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  • Question 1 - A 50-year old, obese gentleman with a compression fracture of T11 vertebra was...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      3
      Seconds

  • Question 2 - A 7-year-old boys undergoes a testicular biopsy after a tumour is found in...

    Incorrect

    • A 7-year-old boys undergoes a testicular biopsy after a tumour is found in his right testis. Elements similar to hair and teeth are found in it. What kind of tumour is this?

      Your Answer: Yolk sac carcinoma

      Correct Answer: Teratoma

      Explanation:

      A teratoma is a tumour containing tissue elements that are similar to normal derivatives of more than one germ layer. They usually contain skin, hair, teeth and bone tissue and are more common in children, behaving as a benign tumour. After puberty, they are regarded as malignant and can metastasise.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      4
      Seconds

  • Question 3 - From which of the following cells is heparin produced? ...

    Incorrect

    • From which of the following cells is heparin produced?

      Your Answer:

      Correct Answer: Mast cells

      Explanation:

      Heparin is a natural highly-sulphated glycosaminoglycan that has anticoagulant functions. It is produced by the body basophils and mast cells.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 4 - For which of the following is NOT screened for in blood for transfusion?...

    Incorrect

    • For which of the following is NOT screened for in blood for transfusion?

      Your Answer:

      Correct Answer: EBV

      Explanation:

      Blood for transfusion is routinely screened for hepatitis B and C, HIV, CMV and syphilis.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 5 - In a study, breast lumps were analysed to determine the characteristic of malignant...

    Incorrect

    • In a study, breast lumps were analysed to determine the characteristic of malignant neoplasm on biopsy. What microscopic findings are suggestive of malignancy?

      Your Answer:

      Correct Answer: Invasion

      Explanation:

      Invasion is suggestive of malignancy and an even better option would have been metastasis. Pleomorphism is found in both benign and malignant neoplasms along with atypia and anaplasia. A height nuclear/cytoplasmic ratio is suggestive of malignancy but not the best indicator. Malignant tumours are aggressive and growth rapidly. Necrosis can be seen in benign tumours if they deplete their blood supply.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 6 - A 25 year-old female medical student presents with fever, lack of appetite, rashes,...

    Incorrect

    • A 25 year-old female medical student presents with fever, lack of appetite, rashes, sore throat and lymphadenopathy. Peripheral smear shows atypical lymphocytes. Which is the most likely organism responsible for this patient's condition?

      Your Answer:

      Correct Answer: Epstein–Barr virus

      Explanation:

      Epstein-Barr virus is in the herpes family of viruses and most people will become infected with EBV sometime during their lives. EBV commonly causes infectious mononucleosis, or mono, a contagious viral illness that initially attacks the lymph nodes in the neck and throat. When these tissues become less effective in fighting infection, sore throats, swelling of the nodes and fever may result.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 7 - A 45-year old gentleman presented to the emergency department at 5.00 AM with...

    Incorrect

    • A 45-year old gentleman presented to the emergency department at 5.00 AM with pain in his left flank. The pain began suddenly and presented in waves throughout the night. Urine examination was normal except for presence of blood and few white blood cells. The pH and specific gravity of the urine were also found to be within normal range. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Ureteric calculus

      Explanation:

      A calculus in the ureter, if less than 5mm in diameter is likely to pass spontaneously. However, a larger calculus irritates the ureter and may become lodged, leading to hydroureter and/or hydronephrosis. Likely sites where the calculus might get lodged, include pelviureteric junction, distal ureter at the level of iliac vessels and the vesicoureteric junction. An obstruction can result in reduced glomerular filtration. There can be deterioration in renal function due to hydronephrosis and a raised glomerular pressure, leading to poor renal blood flow. Permanent renal dysfunction usually takes about 4 weeks to occur. Secondary infection can also occur in chronic obstruction.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 8 - After being admitted to the hospital, a 60-year-old man is administered sodium nitroprusside....

    Incorrect

    • After being admitted to the hospital, a 60-year-old man is administered sodium nitroprusside. Which class of drugs does nitroprusside belong to?

      Your Answer:

      Correct Answer: Vasodilators

      Explanation:

      Sodium nitroprusside is a potent peripheral vasodilator that affects both arterioles and venules. It is often administered intravenously to patients who are experiencing a hypertensive emergency. It reduces both total peripheral resistance as well as venous return, so decreasing both preload and afterload. For this reason it can be used in severe cardiogenic heart failure where this combination of effects can act to increase cardiac output. It is administered by intravenous infusion. Onset is typically immediate and effects last for up to ten minutes. The duration of treatment should not exceed 72 hours.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 9 - After a cerebral infarction, which of these histopathogical findings is most likely to...

    Incorrect

    • After a cerebral infarction, which of these histopathogical findings is most likely to be found?

      Your Answer:

      Correct Answer: Liquefactive necrosis

      Explanation:

      The brain has a high lipid content and typically undergoes liquefaction with ischaemic injury, because it contains little connective tissue but high amounts of digestive enzymes.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 10 - A 70-year-old man suffers an ischaemic stroke and develops a left homonymous hemianopia....

    Incorrect

    • A 70-year-old man suffers an ischaemic stroke and develops a left homonymous hemianopia. Where is the likely infarct?

      Your Answer:

      Correct Answer: Right occipital lobe

      Explanation:

      The man has a left homonymous hemianopia which means he is unable to view objects in the left visual field. This information is processed by the right primary visual cortex which lies in the right occipital lobe.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 11 - A 24-year-old patient with recurrent episodes of deep vein thrombosis presents again to...

    Incorrect

    • A 24-year-old patient with recurrent episodes of deep vein thrombosis presents again to the clinic. Deficiency of which of the following blood proteins is the most probable cause of this episode?

      Your Answer:

      Correct Answer: Antithrombin III

      Explanation:

      Antithrombin III (ATIII) is a blood protein that acts by inhibiting blood coagulation by neutralizing the enzymatic activity of thrombin.
      Antithrombin III deficiency is an autosomal dominant disorder that leads to an increased risk of venous and arterial thrombosis. Clinical manifestations typically appear in young adulthood.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 12 - A 7-year-old boy with facial oedema was brought to the hospital by his...

    Incorrect

    • A 7-year-old boy with facial oedema was brought to the hospital by his parents. Renal function is normal and urinalysis revealed the presence of a profound proteinuria. Which of the following is the most probable cause of these findings?

      Your Answer:

      Correct Answer: Minimal-change disease

      Explanation:

      Minimal-change disease (MCD) refers to a histopathologic glomerular lesion, typically found in children, that is almost always associated with nephrotic syndrome. The most noticeable symptom of MCD is oedema, which can develop very rapidly. Due to the renal loss of proteins muscle wasting and growth failure may be seen in children. Renal function is usually not affected and a proteinuria of more than 40 mg/h/m2 is the only abnormal finding in urinalysis.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 13 - A 65-year old man, known with Type 2 diabetes and chronic renal failure,...

    Incorrect

    • A 65-year old man, known with Type 2 diabetes and chronic renal failure, is likely to eventually present with which of the following conditions?

      Your Answer:

      Correct Answer: Secondary hyperparathyroidism

      Explanation:

      When the parathyroid glands secrete excess parathyroid hormone (PTH) in response to hypocalcaemia, it is known as Secondary hyperparathyroidism and is often seen in patients with renal failure. In chronic renal failure, the kidneys fail to excrete adequate phosphorus and also fail to convert enough vitamin D to its active form. This leads to formation of insoluble calcium phosphate in the body which ultimately causes hypocalcaemia. The glands then undergo hyperplasia and hypertrophy leading to secondary hyperparathyroidism. Symptoms include bone and joint pains, along with limb deformities. The raised PTH also results in pleiotropic effects on blood, the immune system and nervous system.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 14 - Out of the following options, which malignancy has the highest potential for multicentricity?...

    Incorrect

    • Out of the following options, which malignancy has the highest potential for multicentricity?

      Your Answer:

      Correct Answer: Transitional cell carcinoma

      Explanation:

      Transitional cell carcinomas can arise anywhere in the urothelium lining the urinary tract; and hence are known to be multicentric and recur commonly. Prostatic adenocarcinoma most commonly involves the posterior lobe of the prostate gland. Although renal cell carcinomas occasionally show multicentricity, it is not common. Penile carcinomas are usually locally infiltrative lesions. Wilm’s tumours are usually solitary, but can be bilateral or multicentric in 10% cases. Small cell carcinoma of lung and teratomas are usually solitary.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 15 - Which of the following is most likely to cause hypovolaemic hypernatremia: ...

    Incorrect

    • Which of the following is most likely to cause hypovolaemic hypernatremia:

      Your Answer:

      Correct Answer: Hyperalimentation

      Explanation:

      Hypernatremia, characterised by a high serum sodium concentration, is rarely associated with volume overload (hypervolemia). A hypovolaemic hypernatremia may be seen during excessive administration of hypertonic sodium bicarbonate, hypertonic saline or hyperalimentation.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 16 - A 26-year-old female sought consultation due to excessive vaginal discharge. Vaginal smear showed...

    Incorrect

    • A 26-year-old female sought consultation due to excessive vaginal discharge. Vaginal smear showed numerous bacilli under the microscope. The organism was non-pathogenic. What is the most likely organism:

      Your Answer:

      Correct Answer: Lactobacillus species

      Explanation:

      Lactobacillus is a Gram-positive facultative bacteria. It is commonly present in the vagina and the gastrointestinal tract. Colonization of Lactobacillus is usually benign and it makes up a small portion of the gastrointestinal flora.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 17 - A 27-year-old woman, who had been taking a combined oral contraceptive for 6...

    Incorrect

    • A 27-year-old woman, who had been taking a combined oral contraceptive for 6 months, presented with inguinal pain and oedema of the left leg. Which of the following investigations would you recommend to help confirm the diagnosis?

      Your Answer:

      Correct Answer: Duplex scan

      Explanation:

      Oral combined contraceptive pill (OCCP) is a drug used for birth control and treating a number of other conditions. Women who take the OCP have a higher risk of developing deep vein thrombosis (DVT), usually in the legs. Duplex ultrasonography is a safe and non-invasive technique which is used for diagnosing the presence of lower extremity thrombi.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 18 - A patient with testicular seminoma has the following tumour markers: LDH 1.3 times...

    Incorrect

    • A patient with testicular seminoma has the following tumour markers: LDH 1.3 times the reference levels, β-hCG 4500 mIU/ml and AFP 875 ng/ml. What's the serum tumour marker stage in this case?

      Your Answer:

      Correct Answer: S1

      Explanation:

      According to AJCC guidelines, the serum tumour marker staging is the following:
      S0: marker studies within normal limits
      S1: lactate dehydrogenase (LDH) less than 1.5 times the reference range, beta-human chorionic gonadotrophin (β-hCG) <5000 mIU/ml, and alpha-fetoprotein (AFP) <1000 ng/ml
      S2: LDH 1.5–10 times the reference range, β-hCG 5000–50,000 mIU/ml or AFP 1000–10,000 ng/ml
      S3: LDH greater than 10 times the reference range, β-hCG >50,000 mIU/ml or AFP >10,000 ng/ml.
      According to this, the patient’s tumour belongs to the S1 stage.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 19 - Which of the following terms best describes the movement of leukocytes towards a...

    Incorrect

    • Which of the following terms best describes the movement of leukocytes towards a specific target?

      Your Answer:

      Correct Answer: Chemotaxis

      Explanation:

      The movement of leukocytes towards a chemical mediator is termed chemotaxis and the mediators likewise called chemoattractants.
      Diapedesis is the squeezing of the leukocytes from the capillary wall into the intercellular space.
      Endocytosis is engulfing of a small substance by the cells e.g. glucose, protein, fats.
      Margination is lining of the WBC along the periphery of the blood vessel.
      Adhesion is attachment with the vessel wall.
      Phagocytosis is described as engulfing the bacteria or the offending substance.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 20 - A 25-year-old football player suffers severe head trauma during a game. Physical examination...

    Incorrect

    • A 25-year-old football player suffers severe head trauma during a game. Physical examination reveals a decerebrate posture and bilateral papilledema. A CT scan reveals marked diffuse cerebral oedema. This condition will be most severe in which component of the brain?

      Your Answer:

      Correct Answer: White matter

      Explanation:

      The greatest amount of salt and water increase with cerebral oedema occurs within the white matter. Any swelling from oedema, haemorrhage or haematoma increases the intracranial pressure (ICP). As the ICP increases, the cerebral perfusion decreases and brain tissue can become ischaemic, even leading to brain death.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 21 - A 72-year-old male presents with dysuria and chronic haematuria. He was diagnosed with...

    Incorrect

    • A 72-year-old male presents with dysuria and chronic haematuria. He was diagnosed with bladder cancer and tumour invasion of the perivesical fat. What is the stage of the patient's bladder cancer?

      Your Answer:

      Correct Answer: T3

      Explanation:

      Bladder cancer is the growth of abnormal or cancerous cells on the inner lining of the bladder wall. The staging is as follows; stage 0is (Tis, N0, M0): Cancerous cells in the inner lining tissue of the bladder only, stage I (T1, N0, M0): tumour has spread onto the bladder wall, stage II (T2, N0, M0): tumour has penetrated the inner wall and is present in muscle of the bladder wall, stage III (T3, N0, M0): tumour has spread through the bladder to fat around the bladder and stage IV: (T4, N0, M0): tumour has grown through the bladder wall and into the pelvic or abdominal wall. The stage of cancer in the case presented is T3 because of the invasion of perivesical fat.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 22 - A 30-year-old woman is diagnosed with Hodgkin's lymphoma. Which of the following chemotherapy...

    Incorrect

    • A 30-year-old woman is diagnosed with Hodgkin's lymphoma. Which of the following chemotherapy regimens would be used in this case?

      Your Answer:

      Correct Answer: ABVD

      Explanation:

      ABVD is a chemotherapy regimen used in the first-line treatment of Hodgkin’s lymphoma. It consists of concurrent treatment with the chemotherapy drugs, adriamycin, bleomycin, vinblastine and dacarbazine. It supplanted the older MOPP protocol.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 23 - A 30-year old lady presented to her GP with complaints of tremors, excessive...

    Incorrect

    • A 30-year old lady presented to her GP with complaints of tremors, excessive emotional outbursts, weight loss and increased sweating over 20 days. On examination, she had warm and moist skin, a fine tremor of the fingers and hyperreflexia. Her vital signs were normal. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Hyperthyroidism

      Explanation:

      Excess of circulating free thyroid hormones (thyroxine and/or triiodothyronine) leads to hyperthyroidism. Common causes include Graves’ disease, toxic thyroid adenoma and toxic multinodular goitre. Grave’s disease is the most common cause and is responsible for 70-80% cases of hyperthyroidism. Other causes include excess intake of thyroid hormone, amiodarone-related. It is important that hyperthyroidism is not confused with hyperthyroxinaemia (high levels of thyroid hormone in blood), which includes causes like thyroiditis. Both the conditions lead to thyrotoxicosis (symptoms due to hyperthyroxinemia). Symptoms include weight loss associated with increased appetite, anxiety, weakness, heat intolerance, depression, increased sweating, dyspnoea, loss of libido, diarrhoea, palpitations and occasionally arrhythmias. If there is an acute increase in metabolic rate, the condition is known as ‘thyroid storm’. Elderly sometimes present only with fatigue and weight loss and this is called apathetic hyperthyroidism. Neurological symptoms are also seen in hyperthyroidism and these are tremor, chorea, myopathy and periodic paralysis. One of the most serious complications of hyperthyroidism is stroke of cardioembolic origin due to coexisting atrial fibrillation.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 24 - Which of these HLA alleles is most likely to be present in ankylosing...

    Incorrect

    • Which of these HLA alleles is most likely to be present in ankylosing spondylitis?

      Your Answer:

      Correct Answer: HLA-B27

      Explanation:

      Ankylosing spondylitis usually appears between the ages of 20-40 years old and is more frequent in men. It is strongly associated with HLA-B27, along with other spondyloarthropathies, which can be remembered through the mnemonic PAIR (Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, and Reactive arthritis).

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 25 - Which of the following factors will not affect the wound healing process in...

    Incorrect

    • Which of the following factors will not affect the wound healing process in a young women who suffered serious burns to her chest and hands?

      Your Answer:

      Correct Answer: Vitamin A deficiency

      Explanation:

      Healing can be sped-up or slowed down due to various reasons: 1. blood supply, 2. infection, 3. denervation, 4. collection of blood/hematoma, 5. mechanical stress, 6. foreign body, 7. techniques used during surgery and 8. dressing of the wound. Other systemic factors include 1. nutrition e.g. deficiency of zinc, vitamin C, protein deficiency, 2. metabolic status, 3. circulatory status and 4. hormonal influence

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

  • Question 26 - Which of these laboratory findings will indicate a fetal neural tube defect when...

    Incorrect

    • Which of these laboratory findings will indicate a fetal neural tube defect when done between 15 and 20 weeks of pregnancy?

      Your Answer:

      Correct Answer: Increased alpha-fetoprotein

      Explanation:

      Maternal serum screening during the second trimester is a non-invasive way of identifying women at increased risk of having children with a neural tube defect and should be offered to all pregnant women. The results are most accurate when the sample is taken between 15 and 20 weeks of gestation. Elevated levels of alpha-fetoprotein suggest open spina bifida, anencephaly, risk of pregnancy complications, or multiple pregnancy.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
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  • Question 27 - Which of the following is NOT true regarding malignant hyperpyrexia ...

    Incorrect

    • Which of the following is NOT true regarding malignant hyperpyrexia

      Your Answer:

      Correct Answer: It can be caused by nitrous oxide

      Explanation:

      Malignant hyerpyrexia occurs in 1 in 150,000. All inhalational anaesthetic agents and suxamethonium, except nitrous oxide can cause malignant hyperpyrexia.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
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  • Question 28 - The patient who is diagnosed with bladder cancer asked his physician, what could...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
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  • Question 29 - A 57-year-old male smoker noted a lump on his inner lip. Upon physical...

    Incorrect

    • A 57-year-old male smoker noted a lump on his inner lip. Upon physical examination the lump measured more than 2 cm but less than 4 cm in its greatest dimension. He is diagnosed with squamous cell carcinoma of the lip. What is the stage of the patient's cancer according to the TNM staging for head and neck cancers?

      Your Answer:

      Correct Answer: T2

      Explanation:

      Head and neck cancer is a group of cancers that starts within the mouth, nose, throat, larynx, sinuses, or salivary glands. The TNM staging system used for head and neck cancers is a clinical staging system that allows physicians to compare results across patients, assess prognosis, and design appropriate treatment regimens. The staging is as follows; Primary tumour (T): Tis: pre-invasive cancer (carcinoma in situ), T0: no evidence of primary tumour, T1: tumour 2 cm or less in its greatest dimension, T2: tumour more than 2 cm but not more than 4 cm, T3: tumour larger than 4 cm, T4: tumour with extension to bone, muscle, skin, antrum, neck, etc and TX: minimum requirements to assess primary tumour cannot be met. Regional lymph node involvement (N): N0: no evidence of regional lymph node involvement, N1: evidence of involvement of movable homolateral regional lymph nodes, N2: evidence of involvement of movable contralateral or bilateral regional lymph nodes, N3: evidence of involvement of fixed regional lymph nodes and NX: Minimum requirements to assess the regional nodes cannot be met. Distant metastases (M): M0: no evidence of distant metastases, M1: evidence of distant metastases and MX: minimum requirements to assess the presence of distant metastases cannot be met. Staging: Stage I: T1 N0 M0, Stage II: T2 N0 M0, Stage III: T2NOMO and T3N1MO, Stage IV: T4N1M0, any TN2M0, any TN3M0, any T and any NM1. The depth of infiltration is predictive of the prognosis. With increasing depth of invasion of the primary tumour, the risk of nodal metastasis increases and survival decreases. The patient in this scenario therefore has a T2 tumour.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 30 - A 17-year-old female was given an antibiotic for a urinary tract infection. After...

    Incorrect

    • A 17-year-old female was given an antibiotic for a urinary tract infection. After taking the medication the patient developed Steven-Johnson syndrome. Which particular antibiotic usually causes Steven-Johnson syndrome?

      Your Answer:

      Correct Answer: Sulphonamides

      Explanation:

      Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulphonamide antibiotics, and nevirapine.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
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  • Question 31 - A patient with this type of tumour is advised to follow up regularly...

    Incorrect

    • A patient with this type of tumour is advised to follow up regularly for monitoring of tumour size as there is a strong correlation with malignant potential and tumour size. Which of the following is the most likely tumour in this patient?

      Your Answer:

      Correct Answer: Renal adenocarcinoma

      Explanation:

      The distinction between a benign renal adenoma and renal adenocarcinoma is commonly made on the basis of size. Tumours less than 2 cm in size rarely become malignant as opposed to those greater than 3 cm.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
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  • Question 32 - Which of the following diseases affects young adults, causing pain in any bone...

    Incorrect

    • Which of the following diseases affects young adults, causing pain in any bone -particularly long bones- which worsens at night, and is typically relieved by common analgesics, such as aspirin?

      Your Answer:

      Correct Answer: Osteoid osteoma

      Explanation:

      Osteoid osteoma, which tends to affect young adults, can occur in any bone but is most common in long bones. It can cause pain (usually worse at night) that is typically relieved by mild analgesics, such as non-steroidal anti-inflammatory drugs. X-ray findings include a small radiolucent zone surrounded by a larger sclerotic zone.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 33 - Which tumour site is more commonly involved in adults than in children? ...

    Incorrect

    • Which tumour site is more commonly involved in adults than in children?

      Your Answer:

      Correct Answer: Lung

      Explanation:

      In adults, the most common primary site of tumour is in the lungs, compared to children wherein the most common primary site is the blood.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 34 - A 75-year old patient is in atrial fibrallation but has never been on...

    Incorrect

    • A 75-year old patient is in atrial fibrallation but has never been on anticoagulation therapy. To reduce the risk of future emboli, she would benefit from starting on long-term warfarin. Arterial emboli leading to acute limb ischaemia most commonly lodge at which one of the following sites?

      Your Answer:

      Correct Answer: Common femoral artery

      Explanation:

      The common femoral artery is the commonest site of arterial emboli causing acute limb ischemia. The treatment of choice is urgent femoral embolectomy.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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      Seconds

  • Question 35 - A 65-year old gentleman presents to the clinic with chronic back pain and...

    Incorrect

    • A 65-year old gentleman presents to the clinic with chronic back pain and weight loss. His blood count shows a white blood cell count of 10 × 109/l, with a differential count of 66 polymorphonuclear leukocytes, 7 bands, 3 metamyelocytes, 3 myelocytes, 14 lymphocytes, 7 monocytes, and 5 nucleated red blood cells. The haemoglobin is 13 g/dl with a haematocrit of 38.1%, a mean corpuscular volume of 82 fl, and a platelet count of 126 × 109/l. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Metastatic carcinoma

      Explanation:

      The peripheral blood findings suggest a leucoerythroblastic picture, the common causes of which in a 65-year old gentleman includes prostatic or lung malignancy.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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      Seconds

  • Question 36 - A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for...

    Incorrect

    • A 34-year-old woman has been suffering from headaches, fever, vomiting, and confusion for the last 5 days. A CT scan reveals an oedematous mass with ring enhancement in the left temporal region. It is biopsied, revealing glial cells, necrosis, neutrophils and lymphocytes. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Cerebral abscess

      Explanation:

      A cerebral abscess can result from direct extension of cranial infections, penetrating head trauma, haematogenous spread, or for unknown causes. An abscess forms when an area of cerebral inflammation becomes necrotic and encapsulated by glial cells and fibroblasts. Oedema around the abscess can increase the intracranial pressure. Symptoms result from increased intracranial pressure and mass effects. It is most frequent in the third decade of life, and when it occurs in children, it is usually associated with congenital heart disease.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 37 - Which of the following morphological features is most characteristic of hyaline degeneration? ...

    Incorrect

    • Which of the following morphological features is most characteristic of hyaline degeneration?

      Your Answer:

      Correct Answer: Homogeneous, ground-glass, pink-staining appearance of cells

      Explanation:

      The characteristic morphological features of hyaline degeneration is ground-glass, pinking staining cytoplasm with an intact cell membrane. The accumulation of lipids, calcium salts, lipofuscin and an amorphous cytoplasm with an intact cell membrane are all characteristically found in different situations.
      Pyknotic nucleus and orphan Annie eye nucleus are not seen in hyaline degeneration.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 38 - Which type of thyroid tumour represents 75 - 80% of thyroid cancer cases?...

    Incorrect

    • Which type of thyroid tumour represents 75 - 80% of thyroid cancer cases? This type is predominant in children and in patients who have had a previous history of head or neck radiation.

      Your Answer:

      Correct Answer: Papillary carcinoma

      Explanation:

      Papillary thyroid carcinoma is the most common thyroid cancer. This cancer has a high cure rate with 10-year survival rates for all patients with papillary thyroid cancer estimated at 80% to 90%.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 39 - 13 year old girl developed sun burnt cheeks after spending the day playing...

    Incorrect

    • 13 year old girl developed sun burnt cheeks after spending the day playing on the beach. What is the underlying mechanism to her injury?

      Your Answer:

      Correct Answer: Free radical injury

      Explanation:

      Free radicals are a by-product of chemical reactions with an unpaired electron in their outer most shell. They are capable of causing wide spread damage to cells. They can cause autolytic reactions thereby converting the reactants into free radicals. By absorbing sun light, the energy is used to hydrolyse water into hydroxyl (OH) and hydrogen (H) free radicals which can cause injury by lipid peroxidation of membranes, oxidative modification of proteins and damage to the DNA structure.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 40 - A 15 year old girl presented to the emergency with a history of...

    Incorrect

    • A 15 year old girl presented to the emergency with a history of chronic cough, fever and weight loss. Her chest X-ray showed multiple nodules 1-4 cm in size and some of them with cavitation especially in the upper lobe. A sputum sample was positive for acid fast bacilli. Which of the following cells played a part in the development of the lung lesions?

      Your Answer:

      Correct Answer: Macrophage

      Explanation:

      The characteristic cells in granulomatous inflammation are giant cells, formed from merging macrophages and epithelioid cells elongated with granular eosinophilic cytoplasm. Granulomatous reactions are seen in patients with tuberculosis. A tuberculous/caseating granuloma is characterised by a zone of central necrosis lined with giant multinucleated giant cells (Langhans cells) and surrounded by epithelioid cells, lymphocytes and fibroblasts. The caseous zone is present due to the damaged and dead giant cells and epithelioid cells.
      Mast cells are only few in number and fibroblasts lay down collagen.
      Basophils are not present.
      The giant cell made up of macrophages are the most abundant cells in this inflammatory process.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 41 - A 65-year-old smoker presents with painless haematuria, urinary frequency and urgency. He is...

    Incorrect

    • A 65-year-old smoker presents with painless haematuria, urinary frequency and urgency. He is diagnosed with bladder cancer. Which is the most likely type?

      Your Answer:

      Correct Answer: Transitional cell carcinoma

      Explanation:

      90% of bladder cancers are transitional cell carcinomas derived from the bladder urothelium. Risk factors include industrial chemicals, smoking and infection. Schistosomiasis and bladder stones predispose to the squamous cell variety.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 42 - A 40-year old gentleman, who is a known with ulcerative colitis, complains of...

    Incorrect

    • A 40-year old gentleman, who is a known with ulcerative colitis, complains of recent-onset of itching and fatigue. On examination, his serum alkaline phosphatase level was found to be high. Barium radiography of the biliary tract showed a 'beaded' appearance. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Sclerosing cholangitis

      Explanation:

      Primary sclerosing cholangitis is characterised by patchy inflammation, fibrosis and strictures in intra- and extra-hepatic bile ducts. It is a chronic cholestatic condition with 80% patients having associated inflammatory bowel disease (likely to be ulcerative colitis). Symptoms include pruritus and fatigue. ERCP (endoscopic retrograde cholangiopancreatography) or MRCP (magnetic resonance cholangiopancreatography) are diagnostic. Disease can lead to complete obliteration of ducts, which can result in liver failure. Cholangiocarcinoma is also a recognised complication..

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 43 - What is the primary function of the Kupffer cells found in the liver?...

    Incorrect

    • What is the primary function of the Kupffer cells found in the liver?

      Your Answer:

      Correct Answer: Recycling of old red blood cells

      Explanation:

      Kupffer cells found in the liver are part of the monocyte-reticular system. They are specialised macrophages and primarily function to recycle old and damaged RBCs. The RBCs are phagocytosed and the haemoglobin is broken down into haem and globin. The haem is further broken down into iron that is recycled and bilirubin that is conjugated with glucuronic acid and excreted in the bile.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 44 - A patient in the intensive care unit developed hyperphosphatemia. The phosphate level is...

    Incorrect

    • A patient in the intensive care unit developed hyperphosphatemia. The phosphate level is 160 mmol/L. Which of the following is most likely responsible for this abnormality?

      Your Answer:

      Correct Answer: Renal insufficiency

      Explanation:

      Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood. It is caused by conditions that impair renal phosphate excretion (ex: renal insufficiency, hypoparathyroidism, parathyroid suppression) and conditions with massive extracellular fluid phosphate loads (ex: rapid administration of exogenous phosphate, extensive cellular injury or necrosis, transcellular phosphate shifts).

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 45 - A Monospot test in a 17-year old boy presenting with fever, multiple palpable...

    Incorrect

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

      Your Answer:

      Correct Answer: Atypical lymphocytosis

      Explanation:

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

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 46 - Paracentesis of ascetic fluid in a 45-year old woman revealed the following :...

    Incorrect

    • Paracentesis of ascetic fluid in a 45-year old woman revealed the following : clear, yellow fluid with protein 2.0 g/dl and a few mesothelial and mononuclear cells seen. No malignant cells seen. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Micronodular cirrhosis

      Explanation:

      Cirrhosis is disease of the liver that is characterized by fibrosis leading to disorganization of the hepatic architecture. It shows the development of regenerative nodules surrounded by dense fibrotic tissue. Cirrhosis shows non-specific symptoms initially, which include fatigue, anorexia and weight loss. It can later progress to portal hypertension, ascites and liver failure.
      Micronodular cirrhosis is named so, due to the uniformly small nodules (<3 mm in diameter) and thick regular bands of connective tissue. These nodules lack lobular organization with distortion of central hepatic venules and portal triads. Over a period of time, macronodular cirrhosis develops, with bigger nodules (3 mm to 5 cm in diameter) surrounded by broad fibrous bands, and some amount of lobular organization. Mixed cirrhosis combines features of both micronodular and macronodular cirrhosis.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 47 - A 50-year old gentleman was recently diagnosed with hypertension, with no other abnormality...

    Incorrect

    • A 50-year old gentleman was recently diagnosed with hypertension, with no other abnormality on physical examination. Further investigations revealed the following :
      Na+ 144 mmol/l,
      K+ 3.0 mmol/l,
      Cl- 107 mmol/l,
      Bicarbonate 25 mmol/l.
      Blood glucose 5.8 mmol/l.
      What is the likely diagnosis?

      Your Answer:

      Correct Answer: Conn syndrome

      Explanation:

      Overproduction of aldosterone (a mineralocorticoid) by the adrenal glands is known as Conn’s syndrome. It can be either due to an aldosterone-secreting adrenal adenoma (50-60% cases) or adrenal gland hyperplasia (40-50% cases). Excess aldosterone leads to sodium and water retention, along with potassium excretion. This leads to arterial (non-essential) hypertension. Conn’s syndrome is the commonest cause of primary hyperaldosteronism. Other symptoms include muscle cramps, headache (due to hypokalaemia) and metabolic alkalosis, which occurs due to increased secretion of H+ ions by the kidney. The raised pH of the blood traps calcium leading to symptoms of hypocalcaemia, which can be mimicked by liquorice ingestion and Liddle syndrome. To diagnose Conn’s syndrome, the ratio of renin and aldosterone is measured. Due to suppression of renin secretion, there is low renin to aldosterone ratio (<0.05). However, anti-hypertensives may affect the test results and should be withdrawn for 6 weeks. Computed tomography can also be done to detect the presence of adrenal adenoma.
      Cushing’s syndrome does not cause hypokalaemia with normal serum glucose levels. Nelson’s syndrome refers to increased ACTH secretion due to pituitary adenoma. Pheochromocytoma will not lead to hypokalaemia even though hypertension can be seen.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 48 - A histology report of a cervical biopsy taken from a patient with tuberculosis...

    Incorrect

    • A histology report of a cervical biopsy taken from a patient with tuberculosis revealed the presence of epithelioid cells. What are these cells formed from?

      Your Answer:

      Correct Answer: Macrophages

      Explanation:

      Granulomas formed in tuberculosis are called tubercles and are made up polynuclear phagocytes, Langhans cells and epithelioid cells. Macrophages when enlarged, consist of abundant cytoplasm and have a tendency of arranging themselves very closely to each other representing epithelial cells. These enlarged macrophages are therefore termed as epithelioid cells.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 49 - Hyperplastic arteriosclerosis with fibrinoid necrosis, petechial haemorrhages, microinfarcts in the kidneys and elevated...

    Incorrect

    • Hyperplastic arteriosclerosis with fibrinoid necrosis, petechial haemorrhages, microinfarcts in the kidneys and elevated plasma renin are common findings in which of the following patients?

      Your Answer:

      Correct Answer: A 45-year-old woman with scleroderma

      Explanation:

      Scleroderma, also known as systemic sclerosis, is a chronic disease of the connective tissue. Involvement of the kidneys occurs in patients with diffuse scleroderma, causing rapid onset of high blood pressure with hyperreninemia, thrombotic microangiopathy, and progressive renal failure.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 50 - A 47-year old-woman diagnosed with pancreatitis presented to the emergency department complaining of...

    Incorrect

    • A 47-year old-woman diagnosed with pancreatitis presented to the emergency department complaining of a worsening shortness of breath, fever, agitation and cough. Oxygen saturation was 67% in room air. Her respiratory status continued to deteriorate therefore she was intubated. She was admitted to the intensive care unit for management. Chest X-ray demonstrated bilateral perihilar opacities. The patient failed conventional treatment and died several days later. At autopsy, the lung shows growth of type 2 pneumocytes and thickened alveolar walls. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Adult respiratory distress syndrome

      Explanation:

      Acute (or adult) respiratory distress syndrome (ARDS) is a life-threatening lung condition characterised by a non-cardiogenic pulmonary oedema that leads to acute respiratory failure. The most common risk factors for ARDS include trauma with direct lung injury, sepsis, pneumonia, pancreatitis, burns, drug overdose, massive blood transfusion and shock. Acute onset of dyspnoea with hypoxemia, anxiety and agitation is typical. Chest X ray most commonly demonstrates bilateral pulmonary infiltrates. Histological changes include the exudative, proliferative and fibrotic phase. ARDS is mainly a clinical diagnosis.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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