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  • Question 1 - A 32-old woman comes for a follow-up visit after being discharged on medications...

    Incorrect

    • A 32-old woman comes for a follow-up visit after being discharged on medications for her newly diagnosed epilepsy. She now complains of a tremor in her arm when she holds a tray in her hand. You examine the patient and notice she has developed postural tremors.

      Which of the following medications for epilepsy is most likely responsible for this tremor?

      Your Answer: Levetiracetam

      Correct Answer: Sodium valproate

      Explanation:

      A postural tumour is observed when a person maintains a position against gravity, such as holding the arms outstretched. (The patient holding her tray against gravity)

      Sodium valproate is the most commonly prescribed medication for epilepsy. It is commonly associated with tremors as valproate-induced tremors occur in around 6-45% of patients. The tremors are commonly postural, but a resting tremor may also occur.

      Approximately 25% of patients taking sodium valproate are found to develop a tremor within 3-12 months of initiating therapy.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      38.3
      Seconds

  • Question 2 - Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and...

    Incorrect

    • Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and needs intravenous fluids to rehydrate. You give him cyclizine as part of his treatment.

      What is cyclizine's main mechanism of action?

      Your Answer: 5-HT 3 receptor antagonism

      Correct Answer: Antihistamine action

      Explanation:

      Cyclizine is a piperazine derivative that functions as an antihistamine (H1-receptor antagonist). To prevent nausea and vomiting, it is thought to act on the chemoreceptor trigger zone (CTZ) and the labyrinthine apparatus. It has a lower antimuscarinic effect as well.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      27.4
      Seconds

  • Question 3 - The sensation produced by touching the arm with a vibrating tuning fork during...

    Correct

    • The sensation produced by touching the arm with a vibrating tuning fork during a neurological examination is mediated by which of the following spinal tracts:

      Your Answer: Posterior column

      Explanation:

      Fine-touch, proprioception and vibration sensation are mediated by the posterior column-medial lemniscus pathway.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      35.5
      Seconds

  • Question 4 - Which of the following is NOT a typical feature of lithium toxicity: ...

    Incorrect

    • Which of the following is NOT a typical feature of lithium toxicity:

      Your Answer: Hyperreflexia

      Correct Answer: Miosis

      Explanation:

      Features of toxicity include:
      Increasing gastrointestinal disturbances (vomiting, diarrhoea, anorexia)
      Visual disturbances
      Polyuria and incontinence
      Muscle weakness and tremor
      Tinnitus
      CNS disturbances (dizziness, confusion and drowsiness increasing to lack of coordination, restlessness, stupor)
      Abnormal reflexes and myoclonus
      Hypernatraemia
      With severe overdosage (serum-lithium concentration > 2 mmol/L) seizures, cardiac arrhythmias (including sinoatrial block, bradycardia and first-degree heart block), blood pressure changes, electrolyte imbalance, circulatory failure, renal failure, coma and sudden death may occur.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      20.4
      Seconds

  • Question 5 - Regarding codeine, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding codeine, which of the following statements is INCORRECT:

      Your Answer: Codeine is contraindicated in children under 12 years old.

      Correct Answer: There is a reduced risk of toxicity in patients who are ultra-rapid metabolisers of codeine.

      Explanation:

      Codeine phosphate is a weak opioid and can be used for the relief of mild to moderate pain where other painkillers such as paracetamol or ibuprofen have proved ineffective.Codeine is metabolised to morphine which is responsible for its therapeutic effects. Codeine 240 mg is approximately equivalent to 30 mg of morphine. The capacity to metabolise codeine can vary considerably between individuals; there is a marked increase in morphine toxicity in people who are ultra rapid metabolisers, and reduced therapeutic effect in poor codeine metabolisers. Codeine is contraindicated in patients of any age who are known to be ultra-rapid metabolisers of codeine (CYP2D6 ultra-rapid metabolisers).Codeine is also contraindicated in children under 12, and in children of any age who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea due to reports of morphine toxicity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      28.5
      Seconds

  • Question 6 - Which of the following statements is true about anterior cord syndrome? ...

    Correct

    • Which of the following statements is true about anterior cord syndrome?

      Your Answer: There is preservation of proprioception

      Explanation:

      Anterior cord syndrome is an incomplete cord syndrome that predominantly affects the anterior 2/3 of the spinal cord, characteristically resulting in motor paralysis below the level of the lesion as well as the loss of pain and temperature at and below the level of the lesion. The patient presentation typically includes these two findings; however, there is variability depending on the portion of the spinal cord affected. Other findings include back pain, or autonomic dysfunction such as hypotension, neurogenic bowel or bladder, and sexual dysfunction. The severity of motor dysfunction can vary, typically resulting in paraplegia or quadriplegia.

      Proprioception, vibratory sense, two-point discrimination, and fine touch are not affected in anterior cord syndrome. These sensations are under the control of the dorsal column of the spinal cord, which is supplied by two posterior spinal arteries running in the posterior lateral sulci.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      44.4
      Seconds

  • Question 7 - Carbamazepine is indicated for all of the following EXCEPT for: ...

    Incorrect

    • Carbamazepine is indicated for all of the following EXCEPT for:

      Your Answer: Complex focal seizures

      Correct Answer: Myoclonic seizures

      Explanation:

      Carbamazepine is a drug of choice for simple and complex focal seizures and is a first-line treatment option for generalised tonic-clonic seizures. It is also used in trigeminal neuralgia and diabetic neuropathy. Carbamazepine may exacerbate tonic, atonic, myoclonic and absence seizures and is therefore not recommended if these seizures are present.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      18.4
      Seconds

  • Question 8 - Which of the following classes of drugs may predispose to lithium toxicity: ...

    Correct

    • Which of the following classes of drugs may predispose to lithium toxicity:

      Your Answer: Thiazide diuretics

      Explanation:

      Excretion of lithium may be reduced by thiazide diuretics, NSAIDs, and ACE inhibitors thus predisposing to lithium toxicity. Loop diuretics also cause lithium retention but are less likely to result in lithium toxicity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      10.6
      Seconds

  • Question 9 - A 22-year-old student presents with severe headache accompanied with nausea and vomiting. Upon...

    Correct

    • A 22-year-old student presents with severe headache accompanied with nausea and vomiting. Upon observation and examination, it was noted that he is febrile and Kernig's sign is positive. A diagnosis of meningitis was suspected and a lumbar puncture was to be performed.

      Which of the following statements regarding meningitis is true?

      Your Answer: The dura mater is the outermost layer

      Explanation:

      Meningitis is defined as the inflammation of the meninges due to an infection caused by a bacteria or a virus. Symptoms usually include stiffness of the neck, headache, and fever.
      There are 3 meningeal layers that surround the spinal cord and they are the dura mater, arachnoid matter, and pia mater.

      The dura mater is the outermost and thickest layer out of all the 3 layers.
      The arachnoid atter is the middle layer, and is very thin.
      The third and deepest meningeal layer is the pia mater that is bound tightly to the surface of the spinal cord.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      45.2
      Seconds

  • Question 10 - A 32-year-old female is diagnosed case of bipolar disorder and is on medication....

    Incorrect

    • A 32-year-old female is diagnosed case of bipolar disorder and is on medication. She presents to her psychiatric team with symptoms of severe depression. She is currently taking Lithium.

      Out of the following, which is TRUE regarding lithium?

      Your Answer: The normal therapeutic range is 2.0-2.5 mmol/l

      Correct Answer: It commonly causes a tremor

      Explanation:

      Lithium is the drug of choice for bipolar disorders but is commonly associated with side effects and toxicity.

      Fine hand tremor is very commonly seen and reported in as many as 50% of patients during the first week of therapy with Lithium. The tremor tends to reduce with time and is only present in around 5% of patients taking the medication two years or longer. Lithium tremors are more common with older age, presumably due to the additive effects of age-related essential tremors.

      Option The normal therapeutic range is 2.0-2.5 mmol/l: Lithium should be carefully monitored as it has a very low therapeutic index. The normal therapeutic range is 0.4-0.8 mmol/l. Levels should be checked one week after starting therapy and one week after every change in dosage. (Option Levels should be checked one month after starting therapy)

      Option It can induce hyperthyroidism: Lithium has a known effect on thyroid function. Lithium decreases the production of T4 and T3 and commonly causes hypothyroidism. More rarely, lithium causes hyperthyroidism due to thyroiditis.

      Option It can induce diabetes mellitus: Lithium can induce nephrogenic diabetes insipidus but not diabetes mellitus.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      32.2
      Seconds

  • Question 11 - Regarding CSF (cerebrospinal fluid) production, approximately how much is produced per day? ...

    Correct

    • Regarding CSF (cerebrospinal fluid) production, approximately how much is produced per day?

      Your Answer: 500 ml

      Explanation:

      CSF fills the ventricular system, a series of interconnected spaces within the brain, and the subarachnoid space directly surrounding the brain. The intraventricular CSF reflects the composition of the brain’s extracellular space via free exchange across the ependyma, and the brain “floats” in the subarachnoid CSF to minimize the effect of external mechanical forces. The volume of CSF within the cerebral ventricles is approximately 30 mL, and that in the subarachnoid space is about 125 mL. Because about 0.35 mL of CSF is produced each minute, CSF is turned over more than three times daily. Approximately 500 mL of CSF is produced per day, at a rate of about 25 mL per hour.

      CSF is a filtrate of capillary blood formed largely by the choroid plexuses, which comprise pia mater, invaginating capillaries, and ependymal cells specialized for transport. The choroid plexuses are located in the lateral, third, and fourth ventricles. The lateral ventricles are situated within the two cerebral hemispheres. They each connect with the third ventricle through one of the interventricular foramina (of Monro). The third ventricle lies in the midline between the diencephalon on the two sides. The cerebral aqueduct (of Sylvius) traverses the midbrain and connects the third ventricle with the fourth ventricle. The fourth ventricle is a space defined by the pons and medulla below and the cerebellum above. The central canal of the spinal cord continues caudally from the fourth ventricle, although in adult humans the canal is not fully patent and continues to close with age.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      6.5
      Seconds

  • Question 12 - Which of the following is a contraindication to the use of opioid analgesics: ...

    Incorrect

    • Which of the following is a contraindication to the use of opioid analgesics:

      Your Answer: Acute porphyria

      Correct Answer: Raised intracranial pressure

      Explanation:

      Opioids should be avoided in people who have:
      A risk of paralytic ileus (opioids reduce gastric motility)
      Acute respiratory depressionAn acute exacerbation of asthma (opioids can aggravate bronchoconstriction as a result of histamine release)
      Conditions associated with increased intracranial pressure including head injury (opioids can interfere with pupillary response making neurological assessment difficult and may cause retention of carbon dioxide aggravating the increased intracranial pressure)

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      38.2
      Seconds

  • Question 13 - If a lesion is observed in Broca's area, which function is expected to...

    Correct

    • If a lesion is observed in Broca's area, which function is expected to become affected?

      Your Answer: Formation of words

      Explanation:

      The primary functions of the Broca area are both language production and comprehension. While the exact role in the production is still unclear, many believe that it directly impacts the motor movements to allow for speech. Although originally thought to only aid in speech production, lesions in the area can rarely be related to impairments in the comprehension of language. Different regions of the Broca area specialize in various aspects of comprehension. The anterior portion helps with semantics, or word meaning, while the posterior is associated with phonology, or how words sound. The Broca area is also necessary for language repetition, gesture production, sentence grammar and fluidity, and the interpretation of others’ actions.

      Broca’s aphasia is a non-fluent aphasia in which the output of spontaneous speech is markedly diminished and there is a loss of normal grammatical structure. Specifically, small linking words, conjunctions, such as and, or, and but, and the use of prepositions are lost. Patients may exhibit interjectional speech where there is a long latency, and the words that are expressed are produced as if under pressure. The ability to repeat phrases is also impaired in patients with Broca’s aphasia. Despite these impairments, the words that are produced are often intelligible and contextually correct. In pure Broca’s aphasia, comprehension is intact.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      16.7
      Seconds

  • Question 14 - Which of the following tracts must be affected if a patient presents with...

    Incorrect

    • Which of the following tracts must be affected if a patient presents with decreased pain and temperature sensation in both lower extremities?

      Your Answer: The anterior spinothalamic tract

      Correct Answer: The lateral spinothalamic tract

      Explanation:

      The main function of the spinothalamic tract is to carry pain and temperature via the lateral part of the pathway and crude touch via the anterior part. The spinothalamic tract pathway is an imperative sensory pathway in human survival because it enables one to move away from noxious stimuli by carrying pain and temperature information from the skin to the thalamus where it is processed and transmitted to the primary sensory cortex. The primary sensory cortex communicates with the primary motor cortex, which lies close to it, to generate rapid movement in response to potentially harmful stimuli. Furthermore, the spinothalamic tract has a role in responding to pruritogens, causing us to itch. Interestingly, itching suppresses the spinothalamic tract neuron response to the histamine effect.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      23.1
      Seconds

  • Question 15 - An ambulance transports a 23-year-old woman who has taken a witnessed overdose of...

    Incorrect

    • An ambulance transports a 23-year-old woman who has taken a witnessed overdose of her mother's diazepam tablets. She has no significant medical history and does not take any medications on a regular basis.

      In this case, what is the SINGLE MOST APPROPRIATE FIRST DRUG TREATMENT?

      Your Answer: Flumazenil IV 200 mg

      Correct Answer: Flumazenil IV 200 μg

      Explanation:

      Flumazenil is a benzodiazepine antagonist that can be helpful in some overdose situations. It works quickly (in less than a minute), but the effects are fleeting, lasting less than an hour. The dose is 200 micrograms every 1-2 minutes with a maximum dose of 3 milligrams per hour.

      Flumazenil should be avoided by patients who are addicted to benzodiazepines or who take tricyclic antidepressants because it can cause withdrawal symptoms. It can cause seizures or cardiac arrest in these situations.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      46.1
      Seconds

  • Question 16 - Despite taking the oral contraceptive pill, a 29-year-old woman becomes pregnant. During a...

    Incorrect

    • Despite taking the oral contraceptive pill, a 29-year-old woman becomes pregnant. During a medication review, you discover that she is epileptic and that her antiepileptic therapy has recently been changed.

      Which of the following antiepileptics is most likely to impair the oral contraceptive pill's effectiveness?

      Your Answer: Sodium valproate

      Correct Answer: Carbamazepine

      Explanation:

      The metabolism of ethinyl oestradiol and progestogens has been shown to be increased by enzyme-inducing antiepileptics. The oral contraceptive pill (OCP) is less effective in preventing pregnancy as a result of this increased breakdown.

      Antiepileptic drugs that induce enzymes include:
      Carbamazepine
      Phenytoin
      Phenobarbital
      Topiramate

      Antiepileptics that do not induce enzymes are unlikely to affect contraception. Non-enzyme-inducing anticonvulsants include the following:
      Clonazepam
      Gabapentin
      Levetiracetam
      Piracetam
      Sodium valproate is a type of valproate that is used to

      Lamotrigine is an antiepileptic drug that does not cause the production of enzymes. It does, however, require special consideration, unlike other non-enzyme-inducing antiepileptics. The OCP does not appear to affect epilepsy directly, but it does appear to lower lamotrigine levels in the blood. This could result in a loss of seizure control and the occurrence of seizures.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      22.6
      Seconds

  • Question 17 - Following an injury sustained during a rugby match, a 16-year-old boy is brought...

    Incorrect

    • Following an injury sustained during a rugby match, a 16-year-old boy is brought to the Emergency Department by his mother. His forearm appears to be deformed, and you believe he has a distal radius fracture. A numerical rating scale is used to assess his pain, and the triage nurse informs you that he is in moderate pain.'

      The RCEM guidance recommends which of the following analgesics for the treatment of moderate pain in a child of this age?

      Your Answer: Intranasal diamorphine 0.1 mg/kg

      Correct Answer: Oral codeine phosphate 1 mg/kg

      Explanation:

      According to a 2018 audit conducted by the Royal College of Emergency Medicine (RCEM), the standard of care for children presenting to EDs with fractured limbs has deteriorated, with most patients waiting longer than ever before for pain relief. More than one-tenth of the children who came in with significant pain from a limb fracture received no pain relief at all.

      For all patients, including children, the Agency for Health Care Policy and Research (AHCPR) in the United States recommends using the ABCs of pain management:
      A – Ask about pain regularly. Assess pain systematically.
      B – Believe the patient and family in their reports of pain and what relieves it.
      C – Choose pain control options appropriate for the patient, family, and setting.
      D – Deliver interventions in a timely, logical, coordinated fashion.
      E – Empower patients and their families. Enable patients to control their course to the greatest extent possible.

      The RCEM guidelines recommend assessing a child’s pain within 15 minutes of arrival. This is a fundamental requirement. For the assessment of pain in children, a variety of rating scales are available; which one is used depends on the child’s age and ability to use the scale. These are some of them:
      Faces of Wong-Baker Scale for assessing pain
      Scale of numerical evaluation
      The behavioural scale is a scale that measures how people behave.

      The RCEM has provided the following visual guide:
      The RCEM has established the following guidelines for when patients in severe pain should receive appropriate analgesia:
      100% within 60 minutes of arrival or triage, whichever is earliest
      75% within 30 minutes of arrival or triage, whichever is earliest
      50% within 20 minutes of arrival or triage, whichever is earliest

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      62.1
      Seconds

  • Question 18 - Which of the following is a contraindication for aspirin? ...

    Correct

    • Which of the following is a contraindication for aspirin?

      Your Answer: Children under 16 years

      Explanation:

      Aspirin contraindications include: hypersensitivity to NSAIDs; asthma, rhinitis, and nasal polyps; and usage in children or teens.
      There is little evidence of allergic cross-reactivity for salicylates. However, due to similarities in chemical structure and/or pharmacologic activities, the possibility of cross-sensitivity cannot be completely ruled out.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      14.6
      Seconds

  • Question 19 - In which of the following cases is intravenous phenytoin contraindicated? ...

    Incorrect

    • In which of the following cases is intravenous phenytoin contraindicated?

      Your Answer: Hepatic impairment

      Correct Answer: Second degree heart block

      Explanation:

      Phenytoin Contraindications include:

      Hypersensitivity
      Sinus bradycardia
      Sinoatrial block
      Second and third degree A-V block
      Adams-Stokes syndrome
      Concurrent use with delavirdine
      History of prior acute hepatotoxicity attributable to phenytoin

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      19.3
      Seconds

  • Question 20 - A 20-year-old boy took almost 25 tablets of paracetamol almost 4 hours ago....

    Correct

    • A 20-year-old boy took almost 25 tablets of paracetamol almost 4 hours ago. The boy is healthy and has no known comorbid or drug history.

      Out of the following metabolic pathways, which one is primarily responsible for the toxic effects of paracetamol?

      Your Answer: N-hydroxylation

      Explanation:

      Paracetamol is predominantly metabolized in the liver by three main metabolic pathways:
      1. Glucuronidation (45-55%)
      2. Sulphate conjugation (30-35%)
      3. N-hydroxylation via the hepatic cytochrome P450 enzyme system (10-15%)

      Cytochrome P450 enzymes catalyse the oxidation of acetaminophen to the reactive metabolite N-acetyl-p-benzoquinoneimine (NAPQI). NAPQI primarily contributes to the toxic effects of acetaminophen. NAPQI is an intermediate metabolite that is further metabolized by fast conjugation with glutathione. The conjugated metabolite is then excreted in the urine as mercapturic acid. High doses of acetaminophen (overdoses) can lead to hepatic necrosis due to depleting glutathione and high binding levels of reactive metabolite (NAPQI) to important parts of liver cells.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      24.2
      Seconds

  • Question 21 - You suspect that your patient with polycystic kidney disease has developed a berry...

    Incorrect

    • You suspect that your patient with polycystic kidney disease has developed a berry aneurysm as a complication of his disease. The patient complains of a sudden, severe headache. You are guessing subarachnoid haemorrhage secondary to a ruptured berry aneurysm as the cause of his severe headaches. What is the most likely location of his aneurysm?

      Your Answer: Anterior cerebral artery

      Correct Answer: Anterior communicating artery

      Explanation:

      One of the complications that polycystic kidney disease may cause is the development of a brain aneurysm.

      A berry aneurysm is the most common type of brain aneurysm.

      The Circle of Willis, where the major blood vessels meet at the base of the brain, is where it usually appears. The most common junctions of the Circle of Willis where an aneurysm may occur include the anterior communicating artery (35%), internal carotid artery (30%), the posterior communicating artery and the middle cerebral artery (22%), and finally, the posterior circulation sites, most commonly the basilar artery tip.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      62.4
      Seconds

  • Question 22 - A 65-year-old man comes for a visit at the clinic with complaints of...

    Incorrect

    • A 65-year-old man comes for a visit at the clinic with complaints of abdominal pain. On inquiring about drug history, you find out that he has been taking around 8-10 paracetamol to help relieve the pain.

      Out of the following, which one is believed to be the main mechanism of action for paracetamol?

      Your Answer: Selective inhibition of COX-1 receptors

      Correct Answer: Selective inhibition of COX-3 receptors

      Explanation:

      The FDA categorizes Paracetamol as an NSAID (nonsteroidal anti-inflammatory drug) as it is believed to selectively inhibit cyclo-oxygenase 3 (COX-3) receptors in the brain and spinal cord.

      COX-3 is a unique variant of the more known COX-1 and COX-2. It is responsible for the production of prostaglandins in central areas, which sensitizes free nerve endings to the chemical mediators of pain. Therefore, by selectively inhibiting COX-3, paracetamol effectively reduces pain sensation by increasing the pain threshold.
      Acetaminophen does not inhibit cyclooxygenase in peripheral tissues and, therefore, has no peripheral anti-inflammatory effects.
      The antipyretic actions of acetaminophen are likely attributed to direct action on heat-regulating centres in the brain, resulting in peripheral vasodilation, sweating, and loss of body heat.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      50.9
      Seconds

  • Question 23 - A 4-year-old child has been convulsing for 20 minutes. She has received two...

    Incorrect

    • A 4-year-old child has been convulsing for 20 minutes. She has received two doses of lorazepam. She takes phenytoin for maintenance therapy, and you draw up a phenobarbitone infusion.
      What dose of phenobarbitone is advised in the treatment of the convulsing child that reaches that stage of the APLS algorithm? Select ONE answer only.

      Your Answer: 5 mg/kg over 30-60 minutes

      Correct Answer: 20 mg/kg over 30-60 minutes

      Explanation:

      If a convulsing child reaches step 3 of the APLS algorithm, then a phenytoin infusion should be set up at 20 mg/kg over 20 minutes. If they are already taken phenytoin as maintenance therapy, then a phenobarbitone infusion should be set up at 20 mg/kg over 30-60 minutes.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      65.5
      Seconds

  • Question 24 - Regarding cortical areas, which one is found in the posterior part of the...

    Correct

    • Regarding cortical areas, which one is found in the posterior part of the inferior frontal gyrus?

      Your Answer: Broca’s area

      Explanation:

      Broca’s area is involved in the expressive aspects of spoken and written language (production of sentences constrained by the rules of grammar and syntax). It corresponds to the opercular and triangular parts of the inferior frontal gyrus (BA 44 and 45). These areas are defined by two rami (branches) of the lateral sulcus (one ascending, one horizontal) which ‘slice into’ the inferior frontal gyrus. In keeping with its role in speech and language, Broca’s area is immediately anterior to the motor and premotor representations of the face, tongue and larynx. A homologous area in the opposite hemisphere is involved in non-verbal communication such as facial expression, gesticulation and modulation of the rate, rhythm and intonation of speech.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      39.7
      Seconds

  • Question 25 - A 26 year old horse rider has a bad fall and sustains a...

    Incorrect

    • 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: C7

      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 reduced

      C5 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 weakened

      C6 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 weakened

      C7 INJURY
      Nerves control elbow extension and some finger extension; most can straighten their arm and have normal movement of their shoulders

      C8 INJURY
      Nerves control some hand movement; should be able to grasp and release objects

      C5 – 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 finger

      C5 – 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
      117.2
      Seconds

  • Question 26 - A 65-year-old man complains of severe vertigo, nausea, and tinnitus. Upon presenting himself...

    Incorrect

    • A 65-year-old man complains of severe vertigo, nausea, and tinnitus. Upon presenting himself to the emergency room, it was observed that he is exhibiting ataxia, right-sided loss of pain and temperature sense on the face, and left-sided sensory loss to the body. An MRI and CT scan was ordered and the results showed that he is suffering from a right-sided stroke.

      Branches of which of the following arteries are most likely implicated in the case?

      Your Answer: Posterior cerebral artery

      Correct Answer: Basilar artery

      Explanation:

      The lateral pontine syndrome occurs due to occlusion of perforating branches of the basilar and anterior inferior cerebellar (AICA) arteries. It is also known as Marie-Foix syndrome or Marie-Foix-Alajouanine syndrome. It is considered one of the brainstem stroke syndromes of the lateral aspect of the pons.

      It is characterized by ipsilateral limb ataxia, loss of pain and temperature sensation of the face, facial weakness, hearing loss, vertigo and nystagmus, hemiplegia/hemiparesis, and loss of pain and temperature sensation.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      110.4
      Seconds

  • Question 27 - You are reviewing a patient complaining of loss of vision. Previous images shows...

    Incorrect

    • You are reviewing a patient complaining of loss of vision. Previous images shows a lesion at the optic chiasm. What type of visual field defect are you most likely to see in a lesion at the optic chiasm:

      Your Answer: Homonymous hemianopia with macular sparing

      Correct Answer: Bitemporal hemianopia

      Explanation:

      A lesion at the optic chiasm will result in a bitemporal hemianopia.
      A lesion of the optic nerve will result in ipsilateral monocular visual loss.
      A lesion of the optic tract will result in a contralateral homonymous hemianopia.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      59.4
      Seconds

  • Question 28 - In a patient with an ongoing seizure, after what time period should treatment...

    Incorrect

    • In a patient with an ongoing seizure, after what time period should treatment be commenced?

      Your Answer: 30 seconds

      Correct Answer: 5 minutes

      Explanation:

      Immediate emergency care and treatment should be given to children, young people and adults who have prolonged or repeated convulsive seizures.
      Prolonged seizures last 5 minutes or more.
      Repeated seizures refer to 3 or more seizures in an hour.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      20.8
      Seconds

  • Question 29 - A 70-year-old man has a resting tremor, rigidity, bradykinesia, and a shuffling gait....

    Correct

    • A 70-year-old man has a resting tremor, rigidity, bradykinesia, and a shuffling gait. Parkinson's disease is caused by one of the following mechanisms:

      Your Answer: Loss of dopaminergic neurons in the substantia nigra

      Explanation:

      Parkinson’s disease (PD) is one of the most common neurologic disorders, affecting approximately 1% of individuals older than 60 years and causing progressive disability that can be slowed but not halted, by treatment. The 2 major neuropathologic findings in Parkinson’s disease are loss of pigmented dopaminergic neurons of the substantia nigra pars compacta and the presence of Lewy bodies and Lewy neurites. See the images below.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      19.4
      Seconds

  • Question 30 - A patient diagnosed with cranial nerve palsy exhibits asymmetrical movement of the palate,...

    Incorrect

    • A patient diagnosed with cranial nerve palsy exhibits asymmetrical movement of the palate, nasal regurgitation of food, and nasal quality to the voice.

      Which of the following cranial nerves is most likely responsible for the aforementioned features?

      Your Answer: Glossopharyngeal nerve

      Correct Answer: Vagus nerve

      Explanation:

      The vagus nerve, ‘the wanderer’, contains motor fibres (to the palate and vocal cords), sensory components (posterior and floor of external acoustic meatus) and visceral afferent and efferent fibres.

      Palatal weakness can cause nasal speech and nasal regurgitation of food. The palate moves asymmetrically when the patient says ‘ahh’. Recurrent nerve palsy results in hoarseness, loss of volume and ‘bovine cough’.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      29.9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

CNS Pharmacology (1/9) 11%
Pharmacology (3/17) 18%
Anatomy (7/13) 54%
Central Nervous System (9/21) 43%
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