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Question 1
Correct
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A 68-year-old woman complains of headaches, dizziness, and memory loss. About a month ago, she fell from a staircase but only suffered mild head trauma. What is the most likely diagnosis in this case?
Your Answer: Chronic subdural haematoma
Explanation:A quarter to a half of patients with chronic subdural haematoma have no identifiable history of head trauma. If a patient does have a history of head trauma, it usually is mild. The average time between head trauma and chronic subdural haematoma diagnosis is 4–5 weeks. Symptoms include decreased level of consciousness, balance problems, cognitive dysfunction and memory loss, motor deficit (e.g. hemiparesis), headache or aphasia. Some patients present acutely. They usually result from tears in bridging veins which cross the subdural space, and may cause an increase in intracranial pressure (ICP).
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This question is part of the following fields:
- Neurology
- Pathology
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Question 2
Correct
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A 66 year old male, was involved in a MVA. He sustained third degree burns to his abdomen and open bleeding wound to his left leg. The patient complains of dizziness. He is a known hypertensive but during examination was found to be hypotensive. His heart rate is 120/min, with regular rhythm. What is the possible cause of his hypotension?
Your Answer: Hypovolaemia
Explanation:Hypovolemia can be recognized by tachycardia, diminished blood pressure, and the absence of perfusion as assessed by skin signs (skin turning pale) and/or capillary refill time. The patient may feel dizzy, faint, nauseated, or very thirsty. Common causes of hypovolemia are loss of blood, loss of plasma which occurs in severe burns and lesions discharging fluid, loss of body sodium and consequent intravascular water which may occur in cases of diarrhoea and vomiting. In this case the cause of patients hypotension is due to hypovolemia from both loss of plasma and blood.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 3
Correct
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Which of the following is a likely consequence of severe diarrhoea?
Your Answer: A decrease in the sodium content of the body
Explanation:Diarrhoea can occur due to any of the numerous aetiologies, which include infectious, drug-induced, food related, surgical, inflammatory, transit-related or malabsorption. Four mechanisms have been implicated in diarrhoea: increased osmotic load, increased secretion, inflammation and decreased absorption time. Diarrhoea can result in fluid loss with consequent dehydration, electrolyte loss (Na+, K+, Mg2+, Cl–) and even vascular collapse. Loss of bicarbonate ions can lead to a metabolic acidosis.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 4
Incorrect
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Which one of the following is a derivative of the midgut?
Your Answer: Liver
Correct Answer: Caecum
Explanation:The primary intestinal loop is formed from the midgut which gives rise to the distal half of the duodenum, the jejunum, ascending colon, proximal two thirds of the transverse colon and the ileum.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 5
Correct
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Which tumour marker is associated with medullary carcinoma of thyroid?
Your Answer: Calcitonin
Explanation:Medullary carcinoma of thyroid accounts for 3% of thyroid cancers. It arises from the parafollicular cells (C cells) of the thyroid gland that produce calcitonin. It is often familial and caused by mutation of ret proto-oncogene, but can occasionally be sporadic. The familial cases can also occur as part of MEN syndromes IIA and IIB. The high calcitonin leads to down-regulation of the receptors, which does not affect the calcium levels significantly. Medullary carcinoma of thyroid shows characteristic amyloid deposits that stain positively with Congo red. The initial presentation consists of an asymptomatic thyroid nodule. Many cases are diagnosed due to routine screening of relatives of patients with MEN IIA and IIB. Medullary carcinoma can also cause ectopic production of other hormones/peptides such as adrenocorticotrophic hormone, vasoactive intestinal polypeptide, kallikreins and serotonin.
Metastasis from medullary carcinoma spread via the lymphatics to cervical and mediastinal nodes, and can also affect the liver, lungs and bone. Diagnosis is by raised serum calcitonin levels. A provocative test with calcium (15 mg/kg intravenously over 4 hours) also aids in diagnosis by leading to excessive secretion of calcitonin. X-ray might also show dense, conglomerate calcification.
CA-125 is frequently elevated in ovarian carcinomas. CA 15-3 is often associated with breast carcinomas. Alpha-fetoprotein is seen raised in hepatomas and gonadal tumours. Elevated HCG is associated with normal pregnancies, gonadal tumours, and choriocarcinomas. Thyroglobulin is used for surveillance in papillary carcinoma of thyroid. CA 19-9 is used in the management of pancreatic cancer.
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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 young women following a road traffic accident suffered heavy blood loss and developed subsequent anaemia. Which of the following is a consequence of this?
Your Answer: A high reticulocyte count
Explanation:Anaemia refers to a decrease in the circulating levels of haemoglobin in the blood resulting in a reduced ability of the body to transport oxygen effectively. Anaemia from blood loss results in the body further compensating by releasing stored RBCs and immature RBCs from the bone marrow. Thus resulting in a high reticulocyte count.
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This question is part of the following fields:
- General
- Physiology
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Question 7
Incorrect
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A 55 year old man presented with a 4 day history of cough and fever. His sputum culture showed the presence of Strep pneumoniae. Which of the following substances produced by the inflammatory cells will result in effective clearance of this organism from the lung parenchyma?
Your Answer: Leukotriene
Correct Answer: Hydrogen peroxide
Explanation:Hydrogen peroxide is produced by myeloperoxidase to form a potent oxidant that eliminates bacteria, but is not effective in chronic granulomatous diseases.
Platelet activating factor will lead to the activation, adhesion and aggregation of platelets but will not directly kill bacteria.
Prostaglandins cause vasodilation but do not activate neutrophils.
Kallikrein promotes formation of bradykinin that leads to vasodilation.
Leukreines increase vascular permeability.
Cytokines are communicating molecules between immune cells but directly will not kill bacteria.
Interleukins will regulate the immune response.
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This question is part of the following fields:
- Inflammation & Immunology; Respiratory
- Pathology
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Question 8
Incorrect
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In the human body, veins often run a course parallel to the artery that has the same name. Which of the following listed veins doesn't run parallel to the artery of the same name?
Your Answer: Superior epigastric
Correct Answer: Inferior mesenteric
Explanation:The inferior mesenteric artery and inferior mesenteric vein don’t run in tandem because the vein is part of the portal venous system-draining into the splenic vein which drains into the hepatic portal vein. The inferior mesenteric artery is a branch of the descending aorta at the level of L3. The inferior mesenteric vein and artery, however, drain the same region i.e. the descending and sigmoid colon and rectum.
Superior epigastric vessels course together and are the continuation of the internal thoracic artery and vein.
Superficial circumflex iliac vessels course together in the superficial fat of the abdominal wall.
Superior rectal vessels are the terminal ends of the inferior mesenteric vessels, located on the posterior surface of the rectum.
The ileocolic artery and vein are branches off the superior mesenteric vessels. Both course in the mesentery, supplying/draining the caecum, appendix, terminal portion of the ileum. The inferior epigastric vessels run together.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 9
Incorrect
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A 45 year-old female presents with a drooping eyelid. During examination, the same pupil of the patient is found to be dilated. Which nerve could be involve in this case?
Your Answer: Abducens nerve
Correct Answer: Oculomotor nerve
Explanation:The oculomotor nerve controls most of the eye muscles. It also controls the constriction of the pupils and thickening of the lens of the eye. This can be tested in two main ways. By moving a finger toward a person’s face to induce accommodation, their pupils should constrict or shining a light into one eye should result in equal constriction of the other eye. The neurons in the optic nerve decussate in the optic chiasm with some crossing to the contralateral optic nerve tract. This is the basis of the swinging-flashlight test. Loss of accommodation and continued pupillary dilation can indicate the presence of a lesion of the oculomotor nerve.
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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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The circle of Willis is one of the cerebrovascular safeguards comprised of the left and the right posterior communicating artery. Which of the following arteries in the brain is connected to the posterior cerebral artery by these posterior communicating arteries?
Your Answer: Vertebral artery
Correct Answer: Internal carotid artery
Explanation:The Circle of Willis is an anastomosis of cerebral arteries that are located at the base of the brain. The Circle of Willis is one of the important safeguards that ensure back up of blood supply to parts of the brain in case of any cerebrovascular accident. The Circle of Willis is made up of an anterior portion of arteries including; the anterior cerebral arteries. The anterior cerebral arteries are connected to the posterior portion of the circle of Willis by the anterior communicating artery. The posterior portion is made up of the posterior cerebral artery which branch off from the basilar artery. The posterior cerebral artery are connected to the anterior portion of the circle of Willis by the posterior communicating artery. The posterior communicating artery connects the posterior cerebral artery to the internal carotid artery. The circle of Willis receives blood supply from the left and right internal carotid arteries that continues as the middle cerebral artery and posteriorly from the two vertebral arteries that join to form the basilar artery.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 11
Incorrect
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Which nerve mediates the sensation to itch from the skin that is just over the base of the spine of your scapula?
Your Answer: Ventral root of T1
Correct Answer: Dorsal primary ramus of C7
Explanation:The first branches off spinal nerves are called the dorsal and ventral rami. The dorsal rami mediate sensation of the skin over the back and motor supply to the true muscles of the back whilst the ventral rami gives sensation to the skin over the limbs and the skin that is over the ventral side of the trunk. It also gives motor supply to the skeletal muscles of the neck, the trunk and extremities. Hence, itchiness of the part of the skin that is over the spine of the scapula would be mediated by the primary ramus of C7. Accessory nerve doesn’t have any sensory innervation.
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This question is part of the following fields:
- Anatomy
- Neurology
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Question 12
Incorrect
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Coagulation in the body (in vivo) is a process in which several proteins known as coagulation factors are activated in a cascade effect to stop bleeding. Which of the following initiates this cascade effect?
Your Answer: Factor X
Correct Answer: Tissue factor
Explanation:Tissue factor (TF), also known as ‘factor III’ or ‘thromboplastin’, is an anti-coagulation protein that initiates the extrinsic coagulation. TF acts as a transmembrane receptor for Factor VII/VIIa . It is expressed by endothelial cells but also certain tissues, such as the heart and brain.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 13
Incorrect
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A patient gives a history of dull discomfort in her abdomen associated with pain that she points to be on her right shoulder and right scapula. The following organs are most likely to be source of her pain:
Your Answer: Stomach
Correct Answer: Liver, duodenum and gallbladder
Explanation:Referred pain is felt at a point away from the source of the pain or the unpleasant sensation. It arises when a nerve is damaged or compressed at a point but the pain is felt at another site that is the territory of that nerve. Common abdominal causes of referred pain to the shoulder and the shoulder blade are the liver, duodenum and gall bladder.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 14
Incorrect
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Dysarthria, nystagmus and a tremor worsening with directed movement are likely to be seen in:
Your Answer: Parkinsonism
Correct Answer: Cerebellar disease
Explanation:The given symptoms are seen in diseases affecting the cerebellum. A cerebellar tremor is a slow tremor that occurs at the end of a purposeful movement. It is seen in cerebellar disease, such as multiple sclerosis or some inherited degenerative disorders and chronic alcoholism. Classically, tremors are produced in the same side of the body as a one-sided lesion. Cerebellar disease can also result in a wing-beating’ type of tremor called rubral or Holmes’ tremor – a combination of rest, action and postural tremors. Other signs of cerebellar disease include dysarthria (speech problems), nystagmus (rapid, involuntary rolling of the eyes), gait problems and postural tremor of the trunk and neck.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 15
Incorrect
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A 45-year old with sarcoidosis has enlarged tracheobronchial lymph nodes. Which nerve is most likely to be irritated in this patient?
Your Answer: Right vagus
Correct Answer: Left recurrent laryngeal
Explanation:Tracheobronchial lymph nodes are located at the bifurcation of the trachea and are in three groups i.e. the right superior, left superior and inferior. The aorta arches over the left bronchus near the point of tracheal bifurcation. Thus, the nerves that are closely associated with the aorta might be irritated if these nodes become inflamed. The left recurrent laryngeal nerve is such a nerve. The phrenic nerves, both the left and the right, are lateral and thus would not be affected. The right recurrent nerve loops around the right subclavian artery and is distant from this area. The right vagus artery is not associated with the aorta and the sympathetic chain is located in the posterior chest parallel to the vertebra, also not associated with the tracheobronchial tree.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 16
Incorrect
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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: Proximal convoluted tubule
Correct 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 17
Incorrect
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Which of the following is true about a patient who has undergone total colectomy and ileostomy?
Your Answer: Long-term survival is possible, but parenteral nutrition is required to maintain fluid and electrolyte balance
Correct Answer: Following total colectomy and ileostomy, the volume and water content of ileal discharge decreases over time
Explanation:After a patient has undergone total colectomy and ileostomy, the volume of ileal discharge, along with its water content gradually decreases over time. Post surgery, most patients can live a normal life. Iron and vitamin B12 absorption do not take place in the colon and hence are not affected significantly by a colectomy.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 18
Incorrect
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At which cervical level does the common carotid artery bifurcate into the internal and external carotid arteries?
Your Answer: C7
Correct Answer: C4
Explanation:The common carotid arteries are present on the left and right sides of the body. These arteries originate from different sources, but follow symmetrical courses. The right common carotid originates in the neck from the brachiocephalic trunk; the left from the aortic arch in the thorax. These split into the external and internal carotid arteries at the upper border of the thyroid cartilage, at around the level of the fourth cervical vertebra.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 19
Incorrect
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The basilar artery arises from the confluence of which two arteries?
Your Answer: Middle meningeal
Correct Answer: Vertebral
Explanation:The basilar artery is part of the vertebrobasilar system. It is formed by the confluence of the two vertebral arteries which arise from the subclavian arteries. These two vertebral arteries merge at the level of cranial nerve VI at the junction between the pons and the medulla oblangata to form what is know as the basilar artery. This vertebrobasilar system supplies the upper spinal cord, brainstem, cerebellum, and posterior part of brain.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 20
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 21
Incorrect
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Which ectopic tissue is usually contained in the Meckel's diverticulum?
Your Answer: Duodenal
Correct Answer: Gastric
Explanation:The Meckel’s diverticulum is a vestigial remnant of the omphalomesenteric duct. This structure is also referred to as the vitelline and contains two types of ectopic tissue, namely; gastric and pancreatic.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 22
Correct
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A patient is diagnosed with a tumour of the parotid gland. During surgical removal of the gland, which artery is vulnerable to injury?
Your Answer: External carotid artery
Explanation:The external carotid artery is a major artery of the head and neck. It arises from the common carotid artery when it splits into the external and internal carotid artery. It supplies blood to the face and neck. The external carotid artery begins opposite the upper border of the thyroid cartilage and, taking a slightly curved course, passes upward and forward and then inclines backward to the space behind the neck of the mandible, where it divides into the superficial temporal and internal maxillary arteries. It rapidly diminishes in size in its course up the neck, owing to the number and large size of the branches given off from it. At its origin, this artery is more superficial and placed nearer the midline than the internal carotid and is contained within the carotid triangle. The external carotid artery is covered by the skin, superficial fascia, platysma, deep fascia and anterior margin of the sternocleidomastoid. It is crossed by the hypoglossal nerve, by the lingual, ranine, common facial and superior thyroid veins; and by the digastric and stylohyoid; higher up it passes deeply into the substance of the parotid gland, where it lies deep to the facial nerve and the junction of the temporal and internal maxillary veins. It is here that it is in danger during surgery of the parotid gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 23
Incorrect
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What is the mostly likely cause of prolonged activated partial thromboplastin time (aPPT) ?
Your Answer: Poor factor VII synthesis
Correct Answer: Heparin therapy
Explanation:The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT) is an indicator for measuring the efficacy of both the intrinsic and common coagulation pathway. Prolonged aPTT may indicate: use of heparin, antiphospholipid antibody and coagulation factor deficiency (e.g., haemophilia). Deficiencies of factors VIII, IX, XI and XII and rarely von Willebrand factor (if causing a low factor VIII level) may lead to a prolonged aPTT correcting on mixing studies.
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This question is part of the following fields:
- General
- Physiology
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Question 24
Incorrect
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In a cardiac cycle, what event does the closing of atrioventricular (AV) valves coincide with?
Your Answer: End of isovolumic relaxation
Correct Answer: First heart sound
Explanation:In the cardiac cycle, the closing of the atrioventricular (AV) valves coincides with the onset of ventricular systole. This event marks the beginning of the isovolumetric contraction phase, where the ventricles begin to contract, but the volume of blood in the ventricles remains the same because both the AV valves and the semilunar valves (aortic and pulmonary valves) are closed. The closing of the AV valves produces the first heart sound, known as “S1” or “lub.”
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 25
Incorrect
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A gymnast was admitted to hospital for investigation of a weakness in the extension and adduction of his arm. He had a previous penetrating wound in the area of the posterior axillary fold. Which of these muscles is the likely cause?
Your Answer: Trapezius
Correct Answer: Latissimus dorsi
Explanation:All the criteria of this case points towards the latissimus dorsi. This muscle is greatly involved in extension, adduction and medial rotation of the arm and forms the posterior axillary fold which in this case was injured.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 26
Correct
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A neonate with failure to pass meconium is being evaluated. His abdomen is distended and X-ray films of the abdomen show markedly dilated small bowel and colon loops. The likely diagnosis is:
Your Answer: Aganglionosis in the rectum
Explanation:Hirschsprung’s disease (also known as aganglionic megacolon) leads to colon enlargement due to bowel obstruction by an aganglionic section of bowel that starts at the anus. A blockage is created by a lack of ganglion cells needed for peristalsis that move the stool. 1 in 5000 children suffer from this disease, with boys affected four times more commonly than girls. It develops in the fetus in early stages of pregnancy. Symptoms include not having a first bowel movement (meconium) within 48 hours of birth, repeated vomiting and a swollen abdomen. Two-third of cases are diagnosed within 3 months of birth. Some children may present with delayed toilet training and some might not show symptoms till early childhood. Diagnosis is by barium enema and rectal biopsy (showing lack of ganglion cells).
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 27
Correct
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The following organs would be expected to lie within the right lower quadrant of the abdomen, assuming that the gastrointestinal tract is rotated normally:
Your Answer: Distal jejunum, caecum, vermiform appendix
Explanation:The abdomen is divided by theoretical anatomic lines into four quadrants. The median plane follows the linea alba and extends from the xiphoid process to the pubic symphysis and splits the abdomen in half. The transumbilical plane is a horizontal line that runs at the level of the umbilicus. This forms the upper right and left quadrants and the lower right and left quadrants. Structures in the right lower quadrant include: caecum, appendix, part of the small intestine, ascending colon, the right half of the female reproductive system, right ureter. Pain in this region is most commonly associated with appendicitis.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 28
Correct
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A 70-year-old male who has smoked since his teens complains of progressive shortness of breath and a persistent cough. He is diagnosed with COPD. Which of the following abnormalities is most likely to be present in his pulmonary function tests?
Your Answer: Increased residual volume
Explanation:Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by long-term poor airflow. The main symptoms include shortness of breath and cough with sputum production. The best diagnostic test for evaluating patients with suspected chronic obstructive pulmonary disease (COPD) is lung function measured with spirometry. Key spirometrical measures may be obtained with a portable office spirometer and should include forced vital capacity (FVC) and the normal forced expiratory volume in the first second of expiration (FEV1). The ratio of FEV1 to forced vital capacity (FEV1/FVC) normally exceeds 0.75. Patients with COPD typically present with obstructive airflow. Complete pulmonary function testing may show increased total lung capacity, functional residual capacity and residual volume. A substantial loss of lung surface area available for effective oxygen exchange causes diminished carbon monoxide diffusion in the lung (DLco) in patients with emphysema. Tobacco smoking is the most common cause of COPD, with factors such as air pollution and genetics playing a smaller role.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 29
Incorrect
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Where is the mental foramen located?
Your Answer: In the infratemporal fossa
Correct Answer: In the mandible
Explanation:The mental foramen is found bilaterally on the anterior surface of the mandible adjacent to the second premolar tooth. The mental nerve and terminal branches of the inferior alveolar nerve and mental artery leave the mandibular canal through it.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 30
Incorrect
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A surgeon performing a Whipple's procedure, that involves mobilizing the head of the pancreases, accidentally injured a structure immediately posterior to the neck of the pancrease which bled out. Which structure is most likely to have been injured?
Your Answer: Abdominal aorta
Correct Answer: Superior mesenteric artery
Explanation:The structure immediately posterior to the neck of the pancreas is the superior mesenteric vein. The neck of the pancreas lies anterior to the superior mesenteric vein, which joins with the splenic vein to form the portal vein.
The superior mesenteric artery (SMA) is also located in proximity to the neck of the pancreas. Specifically, the SMA emerges from the abdominal aorta just below the level of the pancreas and passes posterior to the neck of the pancreas before it descends into the mesentery to supply the intestines. Thus, both the superior mesenteric vein and the superior mesenteric artery are key vascular structures related to the posterior aspect of the neck of the pancreas.
Bleeding out would suggest an arterial injury.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 31
Incorrect
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An explorative laparotomy is done on a 23 year old following a gunshot abdominal injury through the right iliac fossa. It is found that the ileocolic artery is severed and the bullet had perforated the caecum. From which branch does the ileocolic artery originate?
Your Answer: Inferior mesenteric artery
Correct Answer: Superior mesenteric artery
Explanation:Ileocolic artery branches off from the superior mesenteric artery. It then divides to give a superior and inferior branch.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 32
Correct
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Which best describes the sartorius muscle?
Your Answer: Will flex the leg at the knee joint
Explanation:The sartorius muscle arises from tendinous fibres from the superior iliac spine. It passes obliquely across the thigh from lateral to medial and is inserted into the upper part of the medial side of the tibia. When the sartorius muscle contracts it will flex 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 33
Incorrect
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What is the most likely cause of prolonged bleeding time in a 40 year old women admitted for a laparoscopic cholecystectomy?
Your Answer: Factor II deficiency
Correct Answer: Thrombocytopaenia
Explanation:Bleeding time is related to platelet function, thus a decrease in platelet function, as seen in thrombocytopenia, DIC and von Willebrand disease in which platelet aggregation is defective, leads to an increase in bleeding time. It is not affected by a decrease or deficiency of any other clotting factors. Aspirin and other COX inhibitors prolong bleeding time along with warfarin and heparin.
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This question is part of the following fields:
- General
- Physiology
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Question 34
Incorrect
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Which of the following tumours is very radiosensitive?
Your Answer: Gastric carcinoma
Correct Answer: Seminoma
Explanation:Seminoma is the most radiosensitive tumour and responds well to radiation therapy after unilateral orchidectomy. The ipsilateral inguinal areas are routinely not treated however, depending on the stage, the mediastinum and the left supraclavicular regions may also be irradiated.
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This question is part of the following fields:
- Neoplasia; Urology
- Pathology
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Question 35
Incorrect
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The neurotransmitters adrenaline, noradrenaline and dopamine are derived from which amino acid?
Your Answer: Tryptophan
Correct 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 36
Incorrect
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The oesophagus is an important part of the alimentary canal. It receives blood from various arteries in the body. Which one of the following is an artery that will lead to some level of ischaemia to the oesophagus when ligated?
Your Answer: Superior mesenteric
Correct Answer: Left inferior phrenic
Explanation:The oesophagus receives its blood supply from the following arteries: the inferior thyroid branch of the thyrocervical trunk, the descending thoracic aorta, the left gastric branch of the coeliac artery and the from the left inferior phrenic artery of the abdominal aorta. Hence ligation of the left inferior phrenic will lead to ischemia to some portions of the oesophagus.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 37
Incorrect
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A 40 year old man sustained a fracture to the surgical neck of his left humerus. Which of the following arteries is suspected to be injured in this case?
Your Answer: Subscapular
Correct Answer: Posterior humeral circumflex
Explanation:The posterior humeral circumflex artery arises from the axillary artery and runs with the axillary nerve through the quadrangular space which is bounded laterally by the surgical neck of the humerus. After winding around the surgical neck of the humerus, it is distributed to the deltoid muscle and the shoulder joint. Thus fractures in the surgical neck of the humerus could result in an injury to this artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 38
Correct
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Which muscle in the neck divides the neck into two large triangles?
Your Answer: Sternocleidomastoid
Explanation:The sternocleidomastoid muscle is an important landmark in the neck as it divides the neck into two; anterior and posterior triangles. These triangles help in the location of the structures of the neck including the carotid artery, head and neck lymph nodes, accessory nerve and the brachial plexus. It originates from the manubrium and medial portion of the clavicle and inserts on the mastoid process of the temporal bone, superior nuchal line. The sternocleidomastoid receives blood supply from the occipital artery and the superior thyroid artery. It is innervated by the accessory nerve (motor) and cervical plexus (sensory).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 39
Incorrect
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Calculate the cardiac output of a patient with the following measurements: oxygen uptake 200 ml/min, oxygen concentration in the peripheral vein 7 vol%, oxygen concentration in the pulmonary artery 10 vol% and oxygen concentration in the aorta 15 vol%.
Your Answer: 1333 ml/min
Correct Answer: 4000 ml/min
Explanation:The Fick’s principle states that the uptake of a substance by an organ equals the arteriovenous difference of the substance multiplied by the blood flowing through the organ. We can thus calculate the pulmonary blood flow with pulmonary arterial (i.e., mixed venous) oxygen content, aortic oxygen content and oxygen uptake. The pulmonary blood flow, systemic blood flow and cardiac output can be considered the same assuming there are no intracardiac shunts. Thus, we can calculate the cardiac output. Cardiac output = oxygen uptake/(aortic − mixed venous oxygen content) = 200 ml/min/(15 ml O2/100 ml − 10 ml O2/100 ml) = 200 ml/min/(5 ml O2/100 ml) = 200 ml/min/0.05 = 4000 ml/min.
It is crucial to remember to use pulmonary arterial oxygen content and not peripheral vein oxygen content, when calculating the cardiac output by Fick’s method.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 40
Incorrect
-
A growing tumour is impinging on the lingual artery in the floor of the mouth. Which structure will experience decreased blood flow?
Your Answer: The genioglossus muscle
Correct Answer: The sublingual gland
Explanation:The paired sublingual glands are major salivary glands in the mouth. They are the smallest, most diffuse, and the only unencapsulated major salivary glands. They provide only 3-5% of the total salivary volume. The gland receives its blood supply from the sublingual and submental arteries. The sublingual artery is a branch of the lingual artery, thus damage to the lingual artery will decrease the blood flow to the sublingual gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 41
Incorrect
-
Cancer of the testis most likely metastases to which set of lymph nodes?
Your Answer: Superficial inguinal
Correct 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 42
Incorrect
-
Due to a plantarflexion–inversion ankle sprain, which is the first ligament to rupture?
Your Answer: Tibiocalcaneal ligament
Correct Answer: Anterior talofibular ligament
Explanation:The anterior talofibular ligament passes from the anterior margin of the fibular malleolus. It is the most commonly injured ligament, as part of the lateral ligament of the ankle.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 43
Correct
-
A 27-year old lady is shot in the chest. The bullet enters superior to the upper edge of the clavicle. She had difficulty in breathing which is interpreted by the A&E physician as a likely indicator of a collapsed lung. If that is the case, what portion of the pleura is most likely to have been punctured?
Your Answer: Cupola
Explanation:The cupola is part of the pleura that extends above the first rib into the root of the lung. Most likely to injured in a stab above the level of the clavicle.
Costodiaphragmatic recess: the lowest extent of the pleural sac.
Pulmonary ligament: is a fold of pleura located below the root of the lung.
Mediastinal pleura: part of the pleura that lines the mediastinal cavity.
Hilar reflection is the part of the pleura where the visceral pleura of the lung reflects to become continuous with the parietal pleura.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 44
Incorrect
-
An old man was diagnosed with squamous cell carcinoma with axillary lymph node metastasis. The doctor said he will excise the tumour and remove all axillary lymph nodes lateral to the edge of the pectoralis minor muscle. One of the following axillary lymph nodes won't be removed by this procedure. Which is it?
Your Answer: Central
Correct Answer: Apical
Explanation:The apical lymph node group won’t be removed which include 20 to 30 lymph nodes.
Axillary lymph nodes are grouped according to location. The lateral group, the anterior to pectoral group, the posterior or subscapular group, the central group, and the medial or apical group. The lateral, pectoral, and subscapular groups are found lateral to the pectoralis minor muscle. The central group is situated directly under that muscle. Thus, if all lymph nodes lateral to the medial edge of the pectoralis minor muscle are removed, all the above four groups will be removed. The apical group won’t be removed which is situated medial to the medial edge of the pectoralis minor muscle.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 45
Correct
-
When the pitch of a sound increases, what is the physiological response seen in the listener?
Your Answer: The location of maximal basilar membrane displacement moves toward the base of the cochlea
Explanation:An increase in the frequency of sound waves results in a change in the position of maximal displacement of the basilar membrane in the cochlea. Low pitch sound produces maximal displacement towards the cochlear apex and greatest activation of hair cells there. With an increasing pitch, the site of greatest displacement moves towards the cochlear base. However, increased amplitude of displacement, increase in the number of activated hair cells, increased frequency of discharge of units in the auditory nerve and increase in the range of frequencies to which such units respond, are all seen in increases in the intensity or a sound stimulus.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 46
Correct
-
What are the derivatives of the first brachial arch?
Your Answer: Gives rise to the sphenomandibular ligament
Explanation:The first brachial arch (mandibular) gives rise to the mandibular and maxillary processes. Muscles and bones of this process originate within the arch’s mesoderm. The first arch cartilage (Meckel’s) ossifies to form the incus and malleus of the middle ear. Its perichondrium gives rise to he sphenomandibular ligament and through intermembraneous ossification after the mandible forms, the rest of the cartilage disappears. Muscles of the first arch include: mylohyoid, tensor tympany and palati, temporalis, masseter and lateral pterygoids and the anterior belly of the epigastric. This first arch is supplied by the trigeminal nerve.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 47
Incorrect
-
A 16 year-old boy was stabbed in the right supraclavicular fossa. The sharp object punctured the portion of the parietal pleura that extends above the first rib. What is the name of this portion of the parietal pleura?
Your Answer: Costodiaphragmatic recess
Correct Answer: Cupola
Explanation:Endothoracic fascia: the connective tissue (fascia) that is between the costal parietal pleura and the inner wall of the chest wall.
Costomediastinal recess: the point where the costal pleura becomes mediastinal pleura.
Costodiaphragmatic recess: is the lowest point of the pleural sac where the costal pleura becomes diaphragmatic pleura.
Cupola: the part of the parietal pleura that extends above the first rib level into the root of the neck.
Costocervical recess: this is a made-up term.
Peritracheal fascia: a layer of connective tissue that invests the trachea.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 48
Correct
-
In a young, sexually active male, what is the most common cause of non-gonococcal urethritis?
Your Answer: Chlamydia
Explanation:Non-gonococcal urethritis is most commonly caused by Chlamydia trachomatis (50% cases). Less common organisms include Mycoplasma genitalium, Urea urealyticum and Trichomonas vaginalis. Chlamydia is also the commonest cause of non-gonococcal cervicitis in women and proctitis in both sexes.
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This question is part of the following fields:
- Pathology
- Renal
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Question 49
Incorrect
-
Which of the following diseases can cause paraesthesia along the distribution of the median nerve of the hand, especially after activities which require flexion and extension of the wrist?
Your Answer: Dupuytren’s contracture
Correct Answer: Carpal tunnel syndrome
Explanation:Carpal tunnel syndrome tends to occur in women between the ages of 30-50. There are many risk factors, including diabetes, hypothyroidism, obesity, pregnancy, and repetitive wrist work. Symptoms include pain in the hand and wrist, tingling, and numbness distributed along the median nerve (the palmar side of the thumb, the index and middle fingers, and the radial half of the ring finger), which worsens at night.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 50
Incorrect
-
Painful erections along with deviation of the penis to one side when erect are seen in which of the following conditions?
Your Answer: Posthitis
Correct 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 51
Incorrect
-
What intrinsic muscle of the larynx is responsible for the tensing of the vocal cords?
Your Answer: Thyroarytenoid
Correct Answer: Cricothyroid muscle
Explanation:The cricothyroid muscle is the only tensor muscle of the larynx aiding with phonation. It attaches to the anterolateral aspect of the cricoid and the inferior cornu and lower lamina of the thyroid cartilage. Its action tilts the thyroid forward to help tense the vocal cords.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 52
Incorrect
-
Which condition presents with a positive urine dipstick test for blood, but no blood cells on urine microscopy?
Your Answer: Ureteric lithiasis
Correct Answer: Myoglobinuria
Explanation:Myoglobinuria, or presence of myoglobulin in the urine is seen due to rhabdomyolysis (muscle destruction). Common causes of rhabdomyolysis include trauma, electrical injuries, burns, venom and drugs. Damaged muscle leads to release of myoglobin in the blood. Ideally, the released myoglobin gets filtered and excreted by the kidneys. However, excess myoglobin can occlude the renal filtration system leading to acute tubular necrosis and acute renal dysfunction.
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This question is part of the following fields:
- Pathology
- Renal
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Question 53
Incorrect
-
A patient is unable to move their mandible to the left. Which muscle is affected in this case?
Your Answer: Left medial pterygoid muscle
Correct Answer: Right lateral pterygoid muscle
Explanation:Patients with paralysis of the right pterygoid muscle are unable to move their mandible laterally to the left.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 54
Incorrect
-
A 51-year old woman after undergoing a barium swallowing was discovered to be suffering from an oesophageal hiatal hernia. Which muscle fibres of the diaphragm border this hernia directly if the stomach herniates through an enlarged oesophageal hiatus?
Your Answer: Sternal fibres
Correct Answer: Right crus
Explanation:The oesophageal hiatus is a natural fissure on the thoracic diaphragm that allows passage of the oesophagus and the vagal nerve. The oesophageal hiatus is located in one of the tendinous structures of the diaphragm that connect it to the spine which is known as the right crus. In case of an hiatal hernia, this diaphragmatic structure would be the one bordering the hernia as it is the structure that encircles the oesophageal hiatus.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 55
Incorrect
-
Atractyloside is an inhibitor of electron transport chain. It is expected to have little or no effect on the functioning of which of the following cell types?
Your Answer: Cardiac muscle cells
Correct Answer: Red blood cells
Explanation:Electron transport chain is a series of electron carriers that are embedded in the mitochondrial membrane. It is the place where ATP is made. Inhibiting the electron transport chain will stop production of ATP. Red blood cells are the only cell in the given option which do not contain ATP.
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This question is part of the following fields:
- General
- Physiology
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Question 56
Incorrect
-
During an operation to repair an aortic coarctation in a neonate, a surgeon accidentally cuts the first aortic intercostal arteries as he mobilised the descending aorta. Which one of the following structure might be deprived of its primary source of blood supply following this injury?
Your Answer: Left bronchus
Correct Answer: Right bronchus
Explanation:The right bronchus is supplied by one right bronchial artery that may branch from one of the left bronchial arteries or from the right 3rd posterior intercostal artery (this is the first intercostal artery that arises from the aorta). Damage to this artery might stop blood supply to the main bronchus. Intercostal arteries that go to the first and the second interspaces originate from the highest intercostal artery such that blood supply to either of these spaces would not be interfered with.
The left bronchus receives blood from 2 left bronchial arteries which are direct branches from the descending aorta.
Fibrous pericardium is the sac that contains the heart. Its blood supply is not a major concern.
Visceral pericardium receives its blood supply from the coronary vessels.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 57
Incorrect
-
A 42-year old woman presents to the doctor with jaundice. Her investigations show conjugated hyperbilirubinemia, raised urine bilirubin levels and low urine urobilinogen levels. What is the likely cause of her jaundice?
Your Answer: Primary shunt hyperbilirubinemia
Correct Answer: Blockage of the common bile duct
Explanation:The description of the patient here fits the diagnosis of obstructive jaundice or cholestasis, which results in conjugated hyperbilirubinemia. Cholestasis occurs due to impairment of bile flow, which can be anywhere from the liver cell canaliculus to the ampulla of Vater. Causes can be divided into intrahepatic and extrahepatic.
– Intrahepatic causes include hepatitis, drug toxicity, alcoholic liver disease, primary biliary cirrhosis, cholestasis of pregnancy and metastatic cancer.
– Extrahepatic causes include common duct stone, pancreatic cancer, benign stricture of the common duct, ductal carcinoma, pancreatitis and sclerosing cholangitis.
There is absence of bile constituents in the intestine, which causes spillage in the systemic circulation. Symptoms include pale stools, dark urine, pruritus, malabsorption leading to steatorrhea and deficiency of fat-soluble vitamins. Chronic cases can result in osteoporosis or osteomalacia due to vitamin D deficiency and Ca2+ malabsorption. Cholesterol and phospholipid retention produces hyperlipidaemia despite fat malabsorption (although increased liver synthesis and decreased plasma esterification of cholesterol also contribute); triglyceride levels are largely unaffected. The lipids circulate as a unique, low-density lipoprotein called lipoprotein X.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 58
Incorrect
-
Signals pass through neuromuscular junctions via the neurotransmitter acetylcholine. After release from the skeletal neuromuscular junction, acetylcholine:
Your Answer: Is triggered by acetylcholinesterase
Correct Answer: Causes postsynaptic depolarisation
Explanation:Acetylcholine is released from the presynaptic membrane into the cleft where it binds to the ion gated channels on the post synaptic membrane, causing them to open. This results in sodium entering into the fibre and further depolarizing it, creating an action potential.
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This question is part of the following fields:
- General
- Physiology
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Question 59
Incorrect
-
A 31 -year-old female patient had a blood gas done on presentation to the emergency department. She was found to have a metabolic acidosis and decreased anion gap. The most likely cause of these findings in this patient would be?
Your Answer: Lactic acidosis
Correct Answer: Hypoalbuminemia
Explanation:A low anion gap might be caused by alterations in serum protein levels, primarily albumin (hypoalbuminemia), increased levels of calcium (hypercalcaemia) and magnesium (hypermagnesemia) or bromide and lithium intoxication. However, the commonest cause is hypoalbuminemia, thus if the albumin concentration falls, the anion gap will also be lower. The anion gap should be corrected upwards by 2.5 mmol/l for every 10g/l fall in the serum albumin.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 60
Incorrect
-
A 55-years-old man presented to the emergency department complaining of a squeezing sensation in his chest that has spread to his neck with associated worsening shortness of breath. Which of these laboratory tests would you ask for in this patient:
Your Answer: Antinuclear antibody test
Correct Answer: Creatine kinase-MB
Explanation:Creatine kinase-MB is a test that usually is ordered when the patient has chest pain as a cardiac marker. When a heart attack is suspected and a troponin test (which is more specific for heart damage), is not available CK-MB is ordered. There are 3 forms of CK: CK-MM, CK-BB and CK-MB. CK-MB is commonly found in heart tissue, therefore injured heart muscle cells release CK-MB into the blood. Elevated CK-MB levels indicate that it is probable that a person has recently had a heart attack.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 61
Correct
-
Skeletal muscle fibres are divided into two basic types, type I (slow-twitch fibres) and type II (fast-twitch fibres). Fast muscle fibres do which of the following:
Your Answer: Use anaerobic metabolism
Explanation:Skeletal muscles are divided into two types:
1) type I also known as the slow twitch fibres. They use oxygen for their metabolism and as a result they have a high endurance potential. To support this they have abundant mitochondria and myoglobin, so they appear red/dark.
2) type II fibres also called fast twitch fibres, are low endurance fibres used during anaerobic metabolism. They are required for short bursts of strength and cannot sustain contractions for long periods of time.
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This question is part of the following fields:
- General
- Physiology
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Question 62
Correct
-
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: 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 63
Incorrect
-
A 26-year old man is brought to the A&E with a stab wound to the chest. The wound is in a part of the left lung that might partially fill the costomediastinal recess in full respiration. Where did the weapon strike this man?
Your Answer: Middle lobe
Correct Answer: Lingula
Explanation:During full inspiration, the lingual-of the left lung partially fills the costomediastinal recess. If the apex of the lung is fully filled with air, it would occupy the copula (the part of the pleura that extends above the first rib). The hilum is part of the lung where the neurovascular structures that form the root of the lung enter and leave the lung and doesn’t expand on inspiration. The middle lobe can expand to fill the costomediastinal recess, however, the middle lobe is on the right lung. The inferior lobe, during full inspiration, might fill the costodiaphragmatic recess.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 64
Incorrect
-
During a laparoscopic inguinal hernia repair, the surgeon finds an artery in the extraperitoneal connective tissue (preperitoneal fat) that courses vertically and just medial to the bowel as the bowel passes through the abdominal wall. Which artery is this?
Your Answer: Superficial circumflex iliac
Correct Answer: Inferior epigastric
Explanation:The inferior epigastric artery comes from the external iliac artery just above the inguinal ligament to curve forward in the subperitoneal tissue and then ascend obliquely along the medial margin of the deep inguinal ring. It continues to ascend between the rectus abdominis and the posterior lamella of its sheath after piercing the fascia transversalis and passing anterior to the linea semicircularis. Finally it gives off numerous branches that anastomose above the umbilicus with the superior epigastric branch of the internal mammary artery and with the lower intercostal arteries. As this artery ascends obliquely upwards from its origin it lies along the lower medial margins of the deep inguinal ring and posterior to the start of the spermatic cord. It is found in the preperitoneal fat of the abdomen lying just superficial to the peritoneum and forms the lateral umbilical fold. Hernias that pass lateral to this are indirect and medial to this, direct hernias.
The deep circumflex artery travels along the iliac crest on the inner surface of the abdominal wall. It is very lateral to the abdominal wall and hernias would pass medial to it.
The superficial circumflex iliac, superficial epigastric, superficial external pudendal arteries are all superficial arteries found in the superficial fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 65
Incorrect
-
Regarding the coagulation cascade, Factor VII:
Your Answer: Is a cytokine
Correct Answer: Is a serine protease
Explanation:Factor VII (FVII) is a zymogen for a vitamin K-dependent serine protease essential for the initiation of blood coagulation. It is synthesized primarily in the liver and circulates in plasma. Within the liver, hepatocytes are involved in the synthesis of most blood coagulation factors, such as fibrinogen, prothrombin, factor V, VII, IX, X, XI, XII, as well as protein C and S, and antithrombin, whereas liver sinusoidal endothelial cells produce factor VIII and von Willebrand factor.
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This question is part of the following fields:
- General
- Physiology
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Question 66
Incorrect
-
A 35 year-old woman is undergoing thyroidectomy. The external laryngeal nerve may be injured whilst ligating this artery during the procedure due to its close relationship?
Your Answer: Deep temporal artery
Correct Answer: Superior thyroid artery
Explanation:The superior thyroid artery arises from the external carotid artery just below the level of the greater cornu of the hyoid bone and ends in the thyroid gland. This artery must be ligated at the thyroid when conducting a thyroidectomy. If the artery is severed, but not ligated, it will bleed profusely. In order to gain control of the bleeding, the surgeon may need to extend the original incision laterally to ligate the artery at its origin at the external carotid artery. The external laryngeal branch of the superior laryngeal nerve courses in close proximity to the superior thyroid artery, making it at risk for injury during surgery.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 67
Incorrect
-
A histological examination of a lump showed an abnormal amount and arrangement of normal tissue in an otherwise normal area. This condition is known as?
Your Answer: Mixed tumour
Correct Answer: Hamartoma
Explanation:A hamartoma is a condition best described as tissue normally present in an area arranged haphazardly in an disorganized, abnormal fashion. They are never malignant and do not metastasis.
All the neoplastic, cancerous lesions comprise of a mixture of different cells that are not normal to that area.
Metaplasia is a change in the type of the epithelium.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 68
Incorrect
-
A blood sample of a 58 year old male patient, who underwent an abdominal aortic aneurysm repair, was sent to the laboratory. The laboratory technician said that the patient’s blood agglutinates with antisera anti-A and anti-D, while the patient’s serum agglutinates cells of blood group B. What is the blood group of this patient?
Your Answer: AB positive
Correct Answer: A positive
Explanation:Group A – has only the A antigen on red cells (and B antibody in the plasma)
Group B – has only the B antigen on red cells (and A antibody in the plasma)
Group AB – has both A and B antigens on red cells (but neither A nor B antibody in the plasma)
Group O – has neither A nor B antigens on red cells (but both A and B antibody are in the plasma). Many people also have a so-called Rh factor on the red blood cell’s surface. This is also an antigen and those who have it are called Rh+. A person with Rh– blood does not have Rh antibodies naturally in the blood plasma (as one can have A or B antibodies, for instance) but they can develop Rh antibodies in the blood plasma if they receive blood from a person with Rh+ blood, whose Rh antigens can trigger the production of Rh antibodies. A person with Rh+ blood can receive blood from a person with Rh– blood without any problems. In this scenario the person has blood group A+ as he has A antigen, anti B antibody and Rh antigen
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This question is part of the following fields:
- General
- Physiology
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Question 69
Incorrect
-
Which of the following foramen provides passage of the facial nerve?
Your Answer: Foramen rotundum
Correct Answer: Internal acoustic meatus
Explanation:The internal auditory meatus provides a passage through which the vestibulocochlear nerve, the facial nerve, and the labyrinthine artery (an internal auditory branch of the basilar artery) can pass from inside the skull to structures of the inner ear and face.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 70
Incorrect
-
A 29-year-old woman presents to the doctor complaining of cough, shortness of breath, fever and weight loss. Chest X-ray revealed bilateral hilar and mediastinal lymph node enlargement and bilateral pulmonary opacities. Non-caseating granulomas were found on histological examination. The most likely diagnosis is:
Your Answer: Asbestosis
Correct Answer: Sarcoidosis
Explanation:Sarcoidosis is an inflammatory disease of unknown aetiology that affects multiple organs but predominantly the lungs and intrathoracic lymph nodes. Systemic and pulmonary symptoms may both be present. Pulmonary involvement is confirmed by a chest X-ray and other imaging studies. The main histological finding is the presence of non-caseating granulomas.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 71
Incorrect
-
Which best describes the suprascapular nerve?
Your Answer: It innervates the teres minor muscle
Correct Answer: It contains nerve fibres from C5 and C6 spinal cord segments
Explanation:The suprascapular nerve arises from the cervical spinal nerves 5 and 6 after coming together to form common trunk. This nerve supplies the supraspinatus and infraspinatus muscles giving off branches to the shoulder joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 72
Incorrect
-
Which Statement is true of the brachial plexus?
Your Answer: The nerve to subclavius is a branch of the C8 nerve root
Correct Answer: The posterior cord continues as the axillary nerve
Explanation:The lateral cord continues as the musculocutaeous nerve.
The medial cord continues as the ulnar nerve.
The posterior cord continues as the radial nerve and the axillary nerve.
The nerve to subclavius muscle is a branch of the C6 root.
The suprascapular nerve is a branch from the upper trunk.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 73
Incorrect
-
A 45 year old female had a stroke and was diagnosed with a homonymous hemianopsia. Which of the following structures was likely affected?
Your Answer: Abducent nucleus
Correct Answer: Optic radiation
Explanation:Hemianopia or hemianopsia, is the loss of vision of half of the eye or loss of half the visual field. Homonymous hemianopia is the loss of vision or blindness on half of the same side of both eyes (visual field) – either both lefts of the eyes or both rights of the eyes. This condition is mainly caused by cerebrovascular accidents like a stroke that affects the optic radiation.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 74
Incorrect
-
A cerebellar tremor can be differentiated from a Parkinsonian tremor in that:
Your Answer: Its amplitude remains constant during voluntary movements
Correct Answer: It only occurs during voluntary movements
Explanation:Cerebellar disease leads to intention tremors, which is absent at rest and appears at the onset of voluntary movements. In comparison, Parkinson’s tremor is present at rest. Frequency of tremor is a less reliable means to differentiate between the two as the oscillation amplitude of the tremor is not constant throughout a voluntary action.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 75
Correct
-
A 26-year-old female patient had the following blood report: RBC count = 4. 0 × 106/μl, haematocrit = 27% and haemoglobin = 11 g/dl, mean corpuscular volume (MCV) = 80–100 fl, mean corpuscular haemoglobin concentration (MCHC) = 31–37 g/dl. Which of the following is correct regarding this patient’s erythrocytes:
Your Answer: Normal MCV
Explanation:MCV is the mean corpuscular volume and it is calculated from the haematocrit and the RBC count. It is normally 90 fl. Mean corpuscular haemoglobin concentration (MCHC) [g/dl] = haemoglobin [g/dl]/haematocrit = 11/0.27 = 41 g/dl and is higher than normal range (32 to 36 g/dL).
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This question is part of the following fields:
- General
- Physiology
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Question 76
Correct
-
Driving pressure is considered to be a strong predictor of mortality in patients with ARDS. What is the normal mean intravascular driving pressure for the respiratory circulation?
Your Answer: 10 mmHg
Explanation:Driving pressure is the difference between inflow and outflow pressure. For the pulmonary circulation, this is the difference between pulmonary arterial (pa) and left atrial pressure (pLA). Normally, mean driving pressure is about 10 mmHg, computed by subtracting pLA (5 mmHg) from pA (15 mmHg). This is in contrast to a mean driving pressure of nearly 100 mmHg in the systemic circulation.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 77
Incorrect
-
What is the likely diagnosis in a 55-year old man presenting with jaundice, weight loss, pale coloured stools and elevated alkaline phosphatase?
Your Answer: Cirrhosis of liver
Correct Answer: Pancreatic carcinoma
Explanation:Increased alkaline phosphatase is indicative of cholestasis, with a 4x or greater increase seen 1-2 days after biliary obstruction. Its level can remain elevated several days after the obstruction is resolved due to the long half life (7 days). Increase up to three times the normal level can be seen in hepatitis, cirrhosis, space-occupying lesions and infiltrative disorders. Raised alkaline phosphatase with other liver function tests being normal can occur in focal hepatic lesions like abscesses or tumours, or in partial/intermittent biliary obstruction. However, alkaline phosphatase has several isoenzymes, which originate in different organs, particularly bone. An isolated rise can also be seen in malignancies (bronchogenic carcinoma, Hodgkin’s lymphoma), post-fatty meals (from the small intestine), in pregnancy (from the placenta), in growing children (from bone growth) and in chronic renal failure (from intestine and bone). One can differentiate between hepatic and non-hepatic cause by measurement of enzymes specific to the liver e.g. gamma-glutamyl transferase (GGT).
In an elderly, asymptomatic patient, isolated rise of alkaline phosphatase usually points to bone disease (like Paget’s disease). Presence of other symptoms such as jaundice, pale stools, weight loss suggests obstructive jaundice, most probably due to pancreatic carcinoma.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 78
Incorrect
-
The accumulation of eosinophils within tissues is mostly regulated by which of the following cytokines?
Your Answer: Interleukin-10
Correct Answer: Interleukin-5
Explanation:IL-5 is produced by TH2 helper cells and by mast cells. They stimulate increased secretion of immunoglobulins and stimulate B cell growth. They are the major regulators in eosinophil activation and control. They are also released from eosinophils and mast cells in asthmatic patients and are associate with a many other allergic conditions.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 79
Incorrect
-
When conducting an exploratory laparotomy procedure of a patient diagnosed with a bleeding ulcer of the lesser curvature of the stomach, which artery in this patient are you most likely to ligate to control the bleeding?
Your Answer: Short gastric
Correct Answer: Left gastric
Explanation:The lesser curvature of the stomach is supplied by the left gastric artery along with the right gastric artery. These two arteries are the ones to most likely be ligated if bleeding was to be stopped at the lesser curvature of the stomach. The splenic artery branches from the celiac branch and supplies the spleen. The left gastro-omental, the right and left gastroepiploic arteries supply the greater curvature.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 80
Incorrect
-
Which of the following two cerebral veins join up to form the great cerebral vein, otherwise also known as the great vein of Galen?
Your Answer: Striate veins
Correct Answer: Internal cerebral veins
Explanation:The great vein of Galen or great cerebral vein, is formed by the union of the internal cerebral veins and the basal veins of Rosenthal. This vein curves upwards and backwards along the border of the splenium of the corpus callosum and eventually drains into the inferior sagittal sinus and straight sinus at its anterior extremity.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 81
Correct
-
Which of the following is involved in vitamin B12 absorption?
Your Answer: Intrinsic factor
Explanation:Absorption of vitamin B12 is by an active transport process and occurs in the ileum. Most cobalamins are bound to proteins and are released in the stomach due to low pH and pepsin. The cobalamins then bind to R proteins, i.e. haptocorrin (HC) secreted from salivary glands and gastric juice. Another cobalamin binding protein is Intrinsic factor (IF) secreted from the gastric parietal cells. The cobalamin-HC complex is digested by pancreatic proteases in the intestinal lumen, and the free cobalamin then binds to IF. The complex then reaches a transmembrane receptor in the ileum and undergoes endocytosis. Cobalamin is then released intracellularly and binds to transcobalamin II (TC II). The newly formed complex then exits the ileal cell and enters the blood circulation.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 82
Correct
-
Which nodes are most likely to be enlarged in a patient complaining of a boil located on the labia majora?
Your Answer: Superficial inguinal
Explanation:The perineum, external genitalia, the labia majora and scrotum drain to the superficial inguinal lymph nodes. In a man, the testes do not drain to the superficial inguinal lymph nodes but rather travel in the spermatic cord and drain into the lumbar nodes. The lumbar nodes drain the internal pelvic organs. The sacral nodes drain the prostrate gland, uterus, vagina, rectum and posterior pelvic wall and the external iliac nodes in turn drain the lower limb. The internal iliac nodes drain the pelvis and gluteal region.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 83
Correct
-
A 40 year old woman, who is under anaesthesia for an elective procedure, received an antibiotic injection. She immediately developed a rash and her airway constricted raising the airway pressure. Which mechanism is responsible for this reaction?
Your Answer: Type I hypersensitivity
Explanation:Type I hypersensitivity reaction is an immediate reaction that occurs due to binding of the antigen with antibodies attached to mast cells in a previously sensitized person. It has an immediate phase, which is characterised by vasodilation, leakage of plasma, smooth muscle spasm, or glandular secretions. This manifests in about 5-30 min and usually resolves within 60 mins. The delayed phase follows after 24 hours and can persist up to several days. It is due to infiltration of eosinophils, neutrophils, basophils and CD4+ cells and leads to tissue destruction. The nature of the reaction varies according to the site. It can take the form of skin allergy, hives, allergic rhinitis, conjunctivitis, bronchial asthma or food allergy.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 84
Incorrect
-
Which nuclei of the posterior grey column of the spinal cord are likely affected in a patient who has lost the sensation of pain and temperature?
Your Answer: Intermediolateral nucleus
Correct Answer: Substantia gelatinosa
Explanation:Substantia gelatinosa is one of the nuclei in the posterior grey column along side other posterior grey column nuclei like the nucleus dorsalis, nucleus proprius, and posteromarginal nucleus. These nuclei are a collection of cells in the posterior grey area found in throughout the spinal cord. The substantia gelatinosa receives direct input from the dorsal nerve roots (sensory), especially from thermoreceptors and nociceptors (receptors for temperature and pain).
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This question is part of the following fields:
- Anatomy
- Neurology
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Question 85
Incorrect
-
The collaborative effort of the lateral pterygoid muscles produces which action on the jaw?
Your Answer: Have no effect on the mandible
Correct Answer: Protrude the mandible
Explanation:The combined effort of the lateral pterygoid muscles results in the protrusion of the mandible. The lateral pterygoid muscle is a muscle of mastication located superiorly to the medial pterygoid muscle and has two heads. The superior head originates on the infratemporal surface and infratemporal crest of the greater wing of the sphenoid bone, and the inferior head on the lateral surface of the lateral pterygoid plate. The insertion of this muscle is on the front margin of the articular disc of the temporomandibular joint. The unilateral contraction of the pterygoid muscle results in the laterotrusion of the mandible. It is important to note that the lateral pterygoid muscle is the only muscle of mastication that can open the jaw.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 86
Incorrect
-
A 20-year old boy presented with low grade fever, night sweats and weakness over two months. On examination, he had multiple, non-tender, cervical, supraclavicular and axillary adenopathy. Microscopy of lymph node biopsy showed the presence of Reed-Sternberg cells. He is likely suffering from:
Your Answer: Multiple myeloma
Correct Answer: Hodgkin’s lymphoma
Explanation:Hodgkin’s lymphoma is a disease characterized by malignant proliferation of cells of the lymphoreticular system. It can be localized or disseminated, and can involve the nodes, spleen, liver and marrow. Symptoms of the disease include non-tender lymphadenopathy, fever, night sweats, weight loss, itching and hepatosplenomegaly. Histologically, the involved nodes show the presence of Reed-Sternberg cells, which are large, binucleated cells, in a heterogenous cellular infiltrate of histiocytes, lymphocytes, monocytes, plasma cells and eosinophils.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 87
Incorrect
-
A 5-year-old child is rushed to the emergency department because of fever, erythema and neck stiffness. The child is also hypotensive upon physical examination. Which is the most likely toxin responsible for this child's condition?
Your Answer: Exotoxin
Correct Answer: Endotoxin
Explanation: An endotoxin is part of the bacterial outer membrane, and it is not released until the bacterium is killed by the immune system. The body’s response to an endotoxin can involve severe inflammation. In general, the inflammation process is usually considered beneficial to the infected host, but if the reaction is severe enough, it can lead to sepsis.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 88
Incorrect
-
A 30-year old lady presented to her GP with complaints of tremors, excessive emotional outbursts, weight loss and increased sweating over 20 days. On examination, she had warm and moist skin, a fine tremor of the fingers and hyperreflexia. Her vital signs were normal. What is the likely diagnosis?
Your Answer: Alcohol withdrawal
Correct Answer: Hyperthyroidism
Explanation:Excess of circulating free thyroid hormones (thyroxine and/or triiodothyronine) leads to hyperthyroidism. Common causes include Graves’ disease, toxic thyroid adenoma and toxic multinodular goitre. Grave’s disease is the most common cause and is responsible for 70-80% cases of hyperthyroidism. Other causes include excess intake of thyroid hormone, amiodarone-related. It is important that hyperthyroidism is not confused with hyperthyroxinaemia (high levels of thyroid hormone in blood), which includes causes like thyroiditis. Both the conditions lead to thyrotoxicosis (symptoms due to hyperthyroxinemia). Symptoms include weight loss associated with increased appetite, anxiety, weakness, heat intolerance, depression, increased sweating, dyspnoea, loss of libido, diarrhoea, palpitations and occasionally arrhythmias. If there is an acute increase in metabolic rate, the condition is known as ‘thyroid storm’. Elderly sometimes present only with fatigue and weight loss and this is called apathetic hyperthyroidism. Neurological symptoms are also seen in hyperthyroidism and these are tremor, chorea, myopathy and periodic paralysis. One of the most serious complications of hyperthyroidism is stroke of cardioembolic origin due to coexisting atrial fibrillation.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 89
Incorrect
-
Evaluation of a 60-year old gentleman, who has been a coal miner all his life and is suspected to have pulmonary fibrosis reveals the following: FEV1 of 75% (normal > 65%), arterial oxygen saturation 92%, alveolar ventilation 6000 ml/min at a tidal volume of 600 ml and a breathing rate of 12 breaths/min. There are also pathological changes in lung compliance and residual volume. Calculate his anatomical dead space.
Your Answer: 50 ml
Correct Answer: 100 ml
Explanation:Dead space refers to inhaled air that does not take part in gas exchange. Because of this dead space, taking deep breaths slowly is more effective for gas exchange than taking quick, shallow breaths where a large proportion is dead space. Use of a snorkel by a diver increases the dead space marginally. Anatomical dead space refers to the gas in conducting areas such as mouth and trachea, and is roughly 150 ml (2.2 ml/kg body weight). This corresponds to a third of the tidal volume (400-500 ml). It can be measured by Fowler’s method, a nitrogen wash-out technique. It is posture-dependent and increases with increase in tidal volume. Physiological dead space is equal to the anatomical dead space plus the alveolar dead space, where alveolar dead space is the area in the alveoli where no effective exchange takes place due to poor blood flow in capillaries. This physiological dead space is very small normally (< 5 ml) but can increase in lung diseases. Physiological dead space can be measured by Bohr’s method. Total ventilation per minute (minute ventilation) is given by the product of tidal volume and the breathing rate. Here, the total ventilation is 600 ml times 12 breaths/min = 7200 ml/min. The problem mentions alveolar ventilation to be 6000 ml/min. Thus, the difference between the alveolar ventilation and total ventilation is 7200 – 6000 ml/min = 1200 ml/min, or 100 ml per breath at 12 breaths per min. This 100 ml is the dead space volume.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 90
Incorrect
-
Bile salt reuptake principally occurs where?
Your Answer: In the colon
Correct Answer: In the ileum
Explanation:90 – 95% of the bile salts are absorbed from the small intestine (mostly terminal ileum and then excreted again from the liver. This is known as the enterohepatic circulation. The entire pool recycles twice per meal and approximately 6 to 8 times per day.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 91
Incorrect
-
Which of the following muscles may be affected by a fracture to the tuberosity on the medial surface of the right navicular bone?
Your Answer: Extensor digitorum brevis
Correct Answer: Tibialis posterior
Explanation:The navicular bone is situated at the medial side of the tarsus, between the talus and the cuneiform bones. Its medial surface presents a rounded tuberosity, the lower part of which gives attachment to part of the tendon of the tibialis posterior.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 92
Incorrect
-
Which of the cranial nerves is responsible for touch sensation on the skin over the maxilla region and the mandible?
Your Answer: Abducens
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 93
Incorrect
-
The cranial nerves of the brain provide motor and sensory innervation to the structures of the head and neck. Which of the following cranial nerves provide only motor innervation?
Your Answer: Trigeminal
Correct Answer: Abducens
Explanation:The cranial nerves emerge directly from the brain and the brain stem. They provide sensory, motor or both motor and sensory innervation. Here is a summary of the cranial nerves and their function:
Olfactory – Purely sensory
Optic – Sensory
Oculomotor – Mainly motor
Trochlear – Motor
Trigeminal – Both sensory and motor
Abducens – Mainly motor
Facial – Both sensory and motor
Vestibulocochlear – Mostly sensory
Glossopharyngeal – Both sensory and motor
Vagus – Both sensory and motor
Accessory – Mainly motor
Hypoglossal – Mainly motor
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 94
Incorrect
-
A 25-year-old football player suffers severe head trauma during a game. Physical examination reveals a decerebrate posture and bilateral papilledema. A CT scan reveals marked diffuse cerebral oedema. This condition will be most severe in which component of the brain?
Your Answer: Neuronal cell bodies
Correct Answer: White matter
Explanation:The greatest amount of salt and water increase with cerebral oedema occurs within the white matter. Any swelling from oedema, haemorrhage or haematoma increases the intracranial pressure (ICP). As the ICP increases, the cerebral perfusion decreases and brain tissue can become ischaemic, even leading to brain death.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 95
Correct
-
An ultrasound report of a 35-year old female patient revealed that she had cancer of the pancreas and presented with subsequent severe obstructive jaundice. In which part of this was woman's pancreas was the tumour most likely located?
Your Answer: Head
Explanation:The pancreas is divided into five parts; the head, body, neck, tail, and the uncinate process. Of the five parts, tumours located at the head of the pancreas in most instances cause obstruction of the common bile duct more often than tumours in the other parts of the pancreas. This is because the common bile duct passes through the head of the pancreas from the gallbladder and the liver (it is formed where the cystic and the hepatic bile duct join) to empty bile into the duodenum. This biliary obstruction leads to accumulation of bile in the liver and a consequent bilirubinaemia (raised levels of blood bilirubin). This results in jaundice. The pancreas is not divided into lobes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 96
Incorrect
-
Which of the following morphological features is most characteristic of hyaline degeneration?
Your Answer: Orphan Annie eye nucleus
Correct Answer: Homogeneous, ground-glass, pink-staining appearance of cells
Explanation:The characteristic morphological features of hyaline degeneration is ground-glass, pinking staining cytoplasm with an intact cell membrane. The accumulation of lipids, calcium salts, lipofuscin and an amorphous cytoplasm with an intact cell membrane are all characteristically found in different situations.
Pyknotic nucleus and orphan Annie eye nucleus are not seen in hyaline degeneration.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 97
Incorrect
-
Multiple, non-tender lymphadenopathy with biopsy showing several crowded follicles of small, monomorphic lymphocytes and the absence of Reed-Sternberg cells is seen in which of the following?
Your Answer: Hodgkin’s disease, lymphocyte predominance type
Correct Answer: Poorly differentiated lymphocytic lymphoma
Explanation:Malignant lymphoma usually causes non-tender lymphadenopathy, unlike the tender lymphadenopathy caused by infections (including infectious mononucleosis caused by Epstein-Barr virus). Also, the lymphoid hyperplasia seen in infectious mononucleosis is benign and polyclonal.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 98
Correct
-
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 99
Incorrect
-
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 100
Incorrect
-
The inferior palpebral nerve ascends behind the orbicularis oculi. What is the terminal branch of the inferior palpebral nerve?
Your Answer: Nasociliary nerve
Correct Answer: Infraorbital nerve
Explanation:The inferior palpebral nerve is a branch of the maxillary nerve. It supplies the skin and conjunctiva of the lower eyelid.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 101
Correct
-
Which of the following statements is true of Colles’ fracture?
Your Answer: Is a cause of carpal tunnel syndrome
Explanation:Colles’ fracture is a distal fracture of the radius that is a known cause of carpal tunnel syndrome (compression of the median nerve in the carpal tunnel). It rarely results in ulnar nerve compression. A Colles’ fracture is extra-articular and does not extend into the wrist joint, otherwise this would make it an intra-articular fracture (Barton’s fracture). The distal fragment in a Colles’ fracture is displaced dorsally, unlike in a Smith’s fracture where the distal fragment is displaced volarly (ventrally). Associated fracture of the ulnar styloid process may occur and is a common associated injury.
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This question is part of the following fields:
- Orthopaedics
- Pathology
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Question 102
Incorrect
-
The optic foramen, superior orbital fissure, foramen ovale, foramen rotundum and foramen sinosum are all located on which bone at the base of the skull?
Your Answer: Frontal
Correct Answer: Sphenoid
Explanation:The sphenoid bone consists of two parts, a central part and two wing-like structures that extend sideways towards each side of the skull. It forms the base of the skull, and floor and sides of the orbit. On its central part lies the optic foramen. The foramen ovale, foramen spinosum and foramen rotundum lie on its great wing while the superior orbital fissure lies on its lesser wing.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 103
Correct
-
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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Question 104
Incorrect
-
Which of the following is the most likely cause of massive splenomegaly in a 35-year old gentleman?
Your Answer: Haemochromatosis
Correct Answer: Myelofibrosis
Explanation:Causes of massive splenomegaly include chronic myelogenous leukaemia, chronic lymphocytic leukaemia, lymphoma, hairy cell leukaemia, myelofibrosis, polycythaemia vera, sarcoidosis, Gaucher’s disease and malaria.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 105
Incorrect
-
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: Great vein of Galen
Correct 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 106
Incorrect
-
Endometrial hyperplasia is most likely to be associated with which of the following conditions?
Your Answer: Krukenberg tumour
Correct Answer: Fibrothecoma
Explanation:A benign tumour arising from the ovarian stroma, fibrothecoma are bilateral in 10% cases. The thecoma component of the tumour can produce oestrogen leading to endometrial hyperplasia. The thecoma is rich in lipid content and is responsible for the yellowish appearance of the tumour. Meig’s syndrome is the presence of fibrothecoma with a right-sided hydrothorax.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 107
Correct
-
Nephrotic syndrome is a condition that causes proteinuria, hypoalbuminemia and oedema. Which of the following is the cause of the oedema in these patients?
Your Answer: Decreased oncotic pressure
Explanation:The glomeruli of the kidneys are the parts that normally filter the blood. They consist of capillaries that are fenestrated and allow fluid, salts and other small solutes to flow through, but normally not proteins. In nephrotic syndrome, the glomeruli become damaged allowing small proteins, such as albumin to pass through the kidneys into urine. Oedema usually occurs due to salt and water retention by the diseased kidneys as well as due to the reduced colloid oncotic pressure (because of reduced albumin in the plasma). Lower serum oncotic pressure causes fluid to accumulate in the interstitial tissues.
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This question is part of the following fields:
- Physiology
- Renal
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Question 108
Incorrect
-
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: Flexor pollicis brevis
Correct 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 109
Incorrect
-
An experiment is carried out to observe engulfment and phagocytosis of microbes. Strep pneumoniae are added to a solution of leukocytes with a substance added to enhance the process of phagocytosis. What is this substance?
Your Answer: Histamine
Correct Answer: Complement C3b
Explanation:C3b is cleaved from C3 complement with the help of the enzyme C3- convertase. It binds to the cell surface of the offending substance and opsonizes it. This makes it easy for the phagocytes to detect and eliminate them.
IgM does not act as an opsonin but igG does.
Selectins aid leukocytes to bind to the endothelial surfaces.
C5a is a chemo-attractant and histamine a vasodilator.
NADPH oxidises offending substance after phagocytosis within the macrophage.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 110
Incorrect
-
During uterogrowth, the second pharyngeal arch gives rise to which structures?
Your Answer: Incus
Correct Answer: Stylohyoid muscle
Explanation:The second pharyngeal arch or hyoid arch, is the second of six pharyngeal arches that develops in fetal life during the fourth week of development and assists in forming the side and front of the neck. Derivatives:
Skeletal – From the cartilage of the second arch arises:
Stapes,
Temporal styloid process,
Stylohyoid ligament, and
Lesser cornu of the hyoid bone.
Muscles:
Muscles of face
Occipitofrontalis muscle
Platysma
Stylohyoid muscle
Posterior belly of Digastric
Stapedius muscle
Auricular muscles
Nerve supply: Facial nerve
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 111
Incorrect
-
A 36-year old gentleman with a history of cough for 4 weeks came to the hospital. Examination revealed multiple lymphadenopathy with splenomegaly. Investigations revealed haemoglobin 11 g/dl, haematocrit 32.4%, mean corpuscular volume (MCV) 93 fl, white blood cell count 63 × 109/l, and platelet count 39 × 109/l; along with characteristic Auer rods on peripheral blood smear. What is the likely diagnosis?
Your Answer: Acute lymphoblastic leukaemia (ALL)
Correct Answer: Acute myelogenous leukaemia (AML)
Explanation:AML, or acute myeloid leukaemia is the commonest acute leukaemia affecting adults. increasing in incidence with age. It is a malignancy of the myeloid line of white blood cells. It results in rapid proliferation of abnormal cells, which accumulate in the marrow. Interference with normal cell production leads to a drop in red blood cells, white blood cells and platelets. This causes symptoms such as tiredness, shortness of breath, tendency to bleed or bruise easily and recurrent infections. AML is known to progress quickly and can lead to death in weeks and months if not treated. Leukemic blasts of AML show presence of Auer rods. These are clumps of azurophilic granular material that form needles in the cytoplasm. Composed of fused lysosomes, these contain peroxidase, lysosomal enzymes and crystalline inclusions. Auer rods are classically present in myeloid blasts of M1, M2, M3 and M4 acute leukaemia. They also help to distinguish the preleukemia myelodysplastic syndromes.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 112
Correct
-
Lung compliance is increased by:
Your Answer: Emphysema
Explanation:Lung compliance is increased by emphysema, acute asthma and increasing age and decreased by alveolar oedema, pulmonary hypertension, atelectasis and pulmonary fibrosis.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 113
Incorrect
-
A 45-year-old man complains of shortness of breath, cough and chest pain. Chest X ray revealed a perihilar mass with bronchiectasis in the left mid-lung. Which of the following is most probably associated with these findings?
Your Answer: Large-cell undifferentiated carcinoma
Correct Answer: Bronchial carcinoid
Explanation:Bronchial carcinoids are neuroendocrine tumours that arise from Kulchitsky’s cells of the bronchial epithelium. Kulchitsky’s cells belong to the diffuse endocrine system. Patients affected by this tumour may be asymptomatic or may present with symptoms of airway obstruction, like dyspnoea, wheezing, and cough. Other common findings are recurrent pneumonia, haemoptysis, chest pain and paraneoplastic syndromes. Chest radiographs are abnormal in the majority of cases. Peripheral carcinoids usually present as a solitary pulmonary nodule. For central lesions common findings include hilar or perihilar masses with or without atelectasis, bronchiectasis, or consolidation. Bronchial carcinoids most commonly arise in the large bronchi causing obstruction.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 114
Incorrect
-
During pregnancy the uterus enlarges however after delivery it regresses to its original size. Which of the following organelles is responsible for this regression?
Your Answer: Centrioles
Correct Answer: Lysosomes
Explanation:Lysosomes are formed by budding of the Golgi apparatus and contain enzymes which digest macromolecules. They are found in both plants and animals and are active in autophagic cell death, digestion after phagocytosis and for the cells own recycling process. They fuse with the molecules and release their content resulting in digestion.
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This question is part of the following fields:
- General
- Physiology
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Question 115
Incorrect
-
A child presents with hypertension. Serum potassium analysis shows hypokalaemia. What is the most likely diagnosis?
Your Answer: Hyperglycaemia
Correct Answer: Liddle syndrome
Explanation:Liddle’s syndrome,  is an autosomal dominant disorder, that is characterized by early, and frequently severe, high blood pressure associated with low plasma renin activity, metabolic alkalosis, low blood potassium, and normal to low levels of aldosterone. Liddle syndrome involves abnormal kidney function, with excess reabsorption of sodium and loss of potassium from the renal tubule. Bartter Syndrome also presents with hypokalaemia, however blood pressure of these patients is usually low or normal.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 116
Incorrect
-
A young female in the 15th week of pregnancy presented to the emergency department with the passage of grape-like masses per vagina. Dilatation and curettage was done and microscopy revealed large avascular villi with trophoblastic proliferation. Which one of the following investigations is best recommended for her follow-up?
Your Answer: Endometrial biopsy
Correct Answer: Serum β-hCG
Explanation:Trophoblast is the layer of cells surrounding the blastocyst and that later develops into the chorion and amnion. Gestational trophoblastic disease is a tumour arising from this trophoblast. It can occur during or after either an intrauterine or ectopic pregnancy. If it occurs in a pregnant woman, it usually leads to spontaneous abortion, eclampsia or fetal death. It can be either malignant or benign.
In suspected cases, investigations include measurement of serum beta subunit of human chorionic gonadotrophin (β-hCG) and pelvic ultrasound. Confirmatory test is a biopsy. Post-removal, the disease is classified clinically to assess further treatment. To assess the presence of metastases, further work-up includes computed tomography of the brain, chest, abdomen and pelvis. Chemotherapy is usually needed for persistent disease. If at least three consecutive, weekly serum β-hCG measurements are normal, treatment is considered successful. Follow-up is also done by measuring β-hCG.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 117
Incorrect
-
When exposing the right saphenofemoral junction for flush-ligation of the saphenous vein, which of the following is the most likely to be seen passing through this opening?
Your Answer: Saphenous nerve
Correct Answer: Superficial external pudendal artery
Explanation:The saphenous opening is an oval opening in the fascia lata. It is covered by the cribriform fascia and It is so called because it is perforated by the great saphenous vein and by numerous blood and lymphatic vessels and the superficial external pudendal artery pierces it.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 118
Incorrect
-
What is the normal amount of oxygen that is carried in the blood?
Your Answer: 40 ml oxygen/100 ml blood
Correct Answer: 20 ml oxygen/100 ml blood
Explanation:Normally, 100 ml of blood contains 15g haemoglobin and a single gram of haemoglobin can bind to 1.34 ml oxygen when 100% saturated. Thus, 15 × 1.34 = 20 ml O2/100 ml blood. The haemoglobin in venous blood that is leaving the tissues is about 75% saturated with oxygen, and hence it carries about 15 ml O2/100 ml venous blood. This implies that for each 10 ml of blood, 5 ml oxygen is transported to the tissues. With a p(O2) > 100 mm Hg, only 3 ml of oxygen is dissolved in every one litre of plasma. By increasing the pA(O2) by breathing 100% oxygen, one can add an extra amount of oxygen in the plasma, but the amount of oxygen carried by haemoglobin will not increase significantly as it is already > 95% saturated.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 119
Incorrect
-
Following nerve injury, paralysis of the quadriceps femoris muscle occurs. Which of the following movements will be affected?
Your Answer: Flexion of the leg
Correct Answer: Extension of the leg
Explanation:The quadriceps muscle is a great extensor of the thigh. Therefore, following nerve injury or cutting nerve supply to the quadriceps will affect extension of the thigh
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 120
Incorrect
-
A 45 year-old male, with behavioural changes developed euvolemic hyponatraemia. Which of the following conditions most likely predisposed the patient to develop euvolemic hyponatraemia?
Your Answer: Diuretic therapy
Correct Answer: Psychosis
Explanation:In euvolemic hyponatraemia, there is volume expansion in the body, there is no oedema, but hyponatremia occurs. Causes include: state of severe pain or nausea, psychosis, brain trauma, SIADH, hypothyroidism and glucocorticoid deficiency.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 121
Incorrect
-
A patient with Paget's disease of the bone is predisposed to developing which type of cancer?
Your Answer: Giant-cell tumour
Correct Answer: Osteosarcoma
Explanation:Paget’s disease of bone (PDB) is a focal disorder of bone. It is presumed benign in nature and mediated by abnormal osteoclast function. However osteosarcomas may occur in <1% of patients with Paget's disease of the bone. Osteosarcomas are osteogenic in origin, and consistently arise in sites of pagetic bone. This is not to be confused with Paget's disease of the breast.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 122
Incorrect
-
What is the role of factor VII in coagulation?
Your Answer: Is produced by platelets
Correct Answer: Initiates the process of coagulation in conjunction with tissue factor
Explanation:The main role of factor VII is to initiate the process of coagulation along with tissue factor (TF). TF is found in the blood vessels and is not normally exposed to the bloodstream. When a vessel is injured tissue factor is exposed to blood and circulating factor VII. Factor VII is converted to VIIa by TF.
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This question is part of the following fields:
- General
- Physiology
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Question 123
Incorrect
-
A 15-day old baby was brought to the emergency department with constipation for 4 days. On examination, the abdomen of the baby was found to be distended and tender all over. No bowel sounds were heard. A sigmoid colon biopsy was carried out, which showed absent ganglion cells. What is the diagnosis?
Your Answer: Cystic fibrosis
Correct Answer: Hirschsprung’s disease
Explanation:Hirschsprung’s disease is characterized by congenital absence of the autonomic plexus (Meissner’s and Auerbach’s plexus) in the intestinal wall. Usually limited to the distal colon, it can occasionally involve the entire colon or even the small bowel. There is abnormal or absent peristalsis in the affected segment, resulting in continuous spasm of smooth muscle and partial/complete obstruction. This causes accumulation of intestinal contents and dilatation of proximal segment. Skip lesions are highly uncommon. This disease is seen early in life with 15% patients presenting in first month, 60% by 1 year of age and 85% by the age of 4 years. Symptoms include severe and complete constipation, abdominal distension and vomiting. Patients with involvement of ultra-short segments might have mild constipation with intervening diarrhoea. In older children, symptoms include failure to thrive, anorexia, and lack of an urge to defecate. On examination, an empty rectum is revealed with stool palpable high up in the colon. If not diagnosed in time, it can lead to Hirschsprung’s enterocolitis (toxic megacolon), which can be fulminant and lead to death. Diagnosis involves a barium enema or a rectal suction biopsy. Barium enema shows a transition in diameter between the dilated, normal colon proximal to the narrowed, affected distal segment. It is to be noted that barium enema should be done without prior preparation, which can dilate the abnormal segment, leading to a false-negative result. A 24-hour post-evacuation film can be obtained in the neonatal period – if the colon is still filled with barium, there is a high likelihood of Hirschsprung’s disease. Full-thickness rectal biopsy is diagnostic by showing the absence of ganglion cells. Acetylcholinesterase staining can be done to highlight the enlarged nerve trunks. Abnormal innervation can also be demonstrated by rectal manometry.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 124
Incorrect
-
A 76-year-old man with a urinary tract obstruction due to prostatic hyperplasia develops acute renal failure. Which of the following physiological abnormalities of acute renal failure will be most life threatening for this patient?
Your Answer: Raised serum urea level
Correct Answer: Acidosis
Explanation:Acute renal failure (ARF) is a rapid loss of renal function due to damage to the kidneys, resulting in retention of nitrogenous (urea and creatinine) and non-nitrogenous waste products that are normally excreted by the kidney. This accumulation may be accompanied by metabolic disturbances, such as metabolic acidosis and hyperkalaemia, changes in body fluid balance and effects on many other organ systems. Metabolic acidosis and hyperkalaemia are the two most serious biochemical manifestations of acute renal failure and may require medical treatment with sodium bicarbonate administration and antihyperkalaemic measures. If not appropriately treated these can be life-threatening. ARF is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient amounts of urine.
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This question is part of the following fields:
- Physiology
- Renal
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Question 125
Incorrect
-
Increased resistance to flow of blood in cerebral vessels is most likely seen in:
Your Answer: Epileptic seizure
Correct Answer: Elevation in systemic arterial pressure from 100 to 130 mmHg
Explanation:Constant cerebral blood flow is maintained by autoregulation in the brain, which causes an increase in local vascular resistance to offset an increase in blood pressure. There will be an increase in cerebral blood flow (and decrease in resistance to cerebral blood flow) with a decrease in arterial oxygen or an increase in arterial CO2. Similarly, a decrease in viscosity will also increase the blood flow. Due to increased brain metabolism and activity during a seizure, there will also be an increase in the cerebral blood flow.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 126
Correct
-
A Jewish man was diagnosed with haemophilia C. Which of the following factors is deficient in this form of haemophilia?
Your Answer: Factor XI
Explanation:Haemophilia C, also known as plasma thromboplastin antecedent (PTA) deficiency or Rosenthal syndrome, is a condition caused by the deficiency of the coagulation factor XI. The condition is rare and it is usually found in Ashkenazi Jews.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 127
Incorrect
-
Which of the following is a true statement regarding secretion of gastric acid?
Your Answer: Gastrin reduces gastric acid secretion
Correct Answer: Acetylcholine increases gastric acid secretion
Explanation:Gastric acid secretion is increased by acetylcholine, histamine and gastrin, with the help of cAMP as a secondary messenger. They increase H+ and Cl- secretion by increasing the number of H+/K+ ATPase molecules and Cl- channels. In contrast, gastric acid secretion is decreased by somatostatin, epidermal growth factor and prostaglandins.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 128
Incorrect
-
The petrous part of the internal carotid artery is located inside of which cranial bone?
Your Answer: Frontal
Correct Answer: Temporal
Explanation:The petrous segment, or C2, of the internal carotid is that which is inside the petrous part of the temporal bone. This segment extends until the foramen lacerum. The petrous portion classically has three sections: an ascending, or vertical portion; the genu, or bend; and the horizontal portion.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 129
Incorrect
-
A correct statement about the RECTUM:
Your Answer: Its smooth muscle is innervated by somatic nerves
Correct Answer: It is an important anastomotic site for the portal and caval (systemic) venous systems
Explanation:The rectum is part of the gastrointestinal tract that is continuous above with the sigmoid colon and below with the anal canal. It contains both longitudinal and circular smooth muscles. These are supplied by the enteric nervous system. It is about 12 cm long. It has no sacculations comparable with those of the colon. It has three permanent transverse folds called the valves of Houston. The peritoneum is related to the upper two thirds of the rectum only whereas the lower part is not covered by peritoneum. It is supplied by the superior rectal (hemorrhoidal) branch of the inferior mesenteric artery and the median sacral artery that is a direct branch from the abdominal aorta. It is drained by veins that begin as a plexus that surround the anus. These veins form anastomoses with the portal system (portocaval anastomoses).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 130
Incorrect
-
A 7-year old child from a rural setting complains of recurrent abdominal pain. The child is found to have a heavy parasitic infestation and anaemia. Which type of anaemia is most likely seen in this patient?
Your Answer: Folic acid deficiency anaemia
Correct Answer: Iron deficiency anaemia
Explanation:The most common cause of iron deficiency anaemia in children in developing countries is parasitic infection (hookworm, amoebiasis, schistosomiasis and whipworm).
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 131
Correct
-
Which of the following chemotherapy regimens is most likely to be used in colorectal cancer?
Your Answer: FOLFOX
Explanation:Chemotherapy regimens are often identified by acronyms, identifying the agents used in the drug combination. However, the letters used are not consistent across regimens. FOLFOX is a chemotherapy regimen used for the treatment of colorectal cancer, made up of the following drugs: • FOL: fluorouracil (5-fluorouracil or 5-FU) • F: folinic acid (leucovorin) • OX: oxaliplatin (Eloxatin®).
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 132
Incorrect
-
An alcoholic patient was found to have hypomagnesaemia on blood tests. Which of the following clinical features will have prompted the doctor to check the serum magnesium level in this patient?
Your Answer: Dizziness
Correct Answer: Seizures
Explanation:Hypomagnesaemia is a condition characterised by a low level of magnesium in the blood. The normal range for serum magnesium level is 0.75-1.05 mmol/l. In hypomagnesaemia serum levels of magnesium are less than 0.75 mmol/l. The cardiovascular and nervous systems are the most commonly affected. Neuromuscular manifestations include symptoms like tremor, tetany, weakness, apathy, delirium, a positive Chvostek and Trousseau sign, nystagmus and seizures. Cardiovascular manifestations include electrocardiographic abnormalities and arrhythmias e.g. ventricular fibrillation.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 133
Correct
-
A space defined by the teres major muscle, the teres minor muscle, long head of the triceps brachii muscle and surgical neck of the humerus contains the axillary nerve and the?
Your Answer: Posterior circumflex humeral artery
Explanation:This quadrangular space transmits the posterior circumflex humeral vessels and the axillary nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 134
Incorrect
-
Calculate the stroke volume in an adult male with the following parameters:
Heart rate 70 beats/min
Arterial [O2] 0.24 ml O2/min
Venous [O2] 0.16 ml O2/mi
Whole body O2 consumption 500 ml/min
Pulmonary diastolic pressure 15 mmHg
Pulmonary systolic pressure 25 mmHg
Wedge pressure 5 mmHg.Your Answer: 80 ml
Correct Answer: 90 ml
Explanation:Fick’s principle states that, VO2 = (CO × CAO2) – (CO × CVO2) where VO2 = oxygen consumption, CO = cardiac output, CAO2 = oxygen concentration of arterial blood and CVO2 = oxygen concentration of venous blood. Thus, CO = VO2/CAO2– CVO2, CO = 500/0.24–0.16, CO = 500/0.8, CO = 6.25 l/min. Cardiac output is also given by product of stroke volume and heart rate. Thus, stroke volume = cardiac output / heart rate = 6.25/70 × 1000 stroke volume = 90 ml approximately.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 135
Incorrect
-
A 45 year old lady has been diagnosed with Friedreich's ataxia that has affected her medial group of nuclei in the anterior horn of the spinal cord. Which of the following structures will have their muscles affected?
Your Answer: Forearm
Correct Answer: Axial muscles
Explanation:The cells in the anterior horn can be arranged in the following three main groups: medial, lateral and central. The medial group of nuclei in the anterior horn of the spinal cord are located along the entire length of the spinal cord and are responsible for the innervation of the axial muscles of the body ( muscles of the head and neck region). Thus this disease will most likely affect the functioning of the muscles of the head and neck.
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This question is part of the following fields:
- Anatomy
- Neurology
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Question 136
Correct
-
Which among the following vertebrae marks the lowest extent of the superior mediastinum?
Your Answer: Fourth thoracic
Explanation:The superior mediastinum lies between the manubrium anteriorly and the upper vertebrae of the thorax posteriorly. Below, it is bound by a slightly oblique plane that passes backward from the sternal angle to the lower part of the body of T4 and laterally by the pleura.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 137
Incorrect
-
A 32-year-old man presented with a metabolic acidosis and increased anion gap. What is the most likely cause of the changes of the anion gap in this patient?
Your Answer: Hypergammaglobulinemia
Correct Answer: Lactic acidosis
Explanation:High anion gap in metabolic acidosis is caused generally by the elevation of the levels of acids like ketones, lactate, sulphates in the body, which consume the bicarbonate ions. Other causes of a high anion gap include overdosing on salicylates, uraemia, rhabdomyolysis, hypocalcaemia, hypomagnesaemia, or ingestion of toxins such as ethylene glycol, methanol, propyl alcohol, cyanide and iron.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 138
Correct
-
Which tumour site is more commonly involved in adults than in children?
Your Answer: Lung
Explanation:In adults, the most common primary site of tumour is in the lungs, compared to children wherein the most common primary site is the blood.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 139
Incorrect
-
Thalamic syndrome will most likely result in:
Your Answer: Increased sexual drive
Correct Answer: Hyperaesthesia
Explanation:Signs and symptoms of thalamic syndrome include contralateral hemi anaesthesia, burning or aching sensation in one half of a body (hyperaesthesia), often accompanied by mood swings.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 140
Incorrect
-
Urine specific gravity allows the assessment of which of the following renal functions?
Your Answer: Secretion
Correct 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 141
Incorrect
-
A syndrome responsible for failure to absorb vitamin B12 from the GIT is called?
Your Answer: Erythraemia
Correct Answer: Pernicious anaemia
Explanation:Pernicious anaemia is a type of autoimmune disease in which antibodies form against the parietal cells or intrinsic factor. Intrinsic factor is required for the absorption of vitamin B12. Blood testing typically shows a macrocytic, normochromic anaemia and low levels of serum vitamin B12. A Schilling test can then be used to distinguish between pernicious anaemia, vitamin B12 malabsorption and vitamin B12 deficiency. Symptoms include shortness of breath, pallor and diarrhoea etc.
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This question is part of the following fields:
- General
- Physiology
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Question 142
Incorrect
-
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: Ulnar nerve
Correct 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 143
Incorrect
-
The blood investigations of a 30-year old man with jaundice revealed the following : total bilirubin 6.5 mg/dl, direct bilirubin 1.1 mg/dl, indirect bilirubin 5.4 mg/dl and haemoglobin 7.3 mg/dl. What is the most likely diagnosis out of the following?
Your Answer: Pancreatitis
Correct Answer: Haemolysis
Explanation:Hyperbilirubinemia can be caused due to increased bilirubin production, decreased liver uptake or conjugation, or decreased biliary excretion. Normal bilirubin level is less than 1.2 mg/dl (<20 μmol/l), with most of it unconjugated. Elevated unconjugated bilirubin (indirect bilirubin fraction >85%) can occur due to haemolysis (increased bilirubin production) or defective liver uptake/conjugation (Gilbert syndrome). Such increases are less than five-fold usually (<6 mg/dl or <100 μmol/l) unless there is coexistent liver disease.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 144
Incorrect
-
A 60-year old man with a left-sided indirect inguinal hernia underwent emergency surgery to relieve large bowel obstruction resulting from a segment of the bowel being strangulated in the hernial sac. The most likely intestinal segment involved is:
Your Answer: Ascending colon
Correct Answer: Sigmoid colon
Explanation:The sigmoid colon is the most likely segment involved as it is mobile due to the presence of the sigmoid mesocolon. The descending colon, although on the left side, is a bit superior and is also retroperitoneal. The ascending colon and caecum are on the right side of the abdomen. The rectum is too inferior to enter the deep inguinal ring and the transverse colon is too superior to be involved.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 145
Incorrect
-
Where does the ejaculatory duct open into?
Your Answer: Membranous urethra
Correct Answer: Prostatic urethra
Explanation:There are two ejaculatory ducts, one on either side of the midline. Each ejaculatory duct is formed by the union of the duct from the seminal vesicles with the ductus deferens. They start at the base of the prostate and run forward and downward between the middle and lateral lobes and along the side of the prostatic utricle to end in the prostatic urethra.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 146
Incorrect
-
The superior ulnar collateral artery is a direct branch of this artery:
Your Answer: Radial
Correct Answer: Brachial
Explanation:The brachial artery gives rise to a small branch at the middle of the arm, which is the superior collateral artery. It descends accompanied by the ulnar nerve and anastomoses with the posterior ulnar recurrent and inferior ulnar collateral.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 147
Incorrect
-
The superior rectal artery is a continuation of the:
Your Answer: Superior mesenteric artery
Correct Answer: Inferior mesenteric artery
Explanation:The superior rectal artery or superior haemorrhoidal artery is the continuation of the inferior mesenteric artery. It descends into the pelvis between the layers of the mesentery of the sigmoid colon, crossing the left common iliac artery and vein.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 148
Incorrect
-
In the kidney, the macula densa is an area of closely packed specialized cells lining the wall of the:
Your Answer: Afferent arteriole
Correct Answer: Distal convoluted tubule
Explanation:In the kidney, the macula densa is an area of closely packed specialised cells lining the region of the distal convoluted tubule (DCT) lying next to the glomerular vascular pole. The cells of the macula densa are sensitive to the ionic content and water volume of the fluid in the DCT, producing signals that promote renin secretion by other cells of the juxtaglomerular apparatus.
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This question is part of the following fields:
- Physiology
- Renal
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Question 149
Incorrect
-
An 18 -year-old female is diagnosed with folliculitis in the left axilla. What is the most likely organism that could cause this condition?
Your Answer: Clostridium tetani
Correct Answer: Staphylococcus aureus
Explanation:Folliculitis is the inflammation of the hair follicles. It is usually caused by Staphylococcus infection.
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 150
Incorrect
-
Which of the following structures, is the area in which the superior cerebral veins drain into?
Your Answer: Great cerebral vein
Correct Answer: Superior sagittal sinus
Explanation:The superior cerebral veins are predominantly located on the superior aspect of the brain. They are 8 to 12 in number and they drain the lateral, medial and superior aspects of the cerebral hemispheres.
These veins drain into the superior sagittal sinus, also known as the superior longitudinal sinus – which is located along the attached margin of the falx cerebri.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 151
Incorrect
-
A 25 year old male patient who had sustained a stab wound in the middle of the posterior aspect of the left thigh, was discharged from hospital after dressing and antibiotic prophylaxis. Later on the patient developed bleeding through the wound and upon review, the source was discovered to be an artery that is the direct source of the medial and lateral circumflex arteries. Which is this artery that was injured?
Your Answer: Obturator artery
Correct Answer: Profunda femoris artery
Explanation:The medial and lateral circumflex arteries are direct branches of the Profunda femoris artery otherwise also known as the deep artery of the thigh. The Profunda femoris artery arises from the femoral artery just below the inguinal ligament (approximately 2-5cm below it).
The following are the branches of the deep artery of the thigh:
Lateral circumflex femoral artery
Medial circumflex femoral artery
Perforating arteries
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 152
Correct
-
Which of these laboratory findings will indicate a fetal neural tube defect when done between 15 and 20 weeks of pregnancy?
Your Answer: Increased alpha-fetoprotein
Explanation:Maternal serum screening during the second trimester is a non-invasive way of identifying women at increased risk of having children with a neural tube defect and should be offered to all pregnant women. The results are most accurate when the sample is taken between 15 and 20 weeks of gestation. Elevated levels of alpha-fetoprotein suggest open spina bifida, anencephaly, risk of pregnancy complications, or multiple pregnancy.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 153
Incorrect
-
A medical student is told a substance is freely filtered but is not metabolised, secreted, or stored in the kidney. It has a plasma concentration of 1000 mg/l and its urine excretion rate is 25 mg/min, and the inulin clearance is 100 ml/min. What is the rate of tubular reabsorption of the substance?
Your Answer: 25 mg/min
Correct Answer: 75 mg/min
Explanation:Reabsorption or tubular reabsorption is the process by which the nephron removes water and solutes from the tubular fluid (pre-urine) and returns them to the circulating blood. To calculate the reabsorption rate of substance Z we use the following equation: excretion = (filtration + secretion) – reabsorption. As this substance is freely filtered, its filtration rate is equal to that of inulin. So 25 = (100 + 0) – reabsorption. Reabsorption = 100 – 25 therefore reabsorption = 75 mg/min.
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This question is part of the following fields:
- Physiology
- Renal
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Question 154
Correct
-
Which of the following structures is derived from the dorsal mesogastrium of the stomach during the development of the gut?
Your Answer: Greater omentum
Explanation:In a developing foetus, the stomach has two mesogastria from which most of the abdominal ligaments develop. These two mesogastria are the; ventral mesogastrium and the dorsal mesogastrium. During the embryological development of the gut, different organs develop in each mesogastrium; the spleen and pancreas in the dorsal mesogastrium while the liver in the ventral mesogastrium (with their associated ligaments). In the dorsal mesogastrium the following structures develop; the greater omentum (containing the gastrophrenic ligament and the gastrocolic ligament), gastrosplenic ligament, mesentery, splenorenal ligament and phrenicocolic ligament. The structures that develop from the ventral mesogastrium include the; lesser omentum (containing the hepatoduodenal ligament and the hepatogastric ligament) in association with the liver; the coronary ligament (left triangular ligament, right triangular ligament and hepatorenal ligament) and the falciform ligament (round ligament of liver and ligamentum venosum within).
There are also folds that develop from the dorsal mesogastrium which include; umbilical folds, supravesical fossa, medial inguinal fossa, lateral umbilical fold, lateral inguinal fossa and Ileocecal fold.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 155
Incorrect
-
Which of the following structures carry part of the right bundle branch of the AV bundle?
Your Answer: Pectinate muscles
Correct Answer: Moderator band (septomarginal trabecula)
Explanation:The moderator band extends from the base of the anterior papillary muscle to the ventricular septum. It is the structure which carries part of the right AV bundle. Its role it to prevent overdistention of the ventricle.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 156
Incorrect
-
The most likely cause of a low p(O2) in arterial blood is:
Your Answer: Anaemic hypoxia
Correct Answer: Hypoxic hypoxia
Explanation:Hypoxia is when the whole body or a region is deprived of adequate oxygen supply. Different types of hypoxia include the following:
– Hypoxic hypoxia, which occurs due to poor oxygen supply, as a result of low partial pressure of oxygen in arterial blood. This could be due to low partial pressure of atmospheric oxygen (e.g., at high altitude), sleep apnoea, poor ventilation because of chronic obstructive pulmonary disease or respiratory arrest, or shunts. The other types of hypoxia have a normal partial pressure of oxygen.
– Anaemic hypoxia occurs due to low total oxygen content of the blood, with a normal arterial oxygen pressure.
– Hyperaemic hypoxia occurs due to poor delivery of oxygen to target tissues, such as in carbon monoxide poisoning or methemoglobinemia.
– Histotoxic hypoxia results due to inability of the cells to use the delivered oxygen due to disabled oxidative phosphorylation enzymes.
– Ischaemic (or stagnant) hypoxia occurs due to local flow restriction of well-oxygenated blood, seen in cases like cerebral ischaemia, ischaemic heart disease and intrauterine hypoxia.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 157
Incorrect
-
A 42 year old man with an abdominal aortic aneurysm (AAA) underwent an abdominal aortic angiography which revealed that his inferior mesenteric artery was occluded. If this patient showed no symptoms, the most likely reason is that the area the inferior mesenteric artery supplies, must be supplied by collateral blood flow from which arteries?
Your Answer: Right and middle colic
Correct Answer: Left and middle colic
Explanation:The arterial branches that form an anastomosis between the superior mesenteric artery and the inferior mesenteric artery are the left colic artery and the middle colic artery. The middle colic artery is the most distal branch of the superior mesenteric artery while the left colic forms the most proximal branch of the inferior mesenteric artery. These two arteries will give collateral blood flow in the case that the inferior mesenteric artery gets occluded. The superior mesenteric artery gives off the following branches; ileocolic, appendicular, ileal artery, right colic and middle colic arteries. The left colic, sigmoid and superior rectal arteries are branches of the inferior mesenteric artery. The marginal artery branches off directly from the abdominal aorta.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 158
Incorrect
-
Normally, the O2 transfer in the lungs from alveolar to capillary is perfusion-limited. In which of the following situations does it become a diffusion-limited process?
Your Answer: Increased ventilatory rate
Correct Answer: Pulmonary oedema
Explanation:Normally, the transfer of oxygen from air spaces to blood takes place across the alveolar-capillary membrane by simple diffusion and depends entirely on the amount of blood flow (perfusion-limited process). Diseases that affect this diffusion will transform the normal process to a diffusion limited process. Thus, the diseases which cause a thickened barrier (such as pulmonary oedema due to increased extravascular lung water or asbestosis) will limit the diffusion of oxygen. Chronic obstructive lung diseases will have little effect on diffusion. Inhaling hyperbaric gas mixtures might overcome the diffusion limitation in patients with mild asbestosis or interstitial oedema, by increasing the driving force. Strenuous (not mild) exercise might also favour diffusion limitation and decrease passage time. Increasing the rate of ventilation will not have this affect but will only maintain a high oxygen gradient from air to blood.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 159
Incorrect
-
A 30 year old lawyer presented with a history of pleural effusions, pericarditis, arthralgia without joint deformity and episodes of myalgia for the past 12 months. Blood tests reveal a normocytic anaemia. Which of the following tests should be performed to investigate this condition further?
Your Answer: Bone marrow biopsy
Correct Answer: Antinuclear antibody test
Explanation:These non specific findings are suggestive of autoimmune disease. Antinuclear antibody (ANA) is the first test that should be performed when autoimmune diseases are suspected and later on more specific tests should be performed. This tests aids in the diagnosis of SLE, scleroderma, Sjogren’s syndrome, Raynaud’s disease, juvenile chronic arthritis, rheumatoid arthritis and antiphospholipid antibody syndrome etc. To confirm the disease a history, physical examination along with specific tests are required.
CPK is more specific for acute conditions.
ESR is a non specific test for inflammation.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 160
Incorrect
-
Which of the following is most likely to cause hypovolaemic hypernatremia:
Your Answer: Nephrogenic diabetes insipidus
Correct Answer: Hyperalimentation
Explanation:Hypernatremia, characterised by a high serum sodium concentration, is rarely associated with volume overload (hypervolemia). A hypovolaemic hypernatremia may be seen during excessive administration of hypertonic sodium bicarbonate, hypertonic saline or hyperalimentation.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 161
Incorrect
-
Following an accident, a man was unable to extend the wrist and metacarpophalangeal joints, despite sensation being intact. Which nerve was likely damaged?
Your Answer: Median nerve
Correct Answer: Posterior interosseous nerve
Explanation:The posterior interosseous nerve which causes, what is known as the posterior interosseous nerve syndrome. The nerve is compressed before it bifurcates to form the medial and lateral branches. The compression is beyond the origin of the branches to the radial wrist extensors and the radial sensory nerve. The result of such a case is paralysis of the digital extensors and the extensor carpi ulnaris, resulting in dorsoradial deviation of the wrist.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 162
Incorrect
-
A 29-year-old pregnant woman develops severe hypoxaemia with petechial rash and confusion following a fracture to her left femur. Which is the most probable cause of these symptoms in this patient?
Your Answer: Anaphylaxis
Correct Answer: Fat embolism
Explanation:Fat embolism is a life-threatening form of embolism in which the embolus consists of fatty material or bone marrow particles that are introduced into the systemic venous system. It may be caused by long-bone fractures, orthopaedic procedures, sickle cell crisis, parenteral lipid infusion, burns and acute pancreatitis. Patients with fat embolism usually present with symptoms that include skin, brain, and lung dysfunction.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 163
Incorrect
-
A surgeon performing a laparoscopic repair of an inguinal hernia visualizes a loop of bowel protruding through the abdominal wall to form a direct inguinal hernia. When this is viewed from the side of the abdomen with a laparoscope, in which region would the hernial sac be?
Your Answer: Deep inguinal ring
Correct Answer: Medial inguinal fossa
Explanation:In a direct inguinal hernia, visceral contents exit the abdomen through a weak point in the fascia in the medial inguinal fossa i.e. the area between the medial and lateral umbilical folds. Such a hernia doesn’t pass through the deep inguinal ring or the lateral inguinal fossa. Note that direct hernias can go through the superficial inguinal ring, although rarely. The supravesical fossa, between the median and medial umbilical folds, is formed by a peritoneal reflection from the anterior abdominal wall onto the bladder and the retrovesical fossa is the region behind the urinary bladder.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 164
Correct
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The mandibular nerve, which is the largest of the 3 divisions of the trigeminal nerve, exits the cranial cavity through which foramen?
Your Answer: Foramen ovale
Explanation:At the base of the skull the foramen ovale is one of the larger of the several holes that transmit nerves through the skull. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery, lesser petrosal nerve, a branch of the glossopharyngeal nerve, emissary vein connecting the cavernous sinus with the pterygoid plexus of veins and occasionally the anterior trunk of the middle meningeal vein.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 165
Correct
-
The circle of Willis is an arterial anastomosis in the base of the brain and is one of the cerebrovascular safeguards in the brain. Where is the circle of Willis contained?
Your Answer: Cisterna basalis
Explanation:Cisterns refers to a system of intercommunicating pools formed by the subarachnoid space at the base of the brain and around the brainstem. Cisterna basalis/basal cistern (interpeduncular cistern) is found at the base of the brain between the two temporal lobes and it contains the arterial circle of Willis. The lumbar cistern is contained in the spinal canal while the foramen magna refers to the opening at the base of the skull though which the spinal cord enters into the skull.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 166
Incorrect
-
What best describes the muscles of the posterior compartment of the leg?
Your Answer: All pass deep to the extensor retinaculum
Correct Answer: One of the posterior compartment leg muscles laterally rotates the femur
Explanation:The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris and are the chief extensors of the foot at the ankle joint. Deep muscles include the tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 167
Incorrect
-
13 year old girl developed sun burnt cheeks after spending the day playing on the beach. What is the underlying mechanism to her injury?
Your Answer: Antigen–antibody reaction
Correct Answer: Free radical injury
Explanation:Free radicals are a by-product of chemical reactions with an unpaired electron in their outer most shell. They are capable of causing wide spread damage to cells. They can cause autolytic reactions thereby converting the reactants into free radicals. By absorbing sun light, the energy is used to hydrolyse water into hydroxyl (OH) and hydrogen (H) free radicals which can cause injury by lipid peroxidation of membranes, oxidative modification of proteins and damage to the DNA structure.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Dermatology
- Pathology
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Question 168
Incorrect
-
A 38-year old woman presents to the clinic with a 2 cm eczema-like lesion on the areolar region of her left breast, for 5 months. Biopsy of the lesion showed large cells at the dermal-epidermal junction with positive staining for mucin. What is the likely diagnosis?
Your Answer: Nipple discharge
Correct Answer: Paget’s disease of the breast
Explanation:Paget’s disease of the breast or nipple resembles eczema in appearance with an underlying carcinoma typically. The disease is usually unilateral and presents with inflammation, oozing and crusting along with a non-healing ulcer. Treatment is often delayed due to the innocuous appearance but can be fatal. It results due to spread of neoplastic cells from the ducts of the mammary gland to the epithelium.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 169
Incorrect
-
Which of the following is responsible for the maximum increase in total peripheral resistance on sympathetic stimulation?
Your Answer: Both arteries and veins
Correct Answer: Arterioles
Explanation:Arterioles are also known as the resistance vessels as they are responsible for approximately half the resistance of the entire systemic circulation. They are richly innervated by the autonomic nervous system and hence, will bring about the maximum increase in peripheral resistance on sympathetic stimulation.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 170
Incorrect
-
The gluteus medius muscle:
Your Answer: Extends the thigh at the hip joint
Correct Answer: Is supplied by the superior gluteal nerve
Explanation:The gluteus medius is situated on the outer surface of the pelvis. It arises from the outer surface of the ilium between the iliac crest and posterior gluteal line above and the anterior gluteal line below. The gluteus medius is supplied by the fourth and fifth lumbar and first sacral nerves through the superior gluteal nerve
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 171
Correct
-
A 41 year old women presents with a history of carcinoma involving the right breast with enlarged axillary nodes on the same side. She underwent mastectomy and axillary node clearance. These were sent for histopathological examination. They showed no signs of metastasis. What could be cause of this enlargement in the lymph nodes?
Your Answer: Sinus histiocytosis
Explanation:Sinus histiocytosis also referred to as reticular hyperplasia, refers to the enlargement, distention and prominence of the sinusoids of the lymph nodes. This is a non-specific form of hyperplasia characteristically seen in lymph nodes that drain tumours. The endothelial lining of the lymph node becomes markedly hypertrophied, along with an increase in the number of macrophages which results in the distortion, distention and enlargement of the sinus. In this scenario there is no evidence that an infection or another malignancy could account for the enlargement. Paracortical lymphoid hyperplasia is caused by an immune response.
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This question is part of the following fields:
- Inflammation & Immunology; Female Health
- Pathology
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Question 172
Incorrect
-
Injury to the supraspinatus muscle will affect:
Your Answer: Adduction of the humerus
Correct Answer: Initiation of abduction of the humerus
Explanation:This muscle arises from the medial two-thirds of the supraspinatus fossa and from the supraspinatus fascia. It is inserted into the highest impression on the greater tubercle of the humerus after passing over the upper part of the shoulder joint. It works with the deltoid to raise the arm from the side of the trunk and initiate abduction. It also assists in fixation of the head of the humerus in the glenoid cavity.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 173
Incorrect
-
A 40-year old man sustained a deep laceration to the sole of his left foot. It was found that the belly of extensor digitorum muscle was lacerated and the lateral tarsal artery was severed. The lateral tarsal artery is a branch of the:
Your Answer: Anterior tibial artery
Correct Answer: Dorsalis pedis artery
Explanation:The lateral tarsal artery arises from the dorsalis pedis, as the vessel crosses the navicular bone
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 174
Incorrect
-
A 39-year-old man, after radiological evaluation and thoracentesis, was found to have chylothorax. What is the most probable cause of this diagnose?
Your Answer: Tuberculosis
Correct Answer: Mediastinal malignant lymphoma
Explanation:Chylothorax is a potentially lethal condition characterized by fluid (chyle) accumulation in the pleural cavity, resulting from disruption of lymphatic drainage in the thoracic duct. Chyle is a fluid rich in triglycerides and chylomicrons and can originate from the thorax, the abdomen or both. Malignant tumours, especially lymphoma, are the most common causes of nontraumatic chylothorax. Bronchogenic carcinoma and trauma are the most common causes after lymphomas. Other rare causes of chylothorax are; granulomatous diseases, tuberculosis, congenital malformations, nephrotic syndrome, hypothyroidism, cirrhosis, decompensated heart failure and idiopathic chylothorax.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 175
Incorrect
-
Infection to all of the following will lead to enlargement of the superficial inguinal lymph nodes, except for:
Your Answer: Penile urethra
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 176
Correct
-
A 31-year-old woman is diagnosed with adrenal hyperplasia, and laboratory samples are taken to measure serum aldosterone and another substance. Which is most likely to be the other test that was prescribed to this patient?
Your Answer: Plasma renin
Explanation:The evaluation of a patient in whom hyperaldosteronism is first to determine that hyperaldosteronism is present (serum aldosterone) and, if it is present, to differentiate primary from secondary causes of hyperaldosteronism. The aldosterone-to-renin ratio (ARR) is the most sensitive means of differentiating primary from secondary causes of hyperaldosteronism as it is abnormally increased in primary hyperaldosteronism, and decreased or normal but with high renin levels in secondary hyperaldosteronism.
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This question is part of the following fields:
- Physiology
- Renal
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Question 177
Incorrect
-
From which source does the lingual artery originate?
Your Answer: Maxillary
Correct Answer: External carotid
Explanation:The lingual artery arises from the external carotid between the superior thyroid artery and facial artery. It can be located easily on the lower surface of the tongue. The terminal branch of the lingual artery is the deep lingual artery. On its course the lingual artery gives off side branches: dorsal lingual branches that supply the dorsum of the tongue till the epiglottis; sublingual artery that supplies the sublingual gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 178
Incorrect
-
A 25 year-old male patient was brought to the hospital due to a vehicular accident. A skull x-ray was done which revealed a fracture along the base of the middle cranial fossa. The patient has no sense of touch over the skin over his cheek and chin. Injury to the maxillary and the mandibular nerves is suspected. In which foramina do these two affected sensory branches leave the cranial cavity.
Your Answer: Superior orbital fissure and foramen rotundum
Correct Answer: Foramen rotundum and foramen ovale
Explanation:The patient’s clinical manifestations suggests an injury to the maxillary and mandibular nerves. The maxillary branch (V2) of the trigeminal nerve (CN V) passes through and exits the skull via the pterygopalatine fossa and the foramen rotundum. At the base of the skull the foramen ovale (Latin: oval window) is one of the larger of the several holes (the foramina) that transmit nerves through the skull. The foramen ovale is situated in the posterior part of the sphenoid bone, posterolateral to the foramen rotundum. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery (small meningeal or paradural branch, sometimes derived from the middle meningeal artery), lesser petrosal nerve, a branch of the glossopharyngeal nerve and an emissary vein connecting the cavernous sinus with the pterygoid plexus of veins. Occasionally it will also carry the anterior trunk of the middle meningeal vein.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 179
Incorrect
-
After total thyroidectomy, which of the following investigations is recommended in the immediate post-operative period?
Your Answer: Free catecholamines
Correct Answer: Serum calcium
Explanation:Total thyroidectomy might sometimes result in inadvertent excision or damage of parathyroid glands, leading to hypoparathyroidism. Monitoring serum calcium levels in the post-operative period to detect hypocalcaemia is essential to diagnose and prevent this condition.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 180
Incorrect
-
For calculation of cardiac output by Fick's principle, which of the following vessels is the best source of venous blood to determine the arterial-to-venous oxygen tension difference?
Your Answer: Jugular vein
Correct Answer: Pulmonary artery
Explanation:Fick’s principle states that the total uptake (or release) of a substance by peripheral tissues is equal to the product of the blood flow to the peripheral tissues and the arterial– venous concentration difference (gradient) of the substance. It is used to measure the cardiac output, and the formula is Cardiac output = oxygen consumption divided by arteriovenous oxygen difference. Assuming there are no shunts across the pulmonary system, the pulmonary blood flow equals the systemic blood flow. The arterial and venous blood oxygen content is measured by sampling from the pulmonary artery (low oxygen content) and pulmonary vein (high oxygen content). Peripheral arterial blood is used as a surrogate for the pulmonary vein.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 181
Incorrect
-
Which foramen contains the vertebral artery?
Your Answer: Jugular foramen
Correct Answer: Foramen magnum
Explanation:The foramen magnum is found in the most inferior part of the posterior cranial fossa. It is traversed by vital structures including the medulla oblongata. Its contents include the following: medulla oblongata, meninges, spinal root of the accessory nerve, vertebral arteries, anterior and posterior spinal arteries, tectorial membrane and alar ligaments.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 182
Incorrect
-
Whilst snorkelling, a 30-year old gentleman has the respiratory rate of 10/min, tidal volume of 550 ml and an effective anatomical dead space of 250 ml. What is his alveolar ventilation?
Your Answer: 2000 ml/min
Correct Answer: 3000 ml/min
Explanation:Alveolar ventilation is the amount of air reaching the alveoli per minute. Alveolar ventilation = respiratory rate × (tidal volume – anatomical dead space volume). Thus, alveolar ventilation = 10 × (550 − 250) = 3000 ml/min.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 183
Correct
-
Which of the following factors will not affect the wound healing process in a young women who suffered serious burns to her chest and hands?
Your Answer: Vitamin A deficiency
Explanation:Healing can be sped-up or slowed down due to various reasons: 1. blood supply, 2. infection, 3. denervation, 4. collection of blood/hematoma, 5. mechanical stress, 6. foreign body, 7. techniques used during surgery and 8. dressing of the wound. Other systemic factors include 1. nutrition e.g. deficiency of zinc, vitamin C, protein deficiency, 2. metabolic status, 3. circulatory status and 4. hormonal influence
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 184
Incorrect
-
The posterior boundary of the carotid triangle is bounded by which of the following muscles?
Your Answer: Anterior belly of the digastric
Correct Answer: Sternocleidomastoid
Explanation:The carotid triangle is a portion of the anterior triangle of the neck. It is bounded superiorly by the posterior belly of the digastric muscle, antero-inferiorly by the superior belly of omohyoid and posteriorly by the sternocleidomastoid. The floor is formed by the thyrohyoid, hyoglossus, middle and inferior pharyngeal constrictors and the roof is formed by the skin, superficial fascia, platysma and deep fascia.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 185
Incorrect
-
A 27-year-old HIV patient started on an antifungal agent. Which antifungal agent that inhibits the biosynthesis of fungal ergosterol was given to the patient?
Your Answer: B Flucytosine
Correct Answer: Ketoconazole
Explanation:Ketoconazole is a synthetic imidazole antifungal drug used primarily to treat fungal infections. It inhibits the biosynthesis of ergosterol by blocking demethylation at the C14 site of the ergosterol precursor. Amphotericin B and Nystatin impair permeability of the cell membrane. Flucytosine interferes with DNA synthesis, while the target of griseofulvin is the microtubules
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This question is part of the following fields:
- Microbiology
- Pathology
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Question 186
Incorrect
-
Where do the seminal vesicles lie?
Your Answer: Ductus deferens and ureter
Correct Answer: Base of the bladder and rectum
Explanation:The seminal vesicles are two lobulated membranous pouches situated between the fundus of the bladder and rectum and act as a reservoir for the semen and secrete a fluid that is added to the seminal fluid. Each sac is pyramidal in shape but they all vary in size not only in different individuals but also in the same individuals. The anterior surface is in contact with the fundus of the bladder, extending from near the termination of the ureter to the base of the prostate. Each vesicle consist of single tube, which gives off several irregular caecal diverticula. These separate coils and the diverticula are connected by fibrous tissue.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 187
Incorrect
-
A patient is diagnosed with Conn’s syndrome. Aldosterone is secreted from where?
Your Answer: Liver
Correct Answer: Zona glomerulosa of the adrenal cortex
Explanation:The adrenal gland comprises an outer cortex and an inner medulla, which represent two developmentally and functionally independent endocrine glands.
The adrenal medulla secretes adrenaline (70%) and noradrenaline (30%)
The adrenal cortex consists of three layers (remembered by the mnemonic GFR):
G = zona glomerulosa – secretes aldosterone
F = zona fasciculata – secretes cortisol and sex steroids
R = zona reticularis – secretes cortisol and sex steroids.
Aldosterone facilitates the reabsorption of sodium and water and the excretion of potassium and hydrogen ions from the distal convoluted tubule and collecting ducts. Conn’s syndrome is characterized by increased aldosterone secretion from the adrenal glands.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 188
Correct
-
Calculate the cardiac stroke volume of a patient whose oxygen consumption (measured by analysis of mixed expired gas) is 300 ml/min, arterial O2 content is 20 ml/100 ml blood, pulmonary arterial O2 content is 15 ml/100 ml blood and heart rate is 60/min.
Your Answer: 100 ml
Explanation:By Fick’s principle, VO2 = Q × (CA (O2) − CV (O2)) where VO2 = O2 consumption, Q = cardiac output and CA(O2) and CV(O2) are arterial and mixed venous O2 content respectively. Thus, in the given problem, 300 ml O2/min = Q × (20−15) ml O2/100 ml. Thus, Q = 6000 ml blood/min. Then, we can calculate stroke volume by dividing the cardiac output with heart rate. Thus, stroke volume = 6000 ml/min divided by 60/min stroke volume = 100 ml.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 189
Incorrect
-
What is the pH of freshly formed saliva at ultimate stimulation?
Your Answer: 2. 0
Correct Answer: 8
Explanation:Saliva has four major components: mucus (lubricant), α-amylase (enzyme that initiates digestion of starch), lingual lipase (enzyme that begins fat digestion), and a slightly alkaline electrolyte solution for moistening food. As the secretion rate of saliva increases, its osmolality increases. Moreover, the pH changes from slightly acidic (at rest) to basic (pH 8) at ultimate stimulation. This occurs due to increase of HCO3-. Amylase and mucus also increase in concentration after stimulation.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 190
Incorrect
-
A retroperitoneal structure is:
Your Answer: Sigmoid colon
Correct Answer: Pancreas
Explanation:Retroperitoneal structures are those that are found behind the peritoneum. They include: kidneys, suprarenal glands, bladder, ureter, inferior vena cava, rectum, oesophagus (part of it), part of the pancreas, 2nd, 3rd and 4th parts of the duodenum and ascending and descending parts of the colon.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 191
Incorrect
-
A 34-year-old woman is diagnosed with cerebral oedema after suffering a severe head trauma. Which of the following conditions is not likely to be associated with the extracellular oedema?
Your Answer: Lymphatic blockage
Correct Answer: Increased plasma colloid osmotic pressure
Explanation:Cerebral oedema is extracellular fluid accumulation in the brain. Increased capillary permeability, increased capillary pressure, increased interstitial fluid colloid osmotic pressure and lymphatic blockage would increase fluid movement into the interstitial spaces. Increased plasma colloid osmotic pressure, however, would oppose fluid movement from the capillaries into the interstitial compartment.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 192
Incorrect
-
Multiple cells were labelled using a fluorescent dye that doesn’t cross the cell membrane. One cell in the middle was bleached with a light that destroys the dye, but the cell soon recovers its stain. The presence of which structures best explains this?
Your Answer: Basal lamina
Correct Answer: Gap junctions
Explanation:Gap junctions are attachments between cells that permit intercellular communication e.g. they permit current flow and electrical coupling between myocardial cells. They allow direct electrical transmission among cells and also permit certain substance to pass through as well. They are either homotypic, formed by two identical hemichannels or heterotypic, formed by different hemichannels.
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This question is part of the following fields:
- General
- Physiology
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Question 193
Incorrect
-
Which of the following is found to be elevated in a case of hepatocellular carcinoma?
Your Answer: hCG
Correct Answer: AFP
Explanation:Alpha-fetoprotein (AFP) is a glycoprotein that is normally produced by the yolk sac of the embryo, and then the fetal liver. It is elevated in the new-born and thus, also in the pregnant women. Eventually, it decreases in the first year of life to reach the adult normal value of < 20 ng/ml by 1 year of age. Markedly elevated levels (>500 ng/ml) in a high-risk patient is considered diagnostic for primary hepatocellular carcinoma (HCC). Moreover, due to smaller tumours secreting less quantities of AFP, rising levels can be a better indication. However, not all hepatocellular carcinomas produce AFP. Also, the level of AFP is not a prognostic factor. Populations where hepatitis B and HCC are common (e.g.: sub-Saharan Africans, ethnic Chinese) can see AFP levels as high as 100,000 ng/ml, whereas levels are low (about 3000 ng/ml) in regions with lesser incidences of HCC.
AFP can also be elevated up to 500 ng/ml in conditions like embryonic teratocarcinomas, hepatoblastomas, fulminant hepatitis, hepatic metastases from gastrointestinal tract cancers, some cholangiocarcinomas). Lesser values are seen in acute and chronic hepatitis.
Overall, the sensitivity of AFP value ≥20 ng/ml is 39-64% and the specificity is 76%–91%. Value of 500 ng/ml is considered as the diagnostic cut-off level for HCC.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 194
Correct
-
The LEAST mobile structure in the peritoneal cavity is the:
Your Answer: Pancreas
Explanation:The presence or absence of the mesentery determines mobility of abdominal contents. Structures like the stomach, transverse colon and appendix have mesenteries and thus are relatively mobile. In contrast, the pancreas is a retroperitoneal (behind the peritoneum) structure and therefore is fixed. The greater omentum is a large mobile fold of omentum that hangs down from the stomach .
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 195
Incorrect
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A 50 year-old man, who sustained a head injury experienced sudden onset of horizontal double vision. He is diagnosed with lateral rectus palsy. Which of the following nerves is affected in this condition?
Your Answer: Trigeminal
Correct Answer: Abducent
Explanation:The lateral rectus muscle is one of the 6 extra-ocular muscles that control eye movements. It is responsible for abduction and is the only muscle that is innervated by the abducens nerve (CN VI).
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 196
Correct
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A 34-year-old woman with pelvic inflammatory disease is administered ceftriaxone. The subclass of antibiotics that ceftriaxone belongs to is:
Your Answer: Third-generation cephalosporins
Explanation:Ceftriaxone is a third-generation cephalosporin antibiotic. It has a broad spectrum of activity against Gram-positive and Gram-negative bacteria. Its indications include middle ear infections, endocarditis, meningitis, pneumonia, bone and joint infections, intra-abdominal infections, skin infections, urinary tract infections, gonorrhoea, and pelvic inflammatory disease.
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This question is part of the following fields:
- Pathology
- Pharmacology
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Question 197
Incorrect
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A 45-year-old pregnant woman develops high blood pressure at 20 weeks. She complains of headaches and swollen feet, and a test reveals proteinuria (350 mg/day). Which of the following is the most likely diagnosis?
Your Answer: Chronic renal failure
Correct Answer: Pre-eclampsia
Explanation:Pre-eclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure (two separate readings taken at least 6 h apart of 140/90 or more) and often a significant amount of protein in the urine (>300 mg of protein in a 24-h urine sample). While blood pressure elevation is the most visible sign of the disease, it involves generalised damage to the maternal endothelium of the kidneys and liver, with the release of vasopressive factors only secondary to the original damage. Pre-eclampsia may develop at varying times within pregnancy and its progress differs among patients; most cases present pre-term. It has no known cure apart from ending the pregnancy (induction of labour or abortion). It may also present up to 6 weeks post partum. Risk factors for pre-eclampsia include obesity, prior hypertension, older age, and diabetes mellitus.
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This question is part of the following fields:
- Physiology
- Renal
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Question 198
Incorrect
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Which is a feature of the action of insulin?
Your Answer: Promotes calcium release from bone
Correct Answer: Promotes protein synthesis
Explanation:Insulin is produced by the beta-cells of the islets of Langerhans in the pancreas. Its actions include:
– promoting uptake of glucose into cells
– glycogen synthesis (glycogenesis)
– protein synthesis
– stimulation of lipogenesis (fat formation).
– driving potassium into cells – used to treat hyperkaelamia.
Parathyroid hormone and activated vitamin D are the principal hormones involved in calcium/phosphate metabolism, rather than insulin.
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This question is part of the following fields:
- Endocrine
- Physiology
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Question 199
Incorrect
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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 behind the lateral malleolus
Correct 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 200
Incorrect
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Which muscle is responsible for directing the gaze downward when the eye is abducted?
Your Answer:
Correct Answer: Inferior rectus muscle
Explanation:The inferior rectus muscle is a muscle in the orbit. As with most of the muscles of the orbit, it is innervated by the inferior division of oculomotor nerve (Cranial Nerve III). It depresses, adducts, and helps laterally rotate the eye.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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