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Question 1
Incorrect
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Which of these laboratory findings will indicate a fetal neural tube defect when done between 15 and 20 weeks of pregnancy?
Your Answer: Decreased human chorionic gonadotrophin
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.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 2
Incorrect
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An experiment is carried out to observe engulfment and phagocytosis of microbes. Strep pneumoniae are added to a solution of leukocytes with a substance added to enhance the process of phagocytosis. What is this substance?
Your Answer:
Correct Answer: Complement C3b
Explanation:C3b is cleaved from C3 complement with the help of the enzyme C3- convertase. It binds to the cell surface of the offending substance and opsonizes it. This makes it easy for the phagocytes to detect and eliminate them.
IgM does not act as an opsonin but igG does.
Selectins aid leukocytes to bind to the endothelial surfaces.
C5a is a chemo-attractant and histamine a vasodilator.
NADPH oxidises offending substance after phagocytosis within the macrophage. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 3
Incorrect
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A young girl who presented with a clinical picture of type I hypersensitivity reaction with eosinophilia is most likely to have?
Your Answer:
Correct Answer: Liver flukes
Explanation:Usually a parasitic infection will be associated with a type I hypersensitivity reaction.
Amyloid deposition will not cause an immune reaction.
Organic dust will lead to a type III hypersensitivity reaction.
Cell mediated as well as humoral immune mechanism play a part in syphilis, but they are do not specifically cause a type I reaction.
Malaria is cause by plasmodium and is not cause of a hypersensitivity reaction.
Atopic dermatitis will not be accompanied by eosinophilia. -
This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 4
Incorrect
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The presence of oval fat bodies in the urine is most likely to be seen in which of the following conditions?
Your Answer:
Correct Answer: Nephrotic syndrome
Explanation:Nephrotic syndrome is associated with the presence of oval fat bodies on urinalysis due to increased proteinuria and lipiduria.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 5
Incorrect
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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.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 6
Incorrect
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When a patient that is less than 21 years of age develops a bone tumour. What is the most common benign bone tumour that would be considered in individuals below 21 years?
Your Answer:
Correct Answer: Osteochondroma
Explanation:Osteochondroma is a benign new bone growth that protrudes from the outer contour of bones and is capped by growing cartilage. Nearly 80% of these lesions are noted before the age of 21 years.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 7
Incorrect
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An 26-year-old man sought admission due to persistent non-bloody diarrhoea. The patient is HIV-positive. Examination of stool sample showed numerous acid-fast cysts. Which of the following organism is the most likely cause of diarrhoea?
Your Answer:
Correct Answer: Cryptosporidium parvum
Explanation:Cryptosporidium parvum is one of several species that causes cryptosporidiosis, a parasitic disease of the mammalian intestinal tract. Primary symptoms of C. parvum infection are acute, watery, and non-bloody diarrhoea. C. parvum infection is of particular concern in immunocompromised patients, where diarrhoea can reach 10–15 l per day.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 8
Incorrect
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A 60-year-old man complains of pain in his left thigh. An X-ray reveals bowing of the affected femur, increased bone density, bony enlargement, abnormal bone architecture with coarse cortical trabeculations, and stress microfractures. Which is the most likely diagnosis in this case?
Your Answer:
Correct Answer: Paget’s disease of bone
Explanation:Paget’s disease of bone is a chronic disorder of the adult skeleton in which bone turnover is accelerated in localised areas, replacing normal matrix with softened and enlarged bone and causing gradual pain and deformity in some cases. It is more predominant in men over the age of 40. Characteristic X-ray findings include increased bone density, abnormal architecture with coarse cortical trabeculation or cortical thickening, bowing and bony enlargement; there might also be stress microfractures of the tibia or femur.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 9
Incorrect
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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.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 10
Incorrect
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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.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 11
Incorrect
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A 4-year-old child was brought to a paediatrician for consult due to a palpable mass in his abdomen. The child has poor appetite and regularly complains of abdominal pain. The child was worked up and diagnosed with a tumour. What is the most likely diagnosis ?
Your Answer:
Correct Answer: Nephroblastoma
Explanation:Nephroblastoma is also known as Wilms’ tumour. It is a cancer of the kidneys that typically occurs in children. The median age of diagnose is approximately 3.5 years. With the current treatment, approximately 80-90% of children with Wilms’ tumour survive.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 12
Incorrect
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A 78-year-old woman was brought to the emergency department with decreased consciousness, weakness and dehydration. Which serum electrolyte would most likely be low in this patient?
Your Answer:
Correct Answer: Na+
Explanation:Hyponatremia is a sodium level below 135 mEq/L. Signs and symptoms may include: nausea with vomiting, fatigue, headache or confusion, cramps or spasm, irritability and restlessness and severe cases may lead to seizures and comma.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 13
Incorrect
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A patient presented with continuous bleeding several hours after dental extraction. Which of the following findings is most often associated with clinical bleeding?
Your Answer:
Correct Answer: Factor IX deficiency
Explanation:Factor IX deficiency, also called Haemophilia B or Christmas disease, is a disorder caused by missing or defective clotting factor IX. Deficiency of the factor IX causes irregular bleeding that can happen spontaneously or after mild trauma, surgery and dental extractions.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 14
Incorrect
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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
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Question 15
Incorrect
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Which tumour occurs in young adults, affecting the epiphyses of the bones and sometimes extending to the soft tissues?
Your Answer:
Correct Answer: Benign giant-cell tumour
Explanation:Benign giant-cell tumours tend to affect adults in their twenties and thirties, occur in the epiphyses and can erode the bone and extend into the soft tissues. These tumours have a strong tendency to recur.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 16
Incorrect
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Difficulty in retracting the foreskin of the penis in an uncircumcised male is known as:
Your Answer:
Correct Answer: Phimosis
Explanation:Phimosis is the inability to fully retract the foreskin of the penis in an uncircumcised male. It can be physiological in infancy, in which it could be referred to as ‘developmental non-retractility of the foreskin. However, it is almost always pathological in older children and men. Causes include chronic inflammation (e.g. balanoposthitis), multiple catheterisations, or forceful foreskin retraction. One of the causes is chronic balanitis xerotica obliterans. It leads to development of a ring of indurated tissue near the tip of the prepuce, which prevents retraction. Contributory factors include infections, hormonal and inflammatory factors. The recommended treatment includes circumcision.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 17
Incorrect
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A 76 year old man who presented with lower back pain is diagnosed with prostatic carcinoma that has metastasized to his lumber spine. Which of the following markers is characteristically elevated?
Your Answer:
Correct Answer: PSA
Explanation:Spread of prostatic carcinoma is common to the lumbar spine and pelvis. This results in osteoblastic metastases that will present as lower back pain with increased alkaline phosphatase, prostatic acid phosphates and PSA. PSA is more specific and a PSA > 10 ng/ml for any age is worrisome.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 18
Incorrect
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Which of the following cells would be increased in a patient suffering from a hydatid cyst in the liver?
Your Answer:
Correct Answer: Eosinophils
Explanation:Eosinophils are granulocytes that respond to parasitic infections. They are also involved in allergy response and asthma. They contain granules which stain red with Romanowsky’s method and contain peroxidase, Rnase, Dnase, histamine, lipase and major basic proteins that are toxic to the parasite as well as the hosts tissue. They are about 1-5% of the total WBC population and persist in the blood for 6-12 hours.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 19
Incorrect
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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.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 20
Incorrect
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A 27-year-old HIV patient started on an antifungal agent. Which antifungal agent that inhibits the biosynthesis of fungal ergosterol was given to the patient?
Your Answer:
Correct Answer: Ketoconazole
Explanation:Ketoconazole is a synthetic imidazole antifungal drug used primarily to treat fungal infections. It inhibits the biosynthesis of ergosterol by blocking demethylation at the C14 site of the ergosterol precursor. Amphotericin B and Nystatin impair permeability of the cell membrane. Flucytosine interferes with DNA synthesis, while the target of griseofulvin is the microtubules
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 21
Incorrect
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Question 22
Incorrect
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In which of the following situations will fat necrosis occur?
Your Answer:
Correct Answer: Trauma to the breast
Explanation:Fat necrosis is necrosis of adipose tissue with subsequent deposition of calcium, giving it a white chalky appearance. It is seen characteristically in trauma to the breast and the pancreas with subsequent involvement of the peripancreatic fat. In the breast it may present as a palpable mass with is usually painless or as an incidental finding on mammogram. Fatty acids are released from the traumatic tissue which combine with calcium in a process known as saponification, this is an example of dystrophic calcification in which calcium binds to dead tissue. The central focus is surrounded by macrophages and neutrophils initially, followed by proliferation of fibroblasts, neovascularization and lymphocytic migration to the site of the insult.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 23
Incorrect
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The periphery of a haematoma is infiltrated by fibroblasts, collagen and new vasculature. This process is best described as?
Your Answer:
Correct Answer: Organisation of the haematoma
Explanation:Formation of granulation tissue at the periphery of the hematoma is a normal process leading to resolution. This granulation tissue is composed of new capillaries, fibroblasts and collagen. Lysis of a blood clot can occur, but the actual process of this response is known as organization, wherein the scar tissue will become part of the vessels. This is followed by recanalization and embolization which can lead to eventual complications. Proliferation of a clot will occur due to an imbalance in the clotting and lysing systems. Thrombosis has nothing to do with the process described above.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 24
Incorrect
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A 55-year-old male chronic smoker is diagnosed with non-small-cell cancer. His right lung underwent complete atelectasis and he has a 7cm tumour involving the chest wall. What is the stage of the lung cancer of this patient?
Your Answer:
Correct Answer: T3
Explanation:Non-small-cell lung cancer is staged through TNM classification. The stage of this patient is T3 because based on the TNM classification the tumour is staged T3 if > 7 cm or one that directly invades any of the following: Chest wall (including superior sulcus tumours), diaphragm, phrenic nerve, mediastinal pleura, or parietal pericardium; or the tumour is in the main bronchus < 2 cm distal to the carina but without involvement of the carina, Or it is associated with atelectasis/obstructive pneumonitis of the entire lung or separate tumour nodule(s) in the same lobe.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 25
Incorrect
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A 13 year old girl presented with signs of shortness of breath, chest pain, non-productive cough, oedema of the lower extremities and cyanosis of the fingertips. She has a history of a ventricular septal defect not surgically corrected. The most probable cause of these symptoms is:
Your Answer:
Correct Answer: Shunt reversal
Explanation:A ventricular septal defect (VSD) is a common form of congenital heart defects and is characterised by the presence of a hole in the wall that separates the right from the left ventricle. Medium or large defects can cause many complications. One of these complication is Eisenmenger syndrome, characterised by reversal of the shunt (from left-to-right shunt into a right-to-left) ,cyanosis and pulmonary hypertension.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 26
Incorrect
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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.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 27
Incorrect
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A 25-year-old female had a painful abdomen and several episodes of vomiting. She was severely dehydrated when she was brought to the hospital. Her ABG showed a pH 7.7, p(O2) 75 mmHg, p(CO2) 46 mmHg and bicarbonate 48 mmol/l. The most likely interpretation of this ABG report would be:
Your Answer:
Correct Answer: Metabolic alkalosis
Explanation:Metabolic alkalosis is a primary increase in bicarbonate (HCO3−) with or without compensatory increase in carbon dioxide partial pressure (Pco2); pH may be high or nearly normal. Metabolic alkalosis occurs as a consequence of a loss of H+ from the body or a gain in HCO3 -. In its pure form, it manifests as alkalemia (pH >7.40). As a compensatory mechanism, metabolic alkalosis leads to alveolar hypoventilation with a rise in arterial carbon dioxide tension p(CO2), which diminishes the change in pH that would otherwise occur. Normally, arterial p(CO2) increases by 0.5–0.7 mmHg for every 1 mmol/l increase in plasma bicarbonate concentration, a compensatory response that occurs very rapidly. If the change in p(CO2) is not within this range, then a mixed acid–base disturbance occurs. Likewise, if the increase in p(CO2) is less than the expected change, then a primary respiratory alkalosis is also present. However an elevated serum bicarbonate concentration can also occur due to a compensatory response to primary respiratory acidosis. A bicarbonate concentration greater than 35 mmol/l is almost always caused by metabolic alkalosis (as is the case in this clinical scenario). Calculation of the serum anion gap can also help to differentiate between primary metabolic alkalosis and the metabolic compensation for respiratory acidosis. The anion gap is frequently elevated to a modest degree in metabolic alkalosis because of the increase in the negative charge of albumin and the enhanced production of lactate. However, the only definitive way to diagnose metabolic alkalosis is by performing a simultaneous blood gases analysis, which reveals elevation of both pH and arterial p(CO2) and increased calculated bicarbonate.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 28
Incorrect
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A 66-year-old man complains of constant headaches. On physical examination, the only relevant sign is a dark brown mole located on left his arm which has grown in size over the years and is itchy and painful. A MRI of the brain revealed a solitary lesion at the grey-white junction in the right frontal lobe, without ring enhancement. This lesion is most likely to be:
Your Answer:
Correct Answer: Metastatic carcinoma
Explanation:The location of the mass at the grey–white junction is typical of a metastasis. The most frequent types of metastatic brain tumours originate in the lung, skin, kidney, breast and colon. These tumour cells reach the brain via the bloodstream. This patient is likely to have skin cancer, which caused the metastatic brain tumour.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 29
Incorrect
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A 15-day old baby was brought to the emergency department with constipation for 4 days. On examination, the abdomen of the baby was found to be distended and tender all over. No bowel sounds were heard. A sigmoid colon biopsy was carried out, which showed absent ganglion cells. What is the diagnosis?
Your Answer:
Correct Answer: Hirschsprung’s disease
Explanation:Hirschsprung’s disease is characterized by congenital absence of the autonomic plexus (Meissner’s and Auerbach’s plexus) in the intestinal wall. Usually limited to the distal colon, it can occasionally involve the entire colon or even the small bowel. There is abnormal or absent peristalsis in the affected segment, resulting in continuous spasm of smooth muscle and partial/complete obstruction. This causes accumulation of intestinal contents and dilatation of proximal segment. Skip lesions are highly uncommon. This disease is seen early in life with 15% patients presenting in first month, 60% by 1 year of age and 85% by the age of 4 years. Symptoms include severe and complete constipation, abdominal distension and vomiting. Patients with involvement of ultra-short segments might have mild constipation with intervening diarrhoea. In older children, symptoms include failure to thrive, anorexia, and lack of an urge to defecate. On examination, an empty rectum is revealed with stool palpable high up in the colon. If not diagnosed in time, it can lead to Hirschsprung’s enterocolitis (toxic megacolon), which can be fulminant and lead to death. Diagnosis involves a barium enema or a rectal suction biopsy. Barium enema shows a transition in diameter between the dilated, normal colon proximal to the narrowed, affected distal segment. It is to be noted that barium enema should be done without prior preparation, which can dilate the abnormal segment, leading to a false-negative result. A 24-hour post-evacuation film can be obtained in the neonatal period – if the colon is still filled with barium, there is a high likelihood of Hirschsprung’s disease. Full-thickness rectal biopsy is diagnostic by showing the absence of ganglion cells. Acetylcholinesterase staining can be done to highlight the enlarged nerve trunks. Abnormal innervation can also be demonstrated by rectal manometry.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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Question 30
Incorrect
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A 55-year-old man underwent CT scan of the whole abdomen. The result showed renal cell carcinoma with a tumour size of 7cm and extension into the regional lymph. What is the clinical stage of his renal cell cancer?
Your Answer:
Correct Answer: Stage III
Explanation:Renal cell carcinoma is a kidney cancer that originates in the lining of the proximal convoluted tubule. It is the most common type of kidney cancer in adults, responsible for approximately 90–95% of cases. Renal cell carcinomas can be staged by using the American Joint Committee on Cancer (AJCC) TNM (tumour-node-metastasis) classification, as follows: Stage I: tumours that are 7 cm or smaller and confined to the kidney, Stage II: tumours that are larger than 7 cm but still confined to the kidney, Stage III: tumours extending into the renal vein or vena cava, involving the ipsilateral adrenal gland and/or perinephric fat, or which have spread to one local lymph node and Stage IV: tumours extending beyond Gerota’s fascia, to more than one local node, or with distant metastases Recent literature has questioned whether the cut-off in size between stage I and stage II tumours should be 5 cm instead of 7 cm. The patient’s cancer in this case is stage III.
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This question is part of the following fields:
- Basic Sciences
- Pathology
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SESSION STATS - PERFORMANCE PER SPECIALTY
