Autopsy revealed pink hyaline thrombi in myocardial arteries. What is the likely diagnosis?
Your Answer: Disseminated intravascular coagulopathy
Correct Answer: Thrombotic thrombocytopenic purpura
Explanation:Hyaline thrombi are typically associated with thrombotic thrombocytopenic purpura (TTP), which is caused by non-immunological destruction of platelets. Platelet transfusion is contraindicated in TTP. Platelets and red blood cells also get damaged by loose strands of fibrin deposited in small vessels. Multiple organs start developing platelet-fibrin thrombi (bland thrombi with no vasculitis) typically at arteriocapillary junctions. This is known as ‘thrombotic microangiopathy’. Treatment consists of plasma exchange.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 13
Correct
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A 63-year-old woman complains of a new, persisting headache. She is diagnosed with vasculitis and the histopathological sample revealed giant-cell arteritis. What is the most probable diagnose?
Your Answer: Temporal arteritis
Explanation:Giant cell arteritis (GCA), also known as temporal arteritis, is the most common systemic inflammatory vasculitis that occurs in adults. It is of unknown aetiology and affects arteries large to small however the involvement of the superficial temporal arteries is almost always present. Other commonly affected arteries include the ophthalmic, occipital and vertebral arteries, therefore GCA can result in systemic, neurologic, and ophthalmologic complications. GCA usually is found in patients older than 50 years of age and should always be considered in the differential diagnosis of a new-onset headache accompanied by an elevated erythrocyte sedimentation rate. Diagnosis depends on the results of artery biopsy.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 14
Incorrect
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A 36-year-old woman suddenly suffers from a generalized seizure. She was previously healthy. An emergency CT scan reveals a mass in the posterior fossa, with distortion of the lateral ventricles. After removing the tumour, the biopsy reveals it contains glial fibrillary acidic protein (GEAP). What's the most likely diagnosis?
Your Answer: Neuroblastoma
Correct Answer: Astrocytoma
Explanation:Astrocytomas are primary intracranial tumours derived from astrocyte cells of the brain. They can arise in the cerebral hemispheres, in the posterior fossa, in the optic nerve and, rarely, in the spinal cord. These tumours express glial fibrillary acidic protein (GFAP). In almost half of cases, the first symptom of an astrocytoma is the onset of a focal or generalised seizure. Between 60% and 75% of patients will have recurrent seizures during the course of their illness. Secondary clinical sequelae may be caused by elevated intracranial pressure (ICP) cause by the direct mass effect, increased blood volume, or increased cerebrospinal fluid (CSF) volume. CT will usually show distortion of the third and lateral ventricles, with displacement of the anterior and middle cerebral arteries. Histological diagnosis with tissue biopsy will normally reveal an infiltrative character suggestive of the slow growing nature of the tumour.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 15
Correct
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What is the basic chemical reaction that takes place in the breakdown of complex foodstuffs?
Your Answer: Hydrolysis
Explanation:Breakdown of complex food into simpler compounds is achieved by hydrolysis, with the help of different enzymes specific for different compounds.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 16
Correct
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A surgeon trainee is assisting in an operation to ligate the ductus arteriosus. The consultant supervising explains that caution is required when placing a clamp on the ductus to avoid injury to an important structure immediately dorsal to it. To which structure is the consultant referring?
Your Answer: Left recurrent laryngeal nerve
Explanation:The left recurrent laryngeal nerve branches off the vagus and wraps around the aorta, posterior to the ductus arteriosus/ligamentum arteriosum from whence it courses superiorly to innervate the laryngeal muscles.
Accessory Hemiazygous vein is on the left side of the body draining the posterolateral chest wall and emptying blood into the azygos vein.
The left internal thoracic artery is branch of the left subclavian artery supplying blood to the anterior wall of the thorax.
Left phrenic nerve is lateral to the vagus nerve.
Thoracic duct: is behind the oesophagus, coursing between the aorta and the azygos vein in the posterior chest.
Right recurrent laryngeal nerve: loops around the right subclavian artery and is not in danger in this procedure.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 17
Correct
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In an anatomy demonstration, the instructor asked one of the medical students to pass his index finger inferior to the root of the left lung. The student notices that his finger is blocked by a structure. Which structure do you think is responsible for this?
Your Answer: Pulmonary ligament
Explanation:The pulmonary ligament is dual layer of pleura stretching from the inferior part of the hilar reflection toward the diaphragm.
The costodiaphragmatic recess is the cavity at the inferior border of the lung where the costal pleura becomes the diaphragmatic pleura.
The cupola: is part of the pleura that extends superiorly above the first rib and has no association with the root of the lung.
Inferior vena cava is located in the mediastinum, not near the root of the lung.
Left pulmonary veins being part of the root of the lung, would not block access to behind the lung. Costomediastinal recess is the part of the pleura where the costal pleura become the mediastinal pleura.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 18
Correct
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In the human body, veins often run a course parallel to the artery that has the same name. Which of the following listed veins doesn't run parallel to the artery of the same name?
Your Answer: Inferior mesenteric
Explanation:The inferior mesenteric artery and inferior mesenteric vein don’t run in tandem because the vein is part of the portal venous system-draining into the splenic vein which drains into the hepatic portal vein. The inferior mesenteric artery is a branch of the descending aorta at the level of L3. The inferior mesenteric vein and artery, however, drain the same region i.e. the descending and sigmoid colon and rectum.
Superior epigastric vessels course together and are the continuation of the internal thoracic artery and vein.
Superficial circumflex iliac vessels course together in the superficial fat of the abdominal wall.
Superior rectal vessels are the terminal ends of the inferior mesenteric vessels, located on the posterior surface of the rectum.
The ileocolic artery and vein are branches off the superior mesenteric vessels. Both course in the mesentery, supplying/draining the caecum, appendix, terminal portion of the ileum. The inferior epigastric vessels run together.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 19
Correct
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A patient with a long standing lower motor neuron lesion will have:
Your Answer: Muscle wasting
Explanation:Lower motor neurons (LMNs) connect the brainstem and spinal cord to muscle fibres. Damage to lower motor neurons is indicated by abnormal electromyographic potentials, fasciculations, paralysis, weakening and wasting of skeletal muscles.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 20
Correct
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Which of the following veins is prostate cancer most likely to metastasize through?
Your Answer: Internal vertebral venous plexus
Explanation:The internal vertebral veins are the most likely route of metastasis as they are valveless. They serve an important clinical role as they are the route of free travel for cancerous cells to other body structures. The other veins on the list have valves and would be the least likely routes for metastasis.
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This question is part of the following fields:
- Anatomy
- Neurology
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Question 21
Correct
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Which of the following is the most common germ cell tumour of the testis affecting an adult male?
Your Answer: Seminoma
Explanation:Germ cell tumours represent 90% of primary tumours arising in the testis. They are broadly divided into seminomas and non-seminomas. Seminomas are the most common testicular germ cell tumour seen in 40% cases. The other non-seminomatous histological subtypes include embryonal (25%), teratocarcinoma (25%), teratoma (5%) and pure choriocarcinoma (1%).
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This question is part of the following fields:
- Pathology
- Urology
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Question 22
Correct
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A 7-month-old abandoned baby with congenital non-communicating hydrocephalus is hosted by a clinic at its new-born hostel. A CT scan of the baby's brain reveals what might be a blockage of the ventricular system between the third and the fourth ventricles. Which of the following is the most likely blocked structure?
Your Answer: Cerebral aqueduct
Explanation:The drainage of cerebral spinal fluid from the third ventricle to the fourth ventricle is carried out by the cerebral aqueduct. The cerebral aqueduct is the narrowest passageway in the entire ventricular system and thus forms the most common site of blockage of flow of cerebrospinal fluid. The interventricular foramen allows passage of CSF to the third ventricle. The foramen of Luschka and Magendie are located on the fourth ventricle and allow passage of CSF to the subarachnoid space from the ventricular system. The pontine cistern is a space located on the ventral aspect of the pons. The cisterna magna is an opening on the subarachnoid space between the pia matter and the arachnoid.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 23
Correct
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The posterior cord contains nerve fibres from which of the following levels of the spinal cord?
Your Answer: C5, C6, C7, C8 and T1
Explanation:THE correct answer is A. The posterior cord derives its fibres from the spinal nerves C5,C6,C7,C8,T1. This cord is formed from the fusion of the posterior divisions of the upper, lower, and middle trunks.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 24
Correct
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A 51-year old woman after undergoing a barium swallowing was discovered to be suffering from an oesophageal hiatal hernia. Which muscle fibres of the diaphragm border this hernia directly if the stomach herniates through an enlarged oesophageal hiatus?
Your Answer: Right crus
Explanation:The oesophageal hiatus is a natural fissure on the thoracic diaphragm that allows passage of the oesophagus and the vagal nerve. The oesophageal hiatus is located in one of the tendinous structures of the diaphragm that connect it to the spine which is known as the right crus. In case of an hiatal hernia, this diaphragmatic structure would be the one bordering the hernia as it is the structure that encircles the oesophageal hiatus.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 25
Correct
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The occipital artery is accompanied by which nerve as it arises from the external carotid artery?
Your 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 26
Correct
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A 60 year-old patient being treated for hypertension presents to the ED with swelling of the left upper limb due to poor venous return. On examination, it is found that an aneurysm of the ascending aorta is impinging on a large vein lying immediately anterosuperior to it. Which vein is it likely to be?
Your Answer: Left brachiocephalic
Explanation:Among the veins listed, only the left brachiocephalic vein is anterosuperior to the ascending aorta. The right brachiocephalic vein being on the right side would not be affected by the aortic aneurysm.
The azygos vein lies deep in the chest on the right side.
The internal thoracic vein lies interior to the anterior wall of the chest.
The left superior intercostal vein is close to the aortic arch, crossing it laterally. This vein drains the 2nd to 4th interspaces on the left side.
The Right internal jugular vein joins the right brachiocephalic vein which would not be affected by the aneurysm.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 27
Correct
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Which organ is responsible for the secretion of enzymes that aid in digestion of complex starches?
Your Answer: Pancreas
Explanation:α-amylase is secreted by the pancreas, which is responsible for hydrolysis of starch, glycogen and other carbohydrates into simpler compounds.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 28
Correct
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Identify which of the following muscles acts on two joints?
Your Answer: Sartorius
Explanation:The sartorius muscle, the longest muscle in the body, is one of the two jointed or biarticular muscles. It originates from the anterior superior iliac spine and part of the notch between the anterior superior iliac spine and anterior inferior iliac spine and crosses both the hip joint and the knee joint. At the hip joint the sartorius flexes and rotates the thigh at the hip joint and flexes the leg at the knee joint.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 29
Correct
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A 26-year-old female sought consultation due to excessive vaginal discharge. Vaginal smear showed numerous bacilli under the microscope. The organism was non-pathogenic. What is the most likely organism:
Your Answer: Lactobacillus species
Explanation:Lactobacillus is a Gram-positive facultative bacteria. It is commonly present in the vagina and the gastrointestinal tract. Colonization of Lactobacillus is usually benign and it makes up a small portion of the gastrointestinal flora.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 30
Correct
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After a car accident, a 30-year-old woman is alert and only has minor, superficial injuries. 2 hours later, she becomes unconscious and a CT scan reveals a convex, lens-shaped haemorrhage over the right parietal region. The most likely diagnosis is:
Your Answer: Epidural haematoma
Explanation:Epidural haematomas are usually caused by arterial bleeding, classically due to damage to the middle meningeal artery by a temporal bone fracture. Symptoms develop within minutes to several hours after the injury and consist of increasing headache, decreased level of consciousness, hemiparesis and pupillary dilation with loss of light reactivity. Around 15–20% of epidural hematomas are fatal.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 31
Incorrect
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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: Blasts
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 32
Correct
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A 14 year-old girl is found to have haemophilia B. What pathological problem does she have?
Your Answer: Deficiency of factor IX
Explanation:Haemophilia B (also known as Christmas disease) is due to a deficiency in factor IX. Haemophilia A is due to a deficiency in factor VIII.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 33
Correct
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A 13 year old girl presented with signs of shortness of breath, chest pain, non-productive cough, oedema of the lower extremities and cyanosis of the fingertips. She has a history of a ventricular septal defect not surgically corrected. The most probable cause of these symptoms is:
Your Answer: Shunt reversal
Explanation:A ventricular septal defect (VSD) is a common form of congenital heart defects and is characterised by the presence of a hole in the wall that separates the right from the left ventricle. Medium or large defects can cause many complications. One of these complication is Eisenmenger syndrome, characterised by reversal of the shunt (from left-to-right shunt into a right-to-left) ,cyanosis and pulmonary hypertension.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 34
Correct
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Which lymph nodes are most likely to enlarge due to the spread of infection through the lymphatic channels in a patient with a boil on his scrotum?
Your Answer: Superficial inguinal nodes
Explanation:The superficial inguinal nodes drain the perineum and the external genitalia which include the scrotum and the labia majora. The testes, however, drain to the lumbar nodes.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 35
Correct
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What is the most likely cause of bilateral gynaecomastia in a 55-year old male?
Your Answer: Hepatic failure
Explanation:Hypertrophy of breast tissue in males is known as gynaecomastia. It is normally due to proliferation of stroma and not of mammary ducts. Physiological gynaecomastia can occur during puberty and is often transient, bilateral, symmetrical and possibly tender. Gynaecomastia can occur during old age too, but is usually unilateral. Other causes include hepatic or renal failure, endocrinological disorders, drugs (anabolic steroids, antineoplastic drugs, calcium channel blockers, cimetidine, digitalis, oestrogens, isoniazid, ketoconazole, methadone, metronidazole, reserpine, spironolactone, theophylline), and marijuana. It should not be confused with malignancy which is often hard, asymmetric and fixed to the dermis or fascia. Treatment if indicated, includes withdrawal of the causative factor or treatment of the underlying disorder.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 36
Incorrect
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A machine worker fractured the medial epicondyle of his right humerus resulting in damage to an artery running with the ulnar nerve posterior to the medial epicondyle. The artery injured is the?
Your Answer: Anterior ulnar recurrent
Correct Answer: Superior ulnar collateral
Explanation:The superior ulnar collateral artery runs posterior to the medial epicondyle of the humerus, accompanied by the ulnar nerve. This artery arises from the brachial artery near the middle of the arm and ends under the flexor carpi ulnaris muscle by anastomosing with two arteries: the posterior ulnar recurrent and inferior ulnar collateral.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 37
Correct
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A recognised side-effect of prefrontal leukotomy is:
Your Answer: Confusion
Explanation:Used previously as a treatment for psychiatric disorders, prefrontal leucotomy severs the connection between the prefrontal cortical association area and the thalamus. This leads to functional isolation of the prefrontal and orbitofrontal association cortex. Thus, along with the desired reduction in anger and frustration, undesirable side effects included changes in mood and affect, as well as confusion.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 38
Correct
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The third branch of the maxillary artery lies in which fossa?
Your Answer: Pterygopalatine fossa
Explanation:The maxillary artery supplies deep structures of the face. It branches from the external carotid artery just deep to the neck of the mandible. It is divided into three portions:
– The first or mandibular portion (or bony portion) passes horizontally forward, between the neck of the mandible and the sphenomandibular ligament.
– The second or pterygoid portion (or muscular portion) runs obliquely forward and upward under cover of the ramus of the mandible, on the surface of the lateral pterygoid muscle; it then passes between the two heads of origin of this muscle and enters the fossa.
– The third portion lies in the pterygopalatine fossa in relation to the pterygopalatine ganglion. This is considered the terminal branch of the maxillary artery. Branches from the third portion includes: the sphenopalatine artery, descending palatine artery, infraorbital artery, posterior superior alveolar artery, artery of pterygoid canal, pharyngeal artery, middle superior alveolar artery and anterior superior alveolar artery.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 39
Correct
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A 60-year old patient having a history of cholelithiasis that led to recurrent pain, bloating, nausea and vomiting, was scheduled for surgery to have the gallbladder removed. During the cholecystectomy, the registrar conducting the procedure accidentally punctured a blood vessel that lies immediately posterior to the omental foramen and blood filled the operating field. Which of the following blood vessels was likely punctured?
Your Answer: Inferior vena cava
Explanation:The omental foramen is the pathway that connects the greater peritoneal sac and the lesser peritoneal sac. The omental foramen is bordered posteriorly by the inferior vena cava. This is the blood vessel that would most likely be punctured.
The aorta and its branch, the renal artery, lie postero-lateral to the omental foramen and are deeper than the inferior vena cava hence making them less likely to be injured.
The hepatic portal vein, the hepatic artery and the superior mesenteric vein borders the omental foramen anteriorly and would not be injured by a jab on the posterior border of the omental foramen.
Finally, the splenic artery is found in the splenorenal ligament that borders the omental foramen laterally to the left.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 40
Correct
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A 20-year old involved in a brawl was stabbed in the anterior chest in a structure that is in close proximity to where the first rib articulates with the sternum. What is the structure that was most likely injured?
Your Answer: Sternoclavicular joint
Explanation:The first rib articulates with the sternum right below the sternoclavicular joint.
The sternal angle articulates with the costal cartilage of the second rib.
The nipple is found between the fourth and the fifth ribs, in the fourth intercostal space.
The xiphoid process is located right below the point of articulation of the costal cartilage of rib 7 with the sternum.
The root of the lung is the part of the lung where neurovascular structures enter and leave the lung.
Acromioclavicular joint is the point of articulation between the acromion process and the clavicle, near the shoulder.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 41
Correct
-
A 38-year-old woman with end-stage renal disease, is undergoing haemodialysis. She has normocytic normochromic anaemia. What is the best treatment for her?
Your Answer: Erythropoietin
Explanation:E erythropoietin (EPO) is a hormone that is released by the kidney. It is responsible for the regulation of red blood cell production in the body. It can be made using recombinant technology and is used in the treatment of anaemia of chronic renal failure and in patients under going chemotherapy
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This question is part of the following fields:
- General
- Physiology
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Question 42
Correct
-
A patient sustained an iatrogenic injury to one of the structures passing through the deep inguinal ring. This was during an operation to repair an inguinal hernia. Which structure is most likely to be injured?
Your Answer: Round ligament of the uterus
Explanation:The deep inguinal ring transmits the spermatic cord in the man and the round ligament of the uterus in the female. It is bound below and medially by the inferior epigastric vessels (so these don’t go through it).
The ilioinguinal nerve, although it courses through the inguinal canal, does not pass through it.
The iliohypogastric nerves run between the internal oblique and transversus abdominis in the abdominal wall, piercing the internal oblique at the anterior superior iliac spine to travel just deep to the external oblique.
The inferior epigastric artery runs between the transversus abdominis and the peritoneum forming the lateral umbilical fold.
The medial umbilical ligament is the obliterated umbilical artery that it lies within the medial umbilical fold of peritoneum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 43
Correct
-
Where is the mental foramen located?
Your Answer: In the mandible
Explanation:The mental foramen is found bilaterally on the anterior surface of the mandible adjacent to the second premolar tooth. The mental nerve and terminal branches of the inferior alveolar nerve and mental artery leave the mandibular canal through it.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 44
Correct
-
A patient with Paget's disease of the bone is predisposed to developing which type of cancer?
Your Answer: Osteosarcoma
Explanation:Paget’s disease of bone (PDB) is a focal disorder of bone. It is presumed benign in nature and mediated by abnormal osteoclast function. However osteosarcomas may occur in <1% of patients with Paget's disease of the bone. Osteosarcomas are osteogenic in origin, and consistently arise in sites of pagetic bone. This is not to be confused with Paget's disease of the breast.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 45
Correct
-
A 15 month old boy has a history of repeated bacterial pneumonia, failure to thrive and a sputum culture positive for H.influenzea and S.pneumoniae. There is no history of congenital anomalies. He is most likely suffering from?
Your Answer: X-linked agammaglobulinemia
Explanation:Recurrent bacterial infections may be due to lack of B-cell function, consequently resulting in a lack of gamma globulins production. Once the maternal antibodies have depleted, the disease manifests with greater severity and is called x-linked agammaglobulinemia also known as ‘X-linked hypogammaglobulinemia’, ‘XLA’ or ‘Bruton-type agammaglobulinemia. it is a rare x linked genetic disorder that compromises the bodies ability to fight infections.
Acute leukaemia causes immunodeficiency but not so specific.
DiGeorge syndrome is due to lack of T cell function.
Aplastic anaemia and EBV infection does not cause immunodeficiency.
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This question is part of the following fields:
- Inflammation & Immunology; Respiratory
- Pathology
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Question 46
Correct
-
Injury to this nerve may result in loss of sensation of the mandibular teeth and bone:
Your Answer: Inferior alveolar nerve
Explanation:The inferior alveolar nerve (sometimes called the inferior dental nerve) is a branch of the mandibular nerve, which is itself the third branch of the trigeminal nerve. The inferior alveolar nerves supply sensation to the lower teeth of the mandible.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 47
Correct
-
What is the innervation of the laryngeal mucosa inferior to the true vocal cord?
Your Answer: Recurrent laryngeal nerve
Explanation:Motor innervation to all other muscles of the larynx and sensory innervation to the subglottis is by the recurrent laryngeal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 48
Correct
-
A 27-year old lady presented with dull, abdominal pain and some pain in her lower limbs. On enquiry, it was revealed that she has been suffering from depression for a few months. Physical examination and chest X-ray were normal. Further investigations revealed serum calcium 3.5 mmol/l, albumin 3.8 g/dl and phosphate 0.65 mmol/l. What is the diagnosis?
Your Answer: Parathyroid adenoma
Explanation:Hypercalcaemia with hypophosphatemia indicates parathyroid disorder and adenomas are more common than hyperplasia. In this young age group, metastatic disease is unlikely. Solitary adenomas are responsible for 80-85% cases of primary hyperparathyroidism. 10-15% cases are due to parathyroid hyperplasia and carcinomas account for 2-3% cases. Symptoms include bone pain (bones), nephrolithiasis (stones), muscular aches, peptic ulcer disease, pancreatitis (groans), depression (moans), anxiety and other mental disturbances.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 49
Correct
-
A 26-year-old female patient had the following blood report: RBC count = 4. 0 × 106/μl, haematocrit = 27% and haemoglobin = 11 g/dl, mean corpuscular volume (MCV) = 90 fl, mean corpuscular haemoglobin concentration (MCHC) = 41 g/dl. Further examination of blood sample revealed increased osmotic fragility of the erythrocytes. Which of the following is the most likely cause of this patient’s findings?
Your Answer: Spherocytosis
Explanation:Spherocytes are small rounded RBCs. It is due to an inherited defect of the RBC cytoskeleton membrane tethering proteins. Membrane blebs form that are lost over time and cells become round instead of biconcave. As it is a normochromic anaemia, the MCV is normal. it is diagnosed by osmotic fragility test which reveals increased fragility in a hypotonic solution.
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This question is part of the following fields:
- General
- Physiology
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Question 50
Incorrect
-
Which among the following vertebrae marks the lowest extent of the superior mediastinum?
Your Answer: Seventh cervical
Correct Answer: Fourth thoracic
Explanation:The superior mediastinum lies between the manubrium anteriorly and the upper vertebrae of the thorax posteriorly. Below, it is bound by a slightly oblique plane that passes backward from the sternal angle to the lower part of the body of T4 and laterally by the pleura.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 51
Correct
-
A patient gives a history of dull discomfort in her abdomen associated with pain that she points to be on her right shoulder and right scapula. The following organs are most likely to be source of her pain:
Your Answer: Liver, duodenum and gallbladder
Explanation:Referred pain is felt at a point away from the source of the pain or the unpleasant sensation. It arises when a nerve is damaged or compressed at a point but the pain is felt at another site that is the territory of that nerve. Common abdominal causes of referred pain to the shoulder and the shoulder blade are the liver, duodenum and gall bladder.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 52
Correct
-
The left lateral pterygoid muscle is one of the muscles of mastication. When acting alone, it will shift the mandible towards which direction?
Your Answer: Laterally, to the right
Explanation:The lateral pterygoid or external pterygoid is a muscle of mastication with two heads. It lies superiorly to the medial pterygoid. When acting alone, it will shift the mandible laterally and to the right.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 53
Correct
-
Which one of the following groups of lymph nodes is most likely to be inflamed due to paronychia involving the big toe?
Your Answer: Vertical group of superficial inguinal lymph nodes
Explanation:Paronychia affecting the big toe will result in inflammation of the superficial inguinal lymph nodes as it drains lymph from the big toe.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 54
Correct
-
The proximal tubule is the portion of the ductal system of the nephron of the kidney which leads from Bowman's capsule to the loop of Henle. Which of the following is most likely to be seen in a sample of fluid leaving the proximal tubule?
Your Answer: It will have no amino acids
Explanation:The proximal tubule is the portion of the duct system of the nephron leading from Bowman’s capsule to the loop of Henlé. The most distinctive characteristic of the proximal tubule is its brush border (or ‘striated border’). The luminal surface of the epithelial cells of this segment of the nephron is covered with densely packed microvilli forming a border which greatly increases the luminal surface area of the cells, presumably facilitating their reabsorptive function. Glucose, amino acids, inorganic phosphate, and some other solutes are100% reabsorbed via secondary active transport through co-transporters driven by the sodium gradient out of the nephron.
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This question is part of the following fields:
- Physiology
- Renal
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Question 55
Incorrect
-
Thalamic syndrome will most likely result in:
Your Answer: Increased sexual drive
Correct Answer: Hyperaesthesia
Explanation:Signs and symptoms of thalamic syndrome include contralateral hemi anaesthesia, burning or aching sensation in one half of a body (hyperaesthesia), often accompanied by mood swings.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 56
Correct
-
Which lymph nodes are likely to be enlarged in a patient who has malignant growth involving the anus?
Your Answer: Superficial inguinal
Explanation:The lymphatics from the anus, skin of the perineum and the scrotum end in the superficial inguinal nodes. In case of a malignant growth of the anus, the superficial inguinal lymph nodes would most likely be enlarge.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 57
Incorrect
-
Bloody discharge from the nipple of a 40-year old woman with no obvious lump or abnormality on mammography is suggestive of:
Your Answer: Infiltrating ductal carcinoma
Correct Answer: Intraductal papilloma
Explanation:A small benign tumour, namely intraductal papilloma is most common in women between 35-55 years of age. It is also the commonest cause of spontaneous discharge from a single duct. A lump below the nipple may be sometimes palpable. Ultrasound and ductography are useful investigations., along with cytology of discharge to assess the presence of malignant cells. Confirmation is by breast biopsy.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 58
Correct
-
What causes a reduction in pulmonary functional residual capacity?
Your Answer: Pulmonary fibrosis
Explanation:Pulmonary functional residual capacity (FRC) is = volume of air present in the lungs at the end of passive expiration.
Obstructive diseases (e.g. emphysema, chronic bronchitis, asthma) = an increase in FRC due to an increase in lung compliance and air trapping.
Restrictive diseases (e.g. pulmonary fibrosis) result in stiffer, less compliant lungs and a reduction in FRC.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 59
Incorrect
-
A 62-year-old male patient in the intensive care unit was found to have a low serum phosphate level. What is the serum level of phosphate which is considered as normal in adults?
Your Answer: 1.50–3.0 mmol/l
Correct Answer: 0.8–1.45 mmol/l
Explanation:After calcium, phosphorus is the most plentiful mineral in the human body. It is an important and vital element which our body needs to complete many physiologic processes , such as filtering waste and repairing cells. Phosphorus helps with bone growth and approximately 85% of phosphate in the body is contained in bone. Phosphate is involved in energy storage, and nerve and muscle production. A normal range of plasma phosphate in adults teenagers generally from 0.8 mmol/l to 1.45 mmol/l. The normal range varies depending on age. Infants and children have higher phosphorus levels because more of this mineral is needed for their normal growth and bone development.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
-
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Question 60
Incorrect
-
A 45-year old lady underwent biopsy of a soft, fleshy mass involving her left breast. The biopsy showed lymphoid stroma with minimal fibrosis, surrounding sheets of large vesicular cells with frequent mitoses. Which condition is she most likely suffering from?
Your Answer: Cystosarcoma phyllodes
Correct Answer: Medullary carcinoma of breast
Explanation:Medullary carcinoma is a malignant tumour of the breast with well-defined boundaries and accounts for 5% of all breast cancers. Other special features include a larger size of the neoplastic cells and presence of lymphoid cells at tumour edge. Differential diagnosis includes invasive ductal carcinoma. Prognosis is usually good.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 61
Incorrect
-
A 50-year old lady presented to the clinic with chronic pain in the abdomen. On physical examination, she was found to be pale. Further investigations revealed a decrease in both serum iron and total iron-binding capacity, along with an increase in serum ferritin. These findings are seen in:
Your Answer: Malabsorption
Correct Answer: Anaemia of chronic disease
Explanation:Anaemia of chronic disease is characterized by low serum iron, iron-binding capacity and saturation with increased ferritin (storage iron). Haemolytic anaemia is characterized by normal iron levels as the haemoglobin released from the haemolysed red blood cells is recycled. Anaemia due to chronic blood loss leads to low serum iron, low ferritin and high total iron-binding capacity (TIBC). Malabsorption, especially with duodenal involvement can also lead to iron deficiency anaemia with low ferritin and high TIBC. Megaloblastic anaemia due to vitamin B12 and folate deficiency is not associated with abnormalities in metabolism of iron.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 62
Correct
-
A 43-year-old diabetic man complains of headaches, palpitations, anxiety, abdominal pain and weakness. He is administered sodium bicarbonate used to treat:
Your Answer: Metabolic acidosis
Explanation:Sodium bicarbonate is indicated in the management of metabolic acidosis, which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis. Bicarbonate is given at 50-100 mmol at a time under scrupulous monitoring of the arterial blood gas readings. This intervention, however, has some serious complications including lactic acidosis, and in those cases, should be used with great care.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 63
Correct
-
A 48-year-old man smoker presented to the doctor complaining of a persistent cough and shortness of breath. A chest X-ray indicated the presence of a right upper lung mass. Biopsy of the mass revealed the presence of pink cells with large, irregular nuclei. What is the most probable diagnosis?
Your Answer: Squamous cell carcinoma
Explanation:Squamous cell carcinoma, is a type of non-small cell lung cancer that accounts for approximately 30% of all lung cancers. The presence of squamous cell carcinoma is often related with a long history of smoking and the presence of persistent respiratory symptoms. Chest radiography usually shows the presence of a proximal airway lesion. Histological findings include keratinisation that takes the form of keratin pearls with pink cytoplasm and cells with large, irregular nuclei.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 64
Incorrect
-
A cerebellar tremor can be differentiated from a Parkinsonian tremor in that:
Your Answer:
Correct Answer: It only occurs during voluntary movements
Explanation:Cerebellar disease leads to intention tremors, which is absent at rest and appears at the onset of voluntary movements. In comparison, Parkinson’s tremor is present at rest. Frequency of tremor is a less reliable means to differentiate between the two as the oscillation amplitude of the tremor is not constant throughout a voluntary action.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 65
Incorrect
-
A 35 year-old female developed food poisoning 24H after eating canned food. She complained of abdominal cramps, with nausea and vomiting. Shortly after she suddenly developed weakness, blurring of vision, difficulty in swallowing and breathing. Which of the following organisms is most likely associated with fatal food poisoning?
Your Answer:
Correct Answer: Clostridium botulinum
Explanation:C. botulinum is a Gram-positive, rod-shaped, spore-forming bacterium. It is an obligate anaerobe, meaning that oxygen is poisonous to the cells. Only botulinum toxin types A, B, E, and F cause disease in humans. Types A, B, and E are associated with foodborne illness. Botulism poisoning can occur due to preserved or home-canned, low-acid food that was not processed using correct preservation times and/or pressure. Signs and symptoms of foodborne botulism typically begin between 18 and 36 hours after the toxin gets into the body, but can range from a few hours to several days, depending on the amount of toxin ingested. Botulinum that is produced by Clostridium botulinum can cause respiratory and muscular paralysis.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 66
Incorrect
-
Which of the following is a likely consequence of severe diarrhoea?
Your Answer:
Correct Answer: A decrease in the sodium content of the body
Explanation:Diarrhoea can occur due to any of the numerous aetiologies, which include infectious, drug-induced, food related, surgical, inflammatory, transit-related or malabsorption. Four mechanisms have been implicated in diarrhoea: increased osmotic load, increased secretion, inflammation and decreased absorption time. Diarrhoea can result in fluid loss with consequent dehydration, electrolyte loss (Na+, K+, Mg2+, Cl–) and even vascular collapse. Loss of bicarbonate ions can lead to a metabolic acidosis.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 67
Incorrect
-
A 5 year-old-child with fever complains of sore throat . She was brought to her paediatrician for consult because she has also developed a rash and has swollen lymph nodes. Upon physical examination she cried when her liver was palpated and the tip of her spleen is slightly palpable. Full blood count shows haemoglobin 13 g/dL, Haematocrit 40%, white blood cell count 13x109/L with a WBC differential count of 45 neutrophils, 4 bands, 26 lymphocytes, 15 atypical lymphocytesm, 10 monocytes and 1 eosinophil. Whick is the most likely infectious agent that is responsible for the patient's condition?
Your Answer:
Correct Answer: Epstein–Barr virus
Explanation:Epstein-Barr virus (EBV), also known as human herpes virus 4,is a member of the herpes virus family. EBV spreads most commonly through bodily fluids, primarily saliva. EBV can cause infectious mononucleosis. Symptoms of EBV can include fatigue, fever, inflamed throat, swollen lymph nodes in the neck, enlarged spleen, swollen liver and rash.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 68
Incorrect
-
Renal function is an indication of the state of the kidney, measured by glomerular filtration rate (GFR). In a healthy person, GFR would be greatly increased by:Â
Your Answer:
Correct Answer: Substantial increases in renal blood flow
Explanation:An increase in the rate of renal blood flow (RBF) greatly increases the glomerular filtration rate (GFR). The more plasma available (from increased RBF), the more filtrate is formed. Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman’s capsule per unit time. Central to the physiologic maintenance of GFR is the differential basal tone of the afferent and efferent arterioles.
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This question is part of the following fields:
- Physiology
- Renal
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Question 69
Incorrect
-
Intracellular shifting of hydrogen ions can generate a metabolic alkalosis. In which of the following conditions is metabolic alkalosis caused by this mechanism ?
Your Answer:
Correct Answer: Hypokalaemia
Explanation:Metabolic alkalosis is characterized by a primary increase in the concentration of serum bicarbonate ions. This may occur as a consequence of a loss of hydrogen ions or a gain in bicarbonate. Hydrogen ions may be lost through the kidneys or the GI tract, as for example during vomiting, nasogastric suction or use of diuretics. Intracellular shifting of hydrogen ions develops mainly during hypokalaemia to maintain neutrality. Gain in bicarbonate ions may develop during administration of sodium bicarbonate in high amounts or in amounts that exceed the capacity of excretion of the kidneys, as seen in renal failure. Fluid losses may be another cause of metabolic alkalosis, causing the reduction of extracellular fluid volume.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 70
Incorrect
-
The following branch of the aorta is unpaired:
Your Answer:
Correct Answer: Coeliac artery
Explanation:Branches that stem from the abdominal aorta can be divided into three: the visceral branches, parietal branches and terminal branches. Of the visceral branches, the suprarenal, renal, testicular and ovarian arteries are paired while the coeliac artery and superior and inferior mesenteric arteries are unpaired. Of the parietal branches the inferior phrenic and lumbar arteries are paired while the middle sacral artery is unpaired. The terminal branches i.e. the common iliac arteries are paired.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 71
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 72
Incorrect
-
Macrolides are a group of antibiotics commonly used to treat respiratory tract and soft-tissue infections. Which of the following antibiotics is a macrolide?
Your Answer:
Correct Answer: Erythromycin
Explanation:Erythromycin is a macrolide antibiotic used in the treatment of several bacterial infections, including respiratory tract infections, skin infections, chlamydia infections, pelvic inflammatory disease, and syphilis. It may also be used during pregnancy to prevent Group B streptococcal infection in the new-born.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 73
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 74
Incorrect
-
What is the normal amount of oxygen that is carried in the blood?
Your Answer:
Correct Answer: 20 ml oxygen/100 ml blood
Explanation:Normally, 100 ml of blood contains 15g haemoglobin and a single gram of haemoglobin can bind to 1.34 ml oxygen when 100% saturated. Thus, 15 × 1.34 = 20 ml O2/100 ml blood. The haemoglobin in venous blood that is leaving the tissues is about 75% saturated with oxygen, and hence it carries about 15 ml O2/100 ml venous blood. This implies that for each 10 ml of blood, 5 ml oxygen is transported to the tissues. With a p(O2) > 100 mm Hg, only 3 ml of oxygen is dissolved in every one litre of plasma. By increasing the pA(O2) by breathing 100% oxygen, one can add an extra amount of oxygen in the plasma, but the amount of oxygen carried by haemoglobin will not increase significantly as it is already > 95% saturated.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 75
Incorrect
-
Which of the following is the most likely cause of prolonged thrombin clotting time?
Your Answer:
Correct Answer: Hypofibrinogenemia
Explanation:Thrombin clotting time, also called thrombin time (TT), is test used for the investigation of possible bleeding or clotting disorders. TT reflects the conversion of fibrinogen to fibrin and it’s also very sensitive to the presence of the anticoagulant heparin. A prolonged thrombin time may indicate the presence of hypofibrinogenemia (decreased fibrinogen level ), dysfibrinogenaemia, disseminated intravascular coagulation (DIC), end stage liver disease or malnutrition.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 76
Incorrect
-
The Carpal tunnel does NOT contain:
Your Answer:
Correct Answer: Flexor carpi ulnaris
Explanation:The contents of the carpal tunnel include:
– Median nerve
– Flexor digitorum supervicialis
– Flexor digitorum profundus
– Flexor policis longus
– Flexor carpi radialis
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 77
Incorrect
-
Destruction of the ventromedial nucleus of the hypothalamus will result in:
Your Answer:
Correct Answer: Loss of satiety
Explanation:The ventromedial nucleus of the hypothalamus is divided into an anterior and a superior part. The anterior part controls the female sexual drive, whereas the superior part is responsible for satiety. Destruction of the superior part of the nucleus will result in overeating, as no signal tells the body that it is satisfied.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 78
Incorrect
-
Nephrotic syndrome is a condition that causes proteinuria, hypoalbuminemia and oedema. Which of the following is the cause of the oedema in these patients?
Your Answer:
Correct Answer: Decreased oncotic pressure
Explanation:The glomeruli of the kidneys are the parts that normally filter the blood. They consist of capillaries that are fenestrated and allow fluid, salts and other small solutes to flow through, but normally not proteins. In nephrotic syndrome, the glomeruli become damaged allowing small proteins, such as albumin to pass through the kidneys into urine. Oedema usually occurs due to salt and water retention by the diseased kidneys as well as due to the reduced colloid oncotic pressure (because of reduced albumin in the plasma). Lower serum oncotic pressure causes fluid to accumulate in the interstitial tissues.
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This question is part of the following fields:
- Physiology
- Renal
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Question 79
Incorrect
-
After a severe asthma attack, a 26-year-old woman is left in a markedly hypoxic state. In which of the following organs are the arterial beds most likely to be vasoconstricted due to the hypoxia?
Your Answer:
Correct Answer: Lungs
Explanation:Hypoxic pulmonary vasoconstriction is a local response to hypoxia resulting primarily from constriction of small muscular pulmonary arteries in response to reduced alveolar oxygen tension. This unique response of pulmonary arterioles results in a local adjustment of perfusion to ventilation. This means that if a bronchiole is obstructed, the lack of oxygen causes contraction of the pulmonary vascular smooth muscle in the corresponding area, shunting blood away from the hypoxic region to better-ventilated regions. The purpose of hypoxic pulmonary vasoconstriction is to distribute blood flow regionally to increase the overall efficiency of gas exchange between air and blood.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 80
Incorrect
-
Epstein-Barr virus (EBV) is known to be a carcinogen for:
Your Answer:
Correct Answer: B-cell lymphoma
Explanation:EBV is known to be carcinogenic for B-cell lymphoma, nasopharyngel carcinoma and Hodgkin’s lymphoma.
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This question is part of the following fields:
- Microbiology; Neoplasia
- Pathology
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Question 81
Incorrect
-
Depression of the normal coagulation system and excessive bleeding after surgery can occur in which of the following medical conditions?
Your Answer:
Correct Answer: Liver disease
Explanation:As most of the coagulation factors are synthesized in the liver, liver diseases like hepatitis or cirrhosis will depress the coagulation system. Vitamin K deficiency can also decrease the production of vitamin K dependent coagulation factors VII, XI, X and prothrombin.
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This question is part of the following fields:
- General
- Physiology
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Question 82
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 83
Incorrect
-
At which cervical level does the common carotid artery bifurcate into the internal and external carotid arteries?
Your Answer:
Correct Answer: C4
Explanation:The common carotid arteries are present on the left and right sides of the body. These arteries originate from different sources, but follow symmetrical courses. The right common carotid originates in the neck from the brachiocephalic trunk; the left from the aortic arch in the thorax. These split into the external and internal carotid arteries at the upper border of the thyroid cartilage, at around the level of the fourth cervical vertebra.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 84
Incorrect
-
An elderly, diabetic man has firm, tender nodules at the base of his left middle and ring fingers, which he can't extend fully. What's the most likely diagnosis?
Your Answer:
Correct Answer: Fibromatosis
Explanation:This case is suggestive of Dupuytren’s contracture due to palmar fibromatosis. Its incidence is higher in men over the age of 45 years, and it increases in patients with diabetes, alcoholism, or epilepsy. These nodules are benign, usually appearing as a tender nodule in the palm which becomes painless. The disease has an aggressive clinical behaviour and recurs frequently.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 85
Incorrect
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Vincristine is a chemotherapy agent used to treat a number of types of cancer. Which of the following is a recognised major side-effect of vincristine?
Your Answer:
Correct Answer: Peripheral neuropathy
Explanation:Vincristine is an alkaloid chemotherapeutic agent. It is used to treat a number of types of cancer including acute lymphocytic leukaemia, acute myeloid leukaemia, Hodgkin’s disease, neuroblastoma, and small cell lung cancer among others. The main side-effects of vincristine are peripheral neuropathy and constipation.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 86
Incorrect
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Elevated mean corpuscular volume with hypersegmented neutrophils and low reticulocyte index is seen in on the blood count of a middle-aged lady about to undergo elective surgery. On enquiry, she mentions feeling tired for a few months. Which of the following investigations should be carried out in her to reach a diagnosis?
Your Answer:
Correct Answer: Serum vitamin B12 and folate
Explanation:Elevated levels of MCV indicates megaloblastic anaemia, which are associated with hypersegmented neutrophils. Likely causes include vitamin B12 or folate deficiency. Megaloblastic anaemia results from defective synthesis of DNA. As RNA production continues, the cells enlarge with a large nucleus. The cytoplasmic maturity becomes greater than nuclear maturity. Megaloblasts are produced initially in the marrow, before blood. Dyspoiesis makes erythropoiesis ineffective, causing direct hyperbilirubinemia and hyperuricemia. As all cell lines are affected, reticulocytopenia, thrombocytopenia and leukopenia develop. Large, oval blood cells (macro-ovalocytes) are released in the circulation, along with presence of hypersegmented neutrophils.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 87
Incorrect
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What intrinsic muscle of the larynx is responsible for the tensing of the vocal cords?
Your Answer:
Correct Answer: Cricothyroid muscle
Explanation:The cricothyroid muscle is the only tensor muscle of the larynx aiding with phonation. It attaches to the anterolateral aspect of the cricoid and the inferior cornu and lower lamina of the thyroid cartilage. Its action tilts the thyroid forward to help tense the vocal cords.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 88
Incorrect
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During hysterectomy, the ureter is most likely to be ligated when a surgeon is clamping the?
Your Answer:
Correct Answer: Uterine arteries
Explanation:The ureter forms the posterior boundary of a shallow depression which lodges the ovary and then runs medially and forward on the lateral aspect of the uterine cervix and upper part of the vagina to reach the fundus of the bladder. It is also situated about 2cm from the side of the cervix of the uterus. The relationship of the ureters and uterine arteries is of clinical significance because the arteries are at risk of iatrogenic injury during hysterectomy.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 89
Incorrect
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A 20 year old is brought to the A&E after he fell from a moving cart. The boy has sustained blunt abdominal injury, and the there is a possibility of internal bleeding as the boy is in shock. An urgent exploratory laparotomy is done in the A&E theatre. On opening the peritoneal cavity, the operating surgeon notices a torn gastrosplenic ligament with a large clot around the spleen. Which artery is most likely to have been injured in this case?
Your Answer:
Correct Answer: Short gastric
Explanation:The short gastric arteries branch from the splenic artery near the splenic hilum to travel back in the gastrosplenic ligament to supply the fundus of the stomach. Therefore, these may be injured in this case.
The splenic artery courses deep to the stomach to reach the hilum of the spleen. It doesn’t travel in the gastrosplenic ligament although it does give off branches that do.
The middle colic artery is a branch of the superior mesenteric artery that supplies the transverse colon.
Gastroepiploic artery is the largest branch of the splenic artery that courses between the layers of the greater omentum to anastomose with the right gastroepiploic.
Left gastric artery, a branch of the coeliac trunk. It supplies the left half of the lesser curvature.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 90
Incorrect
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Question 91
Incorrect
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A 76 year old man who presented with lower back pain is diagnosed with prostatic carcinoma that has metastasized to his lumber spine. Which of the following markers is characteristically elevated?
Your Answer:
Correct Answer: PSA
Explanation:Spread of prostatic carcinoma is common to the lumbar spine and pelvis. This results in osteoblastic metastases that will present as lower back pain with increased alkaline phosphatase, prostatic acid phosphates and PSA. PSA is more specific and a PSA > 10 ng/ml for any age is worrisome.
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This question is part of the following fields:
- Neoplasia; Urology
- Pathology
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Question 92
Incorrect
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One of the following structures is contained in the anterior compartment of the lower leg. Which is it?
Your Answer:
Correct Answer: Extensor hallucis muscle
Explanation:The lower leg is made up of four fascial compartments separated from one another by septa that contain the muscles of the lower leg. The four compartments are ; anterior, lateral, deep posterior and superficial posterior compartments.
These are the compartments and there contents:
i) Anterior compartment: Tibialis anterior muscle, extensor hallucis longus muscle, extensor digitorum longus muscle, peroneus tertius muscles, deep fibular nerve and anterior tibial blood vessels
ii) Lateral compartment: Fibularis longus muscle, brevis muscles and superficial fibular nerve
iii) Deep posterior compartment: Tibialis posterior m., flexor hallucis longus m., flexor digitorum longus m. ,popliteus m. , tibial nerve, posterior tibial artery and posterior tibial vessels such as the fibular artery.
iv) Superficial posterior compartment: Gastrocnemius m., soleus m., plantaris m., medial sural cutaneous nerve
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 93
Incorrect
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A space defined by the teres major muscle, the teres minor muscle, long head of the triceps brachii muscle and surgical neck of the humerus contains the axillary nerve and the?
Your Answer:
Correct Answer: Posterior circumflex humeral artery
Explanation:This quadrangular space transmits the posterior circumflex humeral vessels and the axillary nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 94
Incorrect
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Driving pressure is considered to be a strong predictor of mortality in patients with ARDS. What is the normal mean intravascular driving pressure for the respiratory circulation?
Your Answer:
Correct Answer: 10 mmHg
Explanation:Driving pressure is the difference between inflow and outflow pressure. For the pulmonary circulation, this is the difference between pulmonary arterial (pa) and left atrial pressure (pLA). Normally, mean driving pressure is about 10 mmHg, computed by subtracting pLA (5 mmHg) from pA (15 mmHg). This is in contrast to a mean driving pressure of nearly 100 mmHg in the systemic circulation.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 95
Incorrect
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A 65 year old man with a history of diabetes and hypertension presented with a stroke a few months ago severely affecting his speech and movement in the right arm and leg. A cerebral angiogram revealed a middle cerebral artery occlusion. A recent CT scan was done which revealed a 5 cm cystic space in his left parietal lobe. This lesion is a result of which of the following forms of resolution?
Your Answer:
Correct Answer: Liquefactive necrosis
Explanation:Characteristically, the brain will undergo liquefactive necrosis following ischaemic injury. This leaves a cystic space in that region which would show up on a CT scan. Atrophy would result in a generalized decrease in the brain size. Coagulative necrosis typically occurs in parenchymal organs e.g. the spleen or kidney which have a lower lipid content. Caseous necrosis is typical in granulomatous tuberculosis infection. Apoptosis will not form a cystic area as it is programmed cell death involving a individual cells. Gangrenous necrosis is characteristic of ischaemic injury of the lower limb and GI tract. Fibrinous necrosis results from necrotic damage to the blood vessels with the leaking of proteins into the vessel, appearing bright pink on H & E staining.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Neurology
- Pathology
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Question 96
Incorrect
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A 40-year old man sustained a deep laceration to the sole of his left foot. It was found that the belly of extensor digitorum muscle was lacerated and the lateral tarsal artery was severed. The lateral tarsal artery is a branch of the:
Your Answer:
Correct Answer: Dorsalis pedis artery
Explanation:The lateral tarsal artery arises from the dorsalis pedis, as the vessel crosses the navicular bone
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 97
Incorrect
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An operation to resect a tumour of the right lung was stopped as the chest surgeon said that the tumour was crossing the oblique fissure. Which structures are separated by the oblique fissure of the right lung?
Your Answer:
Correct Answer: Lower lobe from both upper and middle lobes
Explanation:The oblique fissure on the right lung separates the lower lobe from both the middle and upper lobe. The lingual is only found on the left lung and is part of the upper lobe.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 98
Incorrect
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Which of the following variables are needed to calculate inspiratory reserve volume of a patient?
Your Answer:
Correct Answer: Tidal volume, vital capacity and expiratory reserve volume
Explanation:Vital capacity = inspiratory reserve volume + tidal volume + expiratory reserve volume. Thus, inspiratory reserve volume can be calculated if tidal volume, vital capacity and expiratory reserve volume are known.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 99
Incorrect
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An ultrasound report of a 35-year old female patient revealed that she had cancer of the pancreas and presented with subsequent severe obstructive jaundice. In which part of this was woman's pancreas was the tumour most likely located?
Your Answer:
Correct Answer: Head
Explanation:The pancreas is divided into five parts; the head, body, neck, tail, and the uncinate process. Of the five parts, tumours located at the head of the pancreas in most instances cause obstruction of the common bile duct more often than tumours in the other parts of the pancreas. This is because the common bile duct passes through the head of the pancreas from the gallbladder and the liver (it is formed where the cystic and the hepatic bile duct join) to empty bile into the duodenum. This biliary obstruction leads to accumulation of bile in the liver and a consequent bilirubinaemia (raised levels of blood bilirubin). This results in jaundice. The pancreas is not divided into lobes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 100
Incorrect
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If a patient takes long-term corticosteroid therapy, which of the following diseases is most likely to develop?
Your Answer:
Correct Answer: Osteoporosis
Explanation:One of the complications of long-term intake of corticosteroids is osteoporosis. Some guidelines recommend prophylactic calcium and vitamin D supplementation in patients who take more than 30 mg hydrocortisone or 7.5 mg of prednisolone daily.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
