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  • Question 1 - A 55-year old patient with signs and symptoms of internal haemorrhage was brought...

    Correct

    • A 55-year old patient with signs and symptoms of internal haemorrhage was brought in for emergency surgery to control the bleeding. Angiography results revealed an advanced duodenal tumour that had perforated the blood vessel immediately behind the first part of the duodenum. Which of the following is the most likely blood vessel that was ruptured by the cancer?

      Your Answer: Gastroduodenal artery

      Explanation:

      The gastroduodenal artery is the artery that lies just behind the first portion of the duodenum. The gastroduodenal artery would be the most likely artery to be perforated by a cancer in this area. The perforation is as a result of the spillage of the acidic content of the chyme in the duodenum. All the other blood vessels in the list would less likely be affected by the gastric expellant from the duodenum. The coronary vein is located in the lesser curvature of the stomach. The inferior pancreaticoduodenal arcade is located inferiorly to the first part of the duodenum on the head of the pancreas. The hepatic artery proper is a branch of the common hepatic artery that is located superior to the first portion of the duodenum. The splenic vein arises from the spleen; it forms the portal vein by joining the superior mesenteric vein. It is laterally detached from the duodenum. Both the left gastric vein and the splenic vein are located superior to the first portion of the duodenum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      32.2
      Seconds

  • Question 2 - When exposing the right saphenofemoral junction for flush-ligation of the saphenous vein, which...

    Incorrect

    • When exposing the right saphenofemoral junction for flush-ligation of the saphenous vein, which of the following is the most likely to be seen passing through this opening?

      Your Answer: Saphenous nerve

      Correct Answer: Superficial external pudendal artery

      Explanation:

      The saphenous opening is an oval opening in the fascia lata. It is covered by the cribriform fascia and It is so called because it is perforated by the great saphenous vein and by numerous blood and lymphatic vessels and the superficial external pudendal artery pierces it.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      74.6
      Seconds

  • Question 3 - A 29-year-old woman presents to the doctor complaining of cough, shortness of breath,...

    Correct

    • A 29-year-old woman presents to the doctor complaining of cough, shortness of breath, fever and weight loss. Chest X-ray revealed bilateral hilar and mediastinal lymph node enlargement and bilateral pulmonary opacities. Non-caseating granulomas were found on histological examination. The most likely diagnosis is:

      Your Answer: Sarcoidosis

      Explanation:

      Sarcoidosis is an inflammatory disease of unknown aetiology that affects multiple organs but predominantly the lungs and intrathoracic lymph nodes. Systemic and pulmonary symptoms may both be present. Pulmonary involvement is confirmed by a chest X-ray and other imaging studies. The main histological finding is the presence of non-caseating granulomas.

    • This question is part of the following fields:

      • Pathology
      • Respiratory
      87.1
      Seconds

  • Question 4 - Which of the following diseases affects young adults, causing pain in any bone...

    Correct

    • 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: 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:

      • Orthopaedics
      • Pathology
      75.4
      Seconds

  • Question 5 - The specimen sent to the pathologist for examination was found to be benign....

    Incorrect

    • The specimen sent to the pathologist for examination was found to be benign. Which one of the following is most likely a benign tumour?

      Your Answer: Haematoma

      Correct Answer: Warthin’s tumour

      Explanation:

      Warthin’s tumour is also known as papillary cystadenoma lymphomatosum. It is a benign cystic tumour of the salivary glands containing abundant lymphocytes and germinal centres. It has a slightly higher incidence in males and most likely occur in older adults aged between 60 to 70 years. This tumour is also associated with smoking. Smokers have an eight-fold greater risk in developing the tumour compared to non-smokers.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      13.6
      Seconds

  • Question 6 - During a laparoscopic surgery, the surgeon visualizes the medical umbilical folds on the...

    Correct

    • During a laparoscopic surgery, the surgeon visualizes the medical umbilical folds on the deep surface of the anterior abdominal wall. What causes the medial umbilical folds?

      Your Answer: Obliterated umbilical arteries

      Explanation:

      The medial umbilical ligament is a structure found on the deep surface of the anterior abdominal wall and is covered by the medial umbilical folds. It is a paired structure that represents the remnants of the fetal umbilical artery. They have no role in humans after birth other than to be used as a landmark for exploring the medial inguinal fossa during laparoscopic inguinal hernia repair.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      49.6
      Seconds

  • Question 7 - Diuretics that act on the ascending limb of the loop of Henle produce:...

    Correct

    • Diuretics that act on the ascending limb of the loop of Henle produce:

      Your Answer: Reduced active transport of sodium

      Explanation:

      The loop of Henlé leads from the proximal convoluted tubule to the distal convoluted tubule. Its primary function uses a counter current multiplier mechanism in the medulla to reabsorb water and ions from the urine. It can be divided into four parts:

      1. Descending limb of loop of Henl̩ Рlow permeability to ions and urea, while being highly permeable to water

      2. Thin ascending limb of loop of Henl̩ Рnot permeable to water, but it is permeable to ions

      3. Medullary thick ascending limb of loop of Henlé – sodium (Na+), potassium (K+) and chloride (Cl–) ions are reabsorbed by active transport. K+ is passively transported along its concentration gradient through a K+ channel in the basolateral aspect of the cells, back into the lumen of the ascending limb.

      4. The cortical thick ascending limb – the site of action where loop diuretics such as furosemide block the K+/Na+/2Cl− co-transporters = reduced active transport.

    • This question is part of the following fields:

      • Physiology
      • Renal
      36.2
      Seconds

  • Question 8 - The rotator cuff surrounds the shoulder joint and consists of the supraspinatus, infraspinatus,...

    Correct

    • The rotator cuff surrounds the shoulder joint and consists of the supraspinatus, infraspinatus, subscapularis and which one other muscle?

      Your Answer: Teres minor

      Explanation:

      The correct answer is the teres minor muscle. These group of muscles play an important role in protecting the shoulder joint and keeping the head of the humerus in the glenoid fossa of the scapula. This fossa is somehow shallow and needs support to allow for the full mobility that the shoulder joint has.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      11.9
      Seconds

  • Question 9 - A man came to the hospital complaining of a sensation of pins and...

    Incorrect

    • A man came to the hospital complaining of a sensation of pins and needles in the dorsum of the thumb and digits 1 and 2. On further examination they found that he had weakness in wrist dorsiflexion and finger extension. Which nerve do you think is injured in this case?

      Your Answer: Median

      Correct Answer: Radial

      Explanation:

      The radial nerve can be injured in multiple sites along its course in the upper limb, and each site has its own presentation. The major complaint is wrist drop which if high above the elbow, can cause numbness of the forearm and hand. It can last for several days or weeks. The most common site of compression for the radial nerve is at the proximal forearm in the area of the supinator muscles.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      27.4
      Seconds

  • Question 10 - A 45 year old lady has been diagnosed with Friedreich's ataxia that has...

    Incorrect

    • A 45 year old lady has been diagnosed with Friedreich's ataxia that has affected her medial group of nuclei in the anterior horn of the spinal cord. Which of the following structures will have their muscles affected?

      Your Answer: Leg

      Correct Answer: Axial muscles

      Explanation:

      The cells in the anterior horn can be arranged in the following three main groups: medial, lateral and central. The medial group of nuclei in the anterior horn of the spinal cord are located along the entire length of the spinal cord and are responsible for the innervation of the axial muscles of the body ( muscles of the head and neck region). Thus this disease will most likely affect the functioning of the muscles of the head and neck.

    • This question is part of the following fields:

      • Anatomy
      • Neurology
      35.1
      Seconds

  • Question 11 - A 4-year-old child was brought to a paediatrician for consult due to a...

    Correct

    • A 4-year-old child was brought to a paediatrician for consult due to a palpable mass in his abdomen. The child has poor appetite and regularly complains of abdominal pain. The child was worked up and diagnosed with a tumour. What is the most likely diagnosis ?

      Your Answer: Nephroblastoma

      Explanation:

      Nephroblastoma is also known as Wilms’ tumour. It is a cancer of the kidneys that typically occurs in children. The median age of diagnose is approximately 3.5 years. With the current treatment, approximately 80-90% of children with Wilms’ tumour survive.

    • This question is part of the following fields:

      • Neoplasia
      • Pathology
      14.8
      Seconds

  • Question 12 - Causes of metabolic acidosis with a normal anion gap include: ...

    Incorrect

    • Causes of metabolic acidosis with a normal anion gap include:

      Your Answer: Renal tubular acidosis

      Correct Answer: Diarrhoea

      Explanation:

      Excess acid intake and excess bicarbonate loss as in diarrhoea, are causes of metabolic acidosis with a normal anion gap. The other conditions all result in an increased anion gap.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      • Physiology
      13.9
      Seconds

  • Question 13 - A medical intern wanting to perform her first thoracentesis (remove fluid from the...

    Correct

    • A medical intern wanting to perform her first thoracentesis (remove fluid from the pleural cavity) wishes to be reminded where to insert the needle to aspirate in order to avoid injuring the lung or neurovascular elements. Where is this place?

      Your Answer: The bottom of interspace 9 in the midaxillary line

      Explanation:

      Thoracentesis is performed in the costodiaphragmatic recess. The needle needs to be inserted below the level of the lungs to avoid injury to the lungs. At the paravertebral line, is between ribs 10 and 12, at the midaxillary line between ribs 8 and 10 and at the midclavicular line between interspaces 6 and 8. The needle should be inserted at the top of the rib (or the bottom of the interspace) to avoid damage to the neurovascular structures found below the rib running in the costal groove.

      The recommended location for the needle insertion varies depending upon the source. It is critical that the patient hold his or her breath to avoid piercing of the lung.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      11.4
      Seconds

  • Question 14 - 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: Right pulmonary artery

      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
      • Thorax
      51.7
      Seconds

  • Question 15 - The anatomical course of the phrenic nerve passes over the following muscle in...

    Incorrect

    • The anatomical course of the phrenic nerve passes over the following muscle in the neck?

      Your Answer: Middle scalene

      Correct Answer: Anterior scalene

      Explanation:

      The phrenic nerve originates in the neck between C3-C5, mostly C4 spinal root. It enters the thoracic cavity past the heart and lungs to the diaphragm. In the neck, this nerve begins at the lateral border of the anterior scalene muscle, its course then continues inferiorly on the anterior aspect of the anterior scalene muscle as it moves towards the diaphragm.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      49.6
      Seconds

  • Question 16 - Which of the following arteries, if ligated, will most likely affect blood supply...

    Correct

    • Which of the following arteries, if ligated, will most likely affect blood supply to the pancreas?

      Your Answer: Superior mesenteric

      Explanation:

      The pancreas is a glandular organ in the body that produces important hormones such as insulin and glucagon. Its blood supply is from branches of the coeliac artery, superior mesenteric artery and the splenic artery. These are the arteries that if ligated, would affect blood supply to the pancreas.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      16.7
      Seconds

  • Question 17 - An episiotomy is indicated for a woman during a difficult vaginal delivery. Whilst...

    Correct

    • An episiotomy is indicated for a woman during a difficult vaginal delivery. Whilst the registrar was performing this procedure she made a median cut too far through the perineal body cutting the structure immediately posterior. Which structure is this?

      Your Answer: External anal sphincter

      Explanation:

      An episiotomy is an incision that is made whenever there is a risk of a tear during vaginal deliver. A posterolateral incision, as opposed to a median incision is preferred. Of the options given, the external anal sphincter lies right posterior to the perineal body. The sacrospinous and the sacrotuberous ligaments are deep in the perineum that they should not be involved in this.

    • This question is part of the following fields:

      • Anatomy
      • Pelvis
      46.4
      Seconds

  • Question 18 - What will the destruction of endoplasmic reticulum stop? ...

    Incorrect

    • What will the destruction of endoplasmic reticulum stop?

      Your Answer: Glycosylation of protein and carbohydrate moieties

      Correct Answer: Synthesis of proteins

      Explanation:

      The rough endoplasmic reticulum is the factory for the manufacturing of proteins. It contains ribosomes attached to it and transports proteins that are destined for membranes and secretions. The rough ER is connected to the nuclear envelope and to the cisternae of the Golgi apparatus by vesicles that shuttle between the two compartments.

    • This question is part of the following fields:

      • General
      • Physiology
      14.8
      Seconds

  • Question 19 - Low molecular weight heparin (LMWH) has less side effects than heparin and is...

    Correct

    • Low molecular weight heparin (LMWH) has less side effects than heparin and is used in the prophylaxis and treatment of venous and arterial thrombotic disorders. Which of the following is LMWHs mechanism of action?

      Your Answer: Inhibition of factor Xa

      Explanation:

      Low molecular weight heparin (LMWH) is a anticoagulant that differs from normal heparin in that it has only short chains of polysaccharide. LMWH inhibits thrombin formation by converting antithrombin from a slow to a rapid inactivator of coagulation factor Xa.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      11.3
      Seconds

  • Question 20 - A 69 Year old lady presented to the emergency department following a massive...

    Incorrect

    • A 69 Year old lady presented to the emergency department following a massive myocardial infarction. She was found to be in hypotensive shock with focal neurological signs. Unfortunately the patient demised. What would be the expected findings on the brain biopsy?

      Your Answer: Coagulative necrosis

      Correct Answer: Liquefactive necrosis

      Explanation:

      Liquefactive necrosis is often associated with bacterial or fungal infections. However, hypoxic death of cells within the central nervous system can also result in liquefactive necrosis. The focal area is soft with a liquefied centre containing necrotic debris and dead white cells. This may later be enclosed by a cystic wall

    • This question is part of the following fields:

      • Cell Injury & Wound Healing; Neurology
      • Pathology
      52.3
      Seconds

  • Question 21 - The mandibular nerve, which is the largest of the 3 divisions of the...

    Incorrect

    • The mandibular nerve, which is the largest of the 3 divisions of the trigeminal nerve, exits the cranial cavity through which foramen?

      Your Answer: Foramen rotundum

      Correct Answer: Foramen ovale

      Explanation:

      At the base of the skull the foramen ovale is one of the larger of the several holes that transmit nerves through the skull. The following structures pass through foramen ovale: mandibular nerve, motor root of the trigeminal nerve, accessory meningeal artery, lesser petrosal nerve, a branch of the glossopharyngeal nerve, emissary vein connecting the cavernous sinus with the pterygoid plexus of veins and occasionally the anterior trunk of the middle meningeal vein.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      108.5
      Seconds

  • Question 22 - A 40 year old patient with an history of obesity has been diagnosed...

    Incorrect

    • A 40 year old patient with an history of obesity has been diagnosed with meralgia parasthetica. The condition was discovered to be caused by the pinching of the lateral femoral cutaneous nerve. Injuries at what spinal levels usually affect this nerve?

      Your Answer: L1, L2

      Correct Answer: L2, L3

      Explanation:

      The lateral femoral cutaneous nerve of the thigh arises from the dorsal division of the lumbar plexus of the second and the third lumbar nerves (L2 – L3). Spinal injuries at this level are likely to affect the lateral femoral cutaneous nerve. The lateral femoral cutaneous nerve innervates the skin on the lateral aspect of the thigh.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      49
      Seconds

  • Question 23 - A 58-year-old woman diagnosed with deep vein thrombosis had been using warfarin for...

    Incorrect

    • A 58-year-old woman diagnosed with deep vein thrombosis had been using warfarin for 10 days. When she presented to the doctor she had haemorrhagic bullae and necrotic lesions in her lower limbs and buttocks. Deficiency of which of the following proteins may have caused the necrotic skin lesions?

      Your Answer: Plasmin

      Correct Answer: Protein C

      Explanation:

      Warfarin-induced skin necrosis is a rare complication of anticoagulant therapy that requires immediate drug cessation. The most common cutaneous findings include petechiae that progress to ecchymoses and haemorrhagic bullae. Warfarin inactivates vitamin K-dependent clotting factors II, VII, IX, and X and vitamin K-dependent proteins C and S. The concentration of protein C falls more rapidly than other vitamin K-dependent factors because they have a shorter half-lives. Skin necrosis is seen mainly in patients with prior protein C deficiency.

    • This question is part of the following fields:

      • Haematology
      • Pathology
      18.9
      Seconds

  • Question 24 - Which of the following is the source of blood supply to the artery...

    Incorrect

    • Which of the following is the source of blood supply to the artery of the round ligament at the head of the femur?

      Your Answer:

      Correct Answer: Obturator artery

      Explanation:

      The posterior branch of the obturator artery provides an articular branch to the head of the femur.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 25 - During an operation to repair an aortic coarctation in a neonate, a surgeon...

    Incorrect

    • During an operation to repair an aortic coarctation in a neonate, a surgeon accidentally cuts the first aortic intercostal arteries as he mobilised the descending aorta. Which one of the following structure might be deprived of its primary source of blood supply following this injury?

      Your Answer:

      Correct Answer: Right bronchus

      Explanation:

      The right bronchus is supplied by one right bronchial artery that may branch from one of the left bronchial arteries or from the right 3rd posterior intercostal artery (this is the first intercostal artery that arises from the aorta). Damage to this artery might stop blood supply to the main bronchus. Intercostal arteries that go to the first and the second interspaces originate from the highest intercostal artery such that blood supply to either of these spaces would not be interfered with.

      The left bronchus receives blood from 2 left bronchial arteries which are direct branches from the descending aorta.

      Fibrous pericardium is the sac that contains the heart. Its blood supply is not a major concern.

      Visceral pericardium receives its blood supply from the coronary vessels.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 26 - 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:

      • Fluids & Electrolytes
      • Pathology
      0
      Seconds

  • Question 27 - Into which vein does the left and right inferior thyroid veins drain? ...

    Incorrect

    • Into which vein does the left and right inferior thyroid veins drain?

      Your Answer:

      Correct Answer: Brachiocephalic vein

      Explanation:

      The brachiocephalic vein is formed by the confluence of the subclavian and internal jugular veins. In addition it receives drainage from: the left and right internal thoracic veins (also called internal mammary veins), left and right inferior thyroid veins and the left superior intercostal vein.
      The superior thyroid veins and middle thyroid veins drain into the internal jugular vein. The right and left inferior thyroid veins to drain into their respective brachiocephalic veins (right and left).

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      0
      Seconds

  • Question 28 - Which organ is most vulnerable to haemorrhagic shock? ...

    Incorrect

    • Which organ is most vulnerable to haemorrhagic shock?

      Your Answer:

      Correct Answer: Kidneys

      Explanation:

      At rest, the brain receives 15% cardiac output, muscles 15%, gastrointestinal tract 30% and kidneys receive 20%. However, if normalised by weight, the largest specific blood flow is received by the kidneys at rest (400 ml/min x 100g), making them highly vulnerable in the case of a haemorrhagic shock.

    • This question is part of the following fields:

      • Cardiovascular
      • Physiology
      0
      Seconds

  • Question 29 - Which of the following muscles is solely contained in the anterior triangle of...

    Incorrect

    • Which of the following muscles is solely contained in the anterior triangle of the neck and divides the anterior triangle into three smaller triangles?

      Your Answer:

      Correct Answer: Digastric

      Explanation:

      The digastric muscle is a small muscle located under the jaw. It lies below the body of the mandible, and extends, in a curved form, from the mastoid process to the symphysis menti. The digastric divides the anterior triangle of the neck into three smaller triangles:

      – The submaxillary triangle, bounded above by the lower border of the body of the mandible and a line drawn from its angle to the sternocleidomastoid, below by the posterior belly of the digastric and the stylohyoid and in front by the anterior belly of the digastric

      – The carotid triangle, bounded above by the posterior belly of the digastric and stylohyoid, behind by the sternocleidomastoid and below by the omohyoid

      – The suprahyoid or submental triangle, bounded laterally by the anterior belly of the digastric, medially by the midline of the neck from the hyoid bone to the symphysis menti and inferiorly by the body of the hyoid bone.

    • This question is part of the following fields:

      • Anatomy
      • Head & Neck
      0
      Seconds

  • Question 30 - One of the following structures is contained in the anterior compartment of the...

    Incorrect

    • One of the following structures is contained in the anterior compartment of the lower leg. Which is it?

      Your Answer:

      Correct Answer: Extensor hallucis muscle

      Explanation:

      The lower leg is made up of four fascial compartments separated from one another by septa that contain the muscles of the lower leg. The four compartments are ; anterior, lateral, deep posterior and superficial posterior compartments.

      These are the compartments and there contents:

      i) Anterior compartment: Tibialis anterior muscle, extensor hallucis longus muscle, extensor digitorum longus muscle, peroneus tertius muscles, deep fibular nerve and anterior tibial blood vessels

      ii) Lateral compartment: Fibularis longus muscle, brevis muscles and superficial fibular nerve

      iii) Deep posterior compartment: Tibialis posterior m., flexor hallucis longus m., flexor digitorum longus m. ,popliteus m. , tibial nerve, posterior tibial artery and posterior tibial vessels such as the fibular artery.

      iv) Superficial posterior compartment: Gastrocnemius m., soleus m., plantaris m., medial sural cutaneous nerve

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Abdomen (3/3) 100%
Anatomy (6/13) 46%
Lower Limb (0/2) 0%
Pathology (4/7) 57%
Respiratory (1/1) 100%
Orthopaedics (1/1) 100%
Neoplasia (1/2) 50%
Physiology (1/3) 33%
Renal (1/1) 100%
Upper Limb (1/2) 50%
Neurology (0/1) 0%
Fluids & Electrolytes (0/1) 0%
Thorax (1/2) 50%
Head & Neck (0/2) 0%
Pelvis (1/1) 100%
General (0/1) 0%
Haematology (1/2) 50%
Cell Injury & Wound Healing; Neurology (0/1) 0%
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