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  • Question 1 - Which of the following veins empties into the left renal vein? ...

    Incorrect

    • Which of the following veins empties into the left renal vein?

      Your Answer: Left phrenic

      Correct Answer: Left suprarenal

      Explanation:

      The left suprarenal vein empties into the left renal vein which crosses the vertebral column to reach the inferior vena cava. The left renal vein also receives the left gonadal vein.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      2
      Seconds

  • Question 2 - Which of the following is found to be elevated in a case of...

    Incorrect

    • Which of the following is found to be elevated in a case of hepatocellular carcinoma?

      Your Answer:

      Correct Answer: AFP

      Explanation:

      Alpha-fetoprotein (AFP) is a glycoprotein that is normally produced by the yolk sac of the embryo, and then the fetal liver. It is elevated in the new-born and thus, also in the pregnant women. Eventually, it decreases in the first year of life to reach the adult normal value of < 20 ng/ml by 1 year of age. Markedly elevated levels (>500 ng/ml) in a high-risk patient is considered diagnostic for primary hepatocellular carcinoma (HCC). Moreover, due to smaller tumours secreting less quantities of AFP, rising levels can be a better indication. However, not all hepatocellular carcinomas produce AFP. Also, the level of AFP is not a prognostic factor. Populations where hepatitis B and HCC are common (e.g.: sub-Saharan Africans, ethnic Chinese) can see AFP levels as high as 100,000 ng/ml, whereas levels are low (about 3000 ng/ml) in regions with lesser incidences of HCC.
      AFP can also be elevated up to 500 ng/ml in conditions like embryonic teratocarcinomas, hepatoblastomas, fulminant hepatitis, hepatic metastases from gastrointestinal tract cancers, some cholangiocarcinomas). Lesser values are seen in acute and chronic hepatitis.
      Overall, the sensitivity of AFP value ≥20 ng/ml is 39-64% and the specificity is 76%–91%. Value of 500 ng/ml is considered as the diagnostic cut-off level for HCC.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 3 - Ventricular filling follows a delay caused by? ...

    Incorrect

    • Ventricular filling follows a delay caused by?

      Your Answer:

      Correct Answer: AV node

      Explanation:

      The AV node is a conducting tissue found between the atria and the ventricles of the heart. It conducts electrical signal from the atria to the ventricles and acts a delaying mechanism preventing the atria and the ventricles from contracting at the same time. This decremental conduction prevents premature ventricular contraction in cases such as atrial fibrillation. A delay in the AV node is the reason for the PR segment seen on the ECG. In certain types of supraventricular tachycardia, a person could have two AV nodes; this will cause a loop in electrical current and uncontrollably rapid heart beat. When this electricity catches up with itself, it will dissipate and return to a normal heart rate.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 4 - A week after a renal transplant the patient received antilymphocyte globulins. Shortly after...

    Incorrect

    • A week after a renal transplant the patient received antilymphocyte globulins. Shortly after she developed fever and hypotension. Which of the following mechanisms is involved in this response?

      Your Answer:

      Correct Answer: Type III hypersensitivity

      Explanation:

      Type III hypersensitivity is characterized by soluble immune complexes which are aggregations of IgG and IgM antibodies with antigens that deposit in different tissues e.g. the skin, joints, kidneys. They can then trigger an immune response by activating the complement cascade. This reaction can take hours to develop and examples include: immuno-complex glomerulonephritis, rheumatoid arthritis, SLE, subacute bacterial endocarditis, arthus reaction and serum sickness.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 5 - A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and...

    Incorrect

    • A 62-year-old woman presented to the doctor complaining of spine pain, fatigue and oliguria. She is diagnosed with chronic renal failure. Dipstick testing shows no protein, glucose, nitrite or ketones but a semi-quantitative sulphosalicylic acid test for urine protein is positive. Which of the following is the most probable cause of chronic renal failure in this patient.

      Your Answer:

      Correct Answer: Multiple myeloma

      Explanation:

      Dipstick results are negative because the proteins found in the urine of this patient are not albumin but Bence Jones proteins. A Bence Jones protein is a monoclonal globulin protein commonly detected in patients affected by multiple myeloma. Multiple myeloma is a malignancy of plasma cells characterised by the production of monoclonal immunoglobulin. Symptoms include bone pain, bone fractures, bleeding, neurologic symptoms, fatigue, frequent infections and weight loss.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 6 - A 22-year old man presented with a mass in his left scrotum which...

    Incorrect

    • A 22-year old man presented with a mass in his left scrotum which was more prominent when standing and felt like a 'bag of worms'. Examination revealed a non-tender mass along the spermatic cord. Also, the right testis was larger than the left testis. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Varicocele

      Explanation:

      Varicocele refers to dilatation and increased tortuosity of the pampiniform plexus – which is a network of veins found in spermatic cord that drain the testicle. Defective valves or extrinsic compression can result in outflow obstruction and cause dilatation near the testis. Normal diameter of the small vessels ranges from 0.5 – 1.5mm. A varicocele is a dilatation more than 2mm.
      The plexus travels from the posterior aspect of testis into the inguinal canal with other structures forming the spermatic cord. They then form the testicular veins out of which the right testicular vein drains into the inferior vena cava and the left into the left renal vein.
      It affects 15-20% men, and 40% of infertile males. Usually diagnosed in 15-25 years of age, they are rarely seen after 40 years of age. Because of the vertical path taken by the left testicular vein to drain into left renal vein, 98% idiopathic varicoceles occur on the left side. It is bilateral in 70% cases. Right-sided varicoceles are rare.
      Symptoms include pain or heaviness in the testis, infertility, testicular atrophy, a palpable mass, which is non-tender and along the spermatic cord (resembling a ‘bag of worms’). The testis on the affected side might be smaller.
      Diagnosis can be made by ultrasound. Provocative measures such as Valsalva manoeuvre or making the patient stand up to increase the dilatation by increasing the intra-abdominal venous pressure.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 7 - During thymectomy the surgeon accidentally nicks a vein that lies just posterior to...

    Incorrect

    • During thymectomy the surgeon accidentally nicks a vein that lies just posterior to the thymus. Which of the following vessels is likely to be injured?

      Your Answer:

      Correct Answer: Left brachiocephalic vein

      Explanation:

      The thymus is located superficially in the anterior mediastinum. The left brachiocephalic vein courses through the mediastinum to join the right brachiocephalic vein and form the superior vena cava on the right side of the thorax. The left brachiocephalic vein, being superficial, courses just deep to the thymus so that it may be susceptible to compression by an adjacent tumour. The left pulmonary vein, left bronchial vein and right pulmonary artery are deep, and enter and exit the lung at its root, thus are not near the thymus. The right superior intercostal vein drains the 2nd to the 4th intercostal spaces and drains into the arch of the azygos vein. It is not, therefore, closely related with the thymus.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 8 - The anatomical dead space in a patient with low oxygen saturation, is 125...

    Incorrect

    • The anatomical dead space in a patient with low oxygen saturation, is 125 ml, with a tidal volume of 500 ml and pa(CO2) of 40 mm Hg. The dead space was determined by Fowler's method. If we assume that the patient's lungs are healthy, what will his mixed expired CO2 tension [pE(CO2)] be?

      Your Answer:

      Correct Answer: 30 mmHg

      Explanation:

      According to Bohr’s equation, VD/VT = (pA(CO2) − pE(CO2))/pA(CO2), where pE(CO2) is mixed expired CO2 and pA(CO2) is alveolar CO2pressure. Normally, the pa(CO2) is virtually identical to pA(CO2). Thus, VD/VT = (pa(CO2)) − pE(CO2)/pa(CO2). By Fowler’s method, VD/VT= 0.25. In the given problem, (pa(CO2) − pE(CO2)/pa(CO2) = (40 − pE(CO2)/40 = 0.25. Thus, pE(CO2) = 30 mmHg. If there is a great perfusion/ventilation inequality, pE(CO2) could be significantly lower than 30 mm Hg, and the patient’s physiological dead space would exceed the anatomical dead space.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 9 - Out of the given options, which of the following is the most likely...

    Incorrect

    • Out of the given options, which of the following is the most likely diagnosis in a 25-year old gentleman presenting with a testicular germ cell tumour?

      Your Answer:

      Correct Answer: Embryonal carcinoma

      Explanation:

      Embryonal carcinoma is a non-seminomatous germ cell tumour of the testis, accounting for 25% testicular tumours. Other germ cell tumours include seminoma, teratoma and choriocarcinoma. Embryonal carcinomas are known to occur in men aged 25-35 years, and occasionally in teens. They are rarely seen in ovaries of females. It can spread to the vas deferens and also to the aortic lymph nodes. Embryonal carcinomas are known to have elements of fetal origin such as cartilage. Usually, the main tumour is about 2.5cm long, with an extension of 8-9cm along the testicular cord. Contiguous spread to the testicle is seen in less than 1% cases.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 10 - A 55 year old lady underwent an uneventful appendicectomy. Two hours later, her...

    Incorrect

    • A 55 year old lady underwent an uneventful appendicectomy. Two hours later, her arterial blood gas analysis on room revealed pH: 7.30, p(CO2): 53 mmHg and p(O2): 79 mmHg. What is the most likely cause of these findings?

      Your Answer:

      Correct Answer: Alveolar hypoventilation

      Explanation:

      In the given problem, there is respiratory acidosis due to hypercapnia from a low respiratory rate and/or volume (hypoventilation). Causes of hypoventilation include conditions impairing the central nervous system (CNS) respiratory drive, impaired neuromuscular transmission and other causes of muscular weakness (drugs and sedatives), along with obstructive, restrictive and parenchymal pulmonary disorders. Hypoventilation leads to hypoxia and hypercapnia reduces the arterial pH. Severe acidosis leads to pulmonary arteriolar vasoconstriction, systemic vascular dilatation, reduced myocardial contractility, hyperkalaemia, hypotension and cardiac irritability resulting in arrhythmias. Raised carbon dioxide concentration also causes cerebral vasodilatation and raised intracranial pressure. Over time, buffering and renal compensation occurs. However, this might not be seen in acute scenarios where the rise in p(CO2) occurs rapidly.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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  • Question 11 - A 60-year-old female has sudden onset of high-grade fever associated with cough with...

    Incorrect

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

      Your Answer:

      Correct Answer: Sputum culture

      Explanation:

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

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 12 - In multiple myeloma, which of these cell types confirms the diagnosis when found...

    Incorrect

    • In multiple myeloma, which of these cell types confirms the diagnosis when found in a smear of bone marrow aspirate?

      Your Answer:

      Correct Answer: Plasma cells

      Explanation:

      A bone marrow aspiration is the diagnostic test for multiple myeloma, which is a malignant bone tumour that usually affects older adults. The smear reveals clusters of plasma cells, while X-rays tend to show circumscribed lytic lesions or diffuse demineralisation.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 13 - A 58-year-old woman presents with signs of inflammation in the first metatarsophalangeal joint:...

    Incorrect

    • A 58-year-old woman presents with signs of inflammation in the first metatarsophalangeal joint: redness, swelling and pain. The analysis of synovial fluid reveals needle-shaped, strongly negatively birefringent crystals. What's the most likely diagnosis in this case?

      Your Answer:

      Correct Answer: Gout

      Explanation:

      Gout is a rheumatic disease caused by the precipitation of monosodium urate crystals into tissues, usually joints. This causes acute or chronic pain; the acute illness initially affects only one joint, often the first metatarsophalangeal joint. The diagnosis of the disease requires the identification of crystal in the synovial fluid. These crystals are needle-shaped and strongly negatively birefringent.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 14 - A 56-year-old woman complains of back pain, muscle spasms, weakness, and a burning...

    Incorrect

    • A 56-year-old woman complains of back pain, muscle spasms, weakness, and a burning sensation that radiates from her left hip to her toes. What's the most likely diagnosis?

      Your Answer:

      Correct Answer: Herniated nucleus pulposus

      Explanation:

      A herniated disk will produce sensory disturbances, causing pain that radiates along the course of the sciatic nerve which is typically burning or stabbing, with or without back pain. The herniation is usually caused by age-related degeneration although trauma, injuries, or straining may also trigger it.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 15 - A 28-year old lady comes to the surgical clinic with a recently detected...

    Incorrect

    • A 28-year old lady comes to the surgical clinic with a recently detected lump in her right breast. On examination, the lump is found to be 1cm, rubbery, mobile with no palpable axillary nodes. Mammography reveals no microcalcifications and the opposite breast appears normal. What is the likely diagnosis?

      Your Answer:

      Correct Answer: Fibroadenoma

      Explanation:

      A benign breast tumour, fibroadenoma is common below the age of 30 years and occurs due to oestrogenic excess. It is characterised by proliferation of both glandular and stromal elements. Fibroadenomas are usually solitary and are mobile, not fixed to surrounding structures. The tumour is elastic, nodular and encapsulated with a grey-white cut surface. The two main histological types include intracanalicular and pericanalicular types, with both types often present in the same tumour. In the intracanalicular type, the stromal proliferation component predominates causing compression of ducts making them appear slit-like. In pericanalicular type, the fibrous stroma dominates around the ductal spaces so that they remain oval on cross section.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 16 - What is expected from complete transection of the inferior gluteal nerve when it...

    Incorrect

    • What is expected from complete transection of the inferior gluteal nerve when it emerges from the greater sciatic foramen?

      Your Answer:

      Correct 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.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
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  • Question 17 - 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
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  • Question 18 - A 60-year-old woman complains of left sided headaches which have been recurring for...

    Incorrect

    • A 60-year-old woman complains of left sided headaches which have been recurring for several years. She recently suffered from a focal seizure for the first time a few days ago. A CT scan shows a mass in the left hemisphere of the brain. The most likely diagnosis is:

      Your Answer:

      Correct Answer: Meningioma

      Explanation:

      Meningiomas are a common benign intracranial tumour, and their incidence is higher in women between the ages of 40-60 years old. Many of these tumours are asymptomatic and are diagnosed incidentally, although some of them may have malignant presentations (less than 2% of cases). These benign tumours can develop wherever there is dura, over the convexities near the venous sinuses, along the base of the skull, in the posterior fossa and, within the ventricles.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 19 - A 14 year-old girl is found to have haemophilia B. What pathological problem...

    Incorrect

    • A 14 year-old girl is found to have haemophilia B. What pathological problem does she have?

      Your Answer:

      Correct Answer: Deficiency of factor IX

      Explanation:

      Haemophilia B (also known as Christmas disease) is due to a deficiency in factor IX. Haemophilia A is due to a deficiency in factor VIII.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
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  • Question 20 - Blood supply to the posterior compartment of the thigh is supplied by which...

    Incorrect

    • Blood supply to the posterior compartment of the thigh is supplied by which artery?

      Your Answer:

      Correct Answer: Perforating

      Explanation:

      There are usually 3 perforating arteries:
      The first gives branches to the adductor brevis and magnus, biceps femoris and gluteus maximus and anastomoses with the inferior gluteal, medial and lateral femoral circumflex.
      The second artery supplies the posterior femoral muscles and anastomose with the first and third perforating vessels.
      The third supplies the posterior femoral muscles.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds

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