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Question 1
Correct
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What is the normal duration of the ST segment?
Your Answer: 0.08 s
Explanation:The ST segment lies between the QRS complex and the T-wave. The normal duration of the ST segment is 0.08 s. ST-segment elevation or depression may indicate myocardial ischaemia or infarction.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 2
Incorrect
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Which is the correct statement regarding gonadal venous drainage:
Your Answer: The right ovarian vein drains into the right renal vein
Correct Answer: The left ovarian vein drains into the left renal vein
Explanation:Spermatic or testicular veins arise from the posterior aspect of the testis and receive tributaries from the epididymis. Upon uniting, they form the pampiniform plexus that makes up the greater mass of the spermatic cord. The vessels that make up this plexus rise up the spermatic cord in front of the ductus deferens. They then unite, below the superficial ring, to form three or four veins that traverse the inguinal canal and enter the abdomen through the deep inguinal ring. They further unite to form 2 veins that ascend up the psoas major muscle behind the peritoneum each lying on either side of the testicular artery. These further unite to form one vein that empties on the right side of the inferior vena cava at an acute angle and on the left side into the renal vein, at a right angle. The left testicular vein courses behind the iliac colon and is thus exposed to pressure from the contents of this part of the bowel. The ovarian vein is the equivalent of the testicular vein in women. They form a plexus in the broad ligament near the ovary and uterine tube and communicate with the uterine plexus. They drain into similar vessels as in a man.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 3
Incorrect
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A chest X-ray in a healthy, non-smoker, asymptomatic 48-year-old woman reveals a 2cm left lower lobe well-defined round opacity. Which of the following conditions is most probably responsible for this finding?
Your Answer: Bronchial carcinoid
Correct Answer: Pulmonary hamartoma
Explanation:An asymptomatic healthy patient with no history of smoking and a lesion of small size most probably has a benign lung lesion. Hamartomas are one of the most common benign tumours of the lung that accounts for approximately 6% of all solitary pulmonary nodules. Pulmonary hamartomas are usually asymptomatic and therefore are found incidentally when performing an imaging test for other reasons.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 4
Correct
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A 27-year old lady presented with dull, abdominal pain and some pain in her lower limbs. On enquiry, it was revealed that she has been suffering from depression for a few months. Physical examination and chest X-ray were normal. Further investigations revealed serum calcium 3.5 mmol/l, albumin 3.8 g/dl and phosphate 0.65 mmol/l. What is the diagnosis?
Your Answer: Parathyroid adenoma
Explanation:Hypercalcaemia with hypophosphatemia indicates parathyroid disorder and adenomas are more common than hyperplasia. In this young age group, metastatic disease is unlikely. Solitary adenomas are responsible for 80-85% cases of primary hyperparathyroidism. 10-15% cases are due to parathyroid hyperplasia and carcinomas account for 2-3% cases. Symptoms include bone pain (bones), nephrolithiasis (stones), muscular aches, peptic ulcer disease, pancreatitis (groans), depression (moans), anxiety and other mental disturbances.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 5
Correct
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Which of the following is NOT a nutritional factor involved in wound healing:
Your Answer: Vitamin B3
Explanation:Vitamin B6 is required for collagen cross-links.
Vitamin A is required for epithelial cell proliferation.
Zinc is required for RNA and DNA synthesis.
Copper is required for cross-linking of collagen.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Physiology
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Question 6
Incorrect
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A 30 year old man suffered severe blood loss, approx. 20-30% of his blood volume. What changes are most likely seen in the pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) respectively following this decrease in cardiac output?
Your Answer: Decrease Decrease
Correct Answer: Increase Decrease
Explanation:Hypovolemia will result in the activation of the sympathetic adrenal discharge resulting is a decrease pulmonary artery pressure and an elevated pulmonary vascular resistance.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 7
Correct
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Which of these is secreted by both macrophages and muscle cells?
Your Answer: Interleukin-6
Explanation:IL-6 is secreted by the T cells and macrophages and is a pro inflammatory cytokine. It is secreted in response to trauma e.g. burns and tissue damage that leads to inflammation. Apart from this its is also a myokine and is elevated due to muscle contraction. Other functions include: stimulate osteoclast formation when secreted by osteoblasts, mediate fever in acute phase response and are responsible for energy metabolism in muscle and fatty tissues. Inhibitors of IL-6 e.g. oestrogen are used as a treatment for postmenopausal osteoporosis.
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This question is part of the following fields:
- Inflammation & Immunology
- Pathology
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Question 8
Correct
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A medical student is asked to calculate the net pressure difference in a capillary wall, considering: Interstitial fluid hydrostatic pressure = –3 mmHg, Plasma colloid osmotic pressure = 28 mmHg, Capillary hydrostatic pressure = 17 mmHg, Interstitial fluid colloid osmotic pressure = 8 mmHg, and Filtration coefficient = 1. Which is the correct answer?
Your Answer: 0 mmHg
Explanation:The rate of filtration at any point along a capillary depends on a balance of forces sometimes called Starling’s forces after the physiologist who first described their operation in detail. The Starling principle of fluid exchange is key to understanding how plasma fluid (solvent) within the bloodstream (intravascular fluid) moves to the space outside the bloodstream (extravascular space). Fluid movement = k[(pc– pi)–(Πc– Πi)] where k = capillary filtration coefficient, pc = capillary hydrostatic pressure, pi= interstitial hydrostatic pressure, Πc = capillary colloid osmotic pressure, Πi = interstitial colloid osmotic pressure. Therefore: 1 × [capillary hydrostatic pressure (17) – interstitial fluid hydrostatic pressure (–3)] – [plasma colloid osmotic pressure (28) – interstitial fluid colloid osmotic pressure (8)] = 0 mmHg
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 9
Incorrect
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The tensor villi palatini muscle is a broad thin, ribbon-like muscle in the head that tenses the soft palate. Which of the following structures is associated with the tensor villi palatini muscle?
Your Answer: The hamulus of the lateral pterygoid plate
Correct Answer: The hamulus of the medial pterygoid plate
Explanation:The pterygoid hamulus is a hook-like process at the lower extremity of the medial pterygoid plate of the sphenoid bone around which the tendon of the tensor veli palatini passes.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 10
Correct
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During cardiac catheterisation in a 20-year old man, the following data is obtained: Pressure (mmHg), O2 saturation (%) Right atrium 7 (N = 5) 90 (N = 75), Right ventricle 35/7 (N = 25/5) 90 (N = 75), Pulmonary artery 35/8 (N = 25/15), 90 (N = 75), Left atrium 7 (N = 9) 95 (N = 95), Left ventricle 110/7 (N = 110/9) 95 (N = 95), Aorta 110/75 (N = 110/75) 95 (N = 95) where N = Normal value. What is the likely diagnosis?
Your Answer: Atrial septal defect
Explanation:A congenital heart disease, ASD or atrial septal defect leads to a communication between the right and left atria due to a defect in the interatrial septum. This leads to mixing of arterial and venous blood from the right and left side of the heart. The hemodynamic significance of this defect depends on the presence of shunting of blood. Normally, the left side of the heart has higher pressure than the right as the left side has to pump blood throughout the body. A large ASD (> 9 mm) will result in a clinically significant left-to-right shunt, causing volume overload of the right atrium and ventricle, eventually leading to heart failure. Cardiac catheterization would reveal very high oxygen saturation in the right atrium, right ventricle and pulmonary artery. Eventually, the left-to-right shunt will lead to pulmonary hypertension and increased afterload in the right ventricle, along with the increased preload due to the shunted blood. This will either cause right ventricular failure, or raise the pressure in the right side of the heart to equal or more than that in the left. Elevation of right atrial pressure to that of left atrial pressure would thus lead to diminishing or complete cessation of the shunt. If left uncorrected, there will be reversal of the shunt, known as Eisenmenger syndrome, resulting in clinical signs of cyanosis as the oxygen-poor blood form right side of the heart will mix with the blood in left side and reach the peripheral vascular system.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 11
Incorrect
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Which of the following organs is an ectoderm derivative?
Your Answer: Gonads
Correct Answer: Adrenal medulla
Explanation:Ectoderm derivatives include the adrenal medulla, posterior pituitary, the epidermis of the skin, nails, hair, sweat glands, mammary glands, sebaceous glands, the central nervous system, the peripheral nervous system, the retina and lens of eye, the pupillary muscle of the iris, melanocytes, Schwann cells and odontoblasts.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 12
Correct
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Which of the following structures carry part of the right bundle branch of the AV bundle?
Your 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 13
Correct
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A patient admitted for esophagectomy showed low levels of the lightest plasma protein in terms of weight. Which of the following is the lightest plasma protein:
Your Answer: Albumin
Explanation:Albumin is the most abundant and the lightest of all the plasma proteins. It maintains osmotic pressure, transports unconjugated bilirubin, thyroid hormones, fatty acids, drugs and acts as a buffer for pH.
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This question is part of the following fields:
- General
- Physiology
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Question 14
Correct
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Which of the following substances is most likely to cause pulmonary vasodilatation?
Your Answer: Nitric oxide
Explanation:In the body, nitric oxide is synthesised from arginine and oxygen by various nitric oxide synthase (NOS) enzymes and by sequential reduction of inorganic nitrate. The endothelium of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, so dilating the artery and increasing blood flow. Nitric oxide/oxygen blends are used in critical care to promote capillary and pulmonary dilation to treat primary pulmonary hypertension in neonatal patients post-meconium aspiration and related to birth defects.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 15
Incorrect
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The thyrocervical trunk branches into which artery that passes upward and in front of the vertebral artery and longus colli muscle:
Your Answer: Transverse cervical
Correct Answer: Inferior thyroid
Explanation:The inferior thyroid artery is an artery in the neck. It arises from the thyrocervical trunk and passes upward, in front of the vertebral artery and longus colli muscle.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 16
Correct
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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: 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 17
Incorrect
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A 42 year old man presents with end stage renal failure and is prepared to receive a kidney from his best friend. HLA testing showed that they are not a 100% match and he is given immunosuppressant therapy for this. Three months later when his renal function is assessed, he showed signs of deteriorating renal function, with decreased renal output, proteinuria of +++ and RBCs in the urine. He was given antilymphocyte globulins and his condition reversed. During the crisis period the patient is likely to be suffering from?
Your Answer: Chronic rejection
Correct Answer: Acute rejection
Explanation:This patients is most likely experiencing an acute rejection. It is a cell mediated attack against the organ that has been transplanted. Antigens are either presented by blood borne cells with in the graft or antigen presenting cells in the body may be presenting class I and class II molecules that have been shed by the graft. Class I will activate CD8 and class II, CD4 cells, both of which will attack the graft.
Chronic rejection is a slow process which occurs months to years after the transplant. The exact mechanism is not very well understood but it probably involves a combination of Type III and Type IV hypersensitivity directed against the foreign MHC molecules which look like self-MHC presenting a foreign antigen.
Hyperacute Transplant Rejection occurs almost immediately and is often evident while you are still in surgery. It is caused by accidental ABO Blood type mismatching of the donor and recipient which almost never happens anymore. This means the host has preformed antibodies against the donated tissue.
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This question is part of the following fields:
- Inflammation & Immunology; Renal
- Pathology
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Question 18
Correct
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A 50-year old gentleman who was admitted for elective surgery was found to have haemoglobin 9.5 g/dl, white blood cell count of 1.4 × 109/l and a mean corpuscular volume (MCV) of 134 fl. Which of the following is the likely finding on his peripheral blood smear?
Your Answer: Hypersegmented neutrophils
Explanation:The likely diagnosis is megaloblastic anaemia, which also shows the presence of hypersegmented neutrophils.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 19
Incorrect
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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: Protracted vomiting
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 20
Correct
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Which of the following will be affected by a lesion in the posterior column-medial lemniscus system?
Your Answer: Fine touch
Explanation:The posterior column–medial lemniscus (PCML) pathway is a sensory pathway that transmits fine touch and conscious proprioceptive information from the body to the brain. As the posterior columns are also known as dorsal columns, the pathway is also called the dorsal column–medial lemniscus system or DCML.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 21
Correct
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What is the innervation of the laryngeal mucosa inferior to the true vocal cord?
Your Answer: Recurrent laryngeal nerve
Explanation:Motor innervation to all other muscles of the larynx and sensory innervation to the subglottis is by the recurrent laryngeal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 22
Correct
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What is the linea aspera:
Your Answer: Serves as an attachment for adductors of the thigh
Explanation:The linea aspera is a prominent longitudinal ridge or crest on the middle third of the femur. It has a medial and a lateral lip and a narrow, rough, intermediate line. The vastus medialis arises from the medial lip of the linea aspera and has superior and inferior prolongations. The vastus lateralis takes origin from the lateral lip . The adductor magnus is inserted into the linea aspera. Two muscles are attached between the vastus lateralis and the adductor magnus: the gluteus maximus is inserted above and the short head of the biceps femoris arises below. Four muscles are inserted between the adductor magnus and the vastus medialis: the iliacus and pectineus superiorly, and the adductor brevis and adductor longus inferiorly.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 23
Correct
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A 70-year old man who is suspected to have a perforated colonic diverticulum is explored in theatre through a midline incision. This incision will be through the:
Your Answer: Linea alba
Explanation:The linea alba is the point where this incision was made. It is a tendinous raphe in the midline of the abdomen extending between the xiphoid process and the symphysis pubis. It is placed between the medial borders of the recti and is formed by the blending of the aponeuroses of the external and internal obliques and transversi.
The linea aspera is a vertical ridge on the posterior surface of the femur.
The arcuate line is the inferior border of the posterior rectus sheath behind the rectus abdominis muscle.
The semilunar line is the lateral margin of the rectus abdominis.
The iliopectineal line is a line on the pelvic bones formed by the arcuate line of the ilium and the pectineal line of the pubis.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 24
Correct
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From which branchial (pharyngeal) pouch does the inferior parathyroid gland arise?
Your Answer: 3rd
Explanation:The following structures arise from each branchial pouch:
1st pouch – eustachian tube, middle ear, mastoid, and inner layer of the tympanic membrane
2nd pouch – middle ear, palatine tonsils
3rd pouch – inferior parathyroid glands, thymus
4th pouch – superior parathyroid glands, ultimobranchial body which forms the parafollicular C-cells of the thyroid gland, musculature and cartilage of larynx (along with the sixth pharyngeal pouch)
5th pouch – rudimentary structure
6th pouch – along with the fourth pouch, contributes to the formation of the musculature and cartilage of the larynx.
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This question is part of the following fields:
- Anatomy
- Endocrine; Embryology
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Question 25
Correct
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Which nerve lies immediately medial to the psoas major muscle?
Your Answer: Obturator
Explanation:The obturator nerve is formed from the ventral divisions of the 2nd, 3rd and 4th lumbar nerves. It courses through the fibres of the psoas major and emerges from the medial border near the pelvic brim.
The iliohypogastric nerve comes from the first lumbar nerve and emerges from the upper part of the lateral border of psoas major.
The ilioinguinal nerve arises with the iliohypogastric nerve from the first lumbar nerve and also emerges from the lateral border of the psoas major muscle.
The lateral femoral cutaneous nerve comes from the posterior division of the 2nd and 3rd lumbar nerves to emerge from the lateral border of the psoas major muscle near its middle.
The femoral nerve also arises from the dorsal divisions, but of the 2nd, 3rd and 4th lumbar nerves and courses through the muscle fibres to emerge at the lower part of the lateral border.
The coccygeal nerve doesn’t arise from the lumbar plexus but from the sacral plexus.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 26
Correct
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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: 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 27
Correct
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During an exploratory laparotomy in a 22 year-old man shot in the abdomen, the operating doctor discovers the large bowel is perforated. Which of the following characteristics of the bowel enabled the surgeon to identify it as the large bowel?
Your Answer: Epiploic appendages
Explanation:The large intestine doesn’t have a continuous layer of longitudinal muscle. Instead, it has three strips of longitudinal muscle called taenia coli. The large intestine is covered with omental appendages that are fat filled. It is also folded into sacculations called haustrations. Serosa is a general term for the outermost coat or serous layer of a visceral structure that lies in the body cavities of the abdomen or thorax.
Complete circular folds are only found in the small intestine.
Valvulae conniventes or valves of Kerckring are the circular folds which are large valvular flaps projecting into the lumen of the small bowel.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 28
Incorrect
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Which of the following conditions of the breast is most often associated with use of oral contraceptives?
Your Answer: Hypertrophy
Correct Answer: Cyst formation
Explanation:Breast cysts are common and are smooth, firm, mobile lumps that can sometimes be tender. Cysts can also be bilateral and are known to recur in 10% of cases. They are more common in women in the third and fourth decades and most often disappear after menopause. Cysts are filled with fluid from the breast which occurs due to the normal menstrual cycle of a woman. The end of the menstrual cycle causes breast cells to swell. After the menses, the cells shrink and the released fluid disappears. However, in some cases this fluid forms a cyst. Incidence of cysts was also linked to use of oral contraceptives.
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This question is part of the following fields:
- Pathology
- Women's Health
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Question 29
Correct
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What's the nodal stage of a testicular seminoma if several lymph nodes between 2cm and 5cm are found?
Your Answer: N2
Explanation:According to the American Joint Committee on Cancer (AJCC) 2002 guidelines, the nodal staging of testicular seminoma is the following:
N0: no regional lymph node metastases
N1: metastasis with lymph nodes 2 cm or less in their greatest dimension or multiple lymph nodes, none more than 2 cm
N2: metastasis with lymph nodes greater than 2 cm but not greater than 5 cm in their greatest dimension, or multiple lymph nodes, any one mass greater than 2 cm, but not more than 5 cm
N3: metastasis with lymph nodes greater than 5 cm in their greatest dimension.
The patient in this case has N2 testicular seminoma. This TNM staging is extremely important because treatment options are decided depending on this classification.
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This question is part of the following fields:
- Pathology
- Urology
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Question 30
Correct
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Decreased velocity of impulse conduction through the atrioventricular node (AV node) in the heart will lead to:
Your Answer: Increased PR interval
Explanation:AV node damage may lead to an increase in the PR interval to as high as 0.25 – 0.40 s (normal = 0.12 – 0.20 s). In the case of severe impairment, there might be a complete failure of passage of impulses leading to complete block. In this case, the atria and ventricles will beat independently of each other.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 31
Correct
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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: 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 32
Correct
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Which muscle would be affected most following injury to the transverse cervical artery?
Your Answer: Trapezius
Explanation:The latissimus dorsi receives blood from the thoracodorsal artery, the supraspinatus receives its blood from the suprascapular artery, the levator scapulae and the rhomboids are supplied by the dorsal scapular artery and the transverse cervical artery supplies blood to the trapezius.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 33
Incorrect
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A 28 year gang member was shot in the chest. The bullet hit a vessel that courses horizontally across the mediastinum. Which of the following vessels is it likely to be?
Your Answer: Right brachiocephalic vein
Correct Answer: Left brachiocephalic vein
Explanation:The superior vena cava that empties blood into the right atrium is formed by the right and the left brachiocephalic veins. Hence, the left brachiocephalic has to course across the mediastinum horizontally to join with its right ‘counterpart’. The left subclavian artery and vein being lateral to the mediastinum do not cross the mediastinum while the left jugular and the common carotid artery course vertically.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 34
Correct
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The uterine artery arises from the?
Your Answer: Internal iliac artery
Explanation:The uterine artery arises from the anterior division of the internal iliac artery and runs medially on the levator ani towards the uterine cervix.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 35
Correct
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Which of the following conditions causes an elevation of the pH in the tissues with elevated arterial CO2 content?
Your Answer: Metabolic alkalosis
Explanation:Metabolic alkalosis is a metabolic condition in which the pH of tissue is elevated beyond the normal range (7.35-7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate, or alternatively a direct result of increased bicarbonate concentrations. Normally, arterial pa(CO2) increases by 0.5–0.7 mmHg for every 1 mEq/l increase in plasma bicarbonate concentration, a compensatory response that is very quick. If the change in pa(CO2) is not within this range, then a mixed acid–base disturbance occurs.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 36
Correct
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A chloride sweat test was performed on a 13-year-old boy. Results indicated a high likelihood of cystic fibrosis. This diagnosis is associated with a higher risk of developing which of the following?
Your Answer: Bronchiectasis
Explanation:Cystic fibrosis is a life-threatening disorder that causes the build up of thick mucus in the lungs, digestive tract, and other areas of the body. It is a hereditary autosomal-recessive disease caused by mutations of the CFTR gene. Cystic fibrosis eventually results in bronchiectasis which is defined as a permanent dilatation and obstruction of bronchi or bronchioles.
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This question is part of the following fields:
- Pathology
- Respiratory
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Question 37
Correct
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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: 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 38
Correct
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A patient with chronic renal disease, missed a day of his dialysis schedule., His serum potassium was 7.6 mmol/L when his electrolytes were checked. What is the ECG finding expected in this patient?
Your Answer: Tented T waves
Explanation:ECG characteristics of hyperkalaemia may show the following changes: P-waves are widened and of low amplitude due to slowing of conduction, widened QRS complex, QRS-T fusion, loss of ST segment and tall tented T waves.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 39
Correct
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Which of the following is not seen as a complication of wound healing?
Your Answer: Malignancy
Explanation:Complications in wound healing can originate due to abnormalities in the repair process. These abnormalities are :
1) Deficient scar formation: insufficient granulation tissue can lead to wound dehiscence and ulceration. Dehiscence or wound rupture is seen most commonly in abdominal surgery due to increased intraabdominal pressure. Ulcerations are common in extremity wounds due to inadequate vascularization.
2) Excessive formation of repair components: collagen being laid down may begin normally however later lead to a raised scar also called a hypertrophic scar, which can extend beyond its boundaries to form a keloid and
3) Formation of contractures.
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This question is part of the following fields:
- Cell Injury & Wound Healing
- Pathology
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Question 40
Correct
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A terrorist running away from the police was shot in the back. The bullet hit his left lung halfway between its apex and the diaphragmatic surface. Which part of the lung was most likely to be injured?
Your Answer: Inferior lobe
Explanation:The oblique fissure of the left lung is so sharp that the posterior surface of the left lung is mostly composed of the inferior lobe so that the point halfway between the apex and the diaphragmatic surface of the lung would result in injury to the inferior lobe.
The hilum is the point on the medial surface of the lung where the structures that form the root of the lung enter and leave the lung.
The lingual on the other hand is part of the superior lobe of the left lung and it is part of the anterior and superior sides of the lung.
The middle lobe is only found on the right lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 41
Incorrect
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A 40-year old woman presents with tightening of the skin over her fingers which makes movement of her fingers difficult.. She also gives a history of her fingers turning blue on exposure to low temperatures. She admits to gradual weight loss. Investigations reveal negative rheumatoid factor, negative antinuclear antibody and a positive anticentromere body. Which of the following conditions is she likely to have?
Your Answer: Zollinger-Ellison syndrome
Correct Answer: Oesophageal stricture
Explanation:Scleroderma is a connective tissue disorder that ranges in severity and progression. The disease could show generalised skin thickening with rapid, fatal, visceral involvement; or only cutaneous involvement (typically fingers and face). The slow progressive form is also known as ‘limited cutaneous scleroderma’ or CREST syndrome (calcinosis cutis, Raynaud’s phenomenon, (o)oesophageal dysmotility, sclerodactyly, and telangiectasia).
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 42
Correct
-
The pattern of drainage of the lymphatic and venous systems of the anterior abdominal wall is arranged around a horizontal plane above which drainage is in a cranial direction and below which drainage is in a caudal direction. Which horizontal plane is being referred to?
Your Answer: Level of the umbilicus
Explanation:The umbilicus is a key landmark for the lymphatic and venous drainage of the abdominal wall. Above it, lymphatics drain into the axillary lymph nodes and the venous blood drains into the superior epigastric vein, into the internal thoracic vein. Below it, lymphatics drain into the superficial inguinal lymph nodes while venous blood drains into the inferior epigastric vein and the external iliac vein.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 43
Correct
-
A 59-year-old man was brought to the emergency department by his family after complaining of sudden, severe upper back pain and a ripping sensation, that radiated to his neck. On arrival, his pulse was weak in one arm compared with the other however his ECG result was normal. Which of the following is most probably the cause of these findings and symptoms?
Your Answer: Acute aortic dissection
Explanation:Acute aortic dissection is a serious condition in which the inner layer of the aorta tears and the blood flows in between the inner and middle layers of the aorta causing their separation (dissection). Aortic dissection can lead to rupture or decreased blood flow to organs. Clinical manifestations most often include the sudden onset of severe, tearing or ripping chest pain that can radiate to the shoulder, back or neck; syncope; altered mental status; dyspnoea; pale skin; stroke symptoms etc. The diagnosis of acute aortic dissection is based on clinical findings, imaging studies, electrocardiography and laboratory analysis.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 44
Incorrect
-
When does the heart rate decrease?
Your Answer: On inspiration
Correct Answer: Pressure on the eyeball
Explanation:Various vagotonic manoeuvres (e.g. Valsalva manoeuvre, carotid sinus massage, pressure on eyeballs, ice-water facial immersion, swallowing of ice-cold water) result in increased parasympathetic tone through the vagus nerve which results in a decrease in heart rate. These manoeuvres may be clinically useful in terminating supraventricular arrhythmias.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 45
Correct
-
Which is the correct order of tendons passing from medial to lateral-posterior to the medial malleolus?
Your Answer: Posterior tibial, flexor digitorum longus, flexor hallucis longus
Explanation:The correct order of structures is the tendon of tibialis posterior, tendon of flexor digitorum longus, posterior tibial artery (and vein), tibial nerve and tendon of flexor hallucis longus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 46
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 47
Incorrect
-
A suspected recreational drug user was brought to the Emergency department in an unconscious state, and was found to be hypoventilating. Which of the following set of arterial blood gas analysis report is most consistent with hypoventilation as the primary cause? pH, pa(CO2) (mmHg), pa(O2) (mmHg).
Your Answer: 7.35, 50, 69
Correct Answer: 7.28, 55, 81
Explanation:Hypoventilation (or respiratory depression) causes an increase in carbon dioxide (hypercapnia) and respiratory acidosis. It can result due to drugs such as alcohol, benzodiazepines, barbiturates, opiates, mechanical conditions or holding ones breath. Strong opioids such as heroin and fentanyl are commonly implicated and can lead to respiratory arrest. In recreational drug overdose, acute respiratory acidosis occurs with an increase in p(CO2) over 45 mm Hg and acidaemia (pH < 7.35)
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 48
Correct
-
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: 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 49
Correct
-
A 38-year-old woman with end-stage renal disease, is undergoing haemodialysis. She has normocytic normochromic anaemia. What is the best treatment for her?
Your Answer: Erythropoietin
Explanation:E erythropoietin (EPO) is a hormone that is released by the kidney. It is responsible for the regulation of red blood cell production in the body. It can be made using recombinant technology and is used in the treatment of anaemia of chronic renal failure and in patients under going chemotherapy
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This question is part of the following fields:
- General
- Physiology
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Question 50
Incorrect
-
Which of the following is a likely consequence of severe diarrhoea?
Your Answer: A metabolic alkalosis
Correct 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 51
Correct
-
A patient in the recovery ward after cardiac surgery is noticed to have a small effusion in the lowest extent of the pleural cavity, into which no lung tissue extends. What is the name of this part of the pleural cavity?
Your Answer: Costodiaphragmatic recess
Explanation:The costodiaphragmatic recess is the part of the pleural cavity where the costal pleura is in continuity with the diaphragmatic pleura. It forms the lowest extent of the pleural cavity.
Costomediastinal recess: a tiny recess that is anteriorly located, where the costal pleura becomes continuous with the mediastinal pleura.
The cupola is the pleural cavity that extends above the first rib.
The inferior mediastinum refers to the posterior, middle and anterior mediastinal divisions together.
The pulmonary ligament on the other hand, is a pleural fold that is situated beneath the root of the lung on the medial aspect of the lung.
Oblique pericardial sinus is not part of the pleural cavity.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 52
Incorrect
-
A 45 year old man who complains of chronic post prandial, burning epigastric pain undergoes a gastrointestinal endoscopy. There is no apparent mass or haemorrhage and a biopsy is taken from the lower oesophageal mucosa just above the gastro-oesophageal junction. The results reveal the presence of columnar cells interspersed with goblet cells. Which change best explains the above mentioned histology?
Your Answer: Dysplasia
Correct Answer: Metaplasia
Explanation:Metaplasia is the transformation of one type of epithelium into another as a means to better cope with external stress on that epithelium. In this case metaplasia occurs due to the inflammation resulting from gastro-oesophageal reflux disease. Dysplasia is disordered cellular growth. Hyperplasia is an increase in cell number but not cell type i.e. transformation. Carcinoma is characterized by cellular atypia. Ischaemia would result in necrosis with ulceration. Carcinoma insitu involves dysplastic atypical cells with the basement membrane intact and atrophy would mean a decrease in number of cells.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Gastrointestinal
- Pathology
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Question 53
Incorrect
-
Choose the most correct answer regarding the obturator internus muscle.
Your Answer: It emerges from the pelvis through the obturator foramen
Correct Answer: It emerges from the pelvis through the lesser sciatic foramen
Explanation:The obturator internus arises from the inner surface of the anterolateral wall of the pelvis and the pelvic surface of the obturator membrane. The fibres converge rapidly towards the lesser sciatic foramen and end in four or five tendinous bands and leave the pelvis through the lesser sciatic foramen.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 54
Correct
-
Which of the following morphological features is most characteristic of hyaline degeneration?
Your 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 55
Incorrect
-
A young boy fell from a tree, sustaining an injury to the elbow area and damaging the nerve behind the medial epicondyle of the humerus. What is the most likely result from that injury?
Your Answer: Function of lumbricals 1 and 2
Correct Answer: Flexion in the distal interphalangeal joint of digit 5
Explanation:The nerve injured in this situation is the ulnar nerve. It passes posterior to the medial epicondyle of the humerus before going between the two heads of the flexor carpi ulnaris muscle. This nerve supplies the muscles and skin of forearm and hand. At the level of medial epicondyle, the injury will led to paralysis in flexor carpi ulnaris and the ulnar half of the flexor digitorum profundus as well as the palmar interossei and hypothenar muscles in the hand. The correct answer will be that the boy will suffer from inability to flex the distal interphalangeal joint of digit 5
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 56
Incorrect
-
All the following statements are FALSE regarding the ophthalmic division of the trigeminal nerve, except:
Your Answer: One of its branches gives motor innervation to the lacrimal gland
Correct Answer: The ophthalmic nerve is the smallest branch of the trigeminal nerve
Explanation:The ophthalmic nerve is the smallest of the three trigeminal divisions. The cutaneous branches of the ophthalmic nerve supply the conjunctiva, the skin over the forehead, the upper eyelid, and much of the external surface of the nose.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 57
Correct
-
The prostatic plexus of nerves contains nerve fibres that innervate penile tissue allowing for erection. From which of the following nerves do these fibres originate?
Your Answer: Pelvic splanchnics
Explanation:Pelvic splanchnic nerves are examples of the parasympathetic nerves that innervate the smooth muscle and glands of the pelvic viscera. They are also the nerves contributing fibres to the prostatic plexus which innervate penile erectile tissue.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 58
Correct
-
Which of the following is a landmark to identify the site of the 2nd costal cartilage?
Your Answer: Sternal angle
Explanation:The sternal angle is an important part where the second costal cartilage attaches to the sternum. Finding the sternal angle will help in finding the second costal cartilage and intercostal space.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 59
Correct
-
Which of the following foramen provides passage of the facial nerve?
Your 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 60
Incorrect
-
A 47 -year-old male was admitted due to a bleeding peptic ulcer. On his 3rd hospital day, he developed a cardiac arrhythmia. His serum potassium was markedly elevated. What is the most likely cause of hyperkalaemia in this patient?
Your Answer: Use of proton pump inhibitors
Correct Answer: Multiple blood transfusions
Explanation:Patients with gastrointestinal bleeding often require blood transfusion. Among the various side effects of blood transfusions, is the increase of potassium levels. The use of stored blood for transfusions is followed by an increase of serum potassium levels. Potassium level increases are more pronounced in patients who receive blood stored for more than 12 d. Furthermore, the lysis and destruction of red blood cells, especially in the transfusion of older PRBCs, can further increase potassium levels. Excessive use of a PPi has been associated with hyperkaelemia however would be less likely in this acute setting.
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This question is part of the following fields:
- Fluids & Electrolytes
- Pathology
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Question 61
Correct
-
The muscle that stabilizes the stapes is innervated by which of the following nerves?
Your Answer: Facial nerve
Explanation:The stapedius is the smallest skeletal muscle in the human body. At just over one millimetre in length, its purpose is to stabilize the smallest bone in the body, the stapes and is innervated by a branch of the facial nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 62
Correct
-
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: 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 63
Correct
-
Which of these substances is secreted by pericytes in the juxtaglomerular cells?
Your Answer: Renin
Explanation:The juxtaglomerular cells synthesise, store and secrete the enzyme renin in the kidney. They are specialised smooth muscle cells in the wall of the afferent arteriole that delivers blood to the glomerulus and thus play a critical role in the renin– angiotensin system and so in renal autoregulation.
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This question is part of the following fields:
- Physiology
- Renal
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Question 64
Correct
-
Extracellular body fluid as compared with intracellular body fluid:
Your Answer: Is relatively rich in glucose
Explanation:The percentages of body water contained in various fluid compartments add up to total body water (TBW). This water makes up a significant fraction of the human body, both by weight and by volume. Ensuring the right amount of body water is part of fluid balance, an aspect of homeostasis. The extracellular fluid (ECF) includes all fluids outside the cells. This fluid can be divided into three fluid departments: interstitial (in the tissue spaces) fluid, blood plasma and lymph, and specialised compartments called transcellular fluid. The extracellular fluid surrounds all the cells in the body and is in equilibrium with the intracellular fluid. So, its composition must remain fairly constant even though substances are passing into and out of the cells. The interstitial fluid, though called a fluid, is in a reality a gel-like composition made up of: water, proteoglycan molecules and collagen. The extracellular fluid constitutes 40% of total body water, with intracellular fluid making up the remaining 60%. It is relatively rich in glucose.
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This question is part of the following fields:
- Fluids & Electrolytes
- Physiology
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Question 65
Correct
-
If the blood flow is constant, oxygen extraction by tissues will show the greatest decrease due to which of the following interventions?
Your Answer: Tissue cooling
Explanation:With a constant blood flow to a given tissue bed, there will be an increase in oxygen extraction by the tissue with the following; an increase in tissue metabolism and oxygen requirements: warming (or fever), exercise, catecholamines and thyroxine. With cooling, the demand for oxygen decreases, leading to decreased oxygen extraction.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 66
Correct
-
The dural venous sinuses are venous channels that drain blood from the brain. This sinuses are located between which structures?
Your Answer: Meningeal and periosteal layers of the dura mater
Explanation:The dural venous sinuses lies between the periosteal and meningeal layer of the dura mater. Dural venous sinuses is unique because it does not run parallel with arteries and allows bidirectional flow of blood intracranially as it is valve-less.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 67
Correct
-
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 68
Correct
-
The midgut loop, also called the primary intestinal loop in a developing embryo, is formed when the midgut bends around which of the following arteries?
Your Answer: Superior mesenteric
Explanation:In a developing foetus, the midgut develops to form most of the intestines. During this development process, the midgut usually bends around the superior mesenteric artery and forms what is referred to as the midgut loop.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 69
Correct
-
The primary area involved in the pathology of Parkinson's disease is:
Your 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.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 70
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 71
Correct
-
Which of the following statements is true regarding the umbilical cord?
Your Answer: Is filled with jelly of Wharton
Explanation:The umbilical cord that connects the fetus to the placenta is about 50cm long. This tissue consists of the body stalk and vitelline duct. The former containing the allantoic diverticulum and the umbilical vessels. The latter contains the connection linking the digestive tube and the yolk sac. This cord is wrapped by stratum of ectoderm and gelatinous tissue or jelly of Wharton. The right umbilical vein plus the vitelline vessels and ducts disappear and this at birth the cord has three vessels which are the umbilical vein and two umbilical arteries.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 72
Correct
-
Which of the following variables are needed to calculate inspiratory reserve volume of a patient?
Your Answer: Tidal volume, vital capacity and expiratory reserve volume
Explanation:Vital capacity = inspiratory reserve volume + tidal volume + expiratory reserve volume. Thus, inspiratory reserve volume can be calculated if tidal volume, vital capacity and expiratory reserve volume are known.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 73
Correct
-
When you rest your elbows on a desk, what bony landmark of the upper limb are you resting on?
Your Answer: Olecranon process of the ulna
Explanation:At the upper and back part of the ulna, there exists a curved eminence which is the olecranon process. This process lodges in the olecranon fossa of the humerus. It’s posterior surface is subcutaneous and this triangular area is what you rest your elbow upon.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 74
Correct
-
After a prolonged coronary artery bypass surgery, a 60-year old gentleman was transfused 3 units of fresh-frozen plasma and 2 units of packed red cells. Two days later, the nurse noticed that he was tachypnoeic and chest X-ray showed signs consistent with adult respiratory distress syndrome. Which of the following variables will be low in this patient?
Your Answer: Compliance of the lung
Explanation:Acute or adult respiratory distress syndrome (ARDS) is a reaction to several forms of lung injuries and is commonly associated with sepsis and SIRS (systemic inflammatory response syndrome), severe traumatic injury, severe head injury, narcotics overdose, drowning, pulmonary contusion, and multiple blood transfusions. There is an increase in risk due to pre-existing liver disease or coagulation abnormalities. It results due to indirect toxic effects of neutrophil-derived inflammatory mediators in the lungs. ARDS is defined by the 1994 American–European Consensus Committee as the acute onset of bilateral infiltrates on chest X-ray, a partial pressure of arterial oxygen (pa(O2)) to fraction of inspired oxygen Fi(O2) ratio of less than 200 mmHg and a pulmonary artery occlusion pressure of less than 18 or the absence of clinical evidence of left arterial hypertension. ARDS is basically pulmonary oedema in the absence of volume overload or poor left ventricular function. This is different from acute lung injury, which shows a pa(O2)/Fi(O2) ratio of less than 300 mmHg. Pathogenesis of ARDS starts from damage to alveolar epithelium and vascular endothelium, causing increased permeability. Damage to surfactant-producing type II cells disrupts the production and function of pulmonary surfactant, causing micro atelectasis and poor gas exchange. There is a decrease in lung compliance and increase in work of breathing. Eventually, there is resorption of alveolar oedema, regeneration of epithelial cells, proliferation and differentiation of type II alveolar cells and alveolar remodelling. Some show resolution and some progress to fibrosing alveolitis, which involves the deposition of collagen in alveolar, vascular and interstitial spaces.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 75
Correct
-
The collaborative effort of the lateral pterygoid muscles produces which action on the jaw?
Your 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 76
Correct
-
An experiment was conducted in which the skeletal muscle protein (not smooth muscle) involved in contraction was selectively inhibited. Which protein was inhibited?
Your Answer: Troponin
Explanation:The mechanism of contraction of smooth muscles is different from that of skeletal muscles in which the contractile protein is troponin whilst in smooth muscle contraction is a protein called calmodulin. Calmodulin reacts with calcium ions and stimulates the formation of myosin crossbridges.
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This question is part of the following fields:
- General
- Physiology
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Question 77
Correct
-
A 34-year-old woman with severe burns, presented to casualty with a blood pressure of 75/40 mmHg and pulse of 172/minute. Obviously the patient is in shock. Which type of shock is it more likely to be?
Your Answer: Hypovolaemic shock
Explanation:Shock is a life-threatening condition that occurs when the organs and tissues of the body are not receiving a sufficient flow of blood. Lack of blood flow, oxygen and nutrients results in the inability to function properly and damage to many organs. Shock requires immediate treatment because, if left untreated the impaired tissue perfusion and cellular hypoxia can cause irreversible tissue injury, collapse, coma or even death. There are various types of physiological shock, including: cardiogenic (due to heart damage), hypovolaemic (due to low total volume of blood or plasma), neurogenic (due to nervous system damage), septic (due to infections) and anaphylactic shock (due to allergic reactions). Hypovolaemic shock can be caused by blood loss due to trauma, internal bleeding or other fluid loss due to severe burns, prolonged diarrhoea, vomiting and sweating.
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This question is part of the following fields:
- Cardiovascular
- Pathology
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Question 78
Correct
-
An old woman complains of a lack of sensation halfway down the anterior surface of the thigh. The cause of this:
Your Answer: Would result from damage to the nerve that innervates the pectineus muscle
Explanation:The pectineus is supplied by the second, third and fourth lumbar nerves through the femoral nerve and by the third lumbar through the accessory obturator when it exists. The anterior surface of the thigh receives its innervation from the femoral nerve as well, thus this is the nerve most likely to be injured
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 79
Incorrect
-
What is the nerve supply of the muscle that is inserted onto the crest of the lesser tubercle of the humerus?
Your Answer: Long thoracic
Correct Answer: Lower subscapular
Explanation:The muscle is the subscapularis muscle which is supplied by the lower subscapular nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 80
Correct
-
Lack of findings in the bladder but presence of atypical epithelial cells in urinalysis is most often associated with which of the following conditions?
Your Answer: Transitional cell carcinoma of renal pelvis
Explanation:The presence of atypical cells in urinalysis without findings in the bladder suggests a lesion located higher up, most probably in ureters or renal pelvis. Transitional cell cancer of the renal pelvis is a disease in which malignant cells form in the renal pelvis and is characterised by the presence of abnormal cells in urine cytology.
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This question is part of the following fields:
- Pathology
- Renal
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Question 81
Correct
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A 30-year-old woman known with Von Willebrand disease (vWD) has to undergo surgery. Which of these complications is most unlikely in this patient?
Your Answer: Hemarthrosis
Explanation:Von Willebrand disease (vWD) is an inherited haemorrhagic disorder characterised by the impairment of primary haemostasis. It is caused by the deficiency or dysfunction of a protein named von Willebrand factor. The most common manifestation due to the condition is abnormal bleeding. Complications include easy bruising, hematomas, epistaxis, menorrhagia, prolonged bleeding and severe haemorrhage. Hemarthrosis is a complication that is more commonly found in haemophilia.
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This question is part of the following fields:
- Haematology
- Pathology
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Question 82
Correct
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A TRUE statement regarding abolition of the cephalic phase of pancreatic secretion is that it:
Your Answer: Will result after vagotomy
Explanation:Recognition and integration of the sight, smell and taste of food triggers the cephalic phase of pancreatic secretion, causing an increase in pancreatic HCO3- and enzyme secretion. The degree of enzyme secretion in this phase is about 50% of the maximal response seen with exogenous CCK and secretin. The vagus nerve regulates the secretion through the cholinergic fibres innervating the acinar cells of the pancreas, and through peptidergic nerve fibres, which innervate ductal cells.
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This question is part of the following fields:
- Gastroenterology
- Physiology
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Question 83
Incorrect
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What is the reason for a deranged thrombin clotting time?
Your Answer: Thrombocytopaenia
Correct Answer: Heparin therapy
Explanation:Thrombic clotting time is also known as thrombin time. It is clinically performed to determine the therapeutic levels of heparin. After plasma is isolated from the blood, bovine thrombin is added to it and the time it takes from the addition to clot is recorded. The reference interval is usually <21s. deranged results are indicative of heparin therapy, hypofibrinogenemia, hyperfibrinogenaemia or lupus anticoagulant.
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This question is part of the following fields:
- General
- Physiology
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Question 84
Correct
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The patient who is diagnosed with bladder cancer asked his physician, what could have been the contributing factor in the development of his bladder cancer?
Your Answer: Smoking
Explanation:Tobacco smoking is the main known contributor to urinary bladder cancer. In most populations, smoking is associated with over half of bladder cancer cases in men and one-third of cases among women.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 85
Incorrect
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Which of the following diseases causes abrupt vertigo, nausea, vomiting, tinnitus, and nystagmus?
Your Answer: Schwannoma
Correct Answer: Vestibular neuronitis
Explanation:Vestibular neuronitis or labyrinthitis causes a self-limited episode of vertigo, presumably due to inflammation of the vestibular division of cranial nerve VIII. Its causes are unknown, It may be due to a virus, but it can be related to a bacterial infection, head injury, stress, allergy, or as a reaction to medication. Symptoms can last up to 7-10 days.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 86
Incorrect
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A medical intern wanting to perform her first thoracentesis (remove fluid from the pleural cavity) wishes to be reminded where to insert the needle to aspirate in order to avoid injuring the lung or neurovascular elements. Where is this place?
Your Answer: The top of interspace 9 in the midaxillary line
Correct Answer: The bottom of interspace 9 in the midaxillary line
Explanation:Thoracentesis is performed in the costodiaphragmatic recess. The needle needs to be inserted below the level of the lungs to avoid injury to the lungs. At the paravertebral line, is between ribs 10 and 12, at the midaxillary line between ribs 8 and 10 and at the midclavicular line between interspaces 6 and 8. The needle should be inserted at the top of the rib (or the bottom of the interspace) to avoid damage to the neurovascular structures found below the rib running in the costal groove.
The recommended location for the needle insertion varies depending upon the source. It is critical that the patient hold his or her breath to avoid piercing of the lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 87
Correct
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A 79-year-old has been bedridden for 2 months after suffering from a stroke. She suddenly developed shortness of breath and chest pain, and was diagnosed with a pulmonary embolism. Which of the following is most likely to increase in this case?
Your Answer: Ventilation/perfusion ratio
Explanation:Pulmonary embolism (PE) is a blockage of an artery in the lungs by an embolus that has travelled from elsewhere in the body through the bloodstream. The change in cardiopulmonary function is proportional to the extent of the obstruction, which varies with the size and number of emboli obstructing the pulmonary arteries. The resulting physiological changes may include pulmonary hypertension with right ventricular failure and shock, dyspnoea with tachypnoea and hyperventilation, arterial hypoxaemia and pulmonary infarction. Consequent alveolar hyperventilation is manifested by a lowered pa(CO2). After occlusion of the pulmonary artery, areas of the lung are ventilated but not perfused, resulting in wasted ventilation with an increased ventilation/perfusion ratio – the physiological hallmark of PE – contributing to a further hyperventilatory state. The risk of blood clots is increased by cancer, prolonged bed rest, smoking, stroke, certain genetic conditions, oestrogen-based medication, pregnancy, obesity, and post surgery.
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This question is part of the following fields:
- Physiology
- Respiratory
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Question 88
Incorrect
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A 38 year-old man falls on an outstretched hand. X-rays indicate an anterior dislocation of one of the carpal bones. Which carpal bone is most commonly dislocated?
Your Answer: Scaphoid
Correct Answer: Lunate
Explanation:The scaphoid bone is the most commonly fractured carpal bone and has an increased risk of avascular necrosis.
The lunate is the most commonly dislocated carpal bone. The displaced bone may compress the median nerve in the carpal tunnel.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 89
Correct
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A 70 year old women, died suddenly. She had a history of hypertension and aortic stenosis. On autopsy her heart weighed 550g. What is the most likely cause of this pathology?
Your Answer: Hypertrophy
Explanation:Due to increased pressure on the heart as a result of hypertension and aortic stenosis, the myocardial fibres hypertrophied to adapt to the increased pressure and to effectively circulate blood around the body. Hyperplasia could not occur, as myocardial fibres are stable cells and cannot divide further.
Fat does not deposit in the heart due to volume overload.
Myocardial oedema is not characteristic of a myocardial injury.
Metaplasia is a change in the type of epithelium.
Atrophy would result in a decreased heart size and inability to function.
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This question is part of the following fields:
- Cell Injury & Wound Healing; Cardiovascular
- Pathology
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Question 90
Correct
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The anatomical course of the phrenic nerve passes over the following muscle in the neck?
Your Answer: Anterior scalene
Explanation:The phrenic nerve originates in the neck between C3-C5, mostly C4 spinal root. It enters the thoracic cavity past the heart and lungs to the diaphragm. In the neck, this nerve begins at the lateral border of the anterior scalene muscle, its course then continues inferiorly on the anterior aspect of the anterior scalene muscle as it moves towards the diaphragm.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 91
Incorrect
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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: Uncinate process
Correct 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 92
Correct
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A 45-year old man presents with sclerosing cholangitis, blood in his stools and apparent iron deficiency anaemia. What will be the most likely finding on his colonic biopsy?
Your Answer: Pseudopolyps
Explanation:Sclerosing cholangitis along with the passage of blood in stools suggests ulcerative colitis affecting the mucosa and submucosa of rectum and colon, with a sharp demarcation with the normal tissue. The musclaris layer is involved in severe cases. Initially, the mucosa is erythematous, friable with scattered haemorrhagic areas and loss of normal vascular pattern. Severe disease is indicated by presence of large mucosal ulcers with purulent exudate. There can be islands of normal mucosa between the ulcerated mucosa, along with few hyperplastic inflammatory mucosal lesions (pseudopolyps). Ulcerative colitis does not lead to development of fistulas or abscesses.
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This question is part of the following fields:
- Gastrointestinal; Hepatobiliary
- Pathology
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Question 93
Correct
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What is expected from complete transection of the inferior gluteal nerve when it emerges from the greater sciatic foramen?
Your Answer: Extension of the thigh would be the action most affected
Explanation:As the inferior gluteal nerve emerges from the greater sciatic foramen below the piriformis muscle, it divides into branches and enters the gluteus maximus muscle which extends the femur and bends the thigh in line with the body.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 94
Correct
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During hysterectomy, the ureter is most likely to be ligated when a surgeon is clamping the?
Your Answer: Uterine arteries
Explanation:The ureter forms the posterior boundary of a shallow depression which lodges the ovary and then runs medially and forward on the lateral aspect of the uterine cervix and upper part of the vagina to reach the fundus of the bladder. It is also situated about 2cm from the side of the cervix of the uterus. The relationship of the ureters and uterine arteries is of clinical significance because the arteries are at risk of iatrogenic injury during hysterectomy.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 95
Incorrect
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A 50-year old, obese gentleman with a compression fracture of T11 vertebra was admitted in the hospital. Examination revealed a raised blood pressure 165/112 mmHg and blood glucose 8.5 mmol/l. His abdomen had the presence of purplish striae. What condition is he likely to be suffering from?
Your Answer: Pheochromocytoma
Correct Answer: Adrenal cortical carcinoma
Explanation:Adrenocortical carcinomas are rare tumours with reported incidence being only two in a million. However, they have a poor prognosis. These are large tumours and range from 4-10 cm in diameter. They arise from the adrenal cortex and 10% cases are bilateral. 50-80% are known to be functional, leading to Cushing syndrome. Even though the tumour affects both sexes equally, functional tumours are slightly commoner in women and non-functional tumours are commoner in men. As compared to women, men also develop this tumour at an older age and seem to have a poorer prognosis.
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This question is part of the following fields:
- Endocrine
- Pathology
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Question 96
Correct
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Which ectopic tissue is usually contained in the Meckel's diverticulum?
Your 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 97
Correct
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A 4-year-old child was brought to a paediatrician for consult due to a palpable mass in his abdomen. The child has poor appetite and regularly complains of abdominal pain. The child was worked up and diagnosed with a tumour. What is the most likely diagnosis ?
Your Answer: Nephroblastoma
Explanation:Nephroblastoma is also known as Wilms’ tumour. It is a cancer of the kidneys that typically occurs in children. The median age of diagnose is approximately 3.5 years. With the current treatment, approximately 80-90% of children with Wilms’ tumour survive.
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This question is part of the following fields:
- Neoplasia
- Pathology
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Question 98
Correct
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The Brunner glands secrete an alkaline product that helps maintain an optimal pH for pancreatic enzyme activity. Where are these glands located?
Your Answer: Submucosa of the duodeneum
Explanation:The Brunner glands are located in the submucosa of the duodenum. These glands are connected to the interstitial lumen by ducts that open into certain crypts. They secrete an alkaline product that protects the duodenal mucosa from the acidic chyme and helps achieve an optimal pH for the enzymes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 99
Correct
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A 40 year old man suffered severe trauma following an MVA. His BP is 70/33 mmhg, heart rate of 140 beats/mins and very feeble pulse. He was transfused 3 units of blood resulting in his BP returning to 100/70 and his heart rate to 90 beats/min. What decreased following transfusion?
Your Answer: Total peripheral resistance
Explanation:The patient is in hypovolemic shock, he is transfused with blood to replace the volume lost. It is important not only to replace fluids but stop active bleeding in resuscitation. Fluid replacement will result in a decreased sympathetic discharge and adequate ventricular filling thus reducing total peripheral resistance and increasing cardiac output and cardiac filling pressures.
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This question is part of the following fields:
- Cardiovascular
- Physiology
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Question 100
Correct
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Difficulty in retracting the foreskin of the penis in an uncircumcised male is known as:
Your Answer: Phimosis
Explanation:Phimosis is the inability to fully retract the foreskin of the penis in an uncircumcised male. It can be physiological in infancy, in which it could be referred to as ‘developmental non-retractility of the foreskin. However, it is almost always pathological in older children and men. Causes include chronic inflammation (e.g. balanoposthitis), multiple catheterisations, or forceful foreskin retraction. One of the causes is chronic balanitis xerotica obliterans. It leads to development of a ring of indurated tissue near the tip of the prepuce, which prevents retraction. Contributory factors include infections, hormonal and inflammatory factors. The recommended treatment includes circumcision.
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This question is part of the following fields:
- Pathology
- Urology
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