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Question 1
Correct
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Cervical intraepithelial neoplasia on Pap smear of a 34-year old lady is most likely associated with which of the following?
Your Answer: Human papillomavirus infection
Explanation:CIN (Cervical intraepithelial neoplasia) is considered a precursor of cervical cancer and is likely caused due to infection with human papillomavirus (HPV) types 16, 18, 31, 33, 35 or 39. The risk factors for cervical cancer include multiple sex partners, young age at the time of first intercourse, intercourse with men whose previous partners had cervical cancer. Also, smoking and immunodeficient states are considered contributory. CIN is graded as mild (grade I), moderate (grade II) and severe dysplasia or carcinoma in situ (grade III). CIN III rarely regresses spontaneously and can lead to invasive carcinoma by invading the basement membrane. Squamous cell carcinomas are the commonest cervical cancer seen in 80-85% of all cases. Others are commonly adenocarcinomas. Cervical cancer can spread by direct extension, lymphatic spread to pelvic and para-aortic nodes or by hematogenous route.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 2
Incorrect
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Which of the following structure forms the floor of the posterior triangle of the neck:
Your Answer: Investing fascia
Correct Answer: Prevertebral fascia
Explanation:The posterior triangle (or lateral cervical region) is a region of the neck which has the following boundaries:
Apex: Union of the sternocleidomastoid and the trapezius muscles at the superior nuchal line of the occipital bone
Anterior: Posterior border of the sternocleidomastoid muscle
Posterior: Anterior border of the trapezius
Base: Middle one third of the clavicle
Roof: Investing layer of the deep cervical fascia
Floor: The anterolateral portion of prevertebral fascia -
This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 3
Correct
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An intern is attempting to put in an arterial line in an ICU patients left foot. Which is the best site to feel for the pulsation of the dorsalis pedis artery in the foot?
Your Answer: Just lateral to the tendon of extensor hallucis longus
Explanation:The dorsalis pedis artery is the continuation of the anterior tibial artery. The pulse of the posterior tibial artery, which comes from the posterior compartment of the leg, may be felt behind the medial malleolus just lateral to the tendon of the extensor hallucis longus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 4
Correct
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A chest x ray of a patient reveals loculated fluid in the right chest, which can be easily aspirated if the needle is inserted through the body wall just above the 9th rib in the midaxillary line. Where is this fluid located?
Your Answer: Costodiaphragmatic recess
Explanation:The costodiaphragmatic recess is the lowest point of the pleural sac where the costal pleura becomes the diaphragmatic pleura. At the midclavicular line, this is found between ribs 6 and 8; at the paravertebral lines, between ribs 10 and 12 and between ribs 8 and 10 at the midaxillary line.
The cardiac notch: is an indentation of the heart on the left lung, located on the anterior surface of the lung.
Cupola: part of the parietal pleura that extends above the first rib.
Oblique pericardial sinus: part of the pericardial sac located posterior to the heart behind the left atrium.
Costomediastinal recess: a reflection of the pleura from the costal surface to the mediastinal surface, is on the anterior surface of the chest.
The inferior mediastinum: is the space in the chest occupied by the heart.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 5
Correct
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A lady presents to the out patient clinic with a painful boil on the skin of her mons pubis. Which nerve supplies the skin of the mons pubis?
Your Answer: Anterior labial
Explanation:Anterior labial branch is the terminal branch of the ilioinguinal nerve that innervates the skin of the mons pubis in women and the skin of the anterior scrotum in men.
The femoral branch of genitofemoral nerve innervates the upper medial thigh.
The iliohypogastric innervates muscles of the abdominal wall.
The subcostal nerve innervates muscles of the abdominal wall and the skin of the lower abdominal wall.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 6
Incorrect
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Different substances have different renal clearance rates. Which of the following substances should have the lowest renal clearance rate in a healthy patient?
Your Answer: Water
Correct Answer: Glucose
Explanation:Under normal conditions the renal clearance of glucose is zero, since glucose is completely reabsorbed in the renal tubules and not excreted. Glycosuria – the excretion of glucose into the urine- is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 7
Correct
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A patient is diagnosed with lung cancer. His physician told him that his lung cancer type is aggressive. It can grow rapidly and may undergo early metastasis, however it is very sensitive to chemotherapy and radiotherapy. Which lung cancer type is most likely present
Your Answer: Small-cell carcinoma
Explanation:Small-cell lung carcinoma (SCLC) is a type of highly malignant cancer that most commonly arises within the lung. SCLC usually metastasizes widely very early on in the natural history of the tumour, and in nearly all cases responds dramatically to chemotherapy and/or radiotherapy. Surgery has no role in the treatment of this disease.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 8
Incorrect
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Where do the cells belonging to the mononuclear phagocyte system originate?
Your Answer: Thymus
Correct Answer: Bone marrow
Explanation:The macrophage originates from a committed bone marrow stem cell. It is called the pluripotent hematopoietic stem cell. This differentiates into a monoblast and then into a promonocyte and finally matures into a monocyte. When called upon they leave the bone marrow and enter into the circulation. Upon entering the tissue they transform into macrophages. Tissue macrophages include: Kupffer cells (liver), alveolar macrophages (lung), osteoclasts (bone), Langerhans cells (skin), microglial cells (central nervous system), and possibly the dendritic immunocytes of the dermis, spleen and lymph nodes.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 9
Incorrect
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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: Vibrio cholerae
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 10
Correct
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Which of the following structure contains the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle?
Your Answer: Edinger–Westphal nucleus
Explanation:The Edinger–Westphal nucleus (accessory oculomotor nucleus) is the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle.
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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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Painful erections along with deviation of the penis to one side when erect are seen in which of the following conditions?
Your Answer: Peyronie’s disease
Explanation:Peyronie’s disease leads to development of fibrous plaques in the penile soft tissue and occurs in 1% of men, most commonly affecting white males above 40 years age. It is a connective tissue disorder named after a French surgeon, François de la Peyronie who first described it. Symptoms include pain, hard lesions on the penis, abnormal curvature of erect penis, narrowing/shortening, painful sexual intercourse and in later stages, erectile dysfunction. 30% cases report fibrosis in other elastic tissues such as Dupuytren’s contractures of the hand. There is likely a genetic predisposition as increased incidence is noted among the male relatives of an affected individual.
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This question is part of the following fields:
- Pathology
- Urology
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Question 12
Incorrect
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A 56 year old gentleman, who is a chronic smoker presents to the clinic with dyspnoea. His Chest X-ray shows intercostal space widening with increased blackening bilaterally. What is the most likely finding on his pulmonary function test?
Your Answer: Increased vital capacity
Correct Answer: Increased total lung capacity
Explanation:In patients suspected of having chronic obstructive pulmonary disease, pulmonary function testing (PFT) is useful to confirm airway obstruction, to quantify its severity and reversibility, for following disease progression and monitoring response to treatment. These tests include:
FEV1 – volume of air forcefully expired during the first second after a full breath
Forced vital capacity (FVC) – total volume of air expired with maximal force and flow-volume loops. The hallmark of airway obstruction is reduction of FEV1, FVC and the ratio of FEV1/FVC, with a concave pattern in expiratory tracing on the flow-volume loop. FEV1 and forced vital capacity (FVC) are easily measured with office spirometry and are useful to assess the severity of disease. Other parameters include increased total lung capacity, functional residual capacity and residual volume, which can help distinguish chronic obstructive pulmonary disease (COPD) from restrictive pulmonary disease where these values are lower than normal. Along with these, other tests are decreased vital capacity; and decreased diffusing capacity for carbon monoxide (DLCO). DLCO is non-specific and can be low in other disorders that affect the pulmonary vascular bed, such as interstitial lung disease. DLCO is however useful to distinguish COPD from asthma, in which DLCO is normal or elevated.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 13
Correct
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Which of the following is likely to result in hematocolpos in a 12-year old girl?
Your Answer: Imperforate hymen
Explanation:Hematocolpos means accumulation of blood in vagina and hematometra is accumulation of blood in the uterus. These are most likely seen with an imperforate hymen; which is seen I 1 in 2000 females. If spontaneous resolution does not occur, treatment involves making a hole in the hymen to allow discharge of menstrual blood.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 14
Correct
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A patient who has used NSAIDS for many years presents to the A&E with symptoms of acute haemorrhagic shock. An emergency endoscopy is done that shows that a duodenal ulcer has perforated the posterior wall of the first part of the duodenum. Which artery is most likely to be the cause of the haemorrhage?
Your Answer: Gastroduodenal
Explanation:The gastroduodenal artery is a branch of the hepatic artery and descends near the pylorus between the first part of the duodenum and the neck of the pancreas to divide at the lower border of the duodenum into the right gastroepiploic and pancreaticoduodenal arteries. Before it divides, it gives off a few branches to the pyloric end of the stomach and to the pancreas. The artery that is most likely involved in this situation is the gastroduodenal artery since it is posterior to the first part of the duodenum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 15
Correct
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An old man presented with atrophy of the thenar eminence despite the sensation over it still being intact. What is the injured nerve in this case?
Your Answer: Median nerve
Explanation:Atrophy of the thenar muscles means injury to the motor supply of these muscles. The nerve that sends innervation to it is the median nerve. But the median nerve does not provide sensory innervation to the overlying skin so sensation is spared.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 16
Incorrect
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A 32-year-old man presents to the doctor complaining of pain in his left calf whilst walking. He says that the pain goes away after a short period of rest but starts again during exercise or walking. The man reveals he has been a smoker for the last 15 years. His blood pressure, blood sugar and cholesterol level are normal. Artery biopsy shows intraluminal thrombosis and vasculitis. What's is the most likely cause of these findings?
Your Answer: Severe atherosclerosis
Correct Answer: Buerger's disease
Explanation:Thromboangiitis obliterans, also known as Buerger’s disease, is a rare type of occlusive peripheral arterial disease, usually seen in smokers, most commonly in men aged 20 to 40. Symptoms most often include intermittent claudication, skin changes, painful ulcers on extremities, pain in the extremities during rest and gangrene. Diagnosis is based on clinical findings, arteriography, echocardiography, and computed tomography angiography. A difference in blood pressure between arms, or between the arms and legs is a common finding. Electrocardiographic findings include nonspecific abnormality or normal results.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 17
Correct
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Which of the following accumulates within a cell due to the aging process?
Your Answer: Lipofuscin
Explanation:Lipofuscin , also known as lipochrome, is a wear and tear pigment or an aging pigment. It represents free radical injury or lipid peroxidation. On microscopic examination is appears as a yellowish brown pigment around the nucleus (perinuclear pigment). It is often seen in cells which are undergoing regressive changes, commonly in the liver and heart of old patients or patients with cancer, cachexia or severe malnutrition.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 18
Correct
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During clinic, a medical student conducts a physical examination on a teenage boy with a lump in the inguinal region. The lump is protruding from the superficial inguinal ring. The student correctly concluded that it was:
Your Answer: Either a direct or an indirect inguinal hernia
Explanation:It is not possible to tell if an inguinal hernia is direct or indirect just by palpating it. Despite the fact that indirect inguinal hernias commonly come out of the superficial inguinal ring to enter the scrotum, direct inguinal hernia might still do this.
Femoral hernia goes through the femoral ring into the femoral canal (has nothing to do with the superficial inguinal ring).
Superficial inguinal lymph nodes lie in the superficial fascia parallel to the inguinal ligament; it would therefore feel more superficial and would not be mistaken for a hernia protruding through the inguinal ring.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 19
Incorrect
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A 45-year old male, who was a chronic smoker presented to the clinic with backache and dry, incessant cough. On examination, he was found to have raised blood pressure, purplish striae on his abdomen, truncal obesity and tenderness over the lower thoracic spine. These findings are suggestive of which condition?
Your Answer: Multiple endocrine neoplasia, type I
Correct Answer: Small-cell anaplastic (oat cell) carcinoma
Explanation:The symptoms suggest Cushing syndrome due to increased glucocorticoid levels. One cause of Cushing syndrome is ectopic production of adrenocorticotrophic hormone from oat cell carcinoma. As oat cell carcinoma is known to be highly metastatic, the tenderness in lower back could represent metastatic involvement.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 20
Correct
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A 20 year old is brought to the A&E after he fell from a moving cart. The boy has sustained blunt abdominal injury, and the there is a possibility of internal bleeding as the boy is in shock. An urgent exploratory laparotomy is done in the A&E theatre. On opening the peritoneal cavity, the operating surgeon notices a torn gastrosplenic ligament with a large clot around the spleen. Which artery is most likely to have been injured in this case?
Your Answer: Short gastric
Explanation:The short gastric arteries branch from the splenic artery near the splenic hilum to travel back in the gastrosplenic ligament to supply the fundus of the stomach. Therefore, these may be injured in this case.
The splenic artery courses deep to the stomach to reach the hilum of the spleen. It doesn’t travel in the gastrosplenic ligament although it does give off branches that do.
The middle colic artery is a branch of the superior mesenteric artery that supplies the transverse colon.
Gastroepiploic artery is the largest branch of the splenic artery that courses between the layers of the greater omentum to anastomose with the right gastroepiploic.
Left gastric artery, a branch of the coeliac trunk. It supplies the left half of the lesser curvature.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 21
Incorrect
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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: Hyperparathyroidism
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 22
Correct
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A specialist registrar was performing the bi-lateral surgical removal of the adrenal glands. He first removed the left adrenal gland before moving on to the right one. However, the registrar noticed that the removal of the right adrenal gland would be a challenge because of an overlying structure. What was this structure that overlies the right suprarenal glad?
Your Answer: Inferior vena cava
Explanation:The adrenal glands or the suprarenal glands are small glands that are found on top of each of the kidneys. They are retroperitoneal glands. The right adrenal gland is found on top of the right kidney and is closely associated with the inferior vena cava as it directly drains into this large vein. In the case where the right adrenal gland is to be surgically removed, the inferior vena cava might prove a problem to manoeuvre as it overlies the right suprarenal gland. The other blood vessels such as the aorta, right renal, superior mesenteric, splenic artery and the hepatic vein as well as the right crus are not closely associated with either of the suprarenal glands.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 23
Correct
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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: 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 24
Correct
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An abdominal aortogram shows occlusion of the inferior mesenteric artery. Which of the following segments of bowel is most likely to have preserved arterial supply?
Your Answer: Caecum
Explanation:The inferior mesenteric artery supplies blood to the end of the transverse colon and all distal structures in the gastrointestinal tract i.e. splenic flexure, descending colon, sigmoid colon and rectum would all be deprived of blood if it were occluded. The caecum receives blood from the superior mesenteric artery so it would not be affected.
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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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Which of the following is the most accurate test for the diagnosis of primary syphilis?
Your Answer: Dark-field microscopy
Explanation:Primary syphilis is transmitted via sexual contact. Lesions on genitalia, called a chancre occur after an asymptomatic incubation period of 10-90 days (average 21 days) after exposure. This chancre is a typically solitary (can be multiple), firm, painless, ulceration over the skin at the point of exposure to spirochete, seen on penis, vagina or rectum. It heals spontaneously after 4-6 weeks. Local lymphadenopathy can be seen.
Diagnosis is made by microscopy of fluid from lesion using dark-field illumination, taking care to not confuse with other treponemal disease. Screening tests include rapid plasma regain (RPR) and Venereal Diseases Research Laboratory (VDRL) tests. False positives are known to occur with these tests and can be seen in viral infections like hepatitis, varicella, Epstein-Barr virus, tuberculosis, lymphoma, pregnancy and IV drug use. More specific tests should therefore be carried out in case these screening tests are positive.
The Treponema pallidum hemagglutination assay (TPHA) and the fluorescent treponemal antibody absorption (FTAABS) test are based on monoclonal antibodies and immunofluorescence and are more specific. However, they can too show false positives with other treponemal diseases like yaws or pinta. Other confirmatory tests include those based on enzyme-linked immunoassays.
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This question is part of the following fields:
- Pathology
- Urology
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Question 26
Correct
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A 36-year-old female was advised to undergo genetic testing of BRCA1 and BRCA2. BRCA1 and BRCA2 are tumour markers specifically for which organ?
Your Answer: Breast
Explanation:Women with harmful mutations in either BRCA1 or BRCA2 have a risk of breast cancer that is about five times the normal risk.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 27
Incorrect
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In which of the following compartments of the femoral sheath is the femoral artery located?
Your Answer: Medial compartment
Correct Answer: Lateral compartment
Explanation:The femoral sheath also known as the crural sheath is made up of three compartments; lateral, intermediate and the medial. The femoral artery is contained in the lateral compartment of the femoral sheath while the femoral vein is in the intermediate compartment.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 28
Incorrect
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In multiple myeloma, which of these cell types confirms the diagnosis when found in a smear of bone marrow aspirate?
Your Answer: Giant cells
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 29
Incorrect
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A surgical registrar performing an adrenalectomy procedure on the left suprarenal gland of a 25 - year old male patient, accidentally jabbed and injured a vital structure that lies anterior to the left suprarenal organ. Which of the following was the structure most likely injured?
Your Answer: Colon
Correct Answer: Pancreas
Explanation:The adrenal (suprarenal) glands are organs of the endocrine system located on top of each of the kidneys. The left suprarenal gland, in question, is crescent in shape and slightly larger than the right suprarenal gland. It is posteriorly located to the lateral aspect of the head of the pancreas which is thus the most likely to be injured. The other organs like the duodenum, liver and the inferior vena cava are related to the right suprarenal gland. The spleen and the colon are not in close proximity with the left suprarenal gland and are not likely to be the organs injured.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 30
Correct
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A 25 year old primi gravida lady was scheduled for a regular antenatal check up. During the vaginal exam of this lady, the registrar discovered a malignant growth on the anterior wall of her vagina. Which of the following structures, adjacent to the vagina, is likely to be involved as well?
Your Answer: Fundus of the bladder
Explanation:The fundus of the bladder is related anatomically to the anterior surface of the vagina and the urethra as well. If there was a malignant growth in the anterior surface of the vagina, then most likely the fundus of the bladder would be involved as well aspotentially the urethra.
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This question is part of the following fields:
- Anatomy
- Pelvis
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SESSION STATS - PERFORMANCE PER SPECIALTY
