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Question 1
Correct
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A patient who has a nerve injury has sparing of the upper half of the orbicularis oculi muscle but not the lower half. Which branch of the facial nerve supplies the lower half of the orbicularis oculi?
Your Answer: Zygomatic branch
Explanation:The facial nerve divides into five terminal branches once in the parotid gland.
1. The temporal branch innervates muscles in the temple, forehead and supraorbital areas.
2. The zygomatic branch innervates muscles in the infraorbital area, the lateral nasal area and the upper lip.
3. The buccal branch innervates muscles in the cheek, the upper lip and the corner of the mouth.
4. The marginal mandibular branch innervates muscles of the lower lip and chin.
5. The cervical branch innervates the platysma muscle. -
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 2
Incorrect
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A 70-year-old woman presents with right-sided loss of pain and temperature sense on the body as well as left-sided loss of pain and temperature sense on the face. She also has complaints of vertigo, nausea, and tinnitus. Further examination of her cranial nerves suggest the presence of Horner's Syndrome. An MRI and CT scan was ordered and results showed that she is suffering from a left-sided stroke.
Branches of which of the following arteries are most likely implicated in the case?Your Answer: Anterior inferior cerebellar artery
Correct Answer: Posterior inferior cerebellar artery
Explanation:Wallenberg syndrome is also known as lateral medullary syndrome and posterior inferior cerebellar artery syndrome. It is the most common posterior circulation ischemic stroke syndrome. The primary pathology of Wallenberg syndrome is occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches.
It is characterized by vertigo with nystagmus, nausea and vomiting, and sometimes hiccups, dysphonia, dysarthria, and dysphagia often present with ipsilateral loss of gag reflex, ipsilateral ataxia with a tendency to fall to the ipsilateral side, pain and numbness with impaired facial sensation on the face, impaired taste sensation, and impaired pain and temperature sensation in the arms and legs.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 3
Incorrect
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What is the main mechanism of action of cyclizine:
Your Answer: Serotonin-5HT3 antagonist
Correct Answer: Histamine-H1 antagonist
Explanation:Antihistamines e.g. cyclizine, are effective against nausea and vomiting caused by many different conditions, including motion sickness and vertigo. These agents act by inhibiting histamine pathways, and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. There is no evidence that any one antihistamine is superior to another but their duration of action and incidence of adverse effects differ. Adverse effects include drowsiness and antimuscarinic effects such as blurred vision, dry mouth, urinary retention, constipation and confusion.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 4
Incorrect
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A 34-year-old man presents with loss of vision in his left eye due to an episode of optic neuritis. Upon history taking, it was noted that he has a history of multiple sclerosis.
Which of the following anatomical points in the visual pathway has the lesion occurred?Your Answer: Optic chiasm
Correct Answer: Optic nerve
Explanation:A lesion in the optic nerve causes ipsilateral monocular visual loss.
Optic neuritis is an inflammatory demyelination of the optic nerve that is highly associated with multiple sclerosis. The two most common symptoms of optic neuritis are vision loss and eye pain. -
This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 5
Incorrect
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Which of the following muscles inserts into the patella?
Your Answer: The gluteal muscles
Correct Answer: The quadriceps femoris complex
Explanation:The quadriceps femoris muscle translates to “four-headed muscle” from Latin. It bears this name because it consists of four individual muscles; rectus femoris, vastus medialis, vastus lateralis, and vastus intermedius. Out of all four muscles, only the rectus femoris crosses both the hip and knee joints. The others cross only the knee joint. These muscles differ in their origin, but share a common quadriceps femoris tendon which inserts into the patella. The function of the quadriceps femoris muscle is to extend the leg at the knee joint and to flex the thigh at the hip joint.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 6
Incorrect
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Which of the following nerves has been damaged when a patient presents with a foot drop?
Your Answer: Tibial nerve
Correct Answer: Common peroneal nerve
Explanation:The common peroneal nerve often referred to as the common fibular nerve, is a major nerve that innervates the lower extremity. It is one of the two major branches off the sciatic nerve and receives fibres from the posterior divisions of L4 through S2 nerve roots. The common peroneal nerve separates from the sciatic nerve in the distal posterior thigh proximal to the popliteal fossa. After branching off of the sciatic nerve, it continues down the thigh, running posteroinferior to the biceps femoris muscle, and crosses laterally to the head of the lateral gastrocnemius muscle through the posterior intermuscular septum. The nerve then curves around the fibular neck before dividing into two branches, the superficial peroneal nerve (SPN) and the deep peroneal nerve (DPN). The common peroneal nerve does not have any motor innervation before dividing; however, it provides sensory innervation to the lateral leg via the lateral sural nerve.
The superficial peroneal nerve innervates the lateral compartment of the leg, and the deep peroneal nerve innervates the anterior compartment of the leg and the dorsum of the foot. These two nerves are essential in the eversion of the foot and dorsiflexion of the foot, respectively. The superficial and deep peroneal nerves provide both motor and sensory innervation.
The most common presentation with common peroneal nerve injury or palsy is acute foot drop, although symptoms may be progressive and can include sensory loss or pain. Weakness in foot eversion may occur if the superficial peroneal nerve component is involved.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 7
Incorrect
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You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus. Which of the following best describes lorazepam's action?
Your Answer: Inhibits effect of GABA
Correct Answer: Potentiates effect of GABA
Explanation:Lorazepam is a type of benzodiazepine.
Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists with sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant characteristics that promote inhibitory synaptic transmission across the central nervous system.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 8
Correct
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Your consultant requests that you do a lumbar puncture on a patient who is suspected of having meningitis. This patient, a 15-year-old female, presented to the emergency department with a fever, headache, and neck stiffness. Where should you aspirate a sample of CSF?
Your Answer: Subarachnoid space
Explanation:A lumbar puncture, also known as a spinal tap, is a procedure that involves inserting a needle into the lower back’s lumbar region.
A needle is inserted into the space between the arachnoid mater and the pia mater, also known as the subarachnoid space, to remove a sample of cerebrospinal fluid.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 9
Correct
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A 27 year old woman presents to ED having sustained a deep laceration to the dorsum of her ring finger whilst cooking. Her proximal interphalangeal joint is fixed in flexion and the distal interphalangeal joint is hyperextended. Which of the following structures in the digit has most likely been injured:
Your Answer: Insertion of the central slip of the extensor tendon
Explanation:Damage to the central slip of the extensor digitorum tendon would result in loss of extension at the proximal interphalangeal joint resulting in a fixed flexion deformity of this joint, and hyperextension of the distal interphalangeal joint due to a loss of balancing forces. This is called the Boutonniere deformity.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 10
Incorrect
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A 26 year old horse rider has a bad fall and sustains a neck injury which displays the following signs:
- ability to extend the wrist against gravity
- paralysis of the hands, trunk, and legs
- absent sensation in the fingers and medial upper arms
- normal sensation over the thumbs
- absent sensation in chest, abdomen, and legs
What is the neurological level of the injury?Your Answer: C5
Correct Answer: C6
Explanation:C1 – C4 INJURY
Most severe of the spinal cord injury levels; paralysis in arms, hands, trunk and legs; patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements; ability to speak is sometimes impaired or reducedC5 INJURY
Person can raise his or her arms and bend elbows; likely to have some or total paralysis of wrists, hands, trunk and legs; can speak and use diaphragm, but breathing will be weakenedC6 INJURY
Nerves affect wrist extension; paralysis in hands, trunk and legs, typically; should be able to bend wrists back; can speak and use diaphragm, but breathing will be weakenedC7 INJURY
Nerves control elbow extension and some finger extension; most can straighten their arm and have normal movement of their shouldersC8 INJURY
Nerves control some hand movement; should be able to grasp and release objectsC5 – Elbow flexors (biceps, brachialis)
C6 – Wrist extensors (extensor carpi radialis longus and brevis)
C7 – Elbow extensors (triceps)
C8 – Finger flexors (flexor digitorum profundus) to the middle fingerC5 – Elbow flexed at 90 degrees, arm at the patient’s side and forearm supinated
C6 – Wrist in full extension
C7 – Shoulder is neutral rotation, adducted and in 90 degrees of flexion with elbow in 45 degrees of flexion
C8 –Full flexed position of the distal phalanx with the proximal finger joints stabilized in a extended position -
This question is part of the following fields:
- Anatomy
- Central Nervous System
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