MCQs in Applied Basic Sciences For The Primary FRCS
MCQs in Applied Basic Sciences For The Primary FRCS
Applied Basic
Sciences
For the Primary FRCS
K.M. Mokbel
Senior House Officer
Orthopaedic Surgery and Trauma
The General Infirmary
Leeds, UK
for the United States and Canada: Kluwer Academic Publishers, PO Box 358, Accord
Station, Hingham, MA 02018-0358, USA
for all other countries: Kluwer Academic Publishers Group, Distribution Center, PO
Box 322, 3300 AH Dordrecht, The Netherlands
Mokbel. K. M. (Kefah M)
MCQs in applied basic sciences for the primary FRCS.
I. Title
616.0076
ISBN 0792389948
Copyright
Foreword iv
Introduction v
Acknowledgements vi
Clinical Pharmacology
Questions 73
Answe~ 78
Microbiology
Questions 98
~e~ 103
Oinical Immunology
Questions 108
~e~ 110
Haematology
Questions 112
Answe~ 114
Oinical Chemistry
Questions 116
~e~ 119
iii
Foreword
Multiple choice questions (MCQs) in medical and surgical examinations are now a
new phenomenon. They have the advantage of testing knowledge rather than its
presentation. However, although practice is the norm for essay questions and the
viva-voce parts of examinations, it is equally crucial when dealing with MCQ
papers where performance and examination outcome can be optimised.
As well as improving examination technique, practising MCQs also has the
advantage of testing knowledge after a period of study, reinforcing knowledge
gained as well as testing its acquisition, and, perhaps most importantly at what is
to everyone a stressful time, providing reassurance that progress is being made.
This book provides a wealth of practice questions to serve these aims,
although it !>hould be remembered in using any such book that some questions will
be more relevant than others to any examination and the First Part of the
Fellowship is no exception to this principle.
Robert Ham
COllsultallt Vascular alld Gelleral SurgeOIl
17le Royal LOlldoll Hospital
LOlldoll £1
December 1991
iv
Introduction
The MCQ format as part of examinations has come to stay. In an essay
assessment, the examiner has to search the paragraphs for relevant facts and
opinions and the examinee can take cover be~ind the smoke-screen of language.
No such cover is provided by multiple choice questioning which not only allows
electronic marking but also offers the candidate a fine stone to sharpen the knife
of his knowledge.
The stimulus for writing this book came from the major changes in the FRCS
examination which took place in England in September 1990. In the 'old' Primary
FRCS examination many of the questions were not clinically relevant. Almost all
the questions in the new Applied Basic Science part of the examinatic.n have a
clinical bias. This new change has been reflected in this book in that almost all the
questions have surgical relevance. Explanations to the answers have also been
provided to make the MCQ exercise a more useful means of learning.
Each question has a main stem followed by five items, each of which must be
identified as true (T) or false (F) or 'don't know'. In the exam a correct response
gains one mark and an incorrect response is penalized by the deduction of one
mark. The 'don't know' response gains nothing. The candidate is advised not to
spend more than 2 minutes per question. A score of 50% is regarded as
satisfactory.
MCQ tenninology
KMMokbel
June 1991, London
v
Acknowledgements
Mr RJ Ham. Consultant in Vascular and General Surgery, The Royal London
Hospital
The figures listed below have been redrawn from the following books, with the
kind permission of the publishers:
Ftgure 4a: from Cuschieri A. Essential Surgical Practice. Bristo~ fohn Wright
[now Butterworth-Heinemann). .
FIgures 5, 6 and 7: from Snooks SJ, WIX>d RFM. Fundamental Anatomy for
Operative General Surgery. Heidelberg, Springer-Verlag.
Ftgure 17a: from Blandy J. Lecture Notes in Urology. Oxford, Blackwell Scientific
Publications
vi
Anatomy (including histology, embryology,
and medical imaging)
A. the fibres of the external oblique muscle lying perpendicular to the line
of incision
B. the fibres of the internal oblique and transversus abdominis lying almost
in a transverse direction
C. Scarpa's fascia deep to the external oblique apeneurosis
D. the trasversalis fascia fused to the peritoneum
E. numerous communications between the appendicular artery and the
ileal arteries
A. the middle rectal arteries run on the inferior surface of the levators ani
muscles
B. the medial umbilical ligament represents the distal segment of the
umbilical artery
C. most of the lymphatic drainage of the pelvic viscera reaches the inguinal
lymph nodes
D. the nerves comprising the sacral plexus lie on the iliacus muscle
E. the obturator nerve gives off no branches to the pelvic viscera and
muscles
A. the neck normally makes an angle of 160° with the long axis of the shaft
in a healthy middle-aged man
B. the intertrochanteric crest connects the two trochanters anterinrly
C. the shaft usually shows a forward convexity
D. the psoas muscle is attached to the greater trochanter
E. the two heads of the gastrocnemius muscle arise from the condyles of
the femur
A. the obturator artery supplies the head via 3. branch which ascends
through the femoral neck
B. the blood supply from the branch of the obturator artery is the most
important item
C. the medial circumflex femoral artery supplies the head via branches that
ascend along the neck deep to the synovial membrane
D. extracapsular fractures of the femoral neck severely damage the blood
supply to the head
E. displaced subcapital fractures of the femoral head seriously damage the
blood supply to the head
ANATOMY 3
A. fOOl drop
B. paraesthesia of the lateral aspect of the foot
C. failure of knee extension
D. sensory loss over the medial part of the lower leg
E. failure of adduction of the thigh at the hip joint
A. the greater trochanter normally lies about 1 inch below a line joining the
anterior superior iliac spine and the iliac tuberosity
B. the lower orifice of the femoral canal lies below and lateral to the pubic
tubercle
C. the angle of Louis lies at the level of T2 vertebra
D. the first rib lies deep to the clavicle and cannot be palpated
E. the cricoid cartilage lies at the level of C6 vertebra
A. the anterior half of the medial meniscus is relatively more mobile than
the posterior half
B. the medial meniscus is attached to the superficial fibres of the medial
collateral ligament
C. the suprapatellar bursa almost always communicates with the knee joint
D. the tibia subluxates posteriorly when the posterior cruciate ligament is
torn
E. the central part of the meniscus is more vascular than its periphery
A. the sac of a direct hernia bulges lateral to the inferior epigastric artery
B. the neck of an indirect hernia lies lateral to the inferior epigastric artery
c. direct hernias are commoner than indirect ones
D. the direct variety is commoner in older men
E. an indirect hernia is more likely to strangulate than a direct hernia
A. the medial part of the inferior wall is formed by the lacunar ligament
B. the superior wall is formed by the lowest fibres of external oblique
C. the posterior wall is re-inforced in its lateral third by the conjoint
tendon
D. the anterior wall is re-inforced in its lateral third by the fibres of origin
of internal oblique
E. the deep inguinal ring lies medial to the inferior epigastric vessels
21. When exploring the wrist the following structures are found to lie superficial
to the nexor retinaculum
A. arises from the same branchial pouch as the upper parathyroid glands
B. is separated from the strap muscles by the pretracheal fascia
C. the middle thyroid vein courses laterally to drain into the internal
jugular vein
D. the upper parathyroid glands usually lie posterior to the gland and
above the inferior thyroid artery
E. in thyroidectomy, the recurrent laryngeal nerve is frequently damaged
when ligating the superior thyroid artery
23. In radical neck dissection, tbe following structures are usually removed or
sacrificed
25. Damage to the sympathetic nerves from the thoracolumbar outflow (Tll to
12) will disturb the function of the
A. detrusor muscle
B. bladder neck
C. trigone
D. external sphincter
E. seminal vesicles
A. the right gland lies in contact with the inferior vena cava antero-medially
B. the left gland lies anterior to the pancreas
C. receive arterial branches from the renal arteries
D. the left gland is drained via one large vein which crosses the midline to
drain into the inferior vena cava
E. are innervated by pre-ganglionic sympathetic fibres, the majority of
which end in the medulla of the gland
A. the lymphatics of the lower half of the canal drain into the medial
superficial inguinal lymph nodes
B. there is a portal-systemic anastomosis halfway down the canal
C. the external sphincter is innervated mainly by sympathetic fibres
D. the pubo-rectalis fibres blend with the superficial part of the external
sphincter to form the ano-rectal ring
E. the lower half of the canal is lined with columnar epithelium
ANATOMY 7
A. apical axillary nodes lie in the space between the pectoralis minor and
the clavicle
B. internal thoracic lymph nodes drain the medial part of the breast
c. some of the supraclavicular lymph nodes receive afferent lymphatics
from the apical axillary nodes
D. anterior (pectoral) axillary nodes usually lie on the pectoralis major
muscle
E. cutaneous lymphatics communicate with those of the stroma
A. the surgical neck lies proximal to the greater and lesser tuberosities
B. the deltoid tuberosity lies halfway down the lateral aspect of the shaft
C. the bicipital groove accommodates the radial nerve
D. the coronoid fossa accommodates the radial head when the elbow is
flexed
E. the lateral lip of the bicipital groove receives the insertion of pectoralis
major
A. plantar flexors of the foot at the ankle joint are supplied by the
superficial peroneal nerve and tibial nerve
B. dorsiflexors of the foot at the ankle joint are supplied by the superficial
peroneal nerve
C. all muscles of the anterior fascial compartment of the thigh are supplied
by branches of the femoral nerve
D. vastus lateralis is the first part of quadriceps femoris to atrophy in knee
joint disease
E. paralysis of gluteus medius and minim us seriously impairs the ability of
the patient to tilt the pelvis when walking
A. the right atrial appendage projects to the left and overlaps the right side
of the aortic root
B. the atrioventricular bundle of His passes through the central fibrous
body
C. the coronary arteries are anatomical end arteries
D. the right coronary artery gives off posterior left ventricular wall arteries
which appear like an inverted C on angiography
E. the sinus node artery arises from the right coronary artery in about 90%
of individuals
A. the terminal branch of the digital artery passes through the pulp space
B. the digital synovial sheaths of the index, middle and ring fingers, on the
dorsal surface of the hand, are continuous with the ulnar bursa
C. the first palmar interosseus muscle is inserted into the medial side of
the base of the proximal phalanx of the thumb
D. the flexor digitorum profundus tendons are inserted into the base of the
middle phalanx
E. the four palmar digital arteries arise mainly from the deep palmar arch
A. the thinnest part of the lateral wall of the skull is where the
postero-inferior part of the parietal bone articulates with the occipital
bone
B. the pterion overlies the anterior division of the middle meningeal artery
and vein
C. fractures of the mandible most commonly occur at the ramus
D. the VIIth and VIIIth cranial nerves pass through the petrous part of the
temporal bone
E. the inner table of the skull bones is thinner and more brittle than the
outer table
40. The following muscles and nerves supplying them are correctly linked
41. The following cutaneous areas and supplying sensory roots are correctly
paired
42. The following nerves and plexus roots are correctly paired
A. 12th rib
B. tail of pancreas
C. left ilio-inguinal nerve
D. spleen
E. left lung
A. the deep cutaneous vascular (reticular) plexus lies at the junction of the
reticular and papillary layers of the dermis
B. Langerhans cells have receptors for the Fc portion of IgG
C. collagen fibres of the reticular dermis are mainly type III
D. surgical incisions perpendicular to Kriessl's lines minimize
post -operative scarring
E. in the predominant pattern of blood supply to the skin, vessels from the
aorta or its major branches form direct cutaneous arteries which lie
superficial to the muscles and parallel to the skin for long distances
46. The statements below concern skin grafts and Oaps which are eventually
re-anastomosed
A. parietal cells are found mainly in the upper half of the gastric glands
B. the number of tubovesicles in resting parietal cells increases when these
cells are stimulated to produce HCI
C. parietal cells release one HC0 3- to accompany every H+ secreted into
the lumen
D. chief cells produce intrinsic factor
E. argentaffin cells are not confined to the stomach but are found
throughout the digestive tract
48. During Syme's operation (amputation in the region of the ankle), the surgeon
will encounter the following structures lying behind and below the medial
malleolus
A. tibialis anterior
B. tibialis posterior
C. peroneus longus
D. all tendons of extensor digitorum longus
E. flexor hallucis longus
52. The following statements concern the blood supply of the small and large
intestine
A. the ethmoidal sinuses are separated from the orbit by a thin plate of
bone
B. the hiatus semilunaris lie low down on the medial wall of the sinus
C. the frontal and posterior ethmoidal sinuses drain into the infundibulum
D. the infundibulum drains into the hiatus semilunaris (the maxillary
opening)
E. the mucous membrane of the sphenoidal sinuses is supplied by the
posterior ethmoidal nerves
ANATOMY 13
A. the subpsoas bursa communicates with the hip joint in most cases
B. rectus femoris frequently has a sesamoid bone which lies just below the
anterior inferior iliac spine
C. the iliofemoral ligament is attached to anterior superior iliac spine
D. gluteus medius passes lateral to the joint capsule to be inserted into the
lesser trochanter
E. traumatic posterior dislocation of the joint occurs more commonly than
anterior dislocation
57. Consider the following postero-anterior plain film of the chest (Figure 1)
Figure 1
59. The clinical features of an injury to the common peroneal nerve due to a
fracture of the neck of the fibula include
61. The clinical features of a lumbar disc prolapse affecting root Sl only include
62. When performing a highly selective vagotomy for duodenal ulcer, the surgeon
usually
A. finds that the anterior vagus gives off branches to the liver and
gallbladder
B. fmds the posterior vagus as a thick cord closely applied to the
oesophagus
C. denervates the parietal area of the stomach
D. divides the coeliac branch of the posterior vagus
E. performs pyloroplasty
ANATOMY 15
rlgure ..
A. the lymphatic drainage of the lower third ends in the coeliac lymph
nodes
B. in the lower third oesophageal tributaries of the azygos veins
anastomose with tributaries of the left gastro-epiploic vein
C. the left recurrent laryngeal nerve lies posterior to the thoracic part of
the oesophagus
D. the left bronchus constricts the oesophagus as it crosses anterior to it
E. the lower third is the commonest site for carcinoma of the oesophagus
66. The following statements concern the prostate and male urethra
A. crypts of Leiberkiihn
B. avascular submucosa
C. lymphatic follicles with germ centres in the lamina propria
D. muscularis externa consisting of outer circular and inner longitudinal
layers of smooth muscle
E. fibrinopurulent exudate on the surface
A. a well-developed capsule with septa subdividing the gland into lobes and
lobules
B. striated ducts whose columnar cells have their nuclei located at the base
of the cell
C. squamous epithelium in a mucoid stroma
D. cribriform nests of cells separated by strands of hyalinized connective
tissue
E. serous alveoli
ANATOMY 17
70. The following differences help the operating surgeon to distinguish between
jejunum and ileum
71. With respect to the gallbladder and common bile duct (CBD)
A. the cystic artery branches from the right hepatic artery and lies most
commonly between the cystic duct and liver
B. the right hepatic duct rarely enters the gallbladder near its junction with
the cystic duct
C. the internal diameter of a normal CBD is about 12 mm on
ultrasonography
D. the wall of the supraduodenal part of the CBD has a venous plexus
which can be seen at operation
E. when performing cholecystectomy through Kocher's incision the
surgeon must not divide the rectus muscle
A. the subclavian vein crosses the first rib posterior to scalenus anterior
B. the phrenic nerve descends anterior to scalenus anterior
C. the cervical dome of pleura lies behind scalenus medius
D. the stellate ganglion lies at the level of C7 vertebra
E. the subclavian artery crosses the first rib anterior to scalenus anterior
18 MCQs IN APPLIED BASIC SCIENCES - For the Primary FRCS
80. The following structures are found in the subplatysmal space (deep to the
platysma and superficial to the deep cervical rascia)
A. the palatine tonsils drain into the deep cervical lymph nodes
B. the potential gap between the middle and lower fibres of the superior
constrictor muscle is the usual site of the pharyngeal pouch
C. the pharyngeal mucous membrane is continuous with that of the
tympanic cavity
D. the piriform fossa is bounded laterally by the aryepiglottic folds
E. the nasopharyngeal tonsils are smallest in childhood and reach their
maximum size after puberty
20 MCQs IN APPLIED BASIC SCIENCES - For the Primary FRCS
83. The ulnar nerve supplies the following muscles in the hand
A. adductor poIlicis
B. all dorsal interossei
C. the lateral two lumbricals
D. abductor poIlicis brevis
E. all hypothenar muscles
A. the submandibular gland comes into direct contact with the sublingual
glands
B. branchial cleft cysts usually lie superficial to sternocleidomastoid
C. some of the submandibular lymph nodes lie within the submandibular
salivary gland
D. the mylohyoid cleft connects the neck to the oral cavity
E. the thyroid isthmus usually lies at the level of the upper three tracheal
rings
87. Consider the following schematic coronal section of part of the pelvis and
perineum (Figure 3)
Obturator inturnus
Ischium
x----~
L-..----Ischiorectal fossa
Pectinate line
Figure 3
A. the facial nerve lies between the superficial and the deep parts of the
gland
B. the parotid duct passes forward deep to the masseter muscle
C. the gland is enclosed in a dense fibrous capsule
D. parasympathetic secretomotor fibres reach the parotid via the great
auricular nerve
E. the glenoid process extends medially behind the temporomandibular
joint
90. The long saphenous vein usually receives the following tributaries in the
femoral triangle
91. The clinical features of complete paralysis of the 3rd cranial nerve include
A. pupil constriction
B. ptosis
C. the eye looks laterally and downward
D. loss of consensual light reflex (light is shone in the affected eye)
E. loss of accommodation reflex
92. The following statements are true about different forms of medical imaging
A. lies in direct contact with the medial surface of the superior constrictor
muscle of the pharynx
B. is separated from the glossopharyngeal nerve by the superior constrictor
muscle
C. has a thin fibrous capsule which is continuous with the pharyngeal
aponeurosis
D. may contain bone
E. is partIy supplied by the inferior tonsillar artery which branches from
the descending palatine artery
ANATOMY 23
97. The following statements concern the development orthe urogenital system
A. follicular cells arise from the epithelium of the dorsal wing of the fourth
pharyngeal pouch
B. parafollicular cells arise from the fifth pharyngeal pouch
C. approximately 50% of thyroglossal cysts lie close to or just inferior to
the body of the hyoid bone
D. thyroglossal cysts may lie at the base of the tongue
E. a thyroglossal fistula usually arises due to rupture of a thyroglossal cyst
Answers
1. A. (F) the external oblique fibres run parallel to the skin incision
B. (T)
C. (F) Scarpa's fascia is superficial to the external oblique
D. (T)
E. (F) the appendicular artery has no anastomosis. This explains the
vulnerability of the appendix to necrosis and perforation once the
artery is blocked
4. A. (F) the popliteal artery is the deepest structure in the popliteal fossa
B. (T)
c. (T)
D. (F) this is part of the medial boundary of the popliteal fossa
E. (T)
Popliteal A.-+-~fll\
Anterior 11f-+-+--Popliteal N.
tibialA.
-/--+-1,1--+--+-- Popliteal V.
Medial approach to
right popliteal artery
Figure 4
7. A. (F) the angle is about 125° in the adult, but it is larger in the young
child
B. (F) the intertrochanteric line connects them anteriorly, and the
intertrochanteric crest connects them posteriorly
C. (T)
D. (F) the fibres are attached to the lesser trochanter
E. (T)
26 MCQs IN APPLIED BASIC SCIENCES - For the Primary FRCS
8. A. (F) this branch reaches the head along the ligament of the head
B. (F) it is less important than the other two routes of blood supply: the
retinacular vessels travelling in the posterior capsule and the
medullary vessels in the femoral neck
c. (T)
D. (F)
E. (T) the small blood supply through the ligamentum teres is
insufficient to maintain the head viable
12. A. (T) the posterior half is firmly attached to deep and oblique portions
of the tibial collateral ligament
B. (F) to the deep and oblique portions
C. (T)
D. (T)
E. (F) the central part is avascular. This implies that only peripheral
lesions can be repaired
15. A. (T)
B. (T)
ANATOMY 27
C. (T)
D. (F) the genital branch of the genito-femoral nerve is part of it
E. (T)
17. A. (T)
B. (F) it is formed by the lowest arching fibres of the internal oblique
and transversus abdominis
C. (F) this re-inforcement lies in the medial third
D. (T)
E. (F) it lies lateral to these vessels
19. A. (T)
B. (T)
c. (F)
D. (T)
E. (T)
21. A. (T)
B. (T)
C. (F) deep to it
D. (T)
E. (F) deep to it
22. A. (F)
B. (T)
C. (T) this is the first vessel to be encountered in thyroidectomy
D. (T) care should be taken not to remove the parathyroid glands during
thyroidectomy
E. (F) the external laryngeal nerve is closely related to the superior
thyroid artery, whereas the recurrent laryngeal nerve may be
closely related to the inferior thyroid artery
28 MCQs IN APPLIED BASIC SCIENCES - For the Primary FRCS
23. A. (T)
B. (T) this causes shoulder drop
C. (T) because the deep cervical lymph nodes are closely attached to it
D. (F)
E. (F)
See Figure 4a
Basal
ganglia
Sympathetic N.
A-+T'I--+-A'
- Extemal sphincter
26. A. (F) below the 2nd arch and above the 3rd
B. (T) the fistula passes between the structures of the 2nd and 3rd
arches
c. (T)
D. (T) 'complete fistula'
E. (F) the lateral part is lined with squamous epithelium and the medial
part with ciliated columnar epithelium
27. A. (T)
B. (F) it lies behind the pancreas
c. (T)
D. (F) it drains into either the left renal vein or the left inferior phrenic
vein
E. (T)
28. A. (T) enlargement of such nodes may be the presentation of anal
carcinoma
B. (T) the superior rectal vein drains into the portal system whereas the
middle and inferior rectal veins drain into the systemic
circulation
C. (F) the external sphincter is made of striped muscle and is innervated
by the inferior rectal nerve branch of the pudendal nerve
D. (F) the pubo-rectalis fibres blend with the deep part of the external
sphincter and with the internal sphincter to form the ano-rectal
ring
E. (F) it is lined with stratified squamous epithelium
30. A. (T)
B. (T)
c. (T) the nodes in the lower part of the posterior triangle
D. (F) these nodes lie under cover of the muscle
E. (T)
31. A. (F) when it is straightened out, it measures about 5" in length
B. (T)
C. (F) it is devoid of peritoneal covering in its lower third
D. (F) this is true in the male. In the female the recto-uterine pouch
with its contents lies in front of the rectum
E. (T)
32. A. (F) the surgical neck lies distal to the tuberosities, whereas the
anatomical neck lies immediately below the head
B. (T)
c. (F) the spiral groove behind and below the deltoid tuberosity
30 MOOs IN APPLIED BASIC SCIENCES - For the Primary FRCS
33. A. (T)
B. (F) it gives off no branches in the arm
C. (F) this is supplied by the ulnar nerve
D. (F) it supplies the first two lumbricals
E. (F) it innervates the palmar aspects of the lateral 3Y2 fingers
34. A. (T)
B. (F) the biceps is supplied by the musculocutaneous nerve
C. (T)
D. (T)
E. (T)
35. A. (T)
B. (F) the deep peroneal nerve
C. (F) psoas is supplied by branches from the lumbar plexus. The
femoral nerve supplies the others (quadriceps femoris, pectineus,
iliacus and sartorius)
D. (F) vastus medialis is the first part to atrophy in knee joint disease
and last to recover
E. (T)
37. A. (T)
B. (T)
C. (F) the nerves supplying the scalp lie mainly in the subcutaneous
connective tissue which lies superficial to galea aponeurotica
D. (T) these valveless veins traverse the loose areolar tissue
E. (F) the skin, subcutaneous connective tissue and galea aponeurotica
are intimately bound together
38. A. (T) this explains how necrosis of the diaphyses of the distal phalanx
may complicate pulp space infection which can cause thrombosis
of this artery
ANATOMY 31
39. A. (F) the thinnest part is the pterion which is located where the
antero-inferior corner of the parietal bone articulates with the
greater wing of the sphenoid
B. (T) injury at this site may result in extradural haemorrhage
C. (F) the neck of the mandible is the commonest site
D. (T)
E. (T)
41. A. (F) 81
B. (T)
C. (F) Ll
D. (T)
E. (F) C7
42. A. (T)
B. (F) Ll
C. (F) L2,3,4
D. (T)
E. (F) Ll,2
43. A. (T)
B. (F) in front of the left kidney
C. (T) traversing quadratus lumborum
D. (F) in front of the left kidney
E. (T)
45. A. (F) the deep plexus lies at the interface between the reticular layer
and the superficial fascia
B. (T) they are immunologically active (graft rejection)
C. (F) they are mainly type I except in early development when type III
predominate
D. (F) incisions parallel to these cleavage lines minimize scarring
E. (F) in the predominant pattern, the main segmental artery lies deep
to the muscle. This gives perforating branches through the
muscles (musculocutaneous arteries)
47. A. (T)
B. (F) the number of tubovesicles decreases as these structures fuse
with the plasmalemma to form microvilli
c. (F) for every H+ secreted into the gastric lumen, one HC0 3 - is
released into the blood
D. (F) intrinsic factor is produced by parietal cells. Chief cells are
zymogenic, i.e. produce pepsin and lipase
E. (T) carcinoid tumours are derived from these cells
48. A. (F)
B. (T)
C. (T)
D. (F)
E. (T)
49. A. (T)
B. (F)
C. (T)
D. (T)
E. (F) supplied by the lateral head of the median nerve
NB. The medial cord branches include: 1) the medial head of the median
nerve; 2) the ulnar nerve; 3) the medial pectoral nerve; 4) the medial
cutaneous nerve of the arm; 5) the medial cutaneous nerve of the forearm
50. A. (T)
B. (T)
C. (F) it is an everter
D. (F) only the medial tendons assist in inversion, whereas the lateral
tendons assist in eversion
E. (F) this muscle assists in plantar flexion
ANATOMY 33
51. A. (T)
B. (F) the nephrogram is seen immediately after finishing the injection
C. (T)
D. (F) it is not reliable for this purpose. However, it may reveal filling
defects or the size of diverticulae
E. (T)
54. A. (T)
B. (F) there is very little communication between these branches. This
explains why segmental infarction follows occlusion of these
vessels
C. (T) when these arteries run to the lower renal pole, they may
compress the ureter risulting in hydronephrosis
D. (F) the adrenal gland is not included. Therefore Gerota's space can
be entered to remove the kidney without injuring the adrenal
gland
E. (T) this may explain the distribution of referred pain seen in ureteral
disease
59. A. (T)
B. (F)
C. (T)
D. (T) the foot is plantar-flexed and inverted
E. (F) this results from injuries to the tibial nerve. It is the opposite of
equinovarus
62. A. (T)
B. (F) it is not applied to the oesophagus, but separated from it by
about 10 mm
C. (T) this is the aim of the operation
D. (F) tries to avoid this
E. (F) this may be performed in truncal vagotomy to aid emptying of
the atonic stomach
E. (F) it lies higher. The coeliac axis usually arises at the level of the
thoraco-lumbar junction
Some of the other structures shown in this scan include: the aorta (R); the
pancreas (D); the left adrenal gland (Z); and posterior vertebral muscles (X)
65. A. (T)
B. (F) the azygos tributaries anastomose with the tributaries of the left
gastric vein which drains into the portal vein (portal-systemic
anastomosis)
C. (F) lies anterior to the oesophagus
D. (T)
E. (F) about 50% of carcinomas occur in the middle third. The
remainder is equally divided between the other two thirds
68. A. (T)
B. (F) the nuclei of these ductal cells are centrally located
C. (F) this is seen in pleomorphic adenoma 'the mixed parotid tumour'
D. (F) this is a feature of adenoid cystic carcinoma
E. (T) it is partly serous gland
E. (T) this is why peritoneal dialysis for acute renal failure is possible
72. A. (F)
B. (T)
C. (T)
D. (T)
E. (F)
(See Figure 5)
Sympathetic wnk
Scalenus
medius muscle -I--t--,tl9::~ Subclavian artery
Scalenus anterior
muscle
Stemcmastoid muscle
Deep cervical fascia
73. A. (T) a double sheet of peritoneum that folds back upon itself
B. (T) e.g. appendicitis, cholecystitis
C. (T) this may result in internal herniation of small bowel
D. (F) by gastroepiploic arteries
E. (F) anterior
75. A. (F)
B. (F) the inferior third has no peritoneal covering
c. (T)
D. (F) this fascia is more developed in the male. It must be identified
clearly during surgery in that region
E. (F) the middle rectal artery is a branch of the internal iliac artery and
the inferior rectal artery is a branch of the internal pudendal
artery
76. A. (T)
B. (F) the primary nerve supply is the accessory nerve. It also receives
branches from C2 and C3
c. (T) damage to these veins during parturition may cause a fibrosed
haematoma in the lower part of the muscle (sternocleidomastoid
tumour) or in severe cases torticollis due to shortening of the
muscle heads
D. (F) flex the neck anteriorly
E. (T)
77. A. (T)
B. (T) it occasionally joins the left renal vein directly
c. (F) the cortex is mesodermal whereas the medulla arises from the
neuroectoderm
D. (T)
E. (F) the right is usually more difficult to explore and remove because
of its close relationship to the right lobe of the liver and inferior
vena cava
78. A. (T)
B. (F) anastomoses are seen at the lower end of the oesophagus
C. (T) between the superior rectal veins (portal) and the middle and
inferior rectal veins (systemic)
D. (T) between the diaphragmatic veins (systemic) and liver veins
(portal)
E. (F)
79. A. (F)
B. (T) damage to this vein when exposing the femoral artery may result
in severe haemorrhage
c. (F)
D. (F) from the posterolateral aspect
E. (F)
See Figure 6 which illustrates some of the contents of the femoral triangle
80. A. (T)
B. (T) submental trauma may result in swelling in the suprahyoid region
c. (F) the carotid sheath is formed by the visceral part of the deep
cervical fascia
D. (T) this supplies platysma
38 MCQs IN APPLIED BASIC SCIENCES - For the Primary FRCS
Anterior superior
iliac spine +.~--Extemal iliac artery
/ - ; - - - - External iliac vein
Sartorius mUISCHI-----+.\\' It----f-l-f---- Deep circumflex
iliac artery
Femoral sheath ~::y--_ _ _ Inferior epigastric
Superficial circumflex artery
iliac artery
t.,p.e-.,---- Femoral canal
Superficial extemal---;---f-...........~ , - -Pubic tubercle
pudendal artery ,
Profunda femoris Adductor longus muscle
artery Long saphenous vein
Lateral circumflex
femoral vein
82. A. (T)
B. (F) the pharyngeal pouch usually develops in the potential gap
between the upper oblique and the lower horizontal fibres of the
inferior constrictor muscle
c. (T) through the auditory tubes
D. (F) bounded by the thyroid cartilage laterally and by the aryepiglottic
folds medially
E. (F) they are largest in early childhood and start to atrophy after
puberty
83. A. (T)
B. (T)
c. (F) these are supplied by the median nerve
ANATOMY 39
84. A. (F) the lienorenal ligament transmits the splenic blood supply
B. (T) this tail can be damaged at splenectomy
c. (T) the spleen may be damaged when mobilizing the splenic flexure
to which the ligament is attached
D. (T) two segments are found in 80% of subjects
three segments are found in 20% of subjects
E. (T)
85. A. (T)
B. (F) usually deep to this muscle
C. (T) this makes it essential to remove the gland during lymph nodes
dissection in that region for malignancy
D. (T) infection may spread from the floor of the mouth to the
submandibular region (Ludwig's angina)
E. (T)
87. A. (F) 'X' represents the cxternal sphincter. 'z' represents the internal
sphincter
B. (T)
C. (F) just above the line
D. (T)
E. (F) the mucosa below the line drains into the inguinal nodes
89. A. (T)
B. (F) passes superficial to the masseter. This makes it susceptible to
damage in facial injuries
c. (T) this limits the swelling in parotitis
D. (F) via the auriculotemporal nerve. In Frey's syndrome, where the
injured auriculotemporal nerve joins the distal end of the great
auricular nerve that supplies the sweat glands in the facial skin,
eating stimulates sweating over the gland rather than salivation
E. (T)
90. A. (T)
B. (F)
C. (T)
D. (T)
E. (T)
Femoral vein
Fossa ova/is
(defect in fascia lata)
Femoral triangle showing entrance of the long saphenous vein through the
fossa ovalis into the femoral vein. Tributaries of the long saphenous vein:
A = superficial circumflex iliac; B = superficial epigastric; C = superficial
external pudendal; D = deep external pudendal; E = medial femoral;
F = lateral femoral
Figure 7
ANATOMY 41
91. A. (F) pupil dilation results. This is because the parasympathetic fibres
that supply the constrictor pupillae are interrupted
B. (T) due to paralysis of levator palpebrae superioris
C. (T) the superior oblique and lateral rectus are not affected
D. (F) the afferent pathway consists of the optic nerve, optic chiasma
and optic tract. The impulses pass to the oculomotor nuclei in the
midbrain on both sides; the efferent pathway consists of the
opposite oculomotor nerve which is intact
E. (T) the efferent pathway is interrupted
92. A. (F) the absence of ionizing radiation makes MRI particularly safe
B. (T)
C. (T)
D. (T)
E. (F) CT imaging depends upon the differential absorption of radiation
by the different tissue types
Midline --~\------~
96. A. (T)
B. (F) when the loops fail to return omphalocele results
C. (T)
D. (T) or pancreatic tissue
E. (T)
97. A. (T)
B. (F) from early splitting of the ureteric bud
C. (T)
D. (F) this journey normally occurs during the 7th month
E. (T) it is rather common!
98. A. (T)
B. (T)
C. (F)
D. (T) the nerve supplies the tonsil
E. (T)
(see Figure 8)
The superior
The carotid -,--;-.........., - constrictor muscle
sheath n,f\j~:::..Facial artery
Palatopharyngeus
Palatine tonsil
with crypts
Ramus of mandible--\..,..o.t~
'@-F--Palatoglossus
Masseter-~lLr'L7
Buccinator-~~tl
Lip--_.r
Figure 8
ANATOMY 43
99. A. (T)
B. (F) incomplete fusion of the trunco-conal ridges leads to a patent
ductus arteriosus
C. (T)
D. (F) leads to right ventricular hypertrophy and underdevelopment of
the left ventricle
E. (T)
100. A. (F) arises from epithelial proliferation at the base of the pharynx
B. (T) calcitonin producing cells
c. (T)
D. (T)
E. (T)
44
A. pulmonary embolism
B. pulmonary arteritis
C. asthma
D. lung collapse
E. emphysema
11. Consider the following diAgram representing subdivisions of the lung volume
(Figure 9)
Figure 9
A. if the patient's blood group is AB, his serum will have the naturally
occurring anti-A and anti-B antibodies
B. naturally occurring anti-A and anti-B antibodies are usually IgG
C. red blood cells are the only carriers of the antigens A, B and H
D. the presence of the D antigen makes the subject rhesus positive
E. rhesus antibodies are naturally occurring antibodies
PHYSIOLOGY AND BIOCHEMISfRY 47
15. The extrinsic pathway of the coagulation cascade involves the following
factors
A. tissue factor
B. factor VII
C. factor IX
D. Ca2 +
E. factor XI
A. exercise
B. alcohol
C. severe hypovolaemia
D. decreased plasma osmolarity
E. pain
A. serum albumin
B. serum creatinine
C. serum P?-microglobulin (in a healthy subject)
D. water deprivation test
E. amino acid chromatography on urine
A. glucagon secretion
B. epinephrine output from the adrenal medulla
C. glucokinase activity
D. growth hormone secretion by the anterior pituitary
E. cortisol secretion
50 MCQs IN APPLIED BASIC SCIENCES - For the Primary FRCS
A. h~stamine
B. HI-blockers
C. gastrin inhibiting polypeptide (GIP)
D. atropine
E. gastrin
30. Twenty-four hours after a haemorrhagic shock the plasma level of the
following hormones is found to be increased
A. cortisol
B. insulin
C. adrenalin
D. growth hormone
E. noradrenaline
31. The following metabolic changes occur in the EBB phase (first 24 hours) of
response to injury
A. plasma pH increases
B. the plasma level of free fatty acid decreases
C. hypoglycaemia
D. the plasma level of non-protein nitrogen decreases
E. plasma glycerol increases
32. On the fourth day following major surgery the plasma level of the following
proteins is found to be increased
A. °bglobulin
B. al umin
C. transferrin
D. 02 globulin
E. P-lipoprotein
PHYSIOLOGY AND BIOCHEMISTRY 51
A. neostigmine
B. abdominal exploration
C. morphine
D. vagotomy
E. excessive hydroxytryptamine secretion in the carcinoid syndrome
c
.Q 100
iG
~i
«SCI
Ul~
CD O
!i.e 50
~·i
~
CD
a..
20 40 60 80 100
Figure 10
A. pyrexia
B. respiratory acidosis
c. states of decreased concentration of 2,3 DPG inside the red cell
D. polycythaemia
E. sickle cell anaemia
42. The following statements concern the cardioplegic solution and myocardial
protection when the aorta is cross clamped proximal to the coronary arteries
in a cardiac operation
A. the myocardium can survive this ischaemia for about 25 minutes, even if
the cardioplegic solution has not been used
B. the cardioplegic solution may contain histidine buffers which bind to
harmful compounds
C. when injected into the coronary arteries the cardioplegic solution has a
temperature of 200 e
D. the cardioplegic solution contains potassium and procaine which cause a
rapid cardiac arrest
E. when the cardioplegic solution is used, the heart can easily survive
ischaemia for about 10 hours
43. The following statements concern thyroid hormones (T3 and T4 ) in a healthy
subject
A. gastrin
B. secretin
C. atropine
D. cholecystokinin-pancreozymin (CCK- PZ)
E. vasoactive intestinal polypeptide (VIP)
46. The following statements concern the basic heart-lung bypass circuit
A. the oxygenator should be about 20" above the level of the patient
B. the circuit has a capacity of 2.5 litres
C. there is an initial haemodilation when the bypass circuit is connected to
the patient
D. the intra-aortic pressure is usually insufficient to keep the aortic valve
closed
E. the patient is usually heparinized
+10
5>
.s
Iii
"E
Q)
(5
a.
Q) -70
c
<l!
.0
E
Q)
~ AS
AI.._ _ _ _- ,
S 10
Time (ms)
Figure 11
56 MCQs IN APPLIED BASIC SCIENCES - For the Primary FRCS
A. records the electrical activity of muscle fibres making up the motor units
B. records the magnitude of muscle contraction
C. shows regular electrical activity when healthy muscle is relaxed
D. can be recorded by placing the electrode on the skin overlying the
muscle
E. shows fibrillation potentials in denervated muscle
A. seizures
B. inhalation of 7% CO,
C. intraventricular administration of norepinephrine
D. chronic anaemia
E. inhalation of hyperbaric oxygen
57. The spinothalamic tracts oftl>e spinal cord transmit the following sensory
modalities
A. pain
B. two point discrimination
C. joint position
D. temperature
E. vibration
PHYSIOLOGY AND BIOCHEMISTRY 57
61. The diagram below shows the various parts ofthe electrocardiogram
(Figure 12)
aT
,--------'"....._---,
R
s
Figure 12
62. The following are non-operative methods for reducing intracranial pressure
A. hypoventilation
B. intravenous mannitol
C. the administration of atracurium
D. the administration of sodium nitroprusside
E. positioning the patient in the head down position
A. noradrenaline
B. VIP (vasoactive intestinal polypeptide)
C. prostaglandins
D. dihydroxy bile acids
E. acetylcholine
65. Within the first week post-injury in a severely traumatized patient, there is
increased
A. secretion of aldosterone
B. excretion of urea in urine
C. protein synthesis
D. lipolysis
E. anti-diuretic hormone secretion
68. The following factors usually depress the cardiac output (CO)
A. intravenous thiopentone
B. a high dose of methohexitone
C. hypothermia
D. moderate anaemia
E. atropine administration
Answers
7. A. (T)
B. (T)
C. (F) lung volumes are normal or increased
D. (T)
E. (T)
62 MCQs IN APPLIED BASIC SCIENCES - For the Primary FRCS
8. A. (T)
B. (T)
C. (T)
D. (F)
E. (F) it is usually reduced
13. A. (T)
B. (F) this indicales another source for erythropoietin production, e.g.
liver
C. (F) it decreases the maturation time of these cells
D. (T) to increase Hb synthesis
E. (T) the elevated Hb level reduces erythropoietin synthesis
14. A. (T)
B. (F) hypoxia stimulates chemoreceptors causing vasoconstriction and
tachycardia through central mechanisms
C. (T)
D. (F) the basoreceptors discharge decreases, as these receptors are
stretch receptors which are stimulated by distension of the
vessels containing them
E. (T) due to sympathetic stimulation
PHYSIOLOGY AND BIOCHEMISfRY 63
15. A. (T)
B. (T)
C. (F)
D. (T)
E. (F)
18. A. (T)
B. (T)
C. (F)
D. (F) the large increase is initial and within 2 weeks the blood flow falls
considerably
E. (T)
19. A. (T)
B. (F) alcohol inhibits ADH secretion
C. (T)
D. (F) this inhibits ADH secretion
E. (T)
20. A. (T) this is equivalent to 6 g of haemoglobin
B. (F) these bacterial enzymes deconjugate bilirubin in the intestine
C. (F) it is secreted against a concentration gradient, therefore an active
transport system is required
D. (T) (the entero-hepatic circulation)
E. (F) urobilinogens are colourless, whereas urobilins are coloured
23. A. (T)
B. (F) phosphate is the principal buffer in urine (HPO/-). Ammonia is
also important
C. (F) they are secreted in exchange for Na +
D. (F) ammonia (NH3) can
E. (T) Pco 2
[H+) =K
[HC0 3-)
24. A. (T) this is because creatinine is actively secreted in the renal tubules
B. (F) (inversely proportional)
C. (T)
D. (F) there are many factors that influence urea production and
concentration
E. (F) creatinine clearance is preferred as inulin has to be injected into
the subject. However, serum creatinine is the simplest and most
widely used estimate of GFR
26. A. (F)
B. (T)
C. (T)
D. (F) this assesses distal tubular function
E. (F) this is a test of proximal tubular function
27. A. (T)
B. (T)
C. (F) this enzyme facilitates glucose uptake by the liver, hence activity
increases with hyperglycaemia
D. (T)
E. (T)
28. A. (T)
B. (F) it partially inhibits the cycle as oxygen is required for oxidation
C. (T) as a coenzyme
D. (F) twelve ATP molecules are produced
E. (T)
C. (T)
D. (T)
E. (F) this hormone stimulates gastric acid secretion
30. A. (T)
B. (F) this initially decreases to rise later
C. (T)
D. (T)
E. (T)
33. A. (F) the pain is not sharply localized but lies across the abdomen at
the level of the umbilicus. This is because the small bowel is
derived from the foregut
B. (F) the gas is mainly derived from the swallowed air
C. (T) Shields demonstrated this in 1965
D. (T)
E. (F) may rise as high as 25 cm of water
34. A. (T)
B. (T) due to the active absorption of the products of carbohydrate and
protein digestion
C. (F) the complex is split off at the brush border and only vitamin B12
is absorbed
D. (F) lipase principally converts triglycerides into monoglycerides and
fatty acids
E. (F) bile salts are re-used. Re-absorption of bile salts occurs in the
terminal ileum
excretion
C. (F) DI results from deficient secretion or action of the hormone
leading to thirst and polyuria
D. (T)
E. (T)
38. A. (T)
B. (T)
C. (F) this shifts the curve to the left
D. (F)
E. (T)
Note: shift to right is advantageous as the blood gives up its oxygen more
readily
39. A. (F) although it begins to fall around the 11th week, it remains
detectable
B. (F) the foetal enzymes are not involved (cf oestriol)
C. (T)
D. (T)
E. (T) this can be used to monitor foeto-placental function
42. A. (T)
B. (T) these compounds are byproducts of ischaemia
C. (F) 4°C. Hypothermia decreases the metabolic rate of the myocardial
cells
D. (T)
E. (F) 10 hours is too long. The solution provides a good protection for
up to 2 hours
PHYSIOLOGY AND BIOCHEMISTRY 67
43. A. (F) thyroxine binding globulin (TBG) is the principal binding protein
B. (T)
C. (F) T3 has a T~ of 1.5 days compared with 6-7 days for T4
D. (T) as (TBG) Increases more T4 binds to it, therefore the
concentration of free T4 decreases and this stimulates TSH
synthesis
E. (T) to synthesize various polypeptides
45. A. (T) the sequence of the 5 amino acids at the C-terminal end is
identical to that of CCK-PZ
B. (T) stimulates electrolyte secretion
C. (F) antimuscarinic agents reduce secretion
D. (T) it also causes gall bladder contraction
E. (T) this is similar in structure to secretin
46. A. (F) the oxygenator should be lower than the patient to allow the
venous blood to drain by gravity syphonage
B. (T)
C. (T) this is due to the added fluid present in the circuit
D. (F)
E. (T)
4 Angiotensin (<X:!-globulin)
~
Angiotensin I
1 Renin 1
i Aldost~
Secret~
Angiotensin II
Angiotensin III
1
Degradation products
1Angiotensinasesl
Figure 13
B. (T)
C. (F) the adrenal cortex, not the medulla, secretes aldosterone
D. (F) angiotensin II does not affect cortisol production
E. (T) bradykinin is a vasodilator
50. A. (T)
B. (F) p-blockers inhibit renin release
c. (F) this inhibits renin release
D. (F) it inhibits renin release, forming a negative feedback mechanism
E. (T)
51. A. (T)
B. (F) the transport system may work in the opposite direction
c. (T)
D. (T)
E. (F) the BBB endothelial cells have six times the mitochondria found
in endothelial cells elsewhere
54. A. (T)
B. (F)
C. (F) no changes in potential are visible
D. (T) the electrode can be also inserted into muscle
E. (T)
55. A. (T) ')I-efferents are facilitated
B. (F) the EEG becomes slow, large and synchronized (sleep-like)
C. (F) such a section abolishes decerebrate rigidity by removing
mid-brain facilitation
D. (T)
E. (F) the cortex 'wakens' as the medullary inhibitory centres are cut off
58. A. (T)
B. (F) these are cholinergic
C. (F) all autonomic preganglionic neurons are cholinergic
D. (F)
E. (F) these are cholinergic
59. A. (T)
B. (F) contraction
C. (T) for near vision
D. (F) contraction
E. (F) erection
60. A. (T)
B. (T)
C. (F) this inhibits gastrin secretion
D. (F) this hormone inhibits gastrin secretion
E. (T)
61. A. (F)
B. (F)
C. (T)
70 MCQs IN APPLIED BASIC SCIENCES - For the Primary FRCS
64. A. (T)
B. (T)
C. (F) chylomicrons pass into the lacteal vessels (lymph)
D. (T) this is seen in abetalipoproteinaemia where triglycerides
accumulate within the enterocytes as fat deposits
E. (F) MCTs are more water-soluble
65. A. (T)
B. (T) due to gluconeogenesis from amino acids and to tissue damage
C. (F)
D. (T)
E. (T)
67. A. (T)
B. (T)
C. (F) hypoxia and hypercapnia increase CBF
D. (F) autonomic mechanisms seem to be unimportant
E. (T)
68. A. (T)
B. (F) CO increases due to vasodilation
PHYSIOLOGY AND BIOCHEMISTRY 71
C. (T)
D. (F) CO usually increases
E. (T) this drug blocks the parasympathetic output to the heart
69. A. (F)
B. (T)
C. (F) Na + absorption is not influenced by intraluminal glucose or
amino acids (See Figure 14)
D. (T) aldosterone increases rate of absorption
E. (T) this accounts for about 15% of basal energy requirement
Lumen HC03-+W---> CO 2 + H~
Epithelium
Figure 14
70. A. (T) by coating red blood cells. Therefore blood should be taken for
cross-matching before dextran administration
B. (F) this is a feature of dextran 40
C. (F) the half-life is about 16 days
D. (F) allergic reactions are rare ( < 0.1 % of cases)
E. (T)
action of testosterone
D. (T) e.g. induction of ovulation in the female, azoospermia in the male
E. (F) LH response is greater in the luteal phase
73. A. (T)
B. (T) therefore antiemetics acting at crz don't need to penetrate this
barrier to be effective
C. (F) 5HT3 antagonists may be effective
D. (T)
E. (F) Hl-receptors have been identified in the vomiting centre
74. A. (T)
B. (T)
C. (F) wide QRS complexes and peaked T-waves are seen in
hyperkalaemia
D. (T) the reduced activity ofthe Na + -K+ pump (ATPase) causes Na +
and water to accumulate in the cell and K + to leak out of it. The
cellular swelling causes cellular dysfunction
E. (F) hypocalcaemia potentiates and hypercalcaemia inhibits the local
anaesthetic action
75. A. (T) i.e. body temperature tends to reach that of the environment
B. (T) blood flow diversion away from the skin and shivering are
inhibited
C. (F) the metabolic rate and heat production are depressed
D. (T)
E. (F) hyperkalaemia and acidosis are characteristic
Clinical Pharmacology
1. Heparin
2. Warfarin
3. Frusemide
6. Metronidazole
9. Morphine
10. Morphine
11. Omeprazole
13. Ceruroxlme
14. Cimetidine
A. reduces the volume and the hydrogen ion concentration of gastric juice
B. blocks androgen receptors
C. inhibits the proton pump in the parietal cells
D. is mainly excreted unchanged in urine
E. blocks both HI and H2 receptors
76 MOOs IN APPLIED BASIC SCIENCES - Primary FRCS
15. Ranitidine
17. Carbenoxolone
19. Figure 15 sbows the various sites of tubular reabsorption of sodium and
water along the nepbron
Na+
Figure 15
A. heparin
B. warfarin
C. cyclosporin
D. acyclovir
E. vancomycin
22. The following statements refer to some drugs used in the treatment of cancer
23. The following statements concern some of the drugs used as part of a general
anaesthetic
24. Digoxin
Answers
1. A. (T)
B. (F) the KCcr is used to monitor heparin anticoagulation
C. (T)
D. (T)
E. (F) this regimen is suitable for the prophylaxis of DW in high risk
patients
2. A. (F) 72 hours after the first dose. This is because the clotting factors
already present in the circulation need to be eliminated
B. (T) this is the main advantage over heparin
C. (F) T~ is about 36 hours
D. (F) by hepatic metabolism
E. (F) cimetidine inhibits the enzyme system which metabolizes
warfarin
3. A. (T)
B. (F) increases ea2 + and Mi+ urinary excretion
C. (T) frusemide has a higher efficacy in the cases of low GFR than
other diuretics
D. (F) gentamicin renal excretion may be reduced leading to
nephrotoxicity and ototoxicity
E. (T)
D. (T)
E. (F) the requirements usually increase in infections (by up to one
third of the usual dose)
11. A. (T)
B. (F) has a long-lasting action (> 12 hours)
c. (T) by decreasing the negative feedback of HCl
D. (T)
E. (F) the microsomal enzymes may be inhibited
15. A. (F)
B. (T)
c. (T)
D. (F) this explains why it does not cause gynaecomastia or impotence
(d. cimetidine)
E. (F) (d. cimetidine)
16. A. (T)
B. (T)
c. (T)
D. (T)
E. (F) this is a recognized side effect of the drug
17. A. (T)
B. (T)
c. (F) it has an aldosterone-like action
D. (F) it is excreted mainly unchanged in the bile
E. (F) from C, it is clear that carbenoxolone may lead to hypertension
and heart failure due to Na + retention. It should therefore be
avoided in the elderly
18. A. (T)
B. (F)
c. (F)
CLINICAL PHARMACOLOGY 81
D. (T)
E. (F)
20. A. (T)
B. (T)
C. (T)
D. (F) mainly renal
E. (F) mainly renal
24. A. (T)
B. (F) contraindicated in this syndrome
C. (F) levels should only be measured if toxicity or non-compliance is
suspected or a therapeutic response is not achieved with the
expected dose
D. (F) hypokalaemia increases toxicity
E. (T)
82
2. When suturing a clean incision with the skin edges being closely apposed and
considering that there are no complications
3. With respect to regeneration, tbe following cells are classified as labile (i.e.
continue to multiply throughout life even under normal pbyslologlcal
conditions)
4. Ionizing radiation
9. Wound healing
12. Oncogenes
A. the cells of the deeper layer of the periosteum have osteogenic potential
B. the pH of the uniting fracture starts decreasing after about 10 days
c. the bone ends show osteoporosis in the early stages of fracture healing
D. woven bone formation is more likely to occur than cartilage formation
whenever there is mobilization
E. globules of fat may enter disrupted vascular spaces and become embolic
15. 1be following are commoner in Crohn's disease than in ulcerative colitis
16. Osteosarcoma
17. Hyperplasia
Figure 16
22. Irrigating the bladder with glycine solution when performing nJRP may lead
to
A. Mycobacterium tuberculosis
B. Staphylococcus QIlTeUS
C. Marfan's syndrome
D. Streptococcus viridans
E. Trichophyton fUbnun
26. Epstein-Barr virus has been implicated in the aetiology or the rollowing
cancers in man
A. dermoid cyst
B. cavernous haemangioma
C. Bowen's disease
D. intradermal naevus
E. erythroplasia of Oueyrat
A. male sex
B. a low Breslow thickness
C. amelanosis
D. involvement of trunk
E. regional lymphadenopathy
A. Arnold-Chiari malformation
B. TB meningitis
C. subarachnoid haemorrhage
D. head injury
E. stenosis of the aqueduct of Sylvius
A. hypergammagiobulinaemia
B. hypoalbuminaemia
C. encephalopathy
D. low plasma levels of von Willebrand's factor
E. hypercholesterolaemia
A. Hodgkin's disease
B. extradural haematoma secondary to head injury
C. inflammatory bowel disease
D. chronic suppurative infections
E. hiatus hernia
A. zinc deficiency
B. excessive tension in the sutures
C. uraemia
D. rheumatoid arthritis
E.. ultraviolet light
GENERAL AND SYSfEMIC PATIIOLOGY 91
Answers
1. A. (T)
B. (T) to form an incomplete tube of epithelium around the whole
suture
c. (T)
D. (F) the early removal decreases the extent of granulation
E. (F) the vascular elements decrease with time until the scar becomes
almost avascular
70 _ +- Non absorbable
sutures
Figure 17
10. A. (T)
B. (T)
C. (T)
D. (F) the protease activity is increased in malignant cells
E. (F) autosomal dominant inheritance
D. (T)
E. (F) the damage can be repaired by the repair systems. The
persistence of certain types of damage for a long time may be
responsible for causing tumours
12. A. (T)
B. (F) only 15%
C. (T)
D. (T)
E. (F) growth suppressor factors are anti-oncogenes
13. A. (T)
B. (F) after about 10 days the pH of the uniting fracture increases
(alkaline tide)
C. (T)
D. (F) woven bone formation occurs whenever there is adequate
immobilization
E. (T)
T2 T3a
Muscle Wall
T3b
T1
Lamina Propria
Ta Pelvic Wall
Mucosa
T4b
Tis
T4a
Prostate
Figure 17.
D. (T)
E. (T)
16. A. (F) the cartilage of the epiphyseal plate resists the advance of the
tumour
B. (T) haematogenous spread
C. (T)
D. (F) commoner in males
E. (T)
19. A. (F) about three-fold increase among first degree relatives. The risk
reaches nine-fold in bilateral breast cancer and in breast cancer
before the menopause
B. (T) relatively very high in the Netherlands and very low in Japan
C. (T)
D. (T)
E. (F) nipple discharge is present in about one third of cases
Note: it is now widely believed that ductal carcinoma also originates in the
lobular ductule
23. A. (T)
B. (T)
C. (F)
D. (T)
E. (F)
25. A. (F) they are usually solitary, averaging 1.5 cm in diameter, pale
brown in colour
B. (F) see the diagram below
C. (T) diabetes mellitus is associated with increased cholesterol
concentration (See Figure 18)
D. (T) a shell of calcium may be deposited on the surface of the stone
E. (F) bile pigment stones may complicate chronic haemolytic anaemias
Cholesterol Phospholipid
(%) (%)
0~ C ____~____~100
____~____~__~~
100 80 60 40 20 o
Bi e acids (%)
Figure 18 Bile samples above t~e line ABC are supersaturated with
cholesterol
96 MCQ. IN APPLIED BASIC SCIENCES - Primary FRCS
27. A. (T)
B. (F)
c. (T)
D. (F) rectum and appendix are the commonest sites
E. (F) on or near the lesser curvature
28. A. (T)
B. (F) polypoid carcinoma is associated with a better prognosis
c. (F) in malignant gastric ulcers, the mucosal folds are interrupted
toward the crater
D. (T)
E. (T)
30. A. (T)
B. (T)
C. (T)
D. (F) Duke never used 'stage D'. This was added to the classification
by others
E. (F) if the regional lymph nodes are involved the carcinoma will be
stage C
31. A. (F)
B. (F)
C. (T)
D. (F)
E. (T)
34. A. (T)
B. (F) there is no disruption
c. (F) if the wound is contaminated
D. (F)
E. (T)
35. A. (T)
B. (T)
C. (T)
D. (T)
E. (F) this usually causes a non-communicating hydrocephalus
36. A. (T) less antigen is removed from the portal blood by the diseased
liver
B. (T)
C. (T) ammonia plays an important part in its causation
D. (F) this factor is synthesized by the vascular endothelium
E. (F) cholesterol is synthesized in the liver
38. A. (T)
B. (F)
C. (T)
D. (T) e.g. osteomyelitis
E. (F)
39. A. (T)
B. (T) this impairs the blood supply
c. (T)
D. (T)
E. (F) this has been shown to be beneficial to wound healing
98
Microbiology
A. Clostridium tetani travels via the nerves to the anterior horn cells in the
spinal cord
B. the tetanospasmin component of the exotoxin acts on synapses to inhibit
the normal inhibitory control of motor nerve impulses
C. the diagnosis is usually made relying on microbiological findings
D. the patient should be given large doses of antitoxin intravenously
E. a positive Nagler reaction may identify the presence of Clostridium
tetalli in the wound exudate
2. Acute osteomyelitis
3. Pseudo-membranous colitis
5. Hepatitis B
A. coagulase positive
B. phosphatase negative
C. fermentation of mannitol
D. fluorescent greenish appearance of colonies
E. serology by identification of Lancefield groups
7. Actinomyces israeli
A. Staphylococcus aureus
B. Yersillia pseudotuberculosis
C. Streptococcus dysgalactiae
D. Staphylococcus epidermidis
E. Clostridium perfrillgells
10. Tuberculosis
A. the primary complex may involve the tonsils with cervical adenitis
B. a positive Mantoux test means complete protection against tuberculosis
C. direct microscopy of a smear stained by the auramine method confirms
the diagnosis in most cases
D. the diagnosis of tuberculous peritonitis is usually made on the basis of
clinical examination and positive blood cultures
E. streptomycin remains the drug of choice
A. Staphylococcus aureus
B. Streptococcus pyogenes
C. Streptococcus /aecalis
D. Pseudomonas aenlginosa
E. Bacteroides /ragilis
A. initial leukopenia
B. release of interleukin 1
C. inhibition of Hageman factor
D. activation of the alternative complement pathway
E. stimulation of platelet aggregation
15. Mumps
A. appendix
B. axilla
C. finger pulp
D. ischio-rectal regions
E. breast
A. erythromycin
B. polymyxin
C. vancomycin
D. nalidixic acid
E. penicillin
19. The following statements concern a sputum sample from a patient with a
possible respiratory tract Infection
A. Clostridium septicllnt
B. Clostridium histolyticum
C. Staphylococcus allreus
D. Listeria mOllocytogelles
E. Clostridium IImyi (oedematiells)
A. gentamicin
B. metronidazole
C. ampicillin
D. c1indamycin
E. cefuroxime
A. possesses leukocidins
B. is resistant to phagocytosis by polymorphonuclear leukocytes
C. is usually responsible for carbuncles
D. phage type III is the commonest cause of boils
E. is usually sensitive to fusidic acid
MICROBIOLOGY 103
25. The following antimicrobials act by inhibiting the cell wall synthesis of the
microbe
A. cefuroxime
B. vancomycin
C. erythromycin
D. gentamicin
E. amphotericin B
Answers
1. A. (F) Clostridium tetalli does not spread beyond the wound, but the
exotoxin does
B. (T)
C. (F) the diagnosis is usually clinical
D. (T) to neutralize toxin
E. (F) this is an identification for Clostridium peifringens
2. A. (T)
B. (F) Staphylococcus aureus accounts for more than 75% of cases
C. (F) positive in a high proportion of cases
D. (F) (haematogenous spread)
E. (T) must be continued for several weeks
3. A. (T)
B. (F) Clostridum dijJici/e is the causative bacteria
C. (T) pseudomembranous plaques may be seen; these should be
biopsied
D. (F) by demonstrating the cytotoxic effect of toxin in a faecal filtrate
and the neutralization of the toxin by specific antiserum
E. (F) clostridia are resistant to aminoglycosides
5. A. (T)
B. (T)
C. (F)
D. (F) non-A non-B hepatitis (hepatitis C) is the commonest
E. (F)
6. A. (T)
B. (F) phosphatase positive
C. (T)
D. (F) the colonies are typically golden, but pigmentation ranges from
orange to white
E. (F) this applies to a streptococcus
7. A. (T)
B. (F) strict anaerobes
C. (T)
D. (F) the ileo-caecal region is involved in about 20% of cases.
Cervico-facial actinomycosis is the commonest, accounting for
about 65% of cases
E. (T)
8. A. (T)
B. (T)
c. (F)
D. (F)
E. (T)
9. All true.
A, B, C and D are examples of opportunistic infections
10. A. (T)
B. (F) a positive test reflects a degree of immunity
C. (T)
D. (F) usually made at laparotomy
E. (F) this has been replaced by less toxic drugs, e.g. isoniazid,
rifampicin, ethambutol, etc
11. A. (T)
B. (T)
C. (F)
D. (F)
E. (F)
12. A. (T)
B. (T) causing fever
C. (F)
D. (T)
E. (T)
See Figure 19
MICROBIOLOGY 105
Platelets Release of
aggregation endogenous
and release pyrogen
(leukocytes)
Activation of
fibrinolysis
(plasmin)
Activation of
kinin systems
(kinin)
~ 1
Activation of complement
system
Figure 19
13. A. (T)
B. (F) by Staphylococcus allreus
C. (F) usually due to streptococci
D. (T)
E. (F) the production of hyaluronidase and streptokinase explains the
invasiveness
14. A. (F) T-cell mediated immunity is impaired, but the antibody response
is normal
B. (T)
C. (T)
D. (F) intravenous amphotericin B
E. (T)
17. A. (T)
B. (F)
C. (T)
D. (F)
E. (T)
18. A. (T) this is very important
B. (F) it is necessary to re-incubate the plates for a further day,
otherwise some bacteria may be missed, e.g. non-sporing
anaerobes which may be present in about 30% of such samples
C. (F) this is relevant to rickettsial infections, e.g. epidemic typhus
D. (T)
E. (T) for rapid confirmation of the prese,~ce of anaerobes
19. A. (F) samples more than 24 hours old should be discarded in order to
avoid misleading results due to oveirgrowth of the contaminating
commensals
B. (T) liquefaction avoids the risk of choosing a non-purulent part of the
specimen, and dilution may prevent the contaminating organisms
from appearing in the cultures
C. (T) this helps to identify Streptococcus pneumonia which is sensitive
to it
D. (F) such a thing should not be reported as the administration of
antibiotics active against the normal flora may render these
organisms resistant to the antibiotic
E. (F) this organism may be seen in the specimen (Gram-negative
pleomorphic coccobacillus), but it is difficult to culture
20. A. (T)
B. (T)
C. (F)
D. (F)
E. (T)
21. All true. Note: it is difficult to control hospital infections due to this organism
because of its ability to grow in solutions used for treatment and its natural
resistance to many antimicrobials
22. A. (F)
B. (T)
C. (F)
D. (T)
E. (F)
23. A. (T)
B. (F) it is readily phagocytosed by these cells, but the polymorphs are
killed after phagocytosis
C. (T)
D. (F) mainly Staphylococcus aureus phage type I and II
E. (T)
MICROBIOLOGY 107
Clinical Immunology
A. CD4 and CD8 cells mediate the acute rej ection of transplantation
B. DRw6-negative grafts do better than DRw6-positive ones
C. multiple blood transfusions prior to grafting increase graft rejection
D. the five-year survival rate of the transplanted kidney is better for one
DR mismatch than for two DR mismatches
E. cyclosporin A is a useful anti-rejection the~rapy
A. dependent on complement
B. independent of antibody
C. dependent on T-lymphocytes
D. usually increased in AIDS patients
E. responsible for autoimmune haemolytic anaemia
A. the CD4 molecule on helper inducer T cells enabled the AIDS virus to
bind and to infect lymphocytes
B. there is a fall in the CD8:CD4 ratio in the peripheral blood
C. the patient may have p-Iymphocytes which are polydonally activated
D. almost all the surviving peripheral CD4 cells are positive for the viral
genome
E. the susceptibility to cytomegalovirus (CMV) infection is due to failure
to produce CMV specific cytotoxic T cells
Answers
1. A. (T)
B. (F) DRw6-positive grafts do better
C. (F) have a beneficial effect
D. (T)
E. (T)
2. A. (T)
B. (F)
C. (F) about 75% have had recurrence
D. (F) 40% for pancreas and 85% for heart
E. (T)
6. A. (T)
B. (F)
C. (T) due to persisting antigen
D. (T)
E. (T)
7. A. (T)
B. (F) sarcomas are rather resistant. Colo-rectal cancer, melanomas
and renal carcinomas respond better
C. (F) IL-2 receptors are not present on such cells
D. (T)
E. (T)
CLINICAL IMMUNOLOGY 111
8. A. (T)
B. (F) there is a fall in the T4:T8 not T8:T4 ratio
C. (T) and hypergammaglobulinaemia
D. (F) only 1 in 104 to 1 inlas are positive for the viral genome
E. (T)
Haematology
A. the patient's serum is screened for atypical IgM antibodies at 37"C using
saline techniques
B. direct Coombs' test is performed to detect antibodies in the patient
against donor red blood cells
C. the erythrocytes from each donor unit are tI:sted against the patient's
serum at 37"C to detect IgG antibodies
D. the cross-match usually takes about 1 hour
E. if no time is allowed for cross-matching, group 0 rhesus positive blood
should be transfused
3. With respect to a patient with iron deficiency anaemia due to a chronic peptic
ulcer, the laboratory findings include
A. normal ferritin
B. low serum iron
C. complete absence of iron from macrophages in bone marrow
D. low total iron binding capacity (TIBC)
E. decreased mean corpuscular volume (MCV)
A. haemophilia
B. von Willebrand's disease
C. vitamin K deficiency
D. idiopathic thrombocytopenic purpura
E. a patient who is fully heparinized
A. haemoglobinuria
B. hypothermia
C. hyperkalaemia
D. air embolism
E. amoebiasis
114 MCQs IN APPLIED BASIC SCIENCES Primary FRCS
10. The following statements refer to blood groups and transfusion of blood
products
Answers
1. A. (F) the detection of IgM antibodies (cold) is carried out at room
temperature
B. (F) the indirect Coombs' test is used for this purpose
C. (T)
D. (T)
E. (F) group 0 rhesus negative blood should be transfused
2. A. (T)
B. (F) the cervical lymph nodes are most commonly involved at
presentation
C. (T)
D. (F) the involvement of non-lymphatic tissu(: (e.g. skin, lung, brain,
etc.) usually occurs late
E. (F) radiotherapy is the treatment of choice for stages I and II
4. A. (T)
B. (T)
C. (T)
D. (F) there is fibrinogen deficiency
E. (T)
HAEMATOLOGY 115
5. A. (T)
B. (F) the antibody (IgG) can cross the placenta, causing neonatal
thrombocytopenia
c. (T) then splenoctomy can be safely performed. Following
splenoctomy the long-term remission rate is about 70% of cases
D. (F) due to the presence of the antibody
E. (T)
6. A. (T) platelet function is impaired
B. (F)
C. (F)
D. (T)
E. (T) this may cause platelet dysfunction
7. A. (F) PT is normal
B. (T) X-linked inheritance
C. (T) after chorionic villus sampling
D. (T)
E. (F) the level of VIII:C is low (coagulant activity)
8. A. (T)
B. (T)
C. (T)
D. (F)
E. (T)
Note. PTTK is sensitive to factors in the intrinsic and common pathways
9. A. (T)
B. (T)
C. (T)
D. (T)
E. (F)
10. A. (T)
B. (F) the possession of the D antigen makes the subject Rh +
C. (F) these antibodies nearly always arise after immunization by
transfusion or pregnancy
D. (F) cryoprecipitate contains factor VIII and fibrinogen. Fresh frozen
plasma (FFP) contains all coagulation factors
E. (T)
11. A. (T)
B. (T)
C. (T)
D. (T)
E. (T) this is surprisingly rare
116
Clinical Chemistry
2. The serum potassium of a 60-year-old lady was found to be 2.2 mmol/L. The
following conditions may explain this abnormal l'esult
A. frusemide therapy
B. Addison's disease (not associated with hypovolaemic shock)
C. villous adenoma of the rectum
D. Jiarrhoea
E. untreated diabetic keto-acidosis
3. The following results are very compatible with a c1liagnosis of acute pre-renal
failure in a surgical patient
A. metabolic acidosis
B. hypercalcaemia
C. normochromic normocytic anaemia
D. hypophosphataemia
E. decreased insulin requirements in an insulin dependent diabetic patient
A. pernicious anaemia
B. Zollinger-Ellison syndrome
C. after vagotomy
D. hypersecretion of gastrin by antral G-cells
E. atrophic gastritis
8. Serum alkaline phosphatase is usually greater than five times the upper limit
of normal (5 x ULN) in the following
A. pregnancy
B. pituitary stalk secretion
C. chronic renal failure
D. dopamine agonists
E. hypothyroidism
11. The following tumour markers and malignancies are correctly paired
A. thyroidectomy
B. acute pancreatitis
C. milk-alkali syndrome
D. sarcoidosis
E. magnesium deficiency
A. renal transplantation
B. thiazide diuretics
C. frusemide administration in a healthy subject
D. thyrotoxicosis
E. hypoparathyroidism
A. adrenocortical insufficiency
B. loss of hypothalamic osmotic receptors
C. cranial diabetes insipidus
D. hepatic failure
E. hyperglycaemia
CLINICAL CHEMISTRY 119
Answers
1. A. (T) dilutional hyponatraemia
B. (T) concentrated urine
C. (F) the serum osmolality is usually decreased in this syndrome (i.e.
< 280 mmolfkg)
D. (T)
E. (F) there is usually a continued sodium loss in urine (>20 mmolfL).
This is due to the fact that the plasma volume is maintained by
water retention and hence there is no hypovolaemic stimulus to
aldosterone secretion
2. A. (T)
B. (F) due to mineralo-cortical deficiency
C. (T) these tumours may secrete excessive potassium
D. (T)
E. (F) this usually causes hyperkalaemia which is due to both
haemoconcentration from fluid loss and acidosis
4. A. (T)
B. (F) hypocalcaemia usually ensues
C. (T) due to depression of bone marrow by accumulated toxins and to
decreased erythropoietin synthesis by the unhealthy kidney
D. (F) hyperphosphataemia ensues
E. (T) due to the fact that insulin is metabolized in the kidneys
5. A. (T)
B. (T)
C. (F) hypokalaemia ensue~ due to loss of K + in the vomitus and to
preservation of Na + (and water) at the expense of K + by the
kidneys
D. (F) this is primary hyperaldosteronism. Aldosterone promotes
sodium reabsorption and potassium secretion in the distal
convoluted tubule and collecting ducts of the kidney
E. (F) hypokalaemia is a feature
8. A. (T)
B. (F) the level is normal
C. (F) serum alkaline phosphatase is increa!;ed in this condition,
although it is usually < 5 x ULN
D. (T)
E. (F) the level may be decreased
9. A. (T)
B. (T) this may interrupt the inhibitory control
C. (T)
D. (F) dopamine agonists such as bromocriptine tend to lower prolactin
levels
E. (T)
10. A. (T) tissue damage and increased aldosterone contribute to this
B. (F) decreases. Increased aldosterone contributes to this
C. (F) increases due to increased excretion of urea and other
nitrogenous compounds. Also more water is reabsorbed under
the influence of increased ADH
D. (T)
E. (F) increases
15. A. (T)
B. (T) this may be seen in neurosurgery, e.g. removal of
craniopharyngioma
C. (F) this causes polyuria
D. (T)
E. (F) polyuria may ensue