1. An 11y.o. girl is admitted w high fever, neck rigidity and vomiting.

The attending doctor

introduces a needle through her lumbar spine to collect a sample of cerebrospinal
fluid.

Which space should the needle reach to allow the collection of the sample?
a. Between the arachnoid and pia mater
b. Between the dura and arachnoid mater
c. Beneath the pia mater
d. Outside the dura mater

2. Which muscle divides the submandibular gland into superficial and deep parts?
a. Geniohyoid
b. Mylohyoid
c. Posterior belly of digastric
d. Stylohyoid

3. A 50y.o. man who received an intramuscular injection in his gluteal region comes back
to the clinic a week later complaining of difficulty in walking. The physician notices that
the pt’s left hip drops when the left foot is raised off the ground.

Which action on the hip joint is impaired due to the injury of the nerve in the above
condition?
a. Abduction
b. Adduction
c. Extension
d. Flexion

4. A 25y.o. man comes to the hospital w a cut injury to the lateral aspect of his knee.
When he is asked to walk, he is unable to hold his ankle joint at the neutral position
during the heel strike and the foot tends to plantarflex.

What muscle is affected in this pt?

a. Gastrocnemius
b. Soleus
c. Tibialis anterior
d. Tibialis posterior

5. A 35y.o. man presents w a lump in the anterior aspect of his thigh. It is cystic,
mobile, and there is a punctum at the centre.

The punctum on the lump represents which of the following?

a. Attachment of the arrector pili muscle
b. Attachment of the hair follicle
c. Opening of the sebaceous gland
 d. Opening of the sweat gland

6. A 60y.o. woman presents w a painful anterior dislocation of her

temporomandibular joints. Her mandible is depressed and she is unable to close
her mouth.

Which muscle is stretched in her jaw and causing pain?

a. Lateral pterygoid
b. Masseter
c. Medial pterygoid
d. Mylohyoid

7. A 50y.o. Labourer is investigated for low backache which is radiating along the back of
his right thigh to the back of his leg. A right postero-lateral protrusion of the
intervertebral
(IV) disc between L3 and L4 is noted in his MRI.

Which anatomical structure has prevented a direct posterior protrusion of the IV disc in
this pt?
a. Anterior longitudinal ligament
b. Interspinous ligament
c. Ligamentum flava
d. Posterior longitudinal ligament

8. A 45y.o. gardener comes to a surgical unit w a painful swelling in the middle of his
right hand of four days’ duration. A mid palmar space infection is diagnosed.

Through which anatomical space of the hand has this infection spread?
a. Carpal tunnel
b. Lumbrical canals
c. Radial bursa
d. Ulnar bursa
9.
Which nerve is most likely to be damaged?
a. Common peroneal
b. Femoral
c. Superior gluteal
d. Tibial

10. A 10y.o. boy fell from a tree and sustained an injury to his right upper limb.
Examination reveals his injury affects the musculocutaneous nerve in the axilla.

Which sign indicates that this nerve is likely to be involved?

a. Weakness in abduction of his right shoulder joint

b. Weakness in extension of his right wrist joint
c. Weakness in flexion of his right elbow joint
d. Weakness in pronation of his right forearm

11. Which bone is derived from the sclerotome?

a. Calcaneum
b. Humerus
c. Scaphoid
d. Vertebra
12.12.
Which axis does the following action revolve around?
a. Anterior lateral
b. Anterior-posterior
c. Transverse
d. Vertical

13. A 35y.o. woman had an unexpected impact to the front of her right knee causing
sudden hyperextension of the knee after collision w a car while cycling.

Which ligament is most likely to be injured?

a. Anterior cruciate
b. Medial collateral
c. Lateral collateral
d. Posterior cruciate

14. While walking together, the mother and father swung a 3y.o. child by pulling his
forearm. The child cries immediately and is not able to move his right elbow. A swelling
is visible over the outer aspect of his right elbow. Radiological examination reveals
partial dislocation of his right radius.

What is the most likely cause of his clinical condition?

a. Rupture of the radial collateral ligament
b. Separation between the radial head and capitulum of the humerus
c. Slipping of the annular ligament over the radial head
d. Tear of the fibrous capsule of the elbow joint
15. A 56y.o. man complains of inability to move his foot following a motorcycle accident.
There is laceration in some part of his right leg. Examination reveals weakness in
both dorsiflexion of the ankle and inversion of the foot.

Which muscle is most likely to be affected?

a. Extensor digitorum longus
b. Peroneus longus
c. Tibialis anterior
d. Tibialis posterior

16. A 52y.o. woman who undergoes a total knee arthroplasty, is positioned in the supine
position w her arms abducted to the side on a paddled arm board. One month after
discharge, she presents w decreased grip strength and bilateral numbness is noted
in her 4th and 5th digits. Anaesthesia positioning-related injury is suspected.

Which nerve is most likely to be injured?

a. Anterior interosseous
b. Musculocutaneous
c. Superficial radial
d. Ulnar

17. A 60y.o. man who is diagnosed w apical lung cancer, presents w droopy eyelids and
sunken eyeballs (Pancoast syndrome). On examination, sensory loss along the
medial side of his forearm and hand is noted.

Which part of the brachial plexus is most likely to be affected by his condition?
a. Lower trunk
b. Posterior cord
c. Ventral ramus of C5
d. Ventral ramus of C7

18. Which statement best describes collagen?

a. It contains a high proportion of hydroxylated proline residues
b. It is a globular, intracellular protein
c. Its structure consists of a superhelix of four ɑ helices twisted together
d. Post-translational modification of collagen involves vitamin A.

19. An army recruit who has newly joined takes part in army training and a long march
and subsequently develops pain in his right forefoot.

Even after one week, the pain has not subsided and he is unable to take part in training.
On examination, there is tenderness on the forefoot. There is no history of significant
trauma to the foot.
 What is the most likely clinical diagnosis of the above condition?
a. Calcaneal spur
b. Pes planus
c. Rupture of extensor hallucis longus tendon
d. Stress fracture of the metatarsal bone

20. A 45y.o. man presented at the A&E department w low back pain and retention of urine
after doing heavy exercise. There is also a history of on and off chronic low back pain.
On examination, there is a loss of sensation on the perineal (saddle) area, lower
motor neuron type muscle weakness below the knee and ankle reflex is absent. X-ray
spine shows no fracture and all laboratory results are normal.

Which is the most likely diagnosis based on his clinical findings?

a. Ankylosing spondylitis
b. Cauda equina syndrome
c. Facet joint arthritis and instability
d. Spinal stenosis

21. A 25y.o. man is involved in sports activities. He complains of pain and swelling at the
back of his heel after doing a high jump. He also complains of difficulty walking and
being unable to stand on tiptoe. On examination, there is swelling and tenderness at
the back of his heel and Thompson test is positive.

Which is the most likely diagnosis for this pt?

a. Acute arthritis of the ankle joint
b. Tendoachillis bursitis
c. Tendoachillis rupture
d. Tendoachillis tendinitis

22. A 55y.o. woman known to suffer from severe disabling rheumatoid arthritis has a
12- month history of dyspnoea. She also complains of a dry cough of similar duration.
She has never smoked and has never been employed. Examination shows a woman
of average build w severe hand deformities and nodules at the elbow. Cardiovascular
examination is normal. Lung fields reveal a diffuse expiratory wheeze. Routine blood
tests, a CXR and an ECG are all normal.

Which is the most likely reason for her symptoms?

a. Bronchial asthma
b. Bronchiectasis
c. Bronchiolitis obliterans
d. Chronic obstructive airway disease
23.23.
Which is the most likely injury in this patient?
a. Epiphyseal injury
b. Greenstick fracture
c. Soft tissue contusion
d. Torus fracture

24. A young sportsman suddenly develops severe pain in the lower end of his leg
while skiing and radiography shows a spiral fracture of the tibia.

What force could have resulted in this fracture?

a. Bending force
b. Compression force
c. Tension force
d. Twisting force

25. A 5y.o.boy sustains a fracture of both bones in his left forearm and it was reduced
satisfactorily. The CXR shows a 5 degree angulation in the radius. His mother is
worried about healing and deformity.

What is the most likely consequence in this pt?

a. Delayed union
b. Malunion
c. Non-union
 d. Remodelling of the deformity

26. What part of the humerus is marked by an orange border in the X-ray below?

a. Anatomical neck of the humerus

b. Greater tuberosity of the head of the humerus
c. Lesser tuberosity of the head of the humerus
d. Surgical neck of the humerus

27. A 50y.o. manual labourer presents w a solitary hypopigmented patch on his back. On
examination behind the left medial epicondyle, the ulnar nerve is enlarged and
tender.

Which nervous system function(s) is/are most likely to be affected in this pt?
a. Light touch and temperature
b. Motor function
c. Proprioception and equilibrium
d. Vibration

28. An electrophysiological study on the medial nerve of a 40y.o. man indicates reduced
conduction velocity. He is a smoker and drinker w a long history of diabetes
mellitus. Examination of his nervous system reveals nothing else remarkable.

Which condition could have contributed most to this electrophysiological finding?

 a. Alcohol consumption
b. Cigarette smoking
c. Demyelinating disease
d. Uncontrolled blood sugar levels

29. A 50y.o. man presents w difficulty in chewing and grinding movements.

Which muscle is responsible for producing these movements?

a. Digastric
b. Geniohyoid
c. Lateral pterygoid
d. Mylohyoid

30. Which muscle is most likely to be affected following a fracture to the ischial tuberosity?
a. Gluteus maximus
b. Gluteus minimus
c. Piriformis
d. Semitendinosus

31. Following a prolonged surgery, a pt is unable to extend his wrist and fingers on his
right hand and extend his right elbow. He also complains of numbness and tingling in
the lateral dorsal aspect of his right hand. His shoulder abduction and extension is
normal.

Which structure is most likely to have been affected?

a. Lateral cord of brachial plexus
b. Posterior cord of brachial plexus
c. Radial nerve
d. Ulnar nerve

32. A 60y.o. woman is diagnosed w osteoarthritis of both knee joints. Pain and limitation
of movements were experienced for more than a yr.

What is the most possible pathogenic mechanism?

a. Biochemical changes of the articular cartilage
b. Degeneration of articular cartilage w disordered repair
c. Immune mediated destruction of the cartilage
d. Intense inflammation of the cartilage

33. A 45y.o. man presents w worsening lower back pain which is worse in the morning
and improves throughout the day. The pain spreads to his buttocks and is associated
w stiffness.

He recalls having this pain since he was in his early twenties, but it has never resolved.
 His lumbar X-ray shows squaring of the vertebral bodies.

Which condition most likely contributes to the findings above?

a. Ankylosing spondylitis
b. Multiple myeloma
c. Osteoporosis
d. Tuberculous spondylitis

34.34.
What is the most possible type of necrosis which can be seen microscopically in these
nodules?
a. Caseous necrosis
b. Coagulative necrosis
c. Fibrinoid necrosis
d. Liquefactive necrosis
35.35.
Which is the microorganism most likely associated w this bone inflammatory condition?
a. Clostridium perfringens
b. Mycobacterium tuberculosis
c. Salmonella typhi
d. Yersinia pestis

36. A 55y.o. woman is seen in the A&E department w clinical features of tiredness, fatigue
and inability to walk. On examination, she is afebrile. She is observed to have
laboured breathing and has weakness in her lower limbs suggestive of predominantly
motor peripheral neuropathy. She has recovered from an episode of viral fever 2
weeks ago. Over the next 2 days, she has more respiratory distress and is further
placed on a ventilator.

What is the most likely clinical condition?

a. Beri-beri
b. Diabetes mellitus
c. Diphtheria
d. Guillain-Barré Syndrome

37. A 60y.o. man presents w progressively worsening pain in his legs and difficulty
walking. On PE, he is revealed to have craniofacial skeletal enlargement. Laboratory
investigations reveal elevated Bone Specific Alkaline Phosphatase and calcium levels.
Serum calcium , phosphorus, parathyroid hormone levels are normal.
Histology shows a mosaic pattern of lamellar bone and prominent cement lines at their
junction.
 What other finding is to be expected in this pt?
a. Decreased serum alkaline phosphatase
b. DEXA scan w T-score less than 2.5
c. Elevated urine hydroxyproline
d. Raised serum uric acid

38. A 28y.o. man complains of lower back pain for the past 2 weeks. The onset of his
pain coincides w heavy lifting and the pain radiates to his right leg. The pain is
aggravated when he coughs or sneezes. On examination, his muscle tone is normal
in both upper and lower limbs. Active plantarflexion of the right ankle is weaker
compared to the left side. The right knee jerk is absent. There is decreased sensation
on the sole and the outer border of his right calf.

Which is the most likely cause of his current condition? (disc herniation PBL)
a. Right L3 nerve root compression
b. Right L4 nerve root compression
c. Right L5 nerve root compression
d. Right S1 nerve root compression

39. A 21y.o. man fractured his right tibia and fibula in a football match. On day 11 of
hospitalisation, he complains of tremendous right leg pain. A PE reveals that his
right lower extremity is oedematous, exquisitely tender and crepitant.
 Which of the following best describes the causative agent?
a. A microaerophilic, non-Gram stained, spirochete bacterium
b. An aerobic, acid-fast, pleomorphic bacillus
c. An aerobic, coagulase-positive, Gram-positive coccus
d. An anaerobic, spore-forming, Gram-positive bacillus

40. A 48y.o. man presents at the outpatient department w pain and swelling of his right
big toe. His serum uric acid level is very high. Tx w an analgesic relieves his pain. The
attending physician prescribes him allopurinol as a part of the long term management
plan.
Which is the reason for giving him allopurinol?
a. To block the release of lysosomal enzymes from leukocytes
b. To increase the solubility of xanthine metabolites in urine
c. To prevent leukocyte migration through endothelial cells
d. To reduce the inflammation mediated by prostaglandins

41. A 15y.o. girl presents w progressive back pain for the past 1 yr. She is noted to be
physically underdeveloped and of a short stature. Her past history reveals that she has
been suffering from chronic kidney disease. Laboratory investigations reveal
hyperphosphatemia and elevated parathyroid hormone levels. Her bone density Z
score is -2.7.
Which statement best explains the pathogenesis of the above findings in this pt?
a. A reduction in bone mineralization due to acquired insensitivity to vitamin D.
b. An imbalance in bone remodeling leading to a decrease in bone mass
c. An inability of the kidneys to adequately excrete phosphate
d. An increase in bone resorption due to increased osteoclastic activity

42. A 30y.o. man is undergoing surgery for nail removal of the middle finger of his left
hand. Local anaesthetic preparations w or w/out adrenaline are available.
Which adverse effect is most likely to occur in this pt if the preparation containing
adrenaline is used?
a. High blood pressure
b. Methaemoglobinaemia
c. Necrosis of finger
d. Ventricular arrhythmia

43. A man fell asleep w his arm slung over the back of his chair. When he woke up , he
complained of a neural deficit in that arm. The doctor treating him considered a night
of Saturday night palsy.
Which deficit is likely to have occurred first?
a. Loss of fine tactile sensation
b. Loss of pain sensation
c. Loss of pressure sensation
 d. Loss of proprioception

44. A 50y.o. man is undergoing an abdominal surgery and the anaesthesiologist plans
to give vecuronium as a neuromuscular blocking agent.
Which drug used concurrently could potentiate the neuromuscular blocking action and
requires dosage reduction of vecuronium?
a. Amoxicillin
b. Ciprofloxacin
c. Clarithromycin
d. Gentamicin

45. Diclofenac has a short plasma half-life of 1-2 hrs but its effect in treating joint
diseases lasts longer than the expected duration of action.
Which statement explains this therapeutic effect of diclofenac?
a. Accumulation in synovial fluid
b. Being a selective COX2 enzyme inhibitor
c. Formation of active metabolites
d. Irreversible inhibition of COX1 and COX2 enzyme

46. A man found that a toolbox was heavier than he expected. Exerting greater force,
he was able to lift the box up.
Which phenomena played the most crucial role in this effort?
a. Hypertrophy of the muscles involved
b. Increased firing of the cerebellar cortex
c. Increased recruitment of motor units
d. Saltatory conduction of motor units

47. Hormonal regulation plays a primary role in plasma calcium and phosphate
homeostasis. Which action is the most significant in their homeostasis when the plasma
ions fall?
a. Calcitonin on renal reabsorption
b. Glucocorticoids on osteoblastic activity
c. Parathyroid hormone on osteoclastic activity
d. Vitamin D3 on intestinal absorption

48. Decreasing chronaxie values over the months at the same point at a denervated
muscle indicates reinnervation.
When this process is not observed in a pt w traumatic injury to the arm, which is the
most likely cause in the affected motor nerve?
a. Decreased formation of bands of Bungner during the weeks following the injury
b. Disruption of mesenchymal CT at the time of injury
c. Excessive macrophagic activity immediately after the injury
d. Failure of chromatolysis during the first two hours of the injury
49. A 40y.o. woman constantly feels stressed in handling her child w
autism. What is the best suggestion for her in handling her own stress
level?
a. Enrol in a physiotherapy session
b. Enrol in a psychological counselling session
c. Enrol in a vocational rehabilitation program
d. Enrol in an applied behavioral analysis session

50. A 28y.o. woman is giving advice to her grandparents on the benefits of

exercise. Which is the best information that she can provide to her
grandparents?
a. Exercise decreases the chances of socialization
b. Exercise decrease dietary intake
c. Exercise increases the chances of institutional care
d. Exercise increases dietary intake