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Question 1
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 2
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 3
Correct
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Which of the following organs is most likely to have dendritic cells?
Your Answer: Skin
Explanation:Dendritic cells are part of the immune system and they function mainly as antigen presenting cells. They are present in small quantities in tissues which are in contact in the external environment. Mainly in the skin and to a lesser extent in the lining of the nose, lungs, stomach and intestines. In the skin they are known as Langerhans cells.
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This question is part of the following fields:
- General
- Physiology
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Question 4
Correct
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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: 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 5
Correct
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Which muscle originates from the common flexor tendon of the forearm?
Your Answer: Flexor digitorum superficialis
Explanation:The medial epicondyle of the humerus is the site of origin of this group of muscles of the forearm. It originates from the medial epicondyle of the humerus by a common tendon. Fibres from the deep fascia of the forearm, near the elbow and septa, pass from this fascia between the muscles. These muscles include the pronator teres, palmaris longus, flexor carpi radialis, flexor carpi ulnaris and flexor digitorum superficialis.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 6
Correct
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Which of the following muscles is innervated by the inferior branch of the right recurrent laryngeal nerve?
Your Answer: Posterior cricoarytenoid
Explanation:The posterior cricoarytenoid muscle, which is the sole abductor of the vocal folds, receives its innervation from the inferior laryngeal nerve which is a continuation of the recurrent laryngeal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 7
Correct
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Which part of the nephron would have to be damaged to stop the reabsorption of the majority of salt and water?
Your Answer: Proximal tubule
Explanation:The proximal tubule is the portion of the duct system of the nephron of the kidney which leads from Bowman’s capsule to the loop of Henle. It is conventionally divided into the proximal convoluted tubule (PCT) and the proximal straight tubule (PST). The proximal tubule reabsorbs the majority (about two-thirds) of filtered salt and water. This is done in an essentially iso-osmotic manner. Both the luminal salt concentration and the luminal osmolality remain constant (and equal to plasma values) along the entire length of the proximal tubule. Water and salt are reabsorbed proportionally because the water is dependent on and coupled with the active reabsorption of Na+. The water permeability of the proximal tubule is high and therefore a significant transepithelial osmotic gradient is not possible.
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This question is part of the following fields:
- Physiology
- Renal
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Question 8
Incorrect
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During an inguinal hernia repair, an incision is made parallel to and 5cm above the inguinal ligament. The registrar is warned to look out for the inferior epigastric vessels to avoid damage. Between which layers of the abdominal wall is the registrar likely to find these vessels?
Your Answer:
Correct Answer: Transversus abdominis muscle and peritoneum
Explanation:The inferior epigastric vessels lie on the inner surface of the transversus abdominis muscle covered by the parietal peritoneum. This layer of peritoneum lies over the inferior epigastric vessels to make the lateral umbilical fold. Camper’s and Scarpa’s fascia are two layers of the superficial fascia, the fatty layer and the membranous layer respectively.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 9
Incorrect
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Which of the cranial nerves is responsible for touch sensation on the skin over the maxilla region and the mandible?
Your Answer:
Correct Answer: Trigeminal
Explanation:The sensation of the face is provided by the trigeminal nerve which is cranial nerve V. It is also responsible for other motor functions such as biting and chewing. The trigeminal nerve has three branches; the ophthalmic nerve (V1), the maxillary nerve((V2) and the mandibular nerve (V3). These three branches exit the skull through separate foramina, namely; the superior orbital fissure, the foramen rotundum and the foramen ovale respectively. The mnemonic for this is ‘Standing room only’. The sensory fibres of the maxillary nerve are distributed to the lower eyelid and cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa, the palate and roof of the pharynx, the maxillary, ethmoid and sphenoid sinuses, and parts of the meninges. The sensory fibres of the mandibular nerve are distributed to the lower lip, the lower teeth and gums, the floor of the mouth, the anterior two-thirds of the tongue, the chin and jaw (except the angle of the jaw, which is supplied by C2–C3), parts of the external ear, and parts of the meninges. The mandibular nerve carries touch/ position and pain/temperature sensation from the mouth. The sensory fibres of the ophthalmic nerve are distributed to the scalp and forehead, the upper eyelid, the conjunctiva and cornea of the eye, the nose (including the tip of the nose), the nasal mucosa, the frontal sinuses and parts of the meninges (the dura and blood vessels). The sensory fibres of the maxillary nerve are distributed to the lower eyelid and cheek, the nares and upper lip, the upper teeth and gums, the nasal mucosa, the palate and roof of the pharynx, the maxillary, ethmoid and sphenoid sinuses, and parts of the meninges.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 10
Incorrect
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How are amino acids transported across the luminal surface of the small intestinal epithelium?
Your Answer:
Correct Answer: Co-transport with sodium ions
Explanation:Once complex peptides are broken down into amino acids by the peptidases present in the brush border of small intestine, they are ready for absorption by at least four sodium-dependent amino acid co-transporters – one each for acidic, basic, neutral and amino acids, present on the luminal plasma membrane. These transporters first bind sodium and can then bind the amino acids. Thus, amino acid absorption is totally dependent on the electrochemical gradient of sodium across the epithelium. The basolateral membrane in contrast, possesses additional transporters to carry amino acids from the cell into the blood, but these are sodium-independent.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 11
Incorrect
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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 12
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:
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 13
Incorrect
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A significantly elevated white cell count of 50 x 109/l with 5% blasts and raised leucocyte alkaline phosphatase is seen in which of the following conditions?
Your Answer:
Correct Answer: Leukaemoid reaction
Explanation:Non-neoplastic proliferation of leucocytes causes an increase in leukocyte alkaline phosphatase (LAP). This is referred to as ‘leukemoid reaction’ because of the similarity to leukaemia with an increased white cell count (>50 × 109/l) with immature forms. Causes of leukemoid reaction includes haemorrhage, drugs (glucocorticoids, all-trans retinoic acid etc), infections such as tuberculosis and pertussis, and as a paraneoplastic phenomenon. Leukemoid reaction can also be seen in infancy as a feature of trisomy 21. This is usually a benign condition, but can be a response to a disease state. Differential diagnosis include chronic myelogenous leukaemia (CML).
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This question is part of the following fields:
- Haematology
- Pathology
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Question 14
Incorrect
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Loperamide is a drug used to treat diarrhoea. What is the mechanism of action of loperamide?
Your Answer:
Correct Answer: Opiate agonist
Explanation:Loperamide is an opioid-receptor agonist and acts on the mu opioid receptors in the myenteric plexus of large intestine. It works by decreasing the motility of the circular and longitudinal smooth muscles of the intestinal wall. It is often used for this purpose in gastroenteritis, inflammatory bowel disease, and short bowel syndrome.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 15
Incorrect
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Where do the cells belonging to the mononuclear phagocyte system originate?
Your Answer:
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 16
Incorrect
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After having donated a unit of blood. The blood bank will prefer to use which of the following anticoagulants to store the blood?
Your Answer:
Correct Answer: Citrate
Explanation:Calcium is necessary for coagulation to occur. Citrate being a chelator and combining with calcium ions to form un-ionised compound will prevent coagulation. Following transfusion the citrate is removed by the liver with in a few minutes. Oxalate also works on the same principle but it is toxic to the body.
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This question is part of the following fields:
- General
- Physiology
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Question 17
Incorrect
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A 13-year-old boy's mother notices he has a lump in his arm, near his right shoulder. An X-ray reveals a lateral projection in the metaphyseal region of his humerus. The lesion is removed and it is found to be composed of bony cortex, capped by cartilage. What's the most likely diagnosis in this case?
Your Answer:
Correct Answer: Osteochondroma
Explanation:Osteochondromas, or osteocartilaginous exostoses, are the most common benign bone tumours, and tend to appear near the ends of long bones. The overgrowth can occur in any bone where cartilage forms bone, and they are capped by cartilage. They are most common in people between the ages of 10-20 years old.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 18
Incorrect
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A patient with testicular seminoma has the following tumour markers: LDH 1.3 times the reference levels, β-hCG 4500 mIU/ml and AFP 875 ng/ml. What's the serum tumour marker stage in this case?
Your Answer:
Correct Answer: S1
Explanation:According to AJCC guidelines, the serum tumour marker staging is the following:
S0: marker studies within normal limits
S1: lactate dehydrogenase (LDH) less than 1.5 times the reference range, beta-human chorionic gonadotrophin (β-hCG) <5000 mIU/ml, and alpha-fetoprotein (AFP) <1000 ng/ml S2: LDH 1.5–10 times the reference range, β-hCG 5000–50,000 mIU/ml or AFP 1000–10,000 ng/ml S3: LDH greater than 10 times the reference range, β-hCG >50,000 mIU/ml or AFP >10,000 ng/ml.
According to this, the patient’s tumour belongs to the S1 stage.
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This question is part of the following fields:
- Pathology
- Urology
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Question 19
Incorrect
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During an operation to repair an indirect inguinal hernia, you are asked to indicate the position of the deep inguinal ring. You indicate this as being:
Your Answer:
Correct Answer: Above the midpoint of the inguinal ligament
Explanation:The deep inguinal ring is near the midpoint of the inguinal ligament, below the anterior superior iliac spine. It is lateral to the inferior epigastric artery. The superficial ring, however, is found above the pubic tubercle. The supravesical fossa is the space between the median and medial umbilical folds.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 20
Incorrect
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An organ transplant patient may be at risk of developing which type of cancer?
Your Answer:
Correct Answer: Skin cancer
Explanation:The most common malignancies encountered in the post–solid organ transplant setting are non-melanoma skin cancers, post-transplant lymphoproliferative disorders and Kaposi’s sarcoma (KS). The pathogenesis of these tumours is likely related to the immunosuppressive drugs used post-transplantation and subsequent viral infection.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 21
Incorrect
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Which of the deep fasciae located in the anterolateral abdominal wall form the inguinal ligament?
Your Answer:
Correct Answer: External abdominal oblique aponeurosis
Explanation:The inguinal ligament is the inferior border of the aponeurosis of the external oblique abdominis and extends from the anterior superior iliac spine to the pubic tubercle from whence it is reflected backward and laterally to attach to the pectineal line and form the lacunar ligament.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 22
Incorrect
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Which of the following cells would be increased in a patient suffering from a hydatid cyst in the liver?
Your Answer:
Correct Answer: Eosinophils
Explanation:Eosinophils are granulocytes that respond to parasitic infections. They are also involved in allergy response and asthma. They contain granules which stain red with Romanowsky’s method and contain peroxidase, Rnase, Dnase, histamine, lipase and major basic proteins that are toxic to the parasite as well as the hosts tissue. They are about 1-5% of the total WBC population and persist in the blood for 6-12 hours.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 23
Incorrect
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In a hypertensive patient with secondary hyperaldosteronism, aldosterone is released mainly in response to:
Your Answer:
Correct Answer: Angiotensin II
Explanation:Secondary hyperaldosteronism in hypertension is either due to primary renin overproduction by the kidneys or renin overproduction secondary to decreased renal blood flow. The main stimulus for aldosterone release are adrenocorticotrophic hormone (ACTH), angiotensin II and high plasma K+ levels. Low plasma Na+ might also stimulate the adrenal cortex. Fluid overload will reduce aldosterone secretion. Atrial natriuretic peptide is secreted under conditions of expanded extracellular volume and will not lead to aldosterone secretion.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 24
Incorrect
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During the fetal stage, the mesonephric tubules gives rise to the?
Your Answer:
Correct Answer: Wolffian duct
Explanation:The development of the kidney proceeds through a series of successive phases, each marked by the development of a more advanced kidney: the pronephros, mesonephros, and metanephros. The development of the pronephric duct proceeds in a cranial-to-caudal direction. As it elongates caudally, the pronephric duct induces nearby intermediate mesoderm in the thoracolumbar area to become epithelial tubules called mesonephric tubules. Each mesonephric tubule receives a blood supply from a branch of the aorta, ending in a capillary tuft analogous to the glomerulus of the definitive nephron. The mesonephric tubule forms a capsule around the capillary tuft, allowing for filtration of blood. This filtrate flows through the mesonephric tubule and is drained into the continuation of the pronephric duct, now called the mesonephric duct or Wolffian duct. The nephrotomes of the pronephros degenerate while the mesonephric duct extends towards the most caudal end of the embryo, ultimately attaching to the cloaca.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 25
Incorrect
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Production of pain is most likely associated with:
Your Answer:
Correct Answer: Substance P
Explanation:Substance P is a short-chain polypeptide that functions as a neurotransmitter and as a neuromodulator, and is thus, a neuropeptide. It has been linked with pain regulation, mood disorders, stress, reinforcement, neurogenesis, respiratory rhythm, neurotoxicity, nausea and emesis. It is also a potent vasodilator as it brings about release of nitric oxide from the endothelium. Its release can also cause hypotension.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 26
Incorrect
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Injury to which of the following arteries is likely to affect the blood supply to the seminal vesicles?
Your Answer:
Correct Answer: Middle rectal
Explanation:Ligation of middle rectal artery is most likely to affect the blood supply of seminal vesicles since arteries supplying the seminal vesicles are derived from the middle and inferior vesical and middle rectal arteries.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 27
Incorrect
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A 58-year-old woman diagnosed with deep vein thrombosis had been using warfarin for 10 days. When she presented to the doctor she had haemorrhagic bullae and necrotic lesions in her lower limbs and buttocks. Deficiency of which of the following proteins may have caused the necrotic skin lesions?
Your Answer:
Correct Answer: Protein C
Explanation:Warfarin-induced skin necrosis is a rare complication of anticoagulant therapy that requires immediate drug cessation. The most common cutaneous findings include petechiae that progress to ecchymoses and haemorrhagic bullae. Warfarin inactivates vitamin K-dependent clotting factors II, VII, IX, and X and vitamin K-dependent proteins C and S. The concentration of protein C falls more rapidly than other vitamin K-dependent factors because they have a shorter half-lives. Skin necrosis is seen mainly in patients with prior protein C deficiency.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 28
Incorrect
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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:
Correct 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 29
Incorrect
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Infection to all of the following will lead to enlargement of the superficial inguinal lymph nodes, except for:
Your Answer:
Correct Answer: Ampulla of the rectum
Explanation:The superficial inguinal lymph nodes form a chain immediately below the inguinal ligament. They receive lymphatic supply from the skin of the penis, scrotum, perineum, buttock and abdominal wall below the level of the umbilicus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 30
Incorrect
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After finding elevated PSA levels, a 69-year-old man undergoes a needle biopsy and is diagnosed with prostatic cancer. What is the stage of this primary tumour?
Your Answer:
Correct Answer: T1c
Explanation:The AJCC uses a TNM system to stage prostatic cancer, with categories for the primary tumour, regional lymph nodes and distant metastases:
TX: cannot evaluate the primary tumour T0: no evidence of tumour
T1: tumour present, but not detectable clinically or with imaging T1a: tumour was incidentally found in less than 5% of prostate tissue resected (for other reasons)
T1b: tumour was incidentally found in more than 5% of prostate tissue resected
T1c: tumour was found in a needle biopsy performed due to an elevated serum prostate-specific antigen
T2: the tumour can be felt (palpated) on examination, but has not spread outside the prostate
T2a: the tumour is in half or less than half of one of the prostate gland’s two lobes
T2b: the tumour is in more than half of one lobe, but not both
T2c: the tumour is in both lobes
T3: the tumour has spread through the prostatic capsule (if it is only part-way through, it is still T2)
T3a: the tumour has spread through the capsule on one or both sides
T3b: the tumour has invaded one or both seminal vesicles
T4: the tumour has invaded other nearby structures.
In this case, the tumour has a T1c stage.
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This question is part of the following fields:
- Pathology
- Urology
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SESSION STATS - PERFORMANCE PER SPECIALTY
