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Question 1
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 2
Correct
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Which of the following conditions can present with multiple abscesses that may discharge sulphur granules?
Your Answer: Actinomycosis
Explanation:Actinomycosis is primarily caused by any of the several members of the bacterial genus Actinomyces. These bacteria are generally anaerobes. And can cause multiple abscesses that may discharge sulphur granules.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 3
Correct
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A 50 year old man on warfarin therapy following insertion of a pacemaker presented with epistaxis. Which of the following is true regarding blood coagulation?
Your Answer: Patients with haemophilia A usually have a normal bleeding time
Explanation:A prolonged bleeding time is seen in platelet disorders like thrombocytopenia. Patients with haemophilia A or B have a prolonged PTT but not a prolonged bleeding time.
Ca2+ is necessary for coagulation.
von Willebrand factor is an important part of the factor VIII complex and promotes platelet adhesion and aggregation.
DIC results in depleted coagulation factors and accumulation of fibrin.
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This question is part of the following fields:
- General
- Physiology
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Question 4
Incorrect
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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: Paget’s disease of the breast
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 5
Correct
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A 40-year old gentleman underwent a computed tomographic scan for the abdomen to rule out blunt abdominal trauma, after a vehicular accident. The scan revealed no abnormal finding except for a 1 cm-sized cortical mass in the left adrenal gland. The doctor-on-call decided to not intervene for this mass because it was likely to be a:
Your Answer: Non-functioning adrenal adenoma
Explanation:Adrenal adenomas are common, benign lesions which are asymptomatic and seen in 10% of population. Usually detected incidentally on Computed tomography (‘incidentaloma’), only around 1 in 10,000 are malignant (adenocarcinoma). Adrenal adenomas rarely need to be investigated, especially if they are homogenous and less than 3 cm in diameter. Follow-up imaging can be done after an interval of 3-6 months to assess any change in size. Some adenomas can secrete cortisol (leading to Cushing syndrome), or aldosterone (leads to Conn syndrome) or androgens (leading to hyperandrogenism).
Haematomas and simple cysts are not usually seen in adrenal gland. Infection due to Histoplasma capsulatum is usually bilateral and leads to multiple granulomas. Adrenal metastasis will usually demonstrate a lung primary and the adrenal lesions will be often multiple and larger than 1 cm.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 6
Correct
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A 45 year old women has a 4 cm non tender mass in her right breast which is fixed to the chest wall. Another 2cm non-tender mass is palpable in the left axilla. Chest x ray reveals multiple nodules ranging from 0.5 - 0.2 cm in both the lungs. What is the stage of her disease?
Your Answer: T4 N1 M1
Explanation:This woman has an invasive primary tumour mass with axillary node and lung metastases, making this stage T4 N1 M1. Looking at the other stems, T1 N1 M0 signifies a small primary cancer with nodal metastases but no distant metastases; T1 N0 M1 signifies a small primary cancer with no lymph node metastases but with distant metastases; T2 N1 M0 signifies a larger primary cancer with nodal metastases but no distant metastases; and T3 N0 M0 indicates a larger primary cancer with no metastases to either lymph nodes or to distant sites.
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This question is part of the following fields:
- Neoplasia; Female Health
- Pathology
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Question 7
Correct
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Which of these antibiotics is the first choice treatment for infections caused by Pseudomonas aeruginosa?
Your Answer: Piperacillin
Explanation:Piperacillin is an extended-spectrum beta-lactam antibiotic of the ureidopenicillin class. It is normally used with a beta-lactamase inhibitor such as tazobactam. The combination has activity against many Gram-positive and Gram-negative pathogens and anaerobes, including Pseudomonas aeruginosa. Piperacillin is sometimes referred to as an anti-pseudomonal penicillin.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 8
Correct
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A 65-year old gentleman presents to the clinic with chronic back pain and weight loss. His blood count shows a white blood cell count of 10 × 109/l, with a differential count of 66 polymorphonuclear leukocytes, 7 bands, 3 metamyelocytes, 3 myelocytes, 14 lymphocytes, 7 monocytes, and 5 nucleated red blood cells. The haemoglobin is 13 g/dl with a haematocrit of 38.1%, a mean corpuscular volume of 82 fl, and a platelet count of 126 × 109/l. What is the likely diagnosis?
Your Answer: Metastatic carcinoma
Explanation:The peripheral blood findings suggest a leucoerythroblastic picture, the common causes of which in a 65-year old gentleman includes prostatic or lung malignancy.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 9
Correct
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A teenage Somalian boy presents with a complaint of an enlarged lower jaw. His blood film shows blast cells and macrophages. Which virus is responsible for this?
Your Answer: Epstein–Barr virus
Explanation:Burkitt’s lymphoma is a type of non-Hodgkin’s lymphoma. Histologically it is characterised by a starry sky appearance due to numerous neoplastic macrophages which are required to clear the rapidly dividing tumour cells/blast cells. Burkitt’s lymphoma commonly affects the jaw bone, forming a huge tumour mass. It is associated with translocation of c-myc gene and has three types: 1) endemic/African type, 2)sporadic and 3)immunodeficiency-associated. The first type is strongly associated with EBV.
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This question is part of the following fields:
- General
- Physiology
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Question 10
Correct
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The neurotransmitters adrenaline, noradrenaline and dopamine are derived from which amino acid?
Your Answer: Tyrosine
Explanation:Tyrosine is the precursor to adrenaline, noradrenaline and dopamine. Tyrosine hydroxylase converts tyrosine to DOPA, which is in turn converted to dopamine, then to noradrenaline and finally adrenaline.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 11
Correct
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A 30-year-old man is brought to the emergency department suffering from extreme dehydration, and subsequent hypotension and tachycardia. Which part of the kidney will compensate for this loss?
Your Answer: Collecting ducts
Explanation:The collecting duct system of the kidney consists of a series of tubules and ducts that physically connect nephrons to a minor calyx or directly to the renal pelvis. The collecting duct system is the last component of the kidney to influence the body’s electrolyte and fluid balance. In humans, the system accounts for 4–5% of the kidney’s reabsorption of sodium and 5% of the kidney’s reabsorption of water. At times of extreme dehydration, over 24% of the filtered water may be reabsorbed in the collecting duct system.
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This question is part of the following fields:
- Physiology
- Renal
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Question 12
Correct
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Which type of contractions are responsible for the propulsion of chyme along the small intestine?
Your Answer: Segmentation
Explanation:Two major types of intestinal contractions are segmentation and peristalsis:
Segmentation occurs most frequently and primarily involves circular muscle. It is essentially a contraction of 2- or 3-cm long intestinal segments while the muscle on either side of it relaxes. Chyme in the segment is displaced in both directions. As the contracted segment relaxes, the previously relaxed segments on either side may contract. This efficiently mixes the chyme with the digestive secretions and exposes the mucosal absorptive surface to the luminal contents. It also serves a propulsive function and contributes to the movement of chyme.
Peristalsis is a propulsive wave of contraction that is initiated by intestinal distension. It is short lived and travels only a few centimetres before dying out. The combined effects of intestinal peristalsis and segmentation provide for both adequate mixing of the intestinal contents and slow, steady movement of chyme.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 13
Correct
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A neurotransmitter of the nigrostriatal pathway is:
Your Answer: Dopamine
Explanation:Dopamine acts as a neurotransmitter in the brain, activating dopamine receptors. It is also a neurohormone released from the hypothalamus. It plays an important role in the reward system. It is believed that dopamine provides a teaching signal to parts of the brain responsible for acquiring new motor sequences (behaviours), by activation of dopamine neurons when an unexpected reward is presented. Loss of dopamine neurones in the nigrostriatal pathway causes Parkinson’s disease. In the frontal lobes, dopamine controls the flow of information from other areas of the brain, and thus, dopamine disorders in this region can cause a decline in neurocognitive functions, especially memory, attention and problem solving. Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention-deficit disorder and some symptoms of schizophrenia. Dopamine is also the primary neuroendocrine regulator of the secretion of prolactin from the anterior pituitary gland. Dopamine is also commonly associated with the pleasure system of the brain. This plays a key role in understanding the mechanism of action of drugs (such as cocaine and the amphetamines), which seem to be directly or indirectly related to the increase of dopamine.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 14
Correct
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Blood supply to the posterior compartment of the thigh is supplied by which artery?
Your Answer: Perforating
Explanation:There are usually 3 perforating arteries:
The first gives branches to the adductor brevis and magnus, biceps femoris and gluteus maximus and anastomoses with the inferior gluteal, medial and lateral femoral circumflex.
The second artery supplies the posterior femoral muscles and anastomose with the first and third perforating vessels.
The third supplies the posterior femoral muscles.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 15
Correct
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What percentage of the cardiac output is delivered to the brain?
Your Answer: 15%
Explanation:Among all body organs, the brain is most susceptible to ischaemia. Comprising of only 2.5% of total body weight, the brain receives 15% of the cardiac output. Oxygen extraction is also higher with venous oxygen levels approximating 13 vol%, and arteriovenous oxygen difference of 7 vol%.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 16
Incorrect
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An old woman complains of a lack of sensation halfway down the anterior surface of the thigh. The cause of this:
Your Answer: Could be the result of nerve damage during surgical procedures in the femoral sheath
Correct Answer: Would result from damage to the nerve that innervates the pectineus muscle
Explanation:The pectineus is supplied by the second, third and fourth lumbar nerves through the femoral nerve and by the third lumbar through the accessory obturator when it exists. The anterior surface of the thigh receives its innervation from the femoral nerve as well, thus this is the nerve most likely to be injured
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 17
Correct
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Which of the following will be a seen in a patient with a plasma thyroid-stimulating hormone (TSH) level of 14 mU/l (normal < 5 mU/l) and a low T3 resin uptake of 19% (normal 25–35%)?
Your Answer: Periorbital swelling and lethargy
Explanation:Low T3 resin uptake combined with raised TSH is indicative of hypothyroidism. Signs and symptoms include dull expression, facial puffiness, lethargy, periorbital swelling due to infiltration with mucopolysaccharides, bradycardia and cold intolerance. Anxiety, palpitations, tachycardia, raised body temperature, heat intolerance and weight loss are all seen in hyperthyroidism.
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This question is part of the following fields:
- Endocrinology
- Physiology
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Question 18
Correct
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An 80 year-old quadriplegic man has been lying supine for 7 weeks in a critical care ward. He develops a right lung abscess that is draining by gravity to a particular region of the lung. Which is the most likely site of pus collection?
Your Answer: Superior segment of the lower lobe
Explanation:The superior segmental bronchus of the lower lobe of the right lung branches posteriorly off the intermediate bronchus or the inferior lobe bronchus. It is therefore more likely to receive fluid or foreign bodies that enter the right main bronchus especially when the patient is supine.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 19
Correct
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T lymphocytes that express the MCH type II antigen are most likely to produce which of the following cytokines?
Your Answer: Gamma interferon
Explanation:Interferon gamma is a soluble cytokine previously known as the macrophage activating factor. It is the only member belonging to the type II class of the interferons. It is secreted by a number of cells taking part in the immune reaction including: T-helper cells (CD-4), cells with immunological memory (CD45PA), killer cells (CD8), dendrite cells (CD23,35), natural killer cells (CD16) and B lymphocytes (CD22,CD23). It has both a defending as well as a pathological effect. It induces differentiation in the myeloid cell in the bone marrow. If macrophages are infected by parasites it activates the macrophages to destroy them. IFN-γ strengthens the anti-tumour activities of the cytotoxic lymphocytes. Together with CD4 or CD8 toxins, produced by lymphocytes, it suppresses the growth of the tumour cells. along with these functions it increases the non specific response of the natural killer cells, causing changes in the cell membrane surface to prevent adhesion and penetration of a virus. It can either increase or decrease B cell response and it activates osteoclasts which increases bone resorption.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 20
Correct
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A 6 year-old boy is brought to you coughing. He is suspected to have aspirated a Lego piece which he was seen playing with. Where would you expect the piece to be?
Your Answer: Right main bronchus
Explanation:Inhaled objects are more likely to enter the right lung for several reasons. First the right bronchus is shorter, wider and more vertical than the left bronchus. Also, the carina (a ridge-like structure at the point of tracheal bifurcation) is set a little towards the left. The terminal bronchiole is a very small space and impossible for the seed to lodge here.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 21
Incorrect
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During strenuous exercise, what else occurs besides tachycardia?
Your Answer: Rise in mixed venous blood O2 saturation
Correct Answer: Increased stroke volume
Explanation:During strenuous exercise there is an increase in:
– Heart rate, stroke volume and therefore cardiac output. (CO = HR x SV)
– Respiratory rate (hyperventilation) which will lead to a reduction in Paco2.
– Oxygen demand of skeletal muscle, therefore leading to a reduction in mixed venous blood oxygen concentration.
Renal blood flow is autoregulated, so renal blood flow is preserved and will tend to remain the same. Mean arterial blood pressure is a function of cardiac output and total peripheral resistance and will increase with exercise, mainly as a result of the increase in cardiac output that occurs.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 22
Correct
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Cancer of the testis most likely metastases to which set of lymph nodes?
Your Answer: Aortic
Explanation:The lymphatic drainage of an organ is related to its blood supply. The lymphatic drainage of the testis drains along the testicular artery to reach the lymph nodes along the aorta.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 23
Correct
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Skin infiltration by neoplastic T lymphocytes is seen in:
Your Answer: Mycosis fungoides
Explanation:Mycosis fungoides is a chronic T-cell lymphoma that involves the skin and less commonly, the internal organs such as nodes, liver, spleen and lungs. It is usually diagnosed in patients above 50 years and the average life expectancy is 7-10 years. It is insidious in onset and presents as a chronic, itchy rash, eventually spreading to involve most of the skin. Lesions are commonly plaque-like, but can be nodular or ulcerated. Symptoms include fever, night sweats and weight loss. Skin biopsy is diagnostic. However, early cases may pose a challenge due to fewer lymphoma cells. The malignant cells are mature T cells (T4+, T11+, T12+). The epidermis shows presence of characteristic Pautrier’s micro abscesses are present in the epidermis.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 24
Correct
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Which of these structures is most likely to be damaged if a patient loses consciousness days or weeks after an otherwise insignificant head trauma, especially in elderly patients?
Your Answer: Dural bridging vein
Explanation:A subdural haematoma is a type of hematoma, usually associated with traumatic brain injury, in which blood collects between the dura mater and the pia-arachnoid mater. Symptoms of subdural haemorrhage have a slower onset than those of epidural haemorrhages because the lower pressure veins bleed more slowly than arteries. These injuries are more common in elderly patients, especially those taking antiplatelet or anticoagulant drugs. Oedema and increased intracranial pressure are unusual.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 25
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 26
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 27
Correct
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Question 28
Incorrect
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Below which level of the spinal cord will the inferior gluteal nerve be unaffected?
Your Answer: S2
Correct Answer: S3
Explanation:The inferior gluteal nerve arises from the dorsal divisions of the fifth lumbar and first and second sacral nerves. According to this fact any lesion at or below the S3 will not affect the inferior gluteal nerve.
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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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Acute respiratory distress syndrome (ARDS) is a medical condition that occurs in critically ill patients, and can be triggered by events such as trauma and sepsis. Which of the following variables is most likely to be lower than normal in a patient with ARDS?
Your Answer: Lung compliance
Explanation:Acute (or Adult) respiratory distress syndrome (ARDS) is a medical condition occurring in critically ill patients characterized by widespread inflammation in the lungs. The development of acute respiratory distress syndrome (ARDS) starts with damage to the alveolar epithelium and vascular endothelium, resulting in increased permeability to plasma and inflammatory cells. These cells pass into the interstitium and alveolar space, resulting in pulmonary oedema. Damage to the surfactant-producing type II cells and the presence of protein-rich fluid in the alveolar space disrupt the production and function of pulmonary surfactant, leading to micro atelectasis and impaired gas exchange. The pathophysiological consequences of lung oedema in ARDS include a decrease in lung volumes, compliance and large intrapulmonary shunts. ARDS may be seen in the setting of pneumonia, sepsis, following trauma, multiple blood transfusions, severe burns, severe pancreatitis, near-drowning, drug reactions, or inhalation injuries.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 30
Correct
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A 65-year-old smoker presents with painless haematuria, urinary frequency and urgency. He is diagnosed with bladder cancer. Which is the most likely type?
Your Answer: Transitional cell carcinoma
Explanation:90% of bladder cancers are transitional cell carcinomas derived from the bladder urothelium. Risk factors include industrial chemicals, smoking and infection. Schistosomiasis and bladder stones predispose to the squamous cell variety.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 31
Correct
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Urine specific gravity allows the assessment of which of the following renal functions?
Your Answer: Concentration
Explanation:Concentrating ability of kidneys is assessed by measuring the urine specific gravity. Normal values of urine specific gravity fall between 1.002 and 1.030 g/ml.
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This question is part of the following fields:
- Pathology
- Renal
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Question 32
Correct
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A 59-year-old man was brought to the emergency department by his family after complaining of sudden, severe upper back pain and a ripping sensation, that radiated to his neck. On arrival, his pulse was weak in one arm compared with the other however his ECG result was normal. Which of the following is most probably the cause of these findings and symptoms?
Your Answer: Acute aortic dissection
Explanation:Acute aortic dissection is a serious condition in which the inner layer of the aorta tears and the blood flows in between the inner and middle layers of the aorta causing their separation (dissection). Aortic dissection can lead to rupture or decreased blood flow to organs. Clinical manifestations most often include the sudden onset of severe, tearing or ripping chest pain that can radiate to the shoulder, back or neck; syncope; altered mental status; dyspnoea; pale skin; stroke symptoms etc. The diagnosis of acute aortic dissection is based on clinical findings, imaging studies, electrocardiography and laboratory analysis.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 33
Incorrect
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How are amino acids transported across the luminal surface of the small intestinal epithelium?
Your Answer: Co-transport with glucose
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 34
Correct
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A patient who complained of pain on the lower left side of the back had an x-ray done which confirmed a hernia passing posterolaterally, just superior to the iliac crest. Where is this hernia passing through?
Your Answer: Lumbar triangle
Explanation:The lumber triangle is bound medially by the border of the latissimus dorsi, laterally by the external abdominal oblique and by the iliac crest inferiorly. This is exactly where the hernia that is described is located.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 35
Correct
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Difficulty in retracting the foreskin of the penis in an uncircumcised male is known as:
Your Answer: Phimosis
Explanation:Phimosis is the inability to fully retract the foreskin of the penis in an uncircumcised male. It can be physiological in infancy, in which it could be referred to as ‘developmental non-retractility of the foreskin. However, it is almost always pathological in older children and men. Causes include chronic inflammation (e.g. balanoposthitis), multiple catheterisations, or forceful foreskin retraction. One of the causes is chronic balanitis xerotica obliterans. It leads to development of a ring of indurated tissue near the tip of the prepuce, which prevents retraction. Contributory factors include infections, hormonal and inflammatory factors. The recommended treatment includes circumcision.
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This question is part of the following fields:
- Pathology
- Urology
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Question 36
Correct
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A terrorist running away from the police was shot in the back. The bullet hit his left lung halfway between its apex and the diaphragmatic surface. Which part of the lung was most likely to be injured?
Your Answer: Inferior lobe
Explanation:The oblique fissure of the left lung is so sharp that the posterior surface of the left lung is mostly composed of the inferior lobe so that the point halfway between the apex and the diaphragmatic surface of the lung would result in injury to the inferior lobe.
The hilum is the point on the medial surface of the lung where the structures that form the root of the lung enter and leave the lung.
The lingual on the other hand is part of the superior lobe of the left lung and it is part of the anterior and superior sides of the lung.
The middle lobe is only found on the right lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 37
Correct
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Cyclophosphamide is used as a chemotherapy and immunosuppressant agent and is indicated in various diseases. One of the most severe complications of its use is cancer of the:
Your Answer: Urinary bladder
Explanation:Cyclophosphamide is used to treat various types of cancer and autoimmune disorders. The main use of cyclophosphamide is in combination with other chemotherapy agents in the treatment of lymphomas, some forms of leukaemia and some solid tumours. Side-effects include nausea and vomiting, bone marrow suppression, stomach ache, diarrhoea, darkening of the skin/nails, alopecia, lethargy, and haemorrhagic cystitis. Cyclophosphamide is itself carcinogenic, potentially causing transitional cell carcinoma of the bladder as a long-term complication.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 38
Correct
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A 76-year-old woman is diagnosed with diabetes mellitus after a urine test revealed she has glucosuria. Glucosuria may occur due to inadequate glucose reabsorption at:
Your Answer: Proximal convoluted tubule
Explanation:Glucose is reabsorbed almost 100% via sodium–glucose transport proteins (apical) and GLUT (basolateral) in the proximal convoluted tubule. Glycosuria or glucosuria is a condition of osmotic diuresis typical in those suffering from diabetes mellitus. Due to a lack of insulin, plasma glucose levels are above normal. This leads to saturation of receptors in the kidneys and glycosuria usually at plasma glucose levels above 11 mmol/l. Rarely, glycosuria is due to an intrinsic problem with glucose reabsorption within the kidneys (such as Fanconi syndrome), producing a condition termed renal glycosuria.
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This question is part of the following fields:
- Physiology
- Renal
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Question 39
Correct
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A 30 year old male has a painless and transilluminant swelling at the upper pole of his left testi. There is a negative cough test. Which of the following is the likely diagnosis?
Your Answer: Spermatocoele
Explanation:Spermatocele, also known as a spermatic cyst is a cystic mass usually occurring at the upper pole of the testis. Differential diagnosis included hydrocele as both are cystic, painless and transilluminant. Ultrasound is a useful modality. If symptomatic or large, surgical excision can be done.
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This question is part of the following fields:
- Pathology
- Urology
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Question 40
Correct
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A patient is unable to move their mandible to the left. Which muscle is affected in this case?
Your Answer: Right lateral pterygoid muscle
Explanation:Patients with paralysis of the right pterygoid muscle are unable to move their mandible laterally to the left.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 41
Correct
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An X ray of a 60 year old male brought to the accident and emergency following a fall down stairs shows a fractured olecranon process of the right ulna with the line of fracture passing through the superior surface, disrupting a muscle. Which among the following muscles was most likely injured?
Your Answer: Triceps brachii
Explanation:The superior surface of the olecranon process forms an attachment for the insertion of the triceps brachii on the posterior aspect. It also has a minor transverse groove for the attachment of part of the posterior ligament of the elbow on the anterior aspect.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 42
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 43
Correct
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The principal motor and sensory nerve of the perineum is the?
Your Answer: Pudendal
Explanation:The pudendal nerve is formed by S1,2,4 anterior branches. It gives off the inferior haemorrhoid nerve before dividing terminally into the perineal nerve and the dorsal nerve of the clitoris or the penis. Thus, it is the principal motor and sensory nerve of the perineum.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 44
Correct
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A cancer patient was found to have a radio resistant tumour. Which tumour does the patient most likely have?
Your Answer: Liposarcoma
Explanation:Liposarcoma is a cancer that arises in fat cells in deep soft tissue. Commonly it occurs inside the thigh or retroperitoneum. It usually affects middle-aged and older adults, over 40 years. Liposarcoma is the most common soft-tissue sarcoma. It is very radio resistant. Five-year survival rates vary from 100% to 56% based on histological subtype.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 45
Correct
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The gynaecologist suspects that her patient has a cervical cancer. What particular test should be done on this patient to screen for cervical cancer?
Your Answer: Pap smear
Explanation:Worldwide, approximately 500,000 new cases of cervical cancer and 274,000 deaths are attributable to cervical cancer yearly. This makes cervical cancer the second most common cause of death from cancer in women. The mainstay of cervical cancer screening has been the Papanicolaou test (Pap smear).
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 46
Correct
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Work of breathing (WOB) is the energy expended to inhale and exhale a breathing gas. Normally, maximal amount of work of breathing is required to overcome:
Your Answer: Elastic lung compliance
Explanation:The forces of elastance (compliance), frictional resistance and inertia have been identified as the forces that oppose lung inflation and deflation. The normal relaxed state of the lung and chest is partially empty. Further exhalation requires muscular work. Inhalation is an active process requiring work. About 60–66% of the total work performed by the respiratory muscles is used to overcome the elastic or compliance characteristics of the lung–chest cage, 30–35% is used to overcome frictional resistance and only 2–5% of the work is used for inertia.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 47
Incorrect
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A CT-scan report of a patient with gastric carcinoma shows that the lymph nodes around the coeliac trunk are enlarged. The coeliac trunk:
Your Answer: Give rise to the splenic, right gastric and common hepatic arteries
Correct Answer: Gives rise to the splenic, left gastric and common hepatic arteries
Explanation:The coeliac trunk is a branch of the aorta arising just below the aortic hiatus of the diaphragm to pass nearly horizontally forward to divide into 3 large branches i.e. the left gastric, the hepatic and the splenic arteries. Occasionally it may give off one of the inferior phrenic arteries. It is covered by the lesser omentum and on the right side bordered by the right coeliac ganglion and the cardiac end of the stomach. Inferiorly it is bordered by the upper border of the pancreas and splenic vein. The embryonic midgut is supplied by the superior mesenteric artery.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 48
Incorrect
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A surgeon ligates the left superior suprarenal artery whilst preforming a left adrenalectomy. Where does the left superior suprarenal artery originate?
Your Answer: Abdominal aorta
Correct Answer: Left inferior phrenic artery
Explanation:The superior suprarenal arteries arises from the inferior phrenic artery on either side.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 49
Incorrect
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What is the innervation of the laryngeal mucosa inferior to the true vocal cord?
Your Answer: External branch of the superior laryngeal nerve
Correct 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 50
Correct
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A 55-year-old woman complains of pain in the proximal and distal interphalangeal joins, and back pain which has increased over the last 4 years and worsens after activity. X-rays reveal Heberden’s and Bouchard’s nodes in her interphalangeal joints and the presence of osteophytes in her spine. What is the most likely diagnosis?
Your Answer: Osteoarthritis
Explanation:Osteoarthritis is most common in older adults, predominating in women between the ages of 40 and 70; after this age, men and women are affected equally. It affects an entire joint, with disruption and potential loss of joint cartilage, along with other joint changes, including bone hypertrophy (osteophyte formation). The pain is usually gradual and is worse after activity, with occasional joint swelling. X-ray findings include marginal osteophytes, narrowing of the joint space, increased density of the subchondral bone, subchondral cyst formation, bony remodelling and joint effusions.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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