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ENDOCRINOLOGY 1. What type of epithelium is present in thyroid follicles. a) Squamous b) Cuboidal c) Columnar – actively secreting d) Transitional 2. What is the blood supply to the parathyroid glands. a) Superior thyroid artery b) Middle thyroid artery c) Inferior thyroid artery – supplies posterior aspect of thyroid artery d) Parathyroid artery e) External carotid artery 3. Identify the correct order for the soft tissue layers surrounding the adrenal gland from external to internal. A) Paranephric fat —> gerota’s fascia —> perinephric fat —> fibrous capsule B) Gerota’s fascia —> paranephric fat —> perinephric fat —> fibrous capsule c) fibrous capsule —> Gerota’s fascia —> perinephric fat —> paranephric fat d) fibrous capsule —> perinephric fat —> Gerota’s fascia —> paranephric fat 4. Which of the following structures does NOT lie in the retroperitoneal space. a) Kidneys b) Tail of pancreas c) Aorta d) Ascending colon e) Oesophagus SAD PUCKER 5. Thyroid hormones belong to which class of hormone. a) Steroids b) Proteins c) Polypeptides d) Amino acid derivatives EXPLANATION 6) D. Due to its anatomical position, a pituitary adenoma (or any tumour) and will push the optic chiasm causing a bitemporal hemianopia visual defect.7) The arrow represents the most superficial layer of the uterus, which is the stratum functionalis. It is supplied by spiral arteries, lies closer to the uterine cavity and it is broken down during menstruation. Stratum functionalis is broken down to stratum compactum (neck of glands and more superficial) and stratum spongiosum (body of glands) Answer- C 8) A. It does not directly influence the action of angiotensin II. Aldosterone causes sodium reabsorption and potassium excretion. This increases the blood volume and blood pressure and thus leads to renin suppression. As seen in Conn’s syndrome (primary aldosteronism), the Aldosterone: Renin ratio will be high due to this effect. Angiotensin I is converted to Angiotensin II by ACE (angiotensin converting enzyme) B. Yes this is correct C. It acts as an opposite of a diuretic- as it is water retaining D. An increase in potassium leads to aldosterone being secreted to regulate levels E. Hyponatremia is seen in Addison’s disease (adrenal insufficiency) caused by both aldosterone and cortisol. Aldosterone insufficiency decreases sodium reabsorption in the collecting ducts of the kidney Answer- B 9) Answer- A. Inferior phrenic artery10) A. Broad ligament – fold of peritoneum that drapes over the uterus, fallopian tubes. It attaches the lateral portions of uterus to the lateral pelvic sidewalls B. Round ligament- remnant of the embryonic gubernaculum. Originates at points where fallopian tubes enter uterus and attaches to the labia majora passing through the inguinal canal C. Oval ligament- no such structure D. Ovarian ligament- attached to ovary inferiorly. Fibrous cord. Links ovary to uterus E. Suspensory ligament- lateral wall of pelvis to ovary. Carries ovarian artery and vein. Answer: E. 11) Always remember MALT for the inguinal canal. Upper wall- M (Muscles- Internal oblique and transverse abdominus) Anterior wall- A (Aponeurosis of external oblique and internal oblique) Lateral wall- L (Inguinal ligament and lacunar ligament) Posterior wall- T (Transversalis fascia, conjoint tendon) Answer: C 12) Answer A. 21- Hydroxylase is the only one you have to remember 13) Decreased functioning of Leydig cell leads to impaired testosterone and INSL-3 secretion. This leads to hypospadias and cryptorchidism. With a decreased functioning of Sertoli cells, there would be diminished capacity to nurture germ cells, and this will lead to infertility and testicular cancer. 5-alpha reductase deficiency is an autosomal recessive intersex condition resulting in the inability to convert testosterone to dihydrotestosterone which is required for masculinization of external genitalia.Kallmann’s syndrome- Failed migration of the GnRH neurons from nasal placode to brain. Is a form of Hypogondotrophic hypogonadism. Patient presents with anosmia Answer- C- Hypospadias. 14) Answer- A. The epididymis is classically known to have pseudostratified columnar epithelium with stereocilia which increase the area for absorption of fluid. 15) A. Alkaline viscous fluid- Seminal vesicle. This fluid neutralizes the acid in the female tract B. Fructose- Also produced by the seminal vesicle. Used for ATP production by sperm C. Prostaglandins – Also produced by the seminal vesicle to aid sperm mobility and viability and to stimulate muscle contraction in the female tract D. Citrate- Yes, the prostate gland secretes a slightly acidic fluid containing citrate (Used for ATP production by sperm). The prostate also produces acid phosphatase and proteolytic enzymes that liquefy coagulated semen. E. Glucose-1 phosphate- Distractor and of no significance Answer- D Upper GI Questions 1. What type of epithelium lines the oesophagus? A – simple columnar B – Stratified squamous keratinised C – stratified squamous non keratinised D – Simple squamous 2. Stomach Blood Supply A – left gastric artery B – right gastric artery C – short gastric arteries D – splenic artery E – Gastrodudenal artery F – Left gastroepiploic artery G – right gastroepiploic artery 3. Layers of StomachA – mucosa B – submucosa C – muscularis D – serosa E – Longitudinal layer of muscle F – circular layer of muscle G – oblique layer of muscle H – muscularis mucosae I – gastric gland J – gastric pits 4. At what level does the oesophagus cross the diaphragm? A – T11 B – T10 C – L1 D – T9 5. Where is vitamin B12 absorbed? A – antrum of stomach B – proximal duodenum C – distal duodenum D – terminal ileum 6. Which of the following is retroperitoneal? A – stomach B – Duodenum C – Jejunum D – Ileum Lower GI Questions 1. What artery allows collateral blood supply around the colon? A – Marginal Artery B – Left Colic Artery C – Right Colic Artery D – Middle Colic Artery 2. What is the name of the inferior mesenteric artery as it crosses the pelvic brim? A – internal iliac artery B – superior rectal artery C – inferior rectal artery D – pudendal artery 3.A – Rectum B – Anal valve C – External Anal Sphincter D – Anal aperture E – Pectinate (Dentate) line F – Internal Anal Sphincter G – Levator ani 4. At which level does the superior mesenteric artery branch off the aorta? A – T12 B – L1 C – L2 D – L3 5. What is the epithelia proximal to the pectinate line? A – Non keratinising squamous epithelia B – Keratinised squamous epithelia C – Simple columnar epithelia D – simple cuboidal epithelia ACCESSORY GI 1. The liver receives blood and nutrients from the GI tract through which vessel? a. Hepatic artery b. Hepatic vein c. Hepatic portal artery d. Hepatic portal vein i. The hepatic portal vein provides around 75% of the blood supply to the liver. It enters at the porta hepatis and contains blood that has been drained from the GI tract. 2. Which ligamentum teres is a physiological remnant of which embryological feature? a. Urachus b. Ductus arteriosus c. Umbilical vein i. The ligamentum teres is a foetal remnant found in the free edge of the falciform ligament. It can be recanalized in portal hypertension which gives rise to the caput medusa examination finding. d. Foramen ovale 3. The surface marking of the fundus of the gallbladder can be identified using which anatomical landmarks? a. Where the right lateral border of the rectus abdominis muscle meets the right costal margin i. This is StuMac’s favourite question. b. Midpoint between the pubic symphysis and the right anterior superior iliac spine th c. 8 intercostal space in the mid-clavicular line on the right side d. 2cm lateral to the umbilicus 4. The pancreas lies at which level? a. Transpyloric plane i. The pancreas lies at the L1 level, in line with the pylorus of the stomach, hence transpyloric plane b. Intertubercular plane c. Mid-clavicular line d. Linea alba 5. The pancreas is connected to the spleen via which structure? a. Major pancreaticoduodenal ampulla b. Lienorenal ligament i. Also known as the splenorenal ligament, the lienorenal ligament is a peritoneal ligament formed by a double layer of peritoneum and contains the tail of the pancreas, splenic artery and splenic vein. c. Transverse mesocolon d. Uncinate process 6. Exocrine cells in the pancreas are arranged in clusters known as what? a. Islets of Langerhans b. Follicles c. Acini i. Exocrine cells of the pancreas are arranged in berry-like lobules (acinus meaning berry) and drain the enzyme precursors into intercalated collecting ducts and then into the pancreatic duct. d. Crypts 7. The splenic artery, which supplies the spleen, also supplies which abdominal organ? a. Duodenum b. Pancreas i. The splenic artery is tortuous and derived from the celiac artery and gives off branches to the pancreas. Note: the pancreas is also supplied by the superior and inferior pancreaticoduodenal arteries. c. Mesentery d. Pylorus 8. Which structure lies inferior to the spleen? a. Left colic flexure i. The left colic flexure is also known as the splenic flexure b. Stomach c. Left kidney d. Diaphragm 9. In which anatomical direction does the spleen enlarge? a. Towards the right lower quadrant i. The spleen enlarges in an inferomedial direction, hence why examination of splenomegaly always begins in the right iliac fossa. b. Towards the left lower quadrant c. Towards the right upper quadrant d. All of the above Male Reproductive Anatomy MCQs Solutions are in bold 1. Secretions from which structure are responsible for lubricating the penis prior to ejaculation? A) Bulbourethral glands B) Prostate gland C) Seminal vesicles D) Testes E) Vas deferens 2. The correct order of the layers of the scrotum is: A) Skin, cremasteric muscle, external spermatic fascia, dartos muscle, internal spermatic fascia, testes B) Skin, dartos muscle, external spermatic fascia, cremasteric muscle, internal spermatic fascia, testes C) Skin, external spermatic fascia, cremasteric muscle, dartos muscle, internal spermatic fascia, testes D) Skin, external spermatic fascia, dartos muscle, cremasteric muscle, internal spermatic fascia, testes E) Skin, external spermatic fascia, dartos muscle, internal spermatic fascia, cremasteric muscle, testes 3. The seminal vesicles are lined by the following type of epithelium: A) Pseudostratified columnar epithelium B) Simple cuboidal epithelium C) Simple squamous epithelium D) Stratified columnar epithelium E) Stratified cuboidal epithelium 4. Which of the following sets of structures are not contained within the spermatic cord? A) Artery of the ductus deferens, sympathetic nerve fibres, ductus deferens B) Cremasteric nerve, ductus deferens, genital branch of the femoral nerve C) Genital branch of the femoral nerve, testicular artery, pampiniform plexus D) Lymphatics, cremasteric artery, sympathetic nerve fibres E) Sympathetic nerve fibres, testicular vein, cremasteric artery 5. Starting in the seminiferous tubules, what is the correct order of structures through which spermatids pass to reach the epididymis? A) Seminiferous tubules, efferent ductules, rete testis, straight tubules B) Seminiferous tubules, efferent ductules, straight tubules, rete testis C) Seminiferous tubules, rete testis, straight tubules, efferent ductules D) Seminiferous tubules, straight tubules, efferent ductules, rete testis E) Seminiferous tubules, straight tubules, rete testis, efferent ductules RENALANATOMY MCQs1. Which type of cell is responsible for renin secretion? A. Intercalated cells B. Juxtaglomerular cells C. Mesangial cells D. Principal cells Answer: B. Juxtaglomerular cells secrete renin (with the macula densa forms the juxtaglomerular apparatus). Intercalated cells of the collecting duct are involved in acid-base homeostasis. Mesangial cells are involved in glomerular filtration. Principal cells of the collecting duct are involved in sodium and potassium regulation via aldosterone and antidiuretic hormone. 2. What is the correct order of tissues surrounding the kidney from superficial to deep? A. Renal capsule, perinephric fat, renal fascia B. Renal capsule, renal fascia, perinephric fat C. Perinephric fat, renal fascia, renal capsule D. Renal fascia, perinephric fat, renal capsule Answer: D. The renal capsule is a tough fibrous capsule helps maintain the shape of the kidney and acts as a barrier against trauma. Perinephric fat surrounds the kidney and their vessels. Renal fascia encloses the kidneys, adrenal gland and perinephric fat, and anchors the kidneys to surrounding structures. 3. The tip of the renal pyramid that projects towards the renal sinus is A. Renal capsule B. Renal column C. Renal papilla D. Renal pelvis Answer: C. The renal medulla consists of renal pyramids. The base of each pyramid faces the renal cortex and its apex (renal papilla) points toward the renal hilum. The renal capsule is a tough fibrous capsule that helps maintain the shape of the kidney and acts as a barrier against trauma. Renal columns are the portions of the renal cortex that extend between the renal pyramids. The renal pelvis is formed from the major calyces and continues as the ureter. 4. Which of the following statements is correct? A. The right renal artery normally passes posteriorly to the inferior vena cava to enter the right kidney B. The right renal artery normally passes anteriorly to the inferior vena cava to enter the right kidney C. The left renal vein passes normally posteriorly to the abdominal aorta to drain into the inferior vena cava D. The right renal vein normally passes posteriorly to the abdominal aorta to drain into the inferior vena cava Answer: A. The right renal artery is normally longer than the left renal artery and passes posteriorly to the IVC to enter the right kidney. The left renal vein is normally longer than the right renal vein and passes anteriorly to the abdominal aorta. 5. What is the parasympathetic supply to the bladder? A. Inferior mesenteric plexus B. Pelvic splanchnic nerve C. Vagus nerve D. Hypogastric nerve Answer: B. Inferior mesenteric plexus – sympathetic innervation to the organs supplied by the inferior mesenteric artery. Vagus nerve - does not innervate the pelvic organs. Hypogastric nerve – sympathetic innervation to the bladder. 6. Which of the following best describes cortical nephrons? A. Blood supply from the peritubular capillaries and vasa recta. B. Ascending limb consists of a thin and thick portion. C. Renal corpuscles lie close to the medulla. D. Represents the majority of nephrons in the kidney. Answer: D. Cortical nephrons make up 80-85% of all nephrons. Their renal corpuscles are found in the outer portion of the cortex. Their short nephron loops lie mainly in the cortex and penetrate only into the outer region of the medulla. 7. Which gland that is found on the superior pole of the kidney? A. Adrenal B. Thyroid C. Thymus D. Pineal Answer: A. Adrenal (i.e. suprarenal gland). Thyroid – found in the neck. Thymus – beneath the sternum. Pineal – found in the brain. 8. Podocytes can be found lining the epithelium of which structure? A. Glomerular capillaries B. Visceral layer of Bowman’s capsule C. Parietal layer of Bowman’s capsule D. Distal convoluted tubule Answer: B. Podocytes (modified simple squamous epithelial cells) line the visceral (inner) layer of Bowman’s capsule and have many foot-like projections (pedicels) which wrap around the single layer of endothelial cells of the glomerular capillaries. The parietal (outer) layer of Bowman’s capsule is composed of simple squamous epithelial cells. The distal convoluted tubule is mostly composed of simple cuboidal epithelial cells.Embryology MBChB2 MCQs Q1. Derivatives of the ectoderm include A. Notochord and skeletal system B. Epithelial lining of digestive tract and reproductive system C. Epidermis and dermis of skin D. Epidermis and epithelial lining of the mouth E. The adrenal cortex Answer D. Ectoderm derivates are mostly ‘outer surfaces’ (such as epidermis, epithelial linings of mouth and anus, cornea and lens of eye, sensory receptors, tooth enamel). The mesoderm produces the notochord, skeletal and muscular systems, reproductive systems (except germ cells) and the adrenal cortex. Endoderm derivates include the epithelial linings of the digestive/respiratory/urinary/reproductive systems. Q2. The notochord is produced from _______ and has an inductive relationship with the overlying _______ A. Endoderm, ectoderm B. Mesoderm, ectoderm C. Mesoderm, endoderm D. Ectoderm, mesoderm E. Ectoderm, mesoderm Answer B. The notochord is a derivative of the mesoderm germ layer. It has an inductive relationship with the overlying ectoderm, resulting in ectoderm thickening to form the neural plate. Q3. The vagina is composed of which type of epithelium? A. Pseudostratified keratinised epithelium B. Simple cuboidal epithelium C. Stratified squamous non-keratinised epithelium D. Transitional epithelium E. Simple columnar epithelium Answer C. The vagina has stratified squamous non-keratinised epithelium, specialised for protection.Q4. The zona pellucida is… A. The fluid filled cavity within the granulosa cells B. The layer of stromal cells that secrete androgens C. Cuboidal cells surrounding the oocyte, secreting oestrogens D. Non-secretory stromal cell layer E. The glycoprotein layer surrounding the oocyte Q5. The development of the kidney occurs in which order and in which anatomical regions? A. Mesonephros (pelvic region) ▯ pronephros (cervical region) ▯ metanephros (abdominal region) B. Pronephros (pelvic region) ▯ mesonephros (abdominal region) ▯ metanephros (cervical region) C. Metanephros (cervical region) ▯ mesonephros (abdominal region) ▯ pronephros (pelvic region) D. Pronephros (cervical region) ▯ mesonephros (abdominal region) ▯ metanephros (pelvic region) E. Mesonephros (cervical region) ▯ metanephros (abdominal region) ▯ pronephros (pelvic region) Answer D. There are 3 sets of structures formed in the process of development: pronephros, mesonephros, metanephros. They form from in the order of pronephros (cervical region, rudimentary non-functional and regresses by week 4) ▯ mesonephros (abdominal region, intermediate mesoderm for initial excretory tubules) ▯ metanephros (pelvic region, definitive kidney appears by week 5 and is functional by week 11, the two components are the ureteric bud and metanephric cap). Q6. The definitive kidney is formed by week ____ but becomes functional by week _____ A. Week 5, week 11 B. Week 5, week 6 C. Week 7, week 15 D. Week 3, week 16 E. Week 8, week 10 Answer A. The metanephros appears in week 5 and is functional by week 11. Q7. Which hormone causes regression of the paramesonephric ducts in males? A. FSH (follicle-stimulating hormone) B. LH (luteinising hormone) C. Testosterone D. AMH (anti-müllerian hormone) E. Oestrogen Answer D. Anti-müllerian hormone (produced by the Sertoli cells of the testis) cause the regression of the paramesonephric duct in males. Whereas the paramesonephric duct in females go on to develop into the fallopian tube (cranial portion), uterus and superior vagina (caudal portion). Q8. The ovary determining gene is _____, whilst the testis determining factor is _____. A. Insulin, Wnt4 B. Wnt4, SRY (Sex determining region of Y chromosome) C. FSH, SRY (Sex determining region of Y chromosome) D. SRY (Sex determining region of Y chromosome), testosterone E. Wnt4, insulin Answer B. The Y chromosome encodes for testis determining factor (SRY: sex determining region of the Y chromosome) – SRY causes differentiation of mesoderm into testis structures. Female sex was at one point assumed to be the ‘default’ biological sex as there was no female equivalent of SRY. However, it has since been discovered that females express Wnt4, which promotes differentiation of mesoderm into ovaries.