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  • Question 1 - A 15-day old male baby was brought to the emergency department with sweating...

    Incorrect

    • A 15-day old male baby was brought to the emergency department with sweating and his lips turning blue while feeding. He was born full term. On examination, his temperature was 37.9°C, blood pressure 75/45 mmHg, pulse was 175/min, and respiratory rate was 42/min. A harsh systolic ejection murmur could be heard at the left upper sternal border. X-ray chest showed small, boot-shaped heart with decreased pulmonary vascular markings. He most likely has:

      Your Answer: Total anomalous pulmonary venous return

      Correct Answer: Tetralogy of Fallot

      Explanation:

      The most common congenital cyanotic heart disease and the most common cause of blue baby syndrome, Tetralogy of Fallot shows four cardiac malformations occurring together. These are ventricular septal defect (VSD), pulmonary stenosis (right ventricular outflow obstruction), overriding aorta (degree of which is variable), and right ventricular hypertrophy. The primary determinant of severity of disease is the degree of pulmonary stenosis. Tetralogy of Fallot is seen in 3-6 per 10,000 births and is responsible for 5-7% congenital heart defects, with slightly higher incidence in males. It has also been associated with chromosome 22 deletions and DiGeorge syndrome. It gives rise to right-to-left shunt leading to poor oxygenation of blood. Primary symptom is low oxygen saturation in the blood with or without cyanosis at birth of within first year of life. Affected children ay develop acute severe cyanosis or ‘tet spells’ (sudden, marked increase in cyanosis, with syncope, and may result in hypoxic brain injury and death). Other symptoms include heart murmur, failure to gain weight, poor development, clubbing, dyspnoea on exertion and polycythaemia. Chest X-ray reveals characteristic coeur-en-sabot (boot-shaped) appearance of the heart. Treatment consists of immediate care for cyanotic spells and Blalock–Taussig shunt (BT shunt) followed by corrective surgery.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      32.6
      Seconds

  • Question 2 - A 17-year-old boy, who had developed shortness of breath and a loss of...

    Incorrect

    • A 17-year-old boy, who had developed shortness of breath and a loss of appetite over the last month, was referred to a haematologist because he presented with easy bruising and petechiae. His prothrombin time, platelet count, partial thromboplastin and bleeding time were all normal. Which of the following would explain the presence of the petechiae and easy bruising tendency?

      Your Answer: von Willebrand’s disease

      Correct Answer: Scurvy

      Explanation:

      Scurvy is a condition caused by a dietary deficiency of vitamin C, also known as ascorbic acid. Humans are unable to synthesize vitamin C, therefore the quantity of it that the body needs has to come from the diet. The presence of an adequate quantity of vitamin C is required for normal collagen synthesis. In scurvy bleeding tendency is due to capillary fragility and not coagulation defects, therefore blood tests are normal.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      16.9
      Seconds

  • Question 3 - A 50 year-old man, who sustained a head injury experienced sudden onset of...

    Incorrect

    • 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: Oculomotor

      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).

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      10.6
      Seconds

  • Question 4 - A biopsy is performed on a 67-year-old-man with testicular seminoma; it reveals that...

    Incorrect

    • A biopsy is performed on a 67-year-old-man with testicular seminoma; it reveals that the tumour affects the tunica vaginalis. The tumour stage in this case is:

      Your Answer: Tis

      Correct Answer: T2

      Explanation:

      The primary tumour staging for testicular seminoma is as follows, according to AJCC guidelines:

      Tis: intratubular germ cell neoplasia (carcinoma in situ)

      T1: tumour limited to testis/epididymis without vascular or lymphatic invasion; the tumour can invade into the tunica albuginea but not the tunica vaginalis

      T2: tumour limited to testis/epididymis with vascular or lymphatic invasion or tumour extending through the tunica albuginea with involvement of the tunica vaginalis

      T3: tumour invading the spermatic cord, with or without vascular/lymphatic invasion

      T4: tumour invading the scrotum, with or without vascular/lymphatic invasion.

      According to these guidelines, the tumour in this case has a T2 stage.

    • This question is part of the following fields:

      • Pathology
      • Urology
      4.2
      Seconds

  • Question 5 - A 60-year old woman who has a left sided post-pneumonic effusion, was to...

    Correct

    • A 60-year old woman who has a left sided post-pneumonic effusion, was to have some pleural fluid aspirated for culture and sensitivity. If the medical intern in charge of the procedure decided to aspirate while the patient is sitting up on her bed, where in the pleural cavity would the fluid tend to accumulate?

      Your Answer: Costodiaphragmatic recess

      Explanation:

      The lowest part of the pleural cavity is the costodiaphragmatic recess and it the space in which the pleural fluid will accumulate when the patient sits up.

      The cupola is part of the pleural cavity that extends into the root of the neck above the first rib.

      The costomediastinal recess is the junction at which the costal pleura becomes the mediastinal pleura.

      The middle mediastinum is the part of the mediastinum that is occupied by the heart.

      The hilar reflection is the point where the mediastinal pleura is reflected to continue on as the visceral pleura.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      3.3
      Seconds

  • Question 6 - The primary area involved in the pathology of Parkinson's disease is: ...

    Incorrect

    • The primary area involved in the pathology of Parkinson's disease is:

      Your Answer: Red nucleus

      Correct Answer: Substantia nigra

      Explanation:

      Parkinson’s disease is a degenerative, movement disorder of the central nervous system, and is typically characterized by muscle rigidity, tremor and bradykinesia (in extreme cases, akinesia). Secondary symptoms include high-level cognitive dysfunction and subtle language problems.

      Parkinson’s disease is also called ‘primary Parkinsonism’ or ‘idiopathic Parkinson’s disease and is the most common cause of Parkinsonism, a group of similar symptoms. The disorder is caused due to loss of pigmented dopaminergic cells in the pars compacta region of the substantia nigra.

    • This question is part of the following fields:

      • Neurology
      • Physiology
      3.6
      Seconds

  • Question 7 - The principal motor and sensory nerve of the perineum is the? ...

    Incorrect

    • The principal motor and sensory nerve of the perineum is the?

      Your Answer: Inferior gluteal

      Correct Answer: Pudendal

      Explanation:

      The pudendal nerve is formed by S1,2,4 anterior branches. It gives off the inferior haemorrhoid nerve before dividing terminally into the perineal nerve and the dorsal nerve of the clitoris or the penis. Thus, it is the principal motor and sensory nerve of the perineum.

    • This question is part of the following fields:

      • Anatomy
      • Pelvis
      16.4
      Seconds

  • Question 8 - A 60-year-old female has sudden onset of high-grade fever associated with cough with...

    Incorrect

    • A 60-year-old female has sudden onset of high-grade fever associated with cough with productive rusty-coloured sputum. Chest x-ray showed left-sided consolidation. What is the most accurate test for the diagnosis of this patient?

      Your Answer: Blood culture

      Correct Answer: Sputum culture

      Explanation:

      Sputum culture is used to detect and identify the organism that are infecting the lungs or breathing passages.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      4.3
      Seconds

  • Question 9 - Which of the following nerves has its terminal branch at the supratrochlear nerve?...

    Incorrect

    • Which of the following nerves has its terminal branch at the supratrochlear nerve?

      Your Answer: Lacrimal

      Correct Answer: Frontal

      Explanation:

      The supratrochlear nerve is a branch of the frontal nerve which comes from the ophthalmic division of cranial nerve V (trigeminal nerve). It passes above the superior oblique nerve and its descending filaments join the infratrochlear branch of the nasociliary nerve. From the orbit, it exits between the supraorbital foramen and the pulley of the superior oblique. It then curves up to the forehead beneath the corrugator supercilli and frontalis muscle. It further divides into branches that supply sensory innervation to the bridge of the nose, medial part of the upper eyelid and medial forehead.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      3.4
      Seconds

  • Question 10 - An 18 -year-old female is diagnosed with folliculitis in the left axilla. What...

    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: Yersinia pestis

      Correct Answer: Staphylococcus aureus

      Explanation:

      Folliculitis is the inflammation of the hair follicles. It is usually caused by Staphylococcus infection.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      28.6
      Seconds

  • Question 11 - During a procedure in the mediastinum, the surgeon accidentally injured a key structure...

    Incorrect

    • During a procedure in the mediastinum, the surgeon accidentally injured a key structure that lies immediately anterior to the thoracic duct. Which structure is likely to be injured?

      Your Answer: Superior vena cava

      Correct Answer: Oesophagus

      Explanation:

      In the mid-thorax, the azygos vein, thoracic duct and aorta (in this order from right to the left) are all located posterior to the oesophagus. The superior vena cava, left internal jugular vein and trachea are not found in the mid thorax.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      58.1
      Seconds

  • Question 12 - An operation to remove a segment of the oesophagus through a right thoracotomy...

    Incorrect

    • An operation to remove a segment of the oesophagus through a right thoracotomy is complicated when a tear develops in a large venous structure in the posterior mediastinum that empties into the superior vena cava. Which of the following structures is likely to be injured?

      Your Answer: Brachiocephalic vein

      Correct Answer: Azygos vein

      Explanation:

      The azygos vein is formed by the union of the right subcostal veins and the ascending lumbar veins at the level of the 12th thoracic vertebra. It enters the thorax through the aortic hiatus to ascend in the posterior mediastinum and arching over the right main bronchus posteriorly at the root of the right lung to join the superior vena cava before it pierces the pericardium.

      The basilic vein is a vein on the medial aspect of the arm that ascends to become the axillary vein.

      The cephalic vein is also a vein of the arm.

      The external jugular and brachiocephalic vein are not in the posterior mediastinum.

      The median cubital vein is found in the cubital fossa of the arm.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      9.1
      Seconds

  • Question 13 - A patient who following 20 years of working in the asbestos industry develops...

    Incorrect

    • A patient who following 20 years of working in the asbestos industry develops malignant mesothelioma and is scheduled for pleuropneumonectomy to remove the entire pleura and lung on the affected side. Which layer would provide a natural cleavage plane for surgical separation of the costal pleura from the thoracic wall?

      Your Answer: Peritracheal fascia

      Correct Answer: Endothoracic fascia

      Explanation:

      The endothoracic fascia is connective tissue that is between the costal parietal pleura and the inner aspect of the chest wall. Removing this layer of connective tissue would make it easy to separate the costal pleura from the thoracic wall.

      Deep fascia: is not found around the lungs. It is a layer of connective tissue that invests a muscle or a group of muscles.

      Parietal pleura: part of the pleura that lines the inner surface of the chest/thoracic cavity.

      Visceral pleura: is the serous membrane that lines the surface of the lungs.

      Transversus thoracis muscle fascia is associated only with the muscle transversus thoracis.

      Peritracheal fascia: a layer of connective tissue that invests the trachea. It is not associated with the thoracic wall or the costal pleura.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      8
      Seconds

  • Question 14 - A 37-year-old woman with a history of rheumatic heart disease presents with 10...

    Correct

    • A 37-year-old woman with a history of rheumatic heart disease presents with 10 days recurrent low fever. Patient underwent laboratory work up and was diagnosed with infective endocarditis. What is the most likely organism that caused the infective endocarditis in this patient?

      Your Answer: Streptococcus viridans

      Explanation:

      Subacute bacterial endocarditis  is often due to streptococci of low virulence, mainly streptococcus viridans. It is a mild to moderate illness which progresses slowly over weeks and months (>2weeks) and has low propensity to hematogenously seed to extracardiac sites.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      19.1
      Seconds

  • Question 15 - A Monospot test in a 17-year old boy presenting with fever, multiple palpable...

    Incorrect

    • A Monospot test in a 17-year old boy presenting with fever, multiple palpable lymph nodes and mild icterus was positive. His blood investigation is likely to show which of the following?

      Your Answer: Normocytic anaemia

      Correct Answer: Atypical lymphocytosis

      Explanation:

      Epstein-Barr virus is the causative agent for infectious mononucleosis leading to presence of atypical lymphocytes in blood. Usually symptomatic in older children and adults, the incubation period is 30-50 days. Symptoms include fatigue, followed by fever, adenopathy and pharyngitis. Fatigue can last for months and is maximum in first few weeks. Fever spikes in the afternoon or early evening, with temperature around 39.5 – 40.5 °C. The ‘typhoidal’ form where fatigue and fever predominate has a low onset and resolution. Pharyngitis resemble that due to streptococcus and can be severe and painful. Lymphadenopathy is bilaterally symmetrical and can involve any nodes, specially the cervical ones. Mild splenomegaly is seen in 50% cases, usually in 2-3rd week. Mild tender hepatomegaly can occur. Less common manifestations include maculopapular eruptions, jaundice, periorbital oedema and palatal enanthema. Diagnostic tests include full blood count and a heterophil antibody test. Morphologically abnormal lymphocytes account for 80% cells and are heterogenous, unlike leukaemia.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      4.5
      Seconds

  • Question 16 -  A 45-year-old man presented to the doctor complaining of a flank pain and...

    Incorrect

    •  A 45-year-old man presented to the doctor complaining of a flank pain and episodes of haematuria. Abdominal ultrasound revealed a left renal mass and the patient underwent a nephrectomy. Histopathological pattern was triphasic with blastemal, epithelial, and stromal components. The pathologist suggested the tumour resulted from the lack of a tumour suppressor gene on chromosome 11. Which of the following tumours is the pathologist most likely suggesting?

      Your Answer: Medullary fibroma

      Correct Answer: Wilms’ tumour

      Explanation:

      Wilms’ tumour is one of the most common malignant tumours of childhood but it can also rarely be found in adults. In biopsy, classical histopathological findings include the triphasic pattern composed by blastemal, epithelial, and stromal elements. First symptoms in children include an abdominal palpable mass, while in adults pain and haematuria are the most common complaints. Deletions of tumours’ suppressor genes on chromosome 11 are usually associated with Wilms’ tumour.

    • This question is part of the following fields:

      • Pathology
      • Renal
      3.9
      Seconds

  • Question 17 - Which of the following will be a likely sequelae of complete ileal resection?...

    Incorrect

    • Which of the following will be a likely sequelae of complete ileal resection?

      Your Answer: Increased calcium absorption

      Correct Answer: Vitamin B12 deficiency

      Explanation:

      The ileum is a part of the small intestine and has a pH of around 7-8 (neutral or slightly alkaline). Its main function is absorption of products of digestion. The ileal wall has multiple villi, which in turn have numerous microvilli. This increases the surface area available for absorption significantly. The cells lining the ileum contain multiple enzymes such as protease and carbohydrase, which aid in the final stages of digestion. Villi contain lacteals which absorb the products of fat digestion, fatty acids and glycerol. Thus, ileal resection will lead to their decreased absorption and increased fat content in the stool. The ileum is also responsible for absorption of vitamin B12.

      Maximum water absorption occurs in the colon followed by the jejunum. Hence, ileal resection is less likely to lead to fluid volume deficiency. Also, most minerals (like calcium, iron etc.) are absorbed in the duodenum, and thus will not be affected by ileal resection.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      5.4
      Seconds

  • Question 18 - In a hypertensive patient with secondary hyperaldosteronism, aldosterone is released mainly in response...

    Incorrect

    • In a hypertensive patient with secondary hyperaldosteronism, aldosterone is released mainly in response to:

      Your Answer: High volume states (fluid overload)

      Correct Answer: Angiotensin II

      Explanation:

      Secondary hyperaldosteronism in hypertension is either due to primary renin overproduction by the kidneys or renin overproduction secondary to decreased renal blood flow. The main stimulus for aldosterone release are adrenocorticotrophic hormone (ACTH), angiotensin II and high plasma K+ levels. Low plasma Na+ might also stimulate the adrenal cortex. Fluid overload will reduce aldosterone secretion. Atrial natriuretic peptide is secreted under conditions of expanded extracellular volume and will not lead to aldosterone secretion.

    • This question is part of the following fields:

      • Endocrinology
      • Physiology
      4.8
      Seconds

  • Question 19 - A 5 year-old-child with fever complains of sore throat . She was brought...

    Incorrect

    • A 5 year-old-child with fever complains of sore throat . She was brought to her paediatrician for consult because she has also developed a rash and has swollen lymph nodes. Upon physical examination she cried when her liver was palpated and the tip of her spleen is slightly palpable. Full blood count shows haemoglobin 13 g/dL, Haematocrit 40%, white blood cell count 13x109/L with a WBC differential count of 45 neutrophils, 4 bands, 26 lymphocytes, 15 atypical lymphocytesm, 10 monocytes and 1 eosinophil. Whick is the most likely infectious agent that is responsible for the patient's condition?

      Your Answer: Rubella virus

      Correct Answer: Epstein–Barr virus

      Explanation:

      Epstein-Barr virus (EBV), also known as human herpes virus 4,is a member of the herpes virus family. EBV spreads most commonly through bodily fluids, primarily saliva. EBV can cause infectious mononucleosis. Symptoms of EBV can include fatigue, fever, inflamed throat, swollen lymph nodes in the neck, enlarged spleen, swollen liver and rash.

    • This question is part of the following fields:

      • Microbiology
      • Pathology
      6
      Seconds

  • Question 20 - A brain tumour causing blockage of the hypophyseal portal system is likely to...

    Incorrect

    • A brain tumour causing blockage of the hypophyseal portal system is likely to result in an increased secretion of which of the following hormones?

      Your Answer:

      Correct Answer: Prolactin

      Explanation:

      The hypophyseal portal system links the hypothalamus and the anterior pituitary. With the help of this system, the anterior pituitary receives releasing and inhibitory hormones from the hypothalamus and regulates the action of other endocrine glands. One of the inhibitory hormones carried by this system is the prolactin-inhibitory hormone. In the absence of this hormone which might occur in case of a blockage of the system, prolactin secretion increases to about three times normal levels.

    • This question is part of the following fields:

      • Endocrinology
      • Physiology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Haematology (2/2) 100%
Pathology (8/8) 100%
Anatomy (6/7) 86%
Head & Neck (1/2) 50%
Urology (1/1) 100%
Thorax (4/4) 100%
Neurology (1/1) 100%
Physiology (4/4) 100%
Pelvis (1/1) 100%
Microbiology (4/4) 100%
Renal (1/1) 100%
Gastroenterology (1/1) 100%
Endocrinology (2/2) 100%
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