EOS 5 – OBA by weh loong gan

1. During development, the liver arises from which of the following ?

A. Foregut

B. Midgut

C. Hindgut

D. Septum transversum

E. Pleuroperitoneal membrane

2. In the anatomical position, which carpal bone lies directly distal to the lunate ?

A. Hamate

B. Scaphoid

C. Trapezoid

D. Triquetrum

E. Capitate

3. Impaired dorsiflexion of foot with decreased sensation in the space between digit 1 and 2.
Which of the following nerve is affected ?

A. Femoral nerve

B. Saphenous nerve

C. Tibial nerve

D. Deep peroneal nerve

E. Superficial peroneal nerve

4. Which of the following muscles will be affected in facial nerve injury ?

A. Omohyoid

B. Thyrohyoid

C. Stylohyoid

D. Sternohyoid

E. Sternothyroid
5. A 38 year old female patient suffers from pleurisy and requires pleural fluid sampling for
thoracentesis. The attending physician asks you to perform the procedure at the right
midaxillary line. Which of the following would be the appropriate level to perform the
procedure ?

A. Above level of 7th rib

B. At the level of 10th rib

C. At the level of 5th rib

D. Between level of 8th and 10thribs

E. Below level of 10th rib

6. In most of the people, the SA node derives its vascular supply from which of the following ?

A. Anterior interventricular artery

B. Posterior interventricular artery

C. Right coronary artery

D. Left circumflex artery

E. Right marginal artery

7. Which muscle is important in abduction of vocal folds ?

A. Cricothyroid

B. Lateral cricoarytenoid

C. Posterior cricoarytenoid

D. Thyroarytenoid

E. Transverse arytenoids

8. During development in the embryo, the ureter arose from which of the following ?

A. Mesonephric duct

B. Metanephric diverticulum

C. Paramesonephric duct

D. Pronephric duct

E. Metanephric mass of intermediate mesoderm

9. What is the main source of subcortical input to the primary auditory cortex ?

A. Superior colliculus

B. Inferior colliculus

C. Lateral geniculate nucleus

D. Medial geniculate nucleus

E. Superior olivary nucleus

10. A 26 year old man presents with worsening pain in his right knee. An x ray of his right knee
shows small lytic lesion in the tibial medial condyle surrounded by focus of sclerosis. What is
the most likely diagnosis ?

A. Gout

B. Rheumatoid arthritis

C. Osteosarcoma

D. Osteomyelitis

E. Osteochondroma

11. A 57 year old man just returned from an overseas trip and reports having severe substernal
chest pain 3 days ago. Which of the following is the most appropriate laboratory test to order
for this patient ?

A. Creatine kinase, MB fraction

B. Total creatine kinase

C. Troponin I

D. Aspartate aminotransferase

E. Lactate dehydrogenase
12. A 9 year old boy had a brain tumour removed 2 years ago. It was located in the vermis of the
cerebellum and was growing into the fourth ventricle. He has now developed signs and
symptoms of spinal cord compression. The tumour that was removed was most likely which
of the following ?

A. Craniopharyngioma

B. Gliobastoma multiforme

C. Medulloblastoma

D. Meningioma

E. Oligodendroglioma

13. Flumazenil is an effective antidote for overdosage with which one of the following drugs ?

A. Buspirone

B. Diazepam

C. Ethanol

D. Morphine

E. Phenobarbital

14. Which of the following is the target of low molecular weight heparin ?

A. Antithrombin III

B. Factor IIa

C. Factor Xa

D. Factor VII

E. Factors II, IX and X

15. Which of the following mechanoreceptors responds to deep pressure ?

A. Meisnner corpuscle

B. Merkel disk

C. Free nerve ending

D. Pacinian corpuscle

E. Ruffini end organ

16. A hepatitis panel is ordered for a 27 year old woman as part of a routine work up for
abdominal pain. Results of serologic testing are negative for HBeAg and HBsAg, but positive
for HBsAb and IgG HBcAb. Which of the following is the appropriate conclusion ?

A. The patient has been exposed to hepatitis B and has completely recovered.

B. The patient has been exposed to hepatitis B and is in acute disease phase.

C. The patient has been exposed to hepatitis B and is in chronic disease phase.

D. The patient has been exposed to hepatitis B and is in window phase.

E. The patient has been exposed to hepatitis B but was never infected.

17. A 43 year old man living in Mexico presents with constipation and abdominal pain for several
months. Radiological studies show pulmonary congestion, cardiomegaly and megacolon.
What insect is the most likely route of transmission for this patient’s illness ?

A. Anopheles mosquitoes

B. Ixodes tick

C. Reduviid bug

D. Sandfly

E. Tsetse fly

18. A continuous machinery murmur is heard over the left upper sternal border in a 6 year old boy
who was born prematurely. The congenital anomaly responsible for these signs and symptoms
produces which of the following patterns of blood flow in fetal life ?

A. It shunts blood from inferior vena cava to aorta

B. It shunts blood from left pulmonary artery to aorta

C. It shunts blood from left ventricle to right ventricle.

D. It shunts blood from portal vein to inferior vena cava

E. It shunts blood from left atrium to right atrium.

19. A 39 year old white woman who suffers from polycythemia vera is presented with severe and
constant right upper quadrant pain over the past two days. Physical examination revelas an
enlarged liver. What other finding would most likely be seen at presentation ?

A. Ascites

B. Asterixis

C. Esophageal varices

D. Hyperpigmented skin

E. Spider angiomata

20. Whihc of the following types of hepatocellular injury is commonly seen after acetaminophen
overdose ?

A. Acute hepatitis

B. Centrilobular necrosis

C. Fibrosis

D. Granuloma formation

E. Microvesicular fatty change

21. An unconscious 57 year old man is brought to the emergency department with massive, bright
red emesis. He has enlarged abdomen that is dull to percussion. Which of the following vessel
anastomoses is responsible for the patient’s bleeding ?

A. Left gastric vein and portal vein

B. Left gastric vein and azygos vein

C. Azygos vein and portal vein

D. Paraumbilical vein and inferior epigastric vein

E. Left gastroepiploic vein and portal vein

22. A 43 year old man with 20 year of history of ulcerative colitis presents to the clinic with
worsening bloody diarrhoea, progressive fatigue, pruritus, visual disturbances and arthralgias.
ERCP shows alternating strictures and dilations of bile ducts. Which of the following
condition is consistent with these ERCP finding ?

A. Cholelithiasis

B. Pancreatic carcinoma

C. Primary hemochromatosis

D. Primary biliary cirrhosis

E. Primary sclerosing cholangitis

23. A 46 year old white woman with rheumatoid arthritis presents with severe pruritus. She is
found to have icteric sclera, palpebral xanthoma and hepatomegaly. She tests positive for
antimitochondrial antibody and increased alkaline phosphatase activity. Which of the
following is most likely responsible for this patient’s presentation ?

A. Destruction of intrahepatic bile ducts

B. Hepatic parenchymal destruction

C. Postal vein thrombosis

D. Obstruction of extrahepatic bile ducts

E. Stenosis of extrahepatic and intrahepatic bile ducts

24. A 40 year old white man is presented with burning retrosternal chest pain after meals. His
pain is relieved by antacids. This chest x ray reveals an 8cm hiatus hernia. This patient is at
risk for developing which of the following types of cancer ?

A. Krukenberg’s tumour

B. Squamous cell carcinoma of esophagus

C. Adenocarcinoma of esophagus

D. Adenocarcinoma of stomach

E. Non small cell carcinoma of lung

25. A 29 year old man is presented with painless testicular mass. Laboratory study shows an
elevated serum HCG level. Which of the following is the most likely site of nodal metastasis
in this tumour ?

A. Para aortic lymph nodes

B. External iliac lymph nodes

C. Deep inguinal lymph nodes

D. Superficial inguinal lymph nodes

E. Internal iliac lymph node

26. A 28 year old woman is presented with excessive bleeding from her gums when she brushes
her teeth. Her laboratory results show an increased partial thromboplastin time and an
increased bleeding time, but are otherwise unremarkable. Which of the following treatments
will most likely to alleviate patient’s symptoms ?

A. Factor VII concentrate

B. Fresh frozen plasma

C. Low molecular weight heparin

D. Cryoprecipitate

E. Protamine sulphate

27. A 25 year old man develops acute onset of fever, malaise, muscle pain, hypertension
abdominal pain, bloody stool and prerenal failure 6 months after recovering from hepatitis B
infection. Which of the following is most likely responsible for this patient’s finding?

A. Microscopic polyangiitis

B. Wegener granulomatosis

C. Kawasaki’s syndrome

D. Takayasu’s arteritis

E. Polyarteritis nodosa
28. A 40 year old man is presented with numbness over his left jaw and lower face. MRI reveals a
schwannoma, which is compressing a cranial nerve as the nerve exits the skull. The cranial
nerve involved in this case exits the skull through which of the following foramina ?

A. Foramen spinosum

B. Foramen ovale

C. Foramen rotundum

D. Superior orbital fissure

E. Jugular foramen

29. A 82 year old woman suffers an ischemic stroke with numerous sequelae, including uvular
deviation to the right side. Assuming the defect is in the lower motor neuron, damage to
which of the cranial nerve is consistent with the finding ?

A. Left IX

B. Left X

C. Left XII

D. Right IX

E. Right X

30. Patient with renal artery stenosis may present with very high blood pressure due to increased
renin secretion. Which of the following structure in the kidney is responsible for sensing
inadequate perfusion and secreting renin ?

A. Afferent arteriole

B. Collecting duct

C. Distal convoluted tubule

D. Efferent arteriole

E. Loop of Henle
31. A 50 year old man has a history of colon cancer and undergoes resection of his colon. He
returns to his physician for regular check up and complains that he is not feeling well in the
past 3 weeks. On physical examination, his blood pressure is 155/94 mmHg and pitting
edema is noted. Urinaysis shows 4+ protein with no RBC or casts. Which of the following
would most likely be present on a kidney biopsy from this patient ?

A. A tram track pattern on light microscopy

B. Non linear mesangial staining with IgA immunofluoresence

C. Lumpy subepithelial deposits on light microscopy

D. A spike and dome pattern of deposition on electron microscopy

E. Crescent shaped lesions in the glomeruli

32. A 57 year old woman is scheduled for elective hysterectomy. Severing of which of the
following structures during surgery would disrupt the most blood flow to the ipsilateral
ovary ?

A. Cardinal ligament

B. Fallopian tube

C. Round ligament

D. Suspensory ligament

E. Uterosacral ligament

33. During dental procedures, it is possible that small fragments may be aspirated into the trachea
and cause aspiration pneumonia. If the patient is sitting upright during the procedure, which
of the following is the most common site of aspiration pneumonia ?

A. Left upper lobe

B. Left lower lobe

C. Right upper lobe

D. Right lower lobe

E. Lingual
34. Which of the following medications can be used effectively to stop the bronchoconstriction
resulting from aspirin allergy ?

A. Cromolyn

B. Prednisone

C. Zileuton

D. Methylxanthines

E. Montelukast

35. An 8 year old boy has attacks characterised by wheezing and shortness of breath that usually
resolve after an hour. Blood test reveals eosinophilia. Which cytokine is involved in the
pathogenesis of this disease ?

A. Interleukin 1

B. Interleukin 2

C. Interleukin 4

D. Tumour necrosis factor alpha

E. Interferon gamma

36. A 10 year old boy is brought to emergency department after becoming less responsive after
several bout of nausea and vomiting. The patient is tachycardiac and is breathing deeply and
slowly. Laboratory studies are remarkable for a serum pH of 7.21, a serum glucose level of
700 mg/dl and a serum bicarbonate level of 16 mEq/L. Intravenous fluids and insulin are
administered. Measurement and management of which of the following electrolytes are the
most critical in this patient ?

A. Bicarbonate

B. Calcium

C. Chloride

D. Potassium

E. Sodium
37. A 5 day old boy is presented with vomiting and constipation. The child has not passed stool
since birth but only recently began vomiting. The vomitus has greenish colouration. Abdomen
is markedly distended and dull to percussion. A sweat chloride test is negative. The disorder
in this infant arises from cells derived from which of the following embryogenic cell
population ?

A. Endoderm

B. Mesoderm

C. Surface ectoderm

D. Neural ectoderm

E. Neural crest

38. A 45 year old man with essential hypertension presents to emergency department with muscle
weakness and palpitations. Peaked T wave and prolonged PR intervals are noted on ECG.
Which of the following medications could be the underlying cause of the changes noted on
this patient’s ECG ?

A. Acetazolamide

B. Furosemide

C. Hydrochlorothiazide

D. Mannitol

E. Spironolactone

39. A 40 year old non smoking woman complains of persistent cough and loss of weight over the
past 3 months. On radiography, a well demarcated subpleural mass is found on the right lung.
Which of the following types of carcinoma does this patient most likely to have ?

A. Adenocarcinoma of lung

B. Carcinoid tumour of lung

C. Metastases to lung from a distant primary tumour

D. Small cell carcinoma of lung

E. Squamous cell carcinoma of lung

40. A 13 year old boy is presented with swelling and pain in his right leg. The X ray film of the
leg shows a large lytic lesion with onion skin appearance located midway along the femur.
Malignancy is suspected and a karyotype of biopsied bone tumour cells is ordered. Which of
the following chromosomal translocations would most likely be found in the karyotype of this
patient ?

A. t ( 9;22 )

B. t ( 11;22 )

C. t ( 8;14 )

D. t ( 14;18 )

E. t ( 15;17 )

41. Cutting which structure causes blindness in the temporal field of the left eye and the nasal
field on the right eye ?

A. Optic nerve of the right eye

B. Optic nerve of the left eye

C. Optic tract of the right eye

D. Optic tract of the left eye

E. Optic chiasm