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  • Question 1 - A neonate with failure to pass meconium is being evaluated. His abdomen is...

    Incorrect

    • A neonate with failure to pass meconium is being evaluated. His abdomen is distended and X-ray films of the abdomen show markedly dilated small bowel and colon loops. The likely diagnosis is:

      Your Answer:

      Correct Answer: Aganglionosis in the rectum

      Explanation:

      Hirschsprung’s disease (also known as aganglionic megacolon) leads to colon enlargement due to bowel obstruction by an aganglionic section of bowel that starts at the anus. A blockage is created by a lack of ganglion cells needed for peristalsis that move the stool. 1 in 5000 children suffer from this disease, with boys affected four times more commonly than girls. It develops in the fetus in early stages of pregnancy. Symptoms include not having a first bowel movement (meconium) within 48 hours of birth, repeated vomiting and a swollen abdomen. Two-third of cases are diagnosed within 3 months of birth. Some children may present with delayed toilet training and some might not show symptoms till early childhood. Diagnosis is by barium enema and rectal biopsy (showing lack of ganglion cells).

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      9
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  • Question 2 - Atrial septal defect (ASD) is most likely to be due to incomplete closure...

    Incorrect

    • Atrial septal defect (ASD) is most likely to be due to incomplete closure of which one of the following structures:

      Your Answer:

      Correct Answer: Foramen ovale

      Explanation:

      Atrial septal defect is a congenital heart defect that results in a communication between the right and left atria of the heart and may involve the interatrial septum. It results from incomplete closure of the foramen ovale which is normally open during fetal life and closes just after birth.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 3 - What forms the pelvic diaphragm? ...

    Incorrect

    • What forms the pelvic diaphragm?

      Your Answer:

      Correct Answer: Levator ani and coccygeus muscles

      Explanation:

      The pelvic diaphragm is formed by the levator ani and the coccygeus muscles. The levator ani forms the greater part of the pelvic floor supporting the viscera in the pelvic cavity.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 4 - Which of the following is the most accurate test for the diagnosis of...

    Incorrect

    • Which of the following is the most accurate test for the diagnosis of primary syphilis?

      Your Answer:

      Correct Answer: Dark-field microscopy

      Explanation:

      Primary syphilis is transmitted via sexual contact. Lesions on genitalia, called a chancre occur after an asymptomatic incubation period of 10-90 days (average 21 days) after exposure. This chancre is a typically solitary (can be multiple), firm, painless, ulceration over the skin at the point of exposure to spirochete, seen on penis, vagina or rectum. It heals spontaneously after 4-6 weeks. Local lymphadenopathy can be seen.
      Diagnosis is made by microscopy of fluid from lesion using dark-field illumination, taking care to not confuse with other treponemal disease. Screening tests include rapid plasma regain (RPR) and Venereal Diseases Research Laboratory (VDRL) tests. False positives are known to occur with these tests and can be seen in viral infections like hepatitis, varicella, Epstein-Barr virus, tuberculosis, lymphoma, pregnancy and IV drug use. More specific tests should therefore be carried out in case these screening tests are positive. The Treponema pallidum hemagglutination assay (TPHA) and the fluorescent treponemal antibody absorption (FTAABS) test are based on monoclonal antibodies and immunofluorescence and are more specific. However, they can too show false positives with other treponemal diseases like yaws or pinta. Other confirmatory tests include those based on enzyme-linked immunoassays.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 5 - What is the most likely condition a new born infant is likely to...

    Incorrect

    • What is the most likely condition a new born infant is likely to suffer from, if he/she was born with incomplete fusion of the embryonic endocardial cushions?

      Your Answer:

      Correct Answer: An atrioventricular septal defect

      Explanation:

      The endocardial cushions in the heart are the mesenchymal tissue that make up the part of the atrioventricular valves, atrial septum and ventricular septum. An incomplete fusion of these mesenchymal cells can cause an atrioventricular septal defect. The terms endocardial cushion defect, atrioventricular septal defect and common atrioventricular canal defect can be used interchangeably with one another.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 6 - Whipple's procedure involves mobilizing the head of the pancreas. As the surgeon does...

    Incorrect

    • Whipple's procedure involves mobilizing the head of the pancreas. As the surgeon does this, he must be careful to avoid injury to a key structure that is found lying behind the head of the pancreas. Which vital structure is this?

      Your Answer:

      Correct Answer: Common bile duct

      Explanation:

      The posterior relations of the head of the pancreas include: the inferior vena cava, the common bile duct, the renal veins, the right crus of the diaphragm and the aorta.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 7 - A 45 -year-old female is recently diagnosed with breast cancer. She has a...

    Incorrect

    • A 45 -year-old female is recently diagnosed with breast cancer. She has a 8-cm-diameter mass in her left breast, with enlarged left axillary node. What is the most likely stage of her disease?

      Your Answer:

      Correct Answer: IIIA

      Explanation:

      Stage IIIA breast cancer is T0–2 N2 M0 or T3 N1-2 M0 disease. It describes invasive breast cancer in which either: the tumour is smaller than 5 cm in diameter and has spread to 4 to 9 axillary lymph nodes; or it is found through imaging studies or clinical exam to have spread to internal mammary nodes (near the breastbone found during imaging tests or a physical exam); or the tumour is larger than 5 cm and has spread to 1 to 9 axillary nodes, or to internal mammary nodes. In this stage, the cancer has not metastasized (spread to distant sites).

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 8 - Which of the following is NOT a nutritional factor involved in wound healing:...

    Incorrect

    • Which of the following is NOT a nutritional factor involved in wound healing:

      Your Answer:

      Correct 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.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 9 - A patient sustained an iatrogenic injury to one of the structures passing through...

    Incorrect

    • A patient sustained an iatrogenic injury to one of the structures passing through the deep inguinal ring. This was during an operation to repair an inguinal hernia. Which structure is most likely to be injured?

      Your Answer:

      Correct Answer: Round ligament of the uterus

      Explanation:

      The deep inguinal ring transmits the spermatic cord in the man and the round ligament of the uterus in the female. It is bound below and medially by the inferior epigastric vessels (so these don’t go through it).
      The ilioinguinal nerve, although it courses through the inguinal canal, does not pass through it.
      The iliohypogastric nerves run between the internal oblique and transversus abdominis in the abdominal wall, piercing the internal oblique at the anterior superior iliac spine to travel just deep to the external oblique.
      The inferior epigastric artery runs between the transversus abdominis and the peritoneum forming the lateral umbilical fold.
      The medial umbilical ligament is the obliterated umbilical artery that it lies within the medial umbilical fold of peritoneum.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 10 - A histopathological analysis of a specimen showed loss of individual cell structure with...

    Incorrect

    • A histopathological analysis of a specimen showed loss of individual cell structure with karyorrhexis and fragmentation. The overall integrity of the tissue structure is preserved. This is typical of which of the following pathologies?

      Your Answer:

      Correct Answer: Viral hepatitis

      Explanation:

      Viral infections will cause necrosis of the hepatocytes with characteristic changes of karyorrhexis and cell fragmentation.
      Brown atrophy of the heart is due to accumulation of lipofuscin in the myocardium.
      Tissue destruction associated with transplant rejection leads to widespread loss of structural integrity.
      Single cell necrosis is not characteristically seen in chronic alcoholic liver.
      Barbiturate overdose will result in hypertrophy of the smooth endoplasmic reticulum.
      Carcinoma insitu will cause dysplastic cells without the overall structural integrity being disrupted.
      Atrophy is due to apoptosis with ordered cellular fragmentation and phagocytosis and will not induce an inflammatory process unlike necrosis.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 11 - What is the innervation of the laryngeal mucosa inferior to the true vocal...

    Incorrect

    • What is the innervation of the laryngeal mucosa inferior to the true vocal cord?

      Your Answer:

      Correct Answer: Recurrent laryngeal nerve

      Explanation:

      Motor innervation to all other muscles of the larynx and sensory innervation to the subglottis is by the recurrent laryngeal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 12 - Which of the following is an anion? ...

    Incorrect

    • Which of the following is an anion?

      Your Answer:

      Correct Answer: Phosphate

      Explanation:

      Cations: sodium, magnesium, calcium and potassium
      Anions: chloride, phosphate, bicarbonate, lactate, sulphate and albumin

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 13 - What is the correct order of structures a needle must pass before it...

    Incorrect

    • What is the correct order of structures a needle must pass before it enters the pleural cavity?

      Your Answer:

      Correct Answer: External intercostals – internal intercostals – innermost intercostals – parietal pleura

      Explanation:

      The correct order of structures from superficial to deep are: the skin and subcutaneous tissue, the external intercostals followed by internal intercostals, innermost intercostals and finally parietal pleura.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 14 - Which cells are most commonly seen in a granulomatous lesion that suggests an...

    Incorrect

    • Which cells are most commonly seen in a granulomatous lesion that suggests an underlying chronic inflammation?

      Your Answer:

      Correct Answer: Lymphocytes

      Explanation:

      Lymphocytes and monocytes are commonly and characteristically recognised in a case of chronic inflammation.
      Eosinophils and neutrophils are seen with acute inflammation.
      Mast cells release histamine in early inflammation.
      Basophils are seen with allergies.
      Plasma cells are seen with viral infection.
      Platelets are not characteristic of any type of inflammation.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 15 - Increased resistance to flow of blood in cerebral vessels is most likely seen...

    Incorrect

    • Increased resistance to flow of blood in cerebral vessels is most likely seen in:

      Your Answer:

      Correct Answer: Elevation in systemic arterial pressure from 100 to 130 mmHg

      Explanation:

      Constant cerebral blood flow is maintained by autoregulation in the brain, which causes an increase in local vascular resistance to offset an increase in blood pressure. There will be an increase in cerebral blood flow (and decrease in resistance to cerebral blood flow) with a decrease in arterial oxygen or an increase in arterial CO2. Similarly, a decrease in viscosity will also increase the blood flow. Due to increased brain metabolism and activity during a seizure, there will also be an increase in the cerebral blood flow.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
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  • Question 16 - Gram positive bacteria differ from gram negative bacteria due to the presence of...

    Incorrect

    • Gram positive bacteria differ from gram negative bacteria due to the presence of which of the following structures?

      Your Answer:

      Correct Answer: Outer membrane

      Explanation:

      The reason bacteria are either Gram-positive or Gram-negative is due to the structure of their cell envelope (the cell envelope is defined as the cell membrane and cell wall plus an outer membrane, if one is present.) Gram-positive bacteria, for example, retain the crystal violet due to the amount of peptidoglycan in the cell wall. It can be said therefore that the Gram-stain procedure separates bacteria into two broad categories based on structural differences in the cell envelope.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 17 - Regarding the venous drainage of the heart which of these is correct? ...

    Incorrect

    • Regarding the venous drainage of the heart which of these is correct?

      Your Answer:

      Correct Answer: The great cardiac vein is the largest tributary of the coronary sinus and this vein starts at the apex of the heart and ascends with the anterior ventricular branch of the left coronary artery

      Explanation:

      Most of the veins of the heart open into the coronary sinus. This is a wide venous channel, about 2.25 cm in length, situated in the posterior part of the coronary sulcus and covered by muscular fibres from the left atrium. Its tributaries are the great, small and middle cardiac veins, the posterior vein of the left ventricle and the oblique vein of the left atrium. The great cardiac vein is the largest tributary of the coronary sinus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 18 - Calculate the cardiac output of a patient with the following measurements: oxygen uptake...

    Incorrect

    • Calculate the cardiac output of a patient with the following measurements: oxygen uptake 200 ml/min, oxygen concentration in the peripheral vein 7 vol%, oxygen concentration in the pulmonary artery 10 vol% and oxygen concentration in the aorta 15 vol%.

      Your Answer:

      Correct Answer: 4000 ml/min

      Explanation:

      The Fick’s principle states that the uptake of a substance by an organ equals the arteriovenous difference of the substance multiplied by the blood flowing through the organ. We can thus calculate the pulmonary blood flow with pulmonary arterial (i.e., mixed venous) oxygen content, aortic oxygen content and oxygen uptake. The pulmonary blood flow, systemic blood flow and cardiac output can be considered the same assuming there are no intracardiac shunts. Thus, we can calculate the cardiac output. Cardiac output = oxygen uptake/(aortic − mixed venous oxygen content) = 200 ml/min/(15 ml O2/100 ml − 10 ml O2/100 ml) = 200 ml/min/(5 ml O2/100 ml) = 200 ml/min/0.05 = 4000 ml/min.
      It is crucial to remember to use pulmonary arterial oxygen content and not peripheral vein oxygen content, when calculating the cardiac output by Fick’s method.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 19 - During an operation to repair an indirect inguinal hernia, it is noticed that...

    Incorrect

    • During an operation to repair an indirect inguinal hernia, it is noticed that the hernial sac is protruding out of the superficial inguinal ring. The superficial inguinal ring is an opening in which structure?

      Your Answer:

      Correct Answer: External abdominal oblique aponeurosis

      Explanation:

      The superficial inguinal ring is an opening in the aponeurosis of the external oblique just above and lateral to the pubic crest. The opening is oblique and corresponds to the fibres of the aponeurosis. It is bound inferiorly by the pubic crest, on either side by the margins of the opening in the aponeurosis and superiorly by the curved intercrural fibres.
      The inferior crus is formed by the portion of the inguinal ligament that is inserted into the pubic tubercle.
      The falx inguinalis is made of arching fibres of the transversalis fascia and the internal abdominal oblique muscle. It forms the posterior wall of the inguinal canal.
      The internal abdominal oblique forms the root of the inguinal canal.
      Scarpa’s and Camper’s fascia are the membranous and fatty layers, respectively of subcutaneous fascia.
      Transversalis fascia covers the posterior surface of the rectus abdominis muscle inferior to the arcuate line.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 20 - A 7-year-old boy is diagnosed with metabolic acidosis as a result of severe...

    Incorrect

    • A 7-year-old boy is diagnosed with metabolic acidosis as a result of severe dehydration. Which of the following conditions is most likely to cause severe dehydration and metabolic acidosis?

      Your Answer:

      Correct Answer: Severe diarrhoea

      Explanation:

      Diarrhoea is defined as having three or more loose or liquid stools per day, or as having more stools than is normal for that person. Severe diarrhoea, causing fluid loss and loss of bicarbonate, will result in marked dehydration and metabolic acidosis.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      0
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  • Question 21 - A 38 year old man is to undergo excision of the base of...

    Incorrect

    • A 38 year old man is to undergo excision of the base of the prostate for malignant growth, which of the following structures is directly related to the base of the prostate?

      Your Answer:

      Correct Answer: Urinary bladder

      Explanation:

      The prostate is situated in the pelvic cavity and is also located immediately below the internal urethral orifice at the commencement of the urethra. It is held in position by the puboprostatic ligaments, the superior fascia of the urogenital diaphragm and the anterior portions of the levatores ani. The base of the prostate is directed upward and is attached to the inferior surface of the urinary bladder while the apex is directed downward and is in contact with the superior fascia of the urogenital diaphragm.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 22 - The operating surgeon notices a structure lying alongside a herniated mass whilst repairing...

    Incorrect

    • The operating surgeon notices a structure lying alongside a herniated mass whilst repairing an indirect inguinal hernia in a female patient. Which structure could this be?

      Your Answer:

      Correct Answer: Round ligament of the uterus

      Explanation:

      The main structure traversing the inguinal canal in women is the round ligament. In men, it is the spermatic cord.
      The iliohypogastric nerve innervates the abdominal wall and runs between the transversus abdominis and internal oblique muscles before piercing the internal oblique at the anterior superior iliac spine to run between the internal and external obliques.
      The inferior epigastric artery is between the peritoneum and the transversus abdominis creating the lateral umbilical fold.
      The ovarian artery and the ovarian vein are branches from the descending aorta and inferior vena cava that supply the ovary in the pelvic cavity.
      The pectineal ligament is a thick fascial layer over the pectineal line of the pubis. It doesn’t traverse the canal.
      The broad ligament if found on the lateral sides of the uterus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 23 - A patient is diagnosed with lung cancer. His physician told him that his...

    Incorrect

    • A patient is diagnosed with lung cancer. His physician told him that his lung cancer type is aggressive. It can grow rapidly and may undergo early metastasis, however it is very sensitive to chemotherapy and radiotherapy. Which lung cancer type is most likely present

      Your Answer:

      Correct Answer: Small-cell carcinoma

      Explanation:

      Small-cell lung carcinoma (SCLC) is a type of highly malignant cancer that most commonly arises within the lung. SCLC usually metastasizes widely very early on in the natural history of the tumour, and in nearly all cases responds dramatically to chemotherapy and/or radiotherapy. Surgery has no role in the treatment of this disease.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 24 - A nerve is injured during a surgical operation to repair an inguinal hernia....

    Incorrect

    • A nerve is injured during a surgical operation to repair an inguinal hernia. It passes through the superficial inguinal ring. Which nerve is it most likely to be?

      Your Answer:

      Correct Answer: Ilioinguinal

      Explanation:

      The ilioinguinal nerve doesn’t pass through the deep inguinal ring but enters the inguinal canal from the side and leaves by passing through the superficial ring thus it is at risk of injury during inguinal hernia repair.
      The femoral branch of genitofemoral nerve travels lateral to the superficial inguinal ring.
      The iliohypogastric nerve and the subcostal nerve travel superior to the inguinal canal and superficial inguinal ring.
      The obturator nerve is a branch of the lumbar plexus that innervates the muscles of the thigh.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 25 - Due to a plantarflexion–inversion ankle sprain, which is the first ligament to rupture?...

    Incorrect

    • Due to a plantarflexion–inversion ankle sprain, which is the first ligament to rupture?

      Your Answer:

      Correct Answer: Anterior talofibular ligament

      Explanation:

      The anterior talofibular ligament passes from the anterior margin of the fibular malleolus. It is the most commonly injured ligament, as part of the lateral ligament of the ankle.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 26 - The sciatic nerve does NOT supply which of the following muscles? ...

    Incorrect

    • The sciatic nerve does NOT supply which of the following muscles?

      Your Answer:

      Correct Answer: Obturator externus

      Explanation:

      The sciatic nerve supplies both gemellae, quadratus femoris, semitendinosus, semimembranosus, both heads of the biceps femoris, the hamstring half of abductor magnus and obturator internus. Obturator externus is supplied by the obturator nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 27 - A Jewish man was diagnosed with haemophilia C. Which of the following factors...

    Incorrect

    • A Jewish man was diagnosed with haemophilia C. Which of the following factors is deficient in this form of haemophilia?

      Your Answer:

      Correct Answer: Factor XI

      Explanation:

      Haemophilia C, also known as plasma thromboplastin antecedent (PTA) deficiency or Rosenthal syndrome, is a condition caused by the deficiency of the coagulation factor XI. The condition is rare and it is usually found in Ashkenazi Jews.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
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  • Question 28 - A 12-year old girl was brought to the hospital with recurrent headaches for...

    Incorrect

    • A 12-year old girl was brought to the hospital with recurrent headaches for 6 months. Her physical examination revealed no abnormality. A CT scan of the head revealed a suprasellar mass with calcifications, eroding the surrounding sella turcica. The lesion is likely to represent:

      Your Answer:

      Correct Answer: Craniopharyngioma

      Explanation:

      Craniopharyngiomas (also known as Rathke pouch tumours, adamantinomas or hypophyseal duct tumours) affect children mainly between the age of 5 and 10 years. It constitutes 9% of brain tumours affecting the paediatric population. These are slow-growing tumours which can also be cystic, and arise from the pituitary stalk, specifically the nests of epithelium derived from Rathke’s pouch. Histologically, this tumour shows nests of squamous epithelium which is lined on the outside by radially arranged cells. Calcium deposition is often seen with a papillary type of architecture.
      ACTH-secreting pituitary adenomas are rare and mostly microadenomas. Paediatric astrocytoma’s usually occur in the posterior fossa. Although null cell adenomas can cause mass effect and give rise to the described symptoms, they are not suprasellar. Prolactinomas can also show symptoms of headache and disturbances in the visual field, however they are known to be small and slow-growing.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
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  • Question 29 - A 13-year-old boy's mother notices he has a lump in his arm, near...

    Incorrect

    • A 13-year-old boy's mother notices he has a lump in his arm, near his right shoulder. An X-ray reveals a lateral projection in the metaphyseal region of his humerus. The lesion is removed and it is found to be composed of bony cortex, capped by cartilage. What's the most likely diagnosis in this case?

      Your Answer:

      Correct Answer: Osteochondroma

      Explanation:

      Osteochondromas, or osteocartilaginous exostoses, are the most common benign bone tumours, and tend to appear near the ends of long bones. The overgrowth can occur in any bone where cartilage forms bone, and they are capped by cartilage. They are most common in people between the ages of 10-20 years old.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
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  • Question 30 - A 55-year-old woman died 3 years after a cardiac transplant due to worsening...

    Incorrect

    • A 55-year-old woman died 3 years after a cardiac transplant due to worsening congestive heart failure. Autopsy revealed diffuse hyperplasia of the vascular intima involving the entire length of the coronary arteries. The most probable cause of deterioration of the cardiac function is:

      Your Answer:

      Correct Answer: Coronary atherosclerosis

      Explanation:

      Allograft coronary artery disease (CAD) can begin right after the transplant and is the major cause of later death in cardiac transplant recipients. This form of atherosclerosis progresses quickly resulting in allograft failure. Due to lack of premonitory symptoms CAD may lead to sudden death.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds

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