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  • Question 1 - A tumour is discovered behind the pectinate line during an examination of a...

    Incorrect

    • A tumour is discovered behind the pectinate line during an examination of a 72-year-old patient with rectal bleeding. Which of the following is the lymphatic drainage of the pectinate line?

      Your Answer: Deep inguinal nodes

      Correct Answer: Superficial inguinal nodes

      Explanation:

      The pectinate line is known as the watershed line because it divides the anal canal into two sections. Below the pectinate line, lymphatic drainage drains to the superficial inguinal lymph nodes.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      29.1
      Seconds

  • Question 2 - A 42-year-old man presented to the emergency room after an incident of slipping...

    Correct

    • A 42-year-old man presented to the emergency room after an incident of slipping and falling onto his back and left hip. Upon physical examination, it was noted that he has pain on hip adduction, but normal hip flexion.

      Which of the following muscles was most likely injured in this case?

      Your Answer: Pectineus

      Explanation:

      The hip adductors are a group of five muscles located in the medial compartment of the thigh. These muscles are the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus.

      The hip flexors consist of 5 key muscles that contribute to hip flexion: iliacus, psoas, pectineus, rectus femoris, and sartorius.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      65.5
      Seconds

  • Question 3 - A 32-year-old woman suffers a deep wound to her thigh while she was...

    Correct

    • A 32-year-old woman suffers a deep wound to her thigh while she was climbing over a barbed wire fence. As a consequence of her injury, the nerve that was severed innervates the gracilis muscle.

      In which of the following nerves is the gracilis muscle innervated by?

      Your Answer: Anterior branch of the obturator nerve

      Explanation:

      The gracilis muscles is innervated by the anterior branch of the obturator nerve (L2-L4).

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      52.5
      Seconds

  • Question 4 - If a patient dislocated his right shoulder and has been referred to the...

    Correct

    • If a patient dislocated his right shoulder and has been referred to the orthopaedic outpatient department for a follow-up after a successful reduction, which of the following is the most important position for him to avoid holding his arm in until he is seen in the clinic?

      Your Answer: Arm at 90 degrees to side with palm up

      Explanation:

      The arm should be placed in a poly-sling that should be worn for about two weeks. A physiotherapist may give gentle movements for the arm to help in reducing stiffness and in relieving the pain. It is important that the patient must avoid positions that could cause re-dislocation.
      The most important position to avoid is the arm being held out at 90 degrees to the side with the palm facing upwards, especially if a force is being applied.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      80.9
      Seconds

  • Question 5 - A patient sustains an injury to the proximal median nerve after falling through...

    Correct

    • A patient sustains an injury to the proximal median nerve after falling through a glass door. Which of the following muscles would you not expect to be affected:

      Your Answer: Flexor carpi ulnaris

      Explanation:

      All of the muscles in the anterior forearm are innervated by the median nerve, except for the flexor carpi ulnaris and the medial half of the flexor digitorum profundus which are innervated by the ulnar nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      79.7
      Seconds

  • Question 6 - A 52-year old male comes to the out-patient department for a groin mass...

    Correct

    • A 52-year old male comes to the out-patient department for a groin mass that protrudes when standing. The patient notes that it is reducible when lying down. On physical examination, there is presence of a cough impulse. The initial assessment is hernia. Further investigation reveals that the mass lies lateral to the epigastric vessels.

      Among the types of hernia, which is the most likely diagnosis of the case above?

      Your Answer: Indirect inguinal hernia

      Explanation:

      Inguinal hernias can present with an array of different symptoms. Most patients present with a bulge in the groin area, or pain in the groin. Some will describe the pain or bulge that gets worse with physical activity or coughing. Symptoms may include a burning or pinching sensation in the groin. These sensations can radiate into the scrotum or down the leg. It is important to perform a thorough physical and history to rule out other causes of groin pain. At times an inguinal hernia can present with severe pain or obstructive symptoms caused by incarceration or strangulation of the hernia sac contents. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. The exam is best performed with the patient standing. Visual inspection of the inguinal area is conducted first to rule out obvious bulges or asymmetry in groin or scrotum. Next, the examiner palpates over the groin and scrotum to detect the presence of a hernia. The palpation of the inguinal canal is completed last. The examiner palpates through the scrotum and towards the external inguinal ring. The patient is then instructed to cough or perform a Valsalva manoeuvre. If a hernia is present, the examiner will be able to palpate a bulge that moves in and out as the patient increases intra abdominal pressure through coughing or Valsalva.

      Groin hernias are categorized into 2 main categories: inguinal and femoral.

      Inguinal hernias are further subdivided into direct and indirect. An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum, and can be reduced superiorly then superolaterally. A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.

      A femoral hernia is a protrusion into the femoral ring. The borders of the femoral ring are the femoral vein laterally, Cooper’s ligament posteriorly, the iliopubic tract/inguinal ligament anteriorly and lacunar ligament medially.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      46.7
      Seconds

  • Question 7 - Which of the following describes the site of a Meckel's diverticulum: ...

    Incorrect

    • Which of the following describes the site of a Meckel's diverticulum:

      Your Answer: Second part of duodenum

      Correct Answer: Ileum

      Explanation:

      Meckel’s lies on the antimesenteric surface of the middle-to-distal ileum, approximately 2 feet proximal to the ileocaecal junction. It appears as a blind-ended tubular outpouching of bowel, about 2 inches long, occurring in about 2% of the population, and may contain two types of ectopic tissue (gastric and pancreatic). The rich blood supply to the diverticulum is provided by the superior mesenteric artery.Proximal to the major duodenal papilla the duodenum is supplied by the gastroduodenal artery (branch of the coeliac trunk) and distal to the major duodenal papilla it is supplied by the inferior pancreaticoduodenal artery (branch of superior mesenteric artery). The arterial supply to the jejunoileum is from the superior mesenteric artery.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      33.1
      Seconds

  • Question 8 - Most of the lymph from vessels that drain the breast is collected in...

    Correct

    • Most of the lymph from vessels that drain the breast is collected in which of the following lymph nodes?

      Your Answer: Axillary nodes

      Explanation:

      Lymph is the fluid that flows through the lymphatic system.

      Axillary lymph nodes are near the breasts. They are often the first location to which breast cancer spreads if it moves beyond the breast tissue. They receive approximately 75% of lymph drainage from the breast via lymphatic vessels, laterally and superiorly.

      The lymph usually first drains to the anterior axillary nodes, and from here, through the central axillary, apical, and supraclavicular nodes in sequence.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      10.3
      Seconds

  • Question 9 - After a work-related accident, a 33-year old male is taken to the emergency...

    Correct

    • After a work-related accident, a 33-year old male is taken to the emergency room with difficulty in adduction and flexion of his left arm at the glenohumeral joint. The attending physician is suspects involvement of the coracobrachialis muscle.

      The nerve injured in the case above is?

      Your Answer: The musculocutaneous nerve

      Explanation:

      The coracobrachialis muscle is innervated by the musculocutaneous nerve (C5-C7) a branch of the lateral cord of the brachial plexus.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      55
      Seconds

  • Question 10 - Which of the following statements concerning the facial nerve is INCORRECT? ...

    Incorrect

    • Which of the following statements concerning the facial nerve is INCORRECT?

      Your Answer: The facial nerve carries parasympathetic fibres to the lacrimal glands.

      Correct Answer: Forehead sparing in facial nerve palsy is indicative of a lower motor neuron lesion.

      Explanation:

      In facial nerve palsy, LMN damage will involve the forehead and there will be an inability to close the eyes due to paralysis of the orbicularis oculi or raise the eyebrows due to paralysis of the occipitofrontalis muscle.
      UMN damage causes sparing of the forehead as the occipitofrontalis and orbicularis oculi muscles have bilateral cortical representation.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      73.3
      Seconds

  • Question 11 - A patient suffers a lower limb fracture that causes damage to the nerve...

    Incorrect

    • A patient suffers a lower limb fracture that causes damage to the nerve that innervates peroneus brevis.
      Peroneus brevis receives its innervation from which of the following nerves? Select ONE answer only.

      Your Answer: Deep peroneal nerve

      Correct Answer: Superficial peroneal nerve

      Explanation:

      Peroneus brevis is innervated by the superficial peroneal nerve.
      Peroneus longus is innervated by the superficial peroneal nerve.
      Peroneus tertius is innervated by the deep peroneal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      41.2
      Seconds

  • Question 12 - Which of these drugs may reduce the efficacy of contraception? ...

    Correct

    • Which of these drugs may reduce the efficacy of contraception?

      Your Answer: Carbamazepine

      Explanation:

      Antiepileptic medications such as carbamazepine (Tegretol), topiramate (Topamax), and phenytoin (Dilantin) are widely known for reducing the contraceptive effectiveness of OCPs.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      9
      Seconds

  • Question 13 - A 25 year old man has sustained a fracture to the surgical neck...

    Incorrect

    • A 25 year old man has sustained a fracture to the surgical neck of the humerus after falling from his bike. Examination suggests an axillary nerve injury. The clinical features expected to be seen in this patient are:

      Your Answer: Weakness of shoulder flexion

      Correct Answer: Weakness of shoulder abduction

      Explanation:

      Axillary nerve injury results in:
      1. weakness of arm abduction (paralysis of deltoid),
      2. weakness of lateral rotation of the arm (paralysis of teres minor)
      3. loss of sensation over the regimental badge area.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      60
      Seconds

  • Question 14 - Which of the following movements is controlled by the pectoralis major muscle? ...

    Correct

    • Which of the following movements is controlled by the pectoralis major muscle?

      Your Answer: Flexion, adduction and medial rotation of the humerus

      Explanation:

      The pectoralis major is a muscle that runs across the top of the chest and connects to a ridge on the back of the humerus (the bone of the upper arm).

      Adduction, or lowering, of the arm (opposed to the deltoideus muscle) and rotation of the arm forward around the axis of the body are two of its main functions.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      65
      Seconds

  • Question 15 - A 25-year-old guy who has had a knee-high plaster cast on his left...

    Correct

    • A 25-year-old guy who has had a knee-high plaster cast on his left leg for the past 5 weeks arrives at the emergency department complaining of numbness on the dorsum of his left foot and an inability to dorsiflex or evert his foot. You know that his symptoms are due to fibular nerve compression. Where is the fibular nerve located?

      Your Answer: Neck of fibula

      Explanation:

      Dorsiflexion and eversion of the foot are innervated by the deep fibular nerve and the superficial fibular nerve, respectively.

      The common fibular nerve runs obliquely downward along the lateral border of the popliteal fossa (medial to the biceps femoris) before branching at the neck of the fibula.

      Thus, it is prone to being affected during an impact injury or fracture to the bone or leg. Casts that are placed too high can also compress the fibular nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      42.6
      Seconds

  • Question 16 - Regarding aspirin at analgesic doses, which of the following statements is CORRECT: ...

    Correct

    • Regarding aspirin at analgesic doses, which of the following statements is CORRECT:

      Your Answer: It is contraindicated in patients with severe heart failure.

      Explanation:

      Aspirin (at analgesic doses) is contraindicated in severe heart failure. Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes resulting in decreased production of prostaglandins (which can lead to irritation of the gastric mucosa). The analgesic dose is greater than the antiplatelet dose, and taken orally it has a duration of action of about 4 hours. Clinical features of salicylate toxicity in overdose include hyperventilation, tinnitus, deafness, vasodilatation, and sweating.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      67.3
      Seconds

  • Question 17 - Which of the following occurs primarily to produce passive expiration: ...

    Correct

    • Which of the following occurs primarily to produce passive expiration:

      Your Answer: Relaxation of diaphragm and external intercostal muscles

      Explanation:

      Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) and the elastic recoil of the lungs. In expiration, depression of the sternal ends of the ribs (‘pump handle’ movement), depression of the lateral shafts of the ribs (‘bucket handle’ movement) and elevation of the diaphragm result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in a decreased intrathoracic volume and increased intrathoracic pressure and thus air is forced out of the lungs.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      31.5
      Seconds

  • Question 18 - 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
      20
      Seconds

  • Question 19 - Which of the following muscles is least likely to be involved in forceful expiration:...

    Correct

    • Which of the following muscles is least likely to be involved in forceful expiration:

      Your Answer: External intercostal muscles

      Explanation:

      Forceful expiration is primarily produced by the deeper thoracic muscles (internal and innermost intercostal muscles, subcostals and transversus thoracis) aided by contraction of the abdominal wall muscles which increase intra-abdominal pressure thus further reducing the volume of the thorax.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      59.3
      Seconds

  • Question 20 - Where on the body is the radial artery pulsation best palpated? ...

    Incorrect

    • Where on the body is the radial artery pulsation best palpated?

      Your Answer: At the wrist just lateral to the palmaris longus tendon

      Correct Answer: At the wrist just lateral to the flexor carpi radialis tendon

      Explanation:

      The radial artery lies lateral to the large tendon of the flexor carpi radialis muscle and anterior to the pronator quadratus at the distal end of the radius. The flexor carpi radialis muscle is used as a landmark in locating the pulse.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      23.5
      Seconds

  • Question 21 - Which of the following nerves is most likely associated with an anterior shoulder...

    Correct

    • Which of the following nerves is most likely associated with an anterior shoulder dislocation?

      Your Answer: Axillary nerve

      Explanation:

      In an anterior dislocation, the arm is an abducted and externally rotated position. In the externally rotated position, the posterosuperior aspect of the humeral head abuts and drives through the anteroinferior aspect of the glenoid rim. This can damage the humeral head, glenoid labrum, or both. An associated humeral head compression fracture is described as a Hill Sach’s lesion. If large enough, it can lead to locked dislocations that may require open reduction. The glenoid labrum is a fibrocartilaginous structure that rings the circumference of the glenoid fossa. Bankart lesions are injuries to the anteroinferior glenoid labrum complex and the most common capsulolabral injury. A bony Bankart lesion refers to an associated fracture of the glenoid rim. These capsulolabral lesions are risk factors for recurrent dislocation.

      Axillary nerve injury is identified in about 42% of acute anterior shoulder dislocations. Nerve transection is rare, and traction injuries are more common. Arterial injury has also been described. The subclavian artery becomes the axillary artery after passing the first rib. The distal portion of the axillary artery is anatomically fixed and, therefore, susceptible to injury in anterior dislocations. Ischemic injury, including pseudoaneurysm and arterial laceration, is rare but carries marked morbidity if not quickly identified.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      10.1
      Seconds

  • Question 22 - The parasympathetic supply to the rectum is from which of the following: ...

    Incorrect

    • The parasympathetic supply to the rectum is from which of the following:

      Your Answer: Sacral splanchnic nerves

      Correct Answer: Pelvic splanchnic nerves

      Explanation:

      Parasympathetic supply is from the pelvic splanchnic nerves (S2 – S4) and inferior hypogastric plexus.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      14.5
      Seconds

  • Question 23 - A newborn baby girl is delivered vaginally to a 19-year old female, however...

    Incorrect

    • A newborn baby girl is delivered vaginally to a 19-year old female, however with complications due to cephalopelvic disproportion. Upon examination by the attending paediatrician, there is a notable 'claw hand' deformity of the left, and sensory loss of the ulnar aspect of the left distal upper extremity.

      What is the most probable diagnosis of the case above?

      Your Answer: Erb’s palsy

      Correct Answer: Klumpke’s palsy

      Explanation:

      Klumpke palsy, named after Augusta Dejerine-Klumpke, is a neuropathy involving the lower brachial plexus. In contrast, the more common Erb–Duchenne palsy involves the more cephalic portion of the brachial plexus C5 to C6. The brachial plexus is a bundle of individual nerves that exit between the anterior and middle scalene muscles in the anterior lateral and basal portion of the neck. Although the most common anatomical presentation of the brachial plexus is between the anterior and middle scalene, there are variations, with the most common being penetration of the anterior scalene. The main mechanism of injury to the lower brachial plexus is hyper-abduction traction, and depending on the intensity, it will lead to signs and symptoms consistent with a neurological insult.

      The most common aetiology resulting in Klumpke palsy is a hyper-abduction trauma to the arm that has enough intensity to traction the lower brachial plexus. Trauma during birth can cause brachial plexus injuries, but again hyper-abduction and traction forces to the upper extremity are usually present.

      The history presented by the patient usually depicts a long axis hyper-abduction traction injury with high amplitude and velocity. The typical patient presentation is a decrease of sensation along the medial aspect of the distal upper extremity along the C8 and T1 dermatome. The patient might also present myotome findings that can range from decreasing muscular strength to muscular atrophy and positional deformity. For example, if the neurological damage has led to muscular atrophy and tightening, the patient may present with a claw hand. This deformity presents a finger and wrist flexion. The patient may also describe the severe pain that starts at the neck and travels down the medial portion of the arm. One other sign of a lower brachial plexus injury is Horner syndrome; because of its approximation to the T1 nerve root, it may damage the cephalic sympathetic chain. If this happens, the patient will develop ipsilateral ptosis, anhidrosis, and miosis.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      26.6
      Seconds

  • Question 24 - Which of the following nerves provides sensory innervation to the anteromedial and anterosuperior...

    Incorrect

    • Which of the following nerves provides sensory innervation to the anteromedial and anterosuperior aspects of the external ear?

      Your Answer: Great auricular nerve

      Correct Answer: Auriculotemporal nerve

      Explanation:

      Sensory innervation to the external ear is supplied by both cranial and spinal nerves. Branches of the trigeminal, facial, and vagus nerves (CN V, VII, X) are the cranial nerve components, while the lesser occipital (C2, C3) and greater auricular (C2, C3) nerves are the spinal nerve components involved. The lateral surface of the tympanic membrane, the external auditory canal, and the external acoustic meatus are all innervated by nervus intermedius (a branch of CN VII), the auriculotemporal nerve (CN V3), and the auricular branch of the vagus nerve. The concha receives split innervation from nervus intermedius, the auricular branch of the vagus nerve, and the greater auricular (spinal) nerve. Beyond the concha, the anteromedial and anterosuperior parts of the pinna are innervated by the auriculotemporal nerve, and a portion of the lateral helix by the lesser occipital nerve. The greater auricular nerve provides innervation to the area of the pinna inferolateral to the lobule.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      26.9
      Seconds

  • Question 25 - Regarding the extensor carpi ulnaris muscle, which of the following statements is true?...

    Incorrect

    • Regarding the extensor carpi ulnaris muscle, which of the following statements is true?

      Your Answer: It assists with the abduction of the hand at the wrist joint

      Correct Answer: It receives its blood supply from the ulnar artery

      Explanation:

      Extensor carpi ulnaris is a fusiform muscle in the posterior forearm. It spans between the elbow and base of the little finger. This muscle belongs to the superficial forearm extensor group, along with anconaeus, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum and extensor digiti minimi muscles.

      Like all the muscles of this compartment, extensor carpi ulnaris works as an extensor of the wrist. Moreover, due to its specific course, this muscle also acts to adduct the hand.

      Extensor carpi ulnaris is innervated by the posterior interosseous nerve (C7, C8), a branch of the deep division of the radial nerve. The radial nerve stems from the posterior cord of the brachial plexus.

      Blood supply to the extensor carpi ulnaris muscle is provided by branches of the radial recurrent and posterior interosseous arteries, which stem from the radial and ulnar arteries, respectively.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      70
      Seconds

  • Question 26 - A 25-year-old footballer develops pain and stiffness in his thigh. A diagnosis of...

    Incorrect

    • A 25-year-old footballer develops pain and stiffness in his thigh. A diagnosis of iliopsoas syndrome is made.
      Iliacus is innervated by which of the following nerves? Select ONE answer only.

      Your Answer: Anterior rami of lumbar nerves L1-L3

      Correct Answer: Femoral nerve

      Explanation:

      Iliacus is innervated by the femoral nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      28.6
      Seconds

  • Question 27 - In which of the following cases is intravenous phenytoin contraindicated? ...

    Correct

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

      Your 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
      14.6
      Seconds

  • Question 28 - Oculomotor (CN III) palsy with sparing of the pupillary reflex is most likely...

    Incorrect

    • Oculomotor (CN III) palsy with sparing of the pupillary reflex is most likely caused by which of the following:

      Your Answer: Subdural haematoma

      Correct Answer: Diabetes mellitus

      Explanation:

      Compressive causes of CN III palsy cause early pupillary dilatation because the parasympathetic fibres run peripherally in the nerve and are easily compressed. In diabetes mellitus the lesions are ischaemic rather than compressive and therefore typically affect the central fibres resulting in pupillary sparing.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      38.3
      Seconds

  • Question 29 - The lymph drainage of the anal canal above the pectinate line is initially...

    Correct

    • The lymph drainage of the anal canal above the pectinate line is initially to the:

      Your Answer: Internal iliac nodes

      Explanation:

      Above the pectinate line, the anal canal drains to the internal iliac lymph nodes which subsequently drain to the lumbar (para-aortic) nodes.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      22.7
      Seconds

  • Question 30 - Which nerve innervates the brachioradialis muscle? ...

    Incorrect

    • Which nerve innervates the brachioradialis muscle?

      Your Answer: The median nerve

      Correct Answer: The radial nerve

      Explanation:

      Brachioradialis is innervated by the radial nerve (from the root values C5-C6) that stems from the posterior cord of the brachial plexus.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      14
      Seconds

  • Question 31 - A patient presents to ED complaining of pins and needles over the lateral...

    Incorrect

    • A patient presents to ED complaining of pins and needles over the lateral three and a half digits. You suspect carpal tunnel syndrome. Which of the following clinical features would you most expect to see on examination:

      Your Answer: Atrophy of the adductor pollicis muscle

      Correct Answer: Inability to touch the pad of the little finger with the thumb

      Explanation:

      Compression of the median nerve in the carpal tunnel will result in weakness and atrophy of the thenar muscles – resulting in weakness of opposition, abduction and flexion of the thumb at the metacarpophalangeal joint and anaesthesia or paraesthesia over the distribution of the palmar digital branch of the median nerve (skin over the palmar surface and fingertips of the lateral three and a half digits). The adductor pollicis muscle is innervated by the ulnar nerve, and abduction of the fingers is produced by the interossei, also innervated by the ulnar nerve. Flexion of the interphalangeal joint of the thumb is produced by the flexor pollicis longus, and flexion of the distal interphalangeal joint of the index finger is produced by the flexor digitorum profundus. Median nerve injury at the wrist will not affect the long flexors of the forearm as these are innervated by the anterior interosseous nerve which arises in the proximal forearm.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      33.6
      Seconds

  • Question 32 - A 30-year old male is taken to the emergency room after suffering a...

    Correct

    • A 30-year old male is taken to the emergency room after suffering a blunt trauma to the abdomen. He is complaining of severe abdominal pain, however all his other vital signs remain stable. A FAST scan is performed to assess for hemoperitoneum.

      If hemoperitoneum is present, it is most likely to be observed in which of the following areas?

      Your Answer: Liver

      Explanation:

      The Focused Assessment with Sonography in Trauma (FAST) is an ultrasound protocol developed to assess for hemoperitoneum and hemopericardium. Numerous studies have demonstrated sensitivities between 85% to 96% and specificities exceeding 98%.

      The FAST exam evaluates four regions for pathologic fluid: (1) the right upper quadrant, (2) the subxiphoid (or subcostal) view, (3) the left upper quadrant, and (4) the suprapubic region.

      The right upper quadrant (RUQ) visualizes the hepatorenal recess, also known as Morrison’s pouch, the right paracolic gutter, the hepato-diaphragmatic area, and the caudal edge of the left liver lobe. The probe is positioned in the sagittal orientation along the patient’s flank at the level of the 8 to 11 rib spaces. The hand is placed against the bed to ensure visualization of the retroperitoneal kidney. The RUQ view is the most likely to detect free fluid with an overall sensitivity of 66%. Recent retrospective evidence suggests the area along the caudal edge of the left lobe of the liver has the highest sensitivity, exceeding 93%.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      29.8
      Seconds

  • Question 33 - A man presents to the emergency department with an injury that has damaged...

    Correct

    • A man presents to the emergency department with an injury that has damaged the opponens pollicis muscle.

      Which of the following statements regarding the opponens pollicis muscle is considered correct?

      Your Answer: It flexes the first metacarpal bone at the carpometacarpal joint

      Explanation:

      Opponens pollicis is a muscle of thenar eminence, it is triangular in shape and lies deep to flexor pollicis brevis and abductor pollicis brevis. It originates from the flexor retinaculum, tubercles of scaphoid and trapezium, abductor pollicis longus tendon.

      Its insertion is in the radial side of the base of proximal phalanx of thumb. It is supplied by the median nerve (C8, T1). It receives blood supply from superficial arch.

      It flexes the metacarpal bone medially across the palm, also rotating it medially, causing opposition, the palmar aspect of the terminal segment of thumb contacts the flexor aspects of any other digit.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      51
      Seconds

  • Question 34 - You note that the prostate of a 60-year-old patient is enlarged during the...

    Incorrect

    • You note that the prostate of a 60-year-old patient is enlarged during the examination. You suspect BPH. Anatomically, the prostate has four main lobes. Which of the lobes is affected by benign prostatic hypertrophy?

      Your Answer: Fibromuscular zone

      Correct Answer: Median lobe

      Explanation:

      Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is characterized by an enlarged prostate gland.

      The prostate is divided into four major lobes. The median lobe is the most commonly affected by benign prostatic enlargement, resulting in urethral obstruction and urine symptoms.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      18.5
      Seconds

  • Question 35 - Regarding CSF (cerebrospinal fluid) production, approximately how much is produced per day? ...

    Incorrect

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

      Your Answer: 250 ml

      Correct 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
      12.9
      Seconds

  • Question 36 - During quiet respiration, position of the right oblique fissure can be marked by...

    Correct

    • During quiet respiration, position of the right oblique fissure can be marked by a line drawn on the thoracic wall that:

      Your Answer: Begins at the spinous process of T4, crosses the fifth intercostal space laterally and follows the contour of rib 6 anteriorly.

      Explanation:

      During quiet respiration, the approximate position of the right oblique fissure can be marked by a line on the thoracic wall that begins at the spinous process of vertebra T4, crosses the fifth intercostal space laterally and then follows the contour of rib 6 anteriorly.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      53.8
      Seconds

  • Question 37 - 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
      21.5
      Seconds

  • Question 38 - Which of the following best describes the mechanism of action of aspirin: ...

    Correct

    • Which of the following best describes the mechanism of action of aspirin:

      Your Answer: Cyclo-oxygenase (COX) inhibitor

      Explanation:

      Aspirin is a non-steroidal anti-inflammatory drug (NSAID). Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes and the resulting inhibition of prostaglandin synthesis results in analgesic, antipyretic and to a lesser extent anti-inflammatory actions.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      6.5
      Seconds

  • Question 39 - The least likely feature expected to be seen in a lesion of the...

    Correct

    • The least likely feature expected to be seen in a lesion of the frontal lobe is which of the following?

      Your Answer: Loss of two-point discrimination

      Explanation:

      Lesions in different areas give rise to different symptoms.
      Lesions of the parietal lobe give rise to loss of two-point discrimination.
      Lesions to Broca’s area give rise to expressive dysphasia results from damage
      Lesions to the primary motor cortex give rise to contralateral weakness of the face and arm.
      Lesions to the prefrontal cortex give rise to personality change.
      Lesions to the frontal eye field give rise to conjugate eye deviation towards side of lesion.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      54.8
      Seconds

  • Question 40 - Aside from the inability to extend the leg above the knee, which of...

    Correct

    • Aside from the inability to extend the leg above the knee, which of the following clinical symptoms should you anticipate seeing in a patient who had a pelvic and right leg injury as well as femoral nerve damage?

      Your Answer: Loss of sensation over the anterior thigh

      Explanation:

      The femoral nerve runs down the front of the leg from the pelvis. It gives the front of the thigh and a portion of the lower leg sensation.

      Extension of the leg at the knee joint, flexion of the thigh at the hip are produced by muscles that is primarily innervated by the femoral nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      118.9
      Seconds

  • Question 41 - Which lobe of the prostate gland is most commonly affected in prostatic carcinoma?...

    Incorrect

    • Which lobe of the prostate gland is most commonly affected in prostatic carcinoma?

      Your Answer: Median

      Correct Answer: Posterior

      Explanation:

      The periurethral portion of the prostate gland increases in size during puberty and after the age of 55 years due to the growth of non-malignant cells in the transition zone of the prostate that surrounds the urethra. Most cancers develop in the posterior lobe, and cancers in this location may be palpated during a digital rectal examination (DRE).

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      11.2
      Seconds

  • Question 42 - Which of the following clinical features is most suggestive of a lesion of...

    Correct

    • Which of the following clinical features is most suggestive of a lesion of the temporal lobe:

      Your Answer: Receptive dysphasia

      Explanation:

      Damage to the Wernicke’s speech area in the temporal lobe can result in a receptive dysphasia. Hemispatial neglect is most likely to occur in a lesion of the parietal lobe. Homonymous hemianopia is most likely to occur in a lesion of the occipital lobe. Expressive dysphasia is most likely to occur in a lesion of the Broca speech area in the frontal lobe. Conjugate eye deviation towards the side of the lesion is most likely to occur in a lesion of the frontal lobe.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      45.8
      Seconds

  • Question 43 - You are taking care of a 55-year-old male patient who is a weightlifter....

    Correct

    • You are taking care of a 55-year-old male patient who is a weightlifter. He is suspected of having a direct inguinal hernia. Where would this hernia appear?

      Your Answer: Medial to the inferior epigastric artery

      Explanation:

      A direct inguinal hernia is a form of groin hernia that occurs when abdominal viscera protrude through a weakness in the posterior wall of the inguinal canal, notably through Hesselbach’s triangle, medial to the inferior epigastric veins.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      24.1
      Seconds

  • Question 44 - Which extraocular muscle is entrapped in a patient with a blowout fracture? ...

    Correct

    • Which extraocular muscle is entrapped in a patient with a blowout fracture?

      Your Answer: Inferior rectus

      Explanation:

      A blowout fracture is an isolated fracture of the orbital walls without compromise of the orbital rims. The common mechanisms are falls, high-velocity ball-related sports, traffic accidents, and interpersonal violence.

      The frontal, ethmoidal, sphenoid, zygomatic, and lacrimal bones form the bony structures of the orbit. Medially, the maxillary and the lacrimal bone form the lacrimal fossa. Together with the lamina papyracea of the ethmoid bone, they form the medial wall. The sphenoid bone forms the posterior wall and houses the orbital canal. Lateral to the orbital canal lies the superior orbital fissure housing cranial nerves III, IV, V, and VI. The zygomatic bone forms the lateral wall. Superior and inferior borders are the frontal and maxillary bones. Located around the globe of the eye and attached to it are 6 extraocular muscles; the 4 rectus muscles and the superior and inferior oblique muscles. The fat and connective tissue around the globe help to reduce the pressure exerted by the extraocular muscles.

      The goal of treatment is to restore aesthetics and physiological function. The problem with orbital blowout fractures is that the volume of the orbit can be increased, resulting in enophthalmos and hypoglobus. In addition, the orbital tissue and inferior rectus muscle can become trapped by the bony fragments leading to diplopia, limitation of gaze, and tethering. Finally, the orbital injury can lead to retinal oedema, hyphema, and significant loss of vision.

      While some cases may be managed with conservative care, others may require some type of surgical intervention.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      22.4
      Seconds

  • Question 45 - The 'pump handle' movement of the thoracic wall describes which of the following movements:...

    Correct

    • The 'pump handle' movement of the thoracic wall describes which of the following movements:

      Your Answer: The anterior ends of the ribs moving upwards and forwards

      Explanation:

      Because the anterior ends of the ribs are inferior to the posterior ends, when the ribs are elevated, the anterior end moves upwards and forwards, moving the sternum upwards and forwards in turn. This ‘pump handle’ upwards and forwards movement changes the anteroposterior (AP) dimension of the thorax.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      43.5
      Seconds

  • Question 46 - All of the following typically occurs as part of normal passive expiration except:...

    Correct

    • All of the following typically occurs as part of normal passive expiration except:

      Your Answer: Contraction of the internal intercostal muscles

      Explanation:

      Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) in addition to the elastic recoil of the lungs.
      In expiration, several movements occur. There are:
      1. depression of the sternal ends of the ribs (‘pump handle’ movement),
      2. depression of the lateral shafts of the ribs (‘bucket handle’ movement) and
      3. elevation of the diaphragm.
      These result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. There is then a decreased intrathoracic volume and increased intrathoracic pressure and air is forced out of the lungs.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      34.7
      Seconds

  • Question 47 - A 38-year-old taxi driver sustained blunt force trauma to his anterior chest from...

    Correct

    • A 38-year-old taxi driver sustained blunt force trauma to his anterior chest from the steering wheel of his car after falling asleep while driving headlong into an oncoming HGV lorry. Bruising around his sternum was observed, which appears to be the central point of impact.

      Which of the following structures is most likely injured by the blunt force trauma?

      Your Answer: Right ventricle

      Explanation:

      In its typical anatomical orientation, the heart has 5 surfaces formed by different internal divisions of the heart:

      Anterior (or sternocostal) – Right ventricle
      Posterior (or base) – Left atrium
      Inferior (or diaphragmatic) – Left and right ventricles
      Right pulmonary – Right atrium
      Left pulmonary – Left ventricle

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      31.2
      Seconds

  • Question 48 - A 33-year-old heavily muscled man presents with left-sided chest pain. After taking part...

    Incorrect

    • A 33-year-old heavily muscled man presents with left-sided chest pain. After taking part in a powerlifting competition, he felt a painful snap at the front of his shoulder and chest. There is also the presence of bruising and swelling over the left side of his chest. A ruptured pectoralis major muscle was suspected upon examining the injured area.

      Which of the following statements regarding the surface markings of the pectoralis major muscle is considered correct?

      Your Answer: The clavicular head originates from the lateral half of the clavicle

      Correct Answer: It inserts into the lateral lip of the bicipital groove of the humerus

      Explanation:

      The pectoralis major is the superior most and largest muscle of the anterior chest wall. It is a thick, fan-shaped muscle that lies underneath the breast tissue and forms the anterior wall of the axilla.

      Its origin lies anterior surface of the medial half of the clavicle, the anterior surface of the sternum, the first 7 costal cartilages, the sternal end of the sixth rib, and the aponeurosis of the external oblique of the anterior abdominal wall.
      The insertion of the pectoralis major is at the lateral lip of the intertubercular sulcus of the humerus. There are 2 heads of the pectoralis major, the clavicular and the sternocostal, which reference their area of origin.
      The function of the pectoralis major is 3-fold and dependent on which heads of muscles are involved:
      – Flexion, adduction and medial rotation of the arm at the glenohumeral joint
      – Clavicular head causes flexion of the extended arm
      – Sternoclavicular head causes extension of the flexed arm

      Arterial supply of the pectoralis major, the pectoral artery, arises from the second branch of the axillary artery, the thoracoacromial trunk.

      The 2 heads of the pectoralis major have different nervous supplies. The clavicular head derives its nerve supply from the lateral pectoral nerve. The medial pectoral nerve innervates the sternocostal head. The lateral pectoral nerve arises directly from the lateral cord of the brachial plexus, and the medial pectoral nerve arises from the medial cord.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      65.9
      Seconds

  • Question 49 - You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus....

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      21.7
      Seconds

  • Question 50 - A 26 year old horse rider has a bad fall and sustains a...

    Correct

    • 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: 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
      64.2
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Abdomen (2/6) 33%
Anatomy (26/44) 59%
Lower Limb (4/6) 67%
Upper Limb (7/14) 50%
Abdomen And Pelvis (2/3) 67%
Cranial Nerve Lesions (0/2) 0%
Central Nervous System (8/11) 73%
Pharmacology (4/6) 67%
Thorax (6/6) 100%
Head And Neck (1/2) 50%
Passmed
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