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  • Question 1 - Which of the following statements about lithium treatment is FALSE: ...

    Incorrect

    • Which of the following statements about lithium treatment is FALSE:

      Your Answer: Patients taking lithium should carry a lithium treatment card.

      Correct Answer: Concomitant treatment with NSAIDs decreases serum-lithium concentration.

      Explanation:

      Lithium levels are raised by NSAIDs because renal clearance is reduced. Lithium is a small ion (74 Daltons) with no protein or tissue binding and is therefore amenable to haemodialysis. Lithium is freely distributed throughout total body water with a volume of distribution between 0.6 to 0.9 L/kg, although the volume may be smaller in the elderly, who have less lean body mass and less total body water. Steady-state serum levels are typically reached within five days at the usual oral dose of 1200 to 1800 mg/day. The half-life for lithium is approximately 18 hours in adults and 36 hours in the elderly.
      Lithium is excreted almost entirely by the kidneys and is handled in a manner similar to sodium. Lithium is freely filtered but over 60 percent is then reabsorbed by the proximal tubules.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      55.9
      Seconds
  • Question 2 - A patient is referred to the Medicine Department for complaints of unilateral hearing...

    Incorrect

    • A patient is referred to the Medicine Department for complaints of unilateral hearing loss, tinnitus and facial numbness. Upon further investigation, an acoustic neuroma is given as the final diagnosis.

      Which of the following nerves is least likely to be affected in acoustic neuroma?

      Your Answer: Vestibulocochlear nerve

      Correct Answer: Trochlear nerve

      Explanation:

      Acoustic neuroma is also called vestibular schwannoma (VS), acoustic neuroma, vestibular neuroma or acoustic neurofibroma. These are tumours that evolve from the Schwann cell sheath and can be either intracranial or extra-axial. They usually occur adjacent to the cochlear and vestibular nerves and most often arise from the inferior division of the latter. Anatomically, acoustic neuroma tends to occupy the cerebellopontine angle. About 5-10% of cerebellopontine angle (CPA) tumours are meningiomas and may occur elsewhere in the brain. Bilateral acoustic neuromas tend to be exclusively found in individuals with type 2 neurofibromatosis.

      The following nerves may be affected due to nerve compression:

      Facial nerve: usually minimal with late presentation except for very large tumours. Depending on the degree of engagement of the nerve, the symptoms may include twitching, increased lacrimation and facial weakness.

      Trigeminal Nerve: paraesthesia in the trigeminal distribution, tingling of the tongue, impairment of the corneal reflex, and less commonly pain which may mimic typical trigeminal neuralgia.

      Glossopharyngeal and Vagus nerves: palatal paresis, hoarseness of voice and dysphagia

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      16.5
      Seconds
  • Question 3 - Which of the following is most likely to cause a bitemporal hemianopia: ...

    Correct

    • Which of the following is most likely to cause a bitemporal hemianopia:

      Your Answer: Pituitary adenoma

      Explanation:

      A bitemporal hemianopia is most likely due to compression at the optic chiasm. This may be caused by pituitary tumour, craniopharyngioma, meningioma, optic glioma or aneurysm of the internal carotid artery. A posterior cerebral stroke will most likely result in a contralateral homonymous hemianopia with macular sparing.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      27.7
      Seconds
  • Question 4 - Which of the following best describes the mechanism of action of aspirin: ...

    Incorrect

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

      Your Answer: Decreases production of cAMP

      Correct 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
      16.3
      Seconds
  • Question 5 - What is the main mechanism of action of metoclopramide: ...

    Incorrect

    • What is the main mechanism of action of metoclopramide:

      Your Answer: Histamine-H1 antagonist

      Correct Answer: Dopamine antagonist

      Explanation:

      Metoclopramide is a dopamine-receptor antagonist. Blockade of inhibitory dopamine receptors in the GI tract may allow stimulatory actions of ACh at muscarinic synapses to predominate. Metoclopramide also blocks dopamine D2-receptors within the chemoreceptor trigger zone (CTZ). At high doses, it is also thought to have some 5-HT3antagonist activity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      58.2
      Seconds
  • Question 6 - Regarding antiemetics, which of the following statements is INCORRECT: ...

    Correct

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

      Your Answer: Of the antiemetics, cyclizine is most commonly associated with acute dystonic reactions.

      Explanation:

      Cyclizine acts by inhibiting histamine pathways and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. Metoclopramide is a dopamine-receptor antagonist which acts both peripherally in the GI tract and centrally within the chemoreceptor trigger zone. Prochlorperazine is a dopamine-D2 receptor antagonist and acts centrally by blocking the chemoreceptor trigger zone. Metoclopramide and prochlorperazine are both commonly associated with extrapyramidal effects, such as acute dystonic reaction. Cyclizine may rarely cause extrapyramidal effects.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      562.7
      Seconds
  • Question 7 - A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense,...

    Correct

    • A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke.

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

      Your Answer: Anterior spinal artery

      Explanation:

      Medial medullary syndrome is a form of stroke that affects the medial medulla of the brain. It is caused by a lesion in the medial part of the medulla, which is due to an infraction of vertebral arteries and/or paramedian branches of the anterior spinal artery.

      It is characterized by contralateral paralysis of the upper and lower limb of the body, a contralateral decrease in proprioception, vibration, and/or fine touch sensation, paresthesias or less commonly dysesthesias in the contralateral trunk and lower limb, and loss of position and vibration sense with proprioceptive dysfunction. Ipsilateral deviation of the tongue due to ipsilateral hypoglossal nerve damage can also be seen.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      145.6
      Seconds
  • Question 8 - Which of the following clinical features is most suggestive of a lesion of...

    Incorrect

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

      Your Answer: Hemispatial neglect

      Correct Answer: Conjugate eye deviation towards the side of the lesion

      Explanation:

      Conjugate eye deviation towards the side of the lesion is seen in damage to the frontal eye field of the frontal lobe. Homonymous hemianopia is typically a result of damage to the occipital lobe (or of the optic radiation passing through the parietal and temporal lobes). Auditory agnosia may been seen in a lesion of the temporal lobe. Hemispatial neglect may be seen in a lesion of the parietal lobe. Receptive dysphasia is seen in damage to Wernicke’s area, in the temporal lobe.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      161
      Seconds
  • Question 9 - A 70-year-old woman presents with right-sided loss of pain and temperature sense on...

    Incorrect

    • A 70-year-old woman presents with right-sided loss of pain and temperature sense on the body as well as left-sided loss of pain and temperature sense on the face. She also has complaints of vertigo, nausea, and tinnitus. Further examination of her cranial nerves suggest the presence of Horner's Syndrome. An MRI and CT scan was ordered and results showed that she is suffering from a left-sided stroke.

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

      Your Answer: Vertebral artery

      Correct Answer: Posterior inferior cerebellar artery

      Explanation:

      Wallenberg syndrome is also known as lateral medullary syndrome and posterior inferior cerebellar artery syndrome. It is the most common posterior circulation ischemic stroke syndrome. The primary pathology of Wallenberg syndrome is occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches.

      It is characterized by vertigo with nystagmus, nausea and vomiting, and sometimes hiccups, dysphonia, dysarthria, and dysphagia often present with ipsilateral loss of gag reflex, ipsilateral ataxia with a tendency to fall to the ipsilateral side, pain and numbness with impaired facial sensation on the face, impaired taste sensation, and impaired pain and temperature sensation in the arms and legs.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      76.6
      Seconds
  • Question 10 - A 34-year-old man presents with loss of vision in his left eye due...

    Correct

    • A 34-year-old man presents with loss of vision in his left eye due to an episode of optic neuritis. Upon history taking, it was noted that he has a history of multiple sclerosis.

      Which of the following anatomical points in the visual pathway has the lesion occurred?

      Your Answer: Optic nerve

      Explanation:

      A lesion in the optic nerve causes ipsilateral monocular visual loss.
      Optic neuritis is an inflammatory demyelination of the optic nerve that is highly associated with multiple sclerosis. The two most common symptoms of optic neuritis are vision loss and eye pain.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      32.5
      Seconds
  • Question 11 - A 70-year-old man has a resting tremor, rigidity, bradykinesia, and a shuffling gait....

    Incorrect

    • 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: A vascular lesion of the subthalamic nucleus

      Correct 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
      220.2
      Seconds
  • Question 12 - An 80-year-old woman with history of hypertension, diabetes, and ischemic stroke, presents with...

    Incorrect

    • An 80-year-old woman with history of hypertension, diabetes, and ischemic stroke, presents with left-sided hemiplegia of the face, tongue, and limbs and right-sided deficits in motor eye activity. A CT scan was ordered and showed a right-sided stroke.

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

      Your Answer: Superior cerebellar artery

      Correct Answer: Basilar artery

      Explanation:

      Weber syndrome is a midbrain stroke characterized by crossed hemiplegia along with oculomotor nerve deficits and it occurs with the occlusion of the median and/or paramedian perforating branches of the basilar artery.

      Typical clinical findings include ipsilateral CN III palsy, ptosis, and mydriasis (such as damage to parasympathetic fibres of CN III) with contralateral hemiplegia.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      96
      Seconds
  • Question 13 - Regarding aspirin at analgesic doses, which of the following statements is CORRECT: ...

    Incorrect

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

      Your Answer: The analgesic dose is smaller than the antiplatelet dose.

      Correct 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
      14.8
      Seconds
  • Question 14 - 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
      59.6
      Seconds
  • Question 15 - 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
      22.1
      Seconds
  • Question 16 - A 54 year old patient presents with vertigo, ipsilateral hemiataxia, dysarthria, ptosis and...

    Incorrect

    • A 54 year old patient presents with vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis.

      Which of these blood vessels has most likely been occluded?

      Your Answer: Posterior cerebral artery

      Correct Answer: Posterior inferior cerebellar artery

      Explanation:

      Posterior inferior cerebellar artery (PICA) occlusion is characterised by vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis. PICA occlusion causes infarction of the posterior inferior cerebellum, inferior cerebellar vermis and lateral medulla.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      19.1
      Seconds
  • Question 17 - Which of the following is NOT a typical side effect of opioid analgesics:...

    Incorrect

    • Which of the following is NOT a typical side effect of opioid analgesics:

      Your Answer: Miosis

      Correct Answer: Diarrhoea

      Explanation:

      All opioids have the potential to cause:
      Gastrointestinal effects – Nausea, vomiting, constipation, difficulty with micturition (urinary retention), biliary spasm
      Central nervous system effects – Sedation, euphoria, respiratory depression, miosis
      Cardiovascular effects – Peripheral vasodilation, postural hypotension
      Dependence and tolerance

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      11.7
      Seconds
  • Question 18 - Which of these is NOT a lithium side effect: ...

    Incorrect

    • Which of these is NOT a lithium side effect:

      Your Answer: Hyperthyroidism

      Correct Answer: Peptic ulcer disease

      Explanation:

      Adverse Effects of lithium Include

      Leucocytosis (most patients)
      Polyuria/polydipsia (30-50%)
      Dry mouth (20-50%)
      Hand tremor (45% initially, 10% after 1 year of treatment)
      Confusion (40%)
      Decreased memory (40%)
      Headache (40%)
      Muscle weakness (30% initially, 1% after 1 year of treatment)
      Electrocardiographic (ECG) changes (20-30%)
      Nausea, vomiting, diarrhoea (10-30% initially, 1-10% after 1-2 years of treatment)
      Hyperreflexia (15%)
      Muscle twitch (15%)
      Vertigo (15%)
      Extrapyramidal symptoms, goitre (5%)
      Hypothyroidism (1-4%)
      Acne (1%)
      Hair thinning (1%)

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      22.9
      Seconds
  • Question 19 - Which of the following is NOT a typical cerebellar sign: ...

    Incorrect

    • Which of the following is NOT a typical cerebellar sign:

      Your Answer: Dysdiadochokinesia

      Correct Answer: Hypertonia

      Explanation:

      Hypotonia means decreased muscle tone. It can be a condition on its own, called benign congenital hypotonia, or it can be indicative of another problem where there is progressive loss of muscle tone, such as muscular dystrophy or cerebral palsy. It is usually detected during infancy. Hypotonia is characteristic of cerebellar dysfunction.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      96.4
      Seconds
  • Question 20 - A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense,...

    Incorrect

    • A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke.

      Which of the following is considered the best diagnosis for the case presented above?

      Your Answer: Medial pontine syndrome

      Correct Answer: Medial medullary syndrome

      Explanation:

      Medial medullary syndrome is a form of stroke that affects the medial medulla of the brain. It is caused by a lesion in the medial part of the medulla, which is due to an infraction of vertebral arteries and/or paramedian branches of the anterior spinal artery.

      It is characterized by contralateral paralysis of the upper and lower limb of the body, a contralateral decrease in proprioception, vibration, and/or fine touch sensation, paresthesias or less commonly dysesthesias in the contralateral trunk and lower limb, and loss of position and vibration sense with proprioceptive dysfunction. Ipsilateral deviation of the tongue due to ipsilateral hypoglossal nerve damage can also be seen.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      20.3
      Seconds
  • Question 21 - Which of the following statements is correct regarding paracetamol? ...

    Incorrect

    • Which of the following statements is correct regarding paracetamol?

      Your Answer: Paracetamol can cause gastric irritation, particularly in the elderly.

      Correct Answer: Liver damage peaks 3 to 4 days after paracetamol ingestion.

      Explanation:

      The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      23.8
      Seconds
  • Question 22 - A 22-year-old student presents with severe headache accompanied with nausea and vomiting. Upon...

    Incorrect

    • 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 pia mater lines the inner surface of the skull

      Correct 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
      110.7
      Seconds
  • Question 23 - A 33-year-old woman demonstrates right-sided superior homonymous quadrantanopia upon visual field testing. A...

    Incorrect

    • A 33-year-old woman demonstrates right-sided superior homonymous quadrantanopia upon visual field testing. A diagnosis of a brain tumour has been established.

      Which of the following anatomical points in the visual pathway has the lesion occurred?

      Your Answer: Upper optic radiation

      Correct Answer: Lower optic radiation

      Explanation:

      Homonymous quadrantanopia is not a disease; it is a clinical finding that points towards a lesion of the optic radiations coursing through the temporal lobe.
      Homonymous superior quadrantanopia is caused by damage to the contralateral inferior parts of the posterior visual pathway: the inferior optic radiation (temporal Meyer loop), or the inferior part of the occipital visual cortex below the calcarine fissure.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      32.2
      Seconds
  • Question 24 - A patient complains of headache and visual loss. CT scan demonstrates a lesion...

    Incorrect

    • A patient complains of headache and visual loss. CT scan demonstrates a lesion of the temporal lobe. What type of visual field defect would you most expect to see in this patient:

      Your Answer: Contralateral homonymous hemianopia

      Correct Answer: Contralateral homonymous superior quadrantanopia

      Explanation:

      Axons from the lateral geniculate nucleus (LGN) carry visual information, via the upper and lower optic radiations, to the visual cortex in the occipital lobe:
      The upper optic radiation carries fibres from the superior retinal quadrants (corresponding to the inferior visual field quadrants) and travels through the parietal lobe to reach the visual cortex.
      The lower optic radiation carries fibres from the inferior retinal quadrants (corresponding to the superior visual field quadrants) and travels through the temporal lobe to reach the visual cortex of the occipital lobe.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      7.9
      Seconds
  • Question 25 - Which of the following is NOT a contraindication to treatment with aspirin at...

    Incorrect

    • Which of the following is NOT a contraindication to treatment with aspirin at analgesic doses:

      Your Answer: Severe cardiac failure

      Correct Answer: Myasthenia gravis

      Explanation:

      Aspirin (at analgesic doses) is contraindicated in:
      People with a history of true hypersensitivity to aspirin or salicylates (symptoms of hypersensitivity to aspirin or salicylates include bronchospasm, urticaria, angioedema, and vasomotor rhinitis)
      People with active or previous peptic ulceration
      People with haemophilia or another bleeding disorder
      Children younger than 16 years of age (risk of Reye’s syndrome)
      People with severe cardiac failure
      People with severe hepatic impairment
      People with severe renal impairment

      N.B. Owing to an association with Reye’s syndrome, aspirin-containing preparations should not be given to children under 16 years, unless specifically indicated, e.g. for Kawasaki disease.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      33.8
      Seconds
  • Question 26 - What is the main mechanism of action of cyclizine: ...

    Incorrect

    • What is the main mechanism of action of cyclizine:

      Your Answer: Dopamine-D2 antagonist

      Correct Answer: Histamine-H1 antagonist

      Explanation:

      Antihistamines e.g. cyclizine, are effective against nausea and vomiting caused by many different conditions, including motion sickness and vertigo. These agents act by inhibiting histamine pathways, and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. There is no evidence that any one antihistamine is superior to another but their duration of action and incidence of adverse effects differ. Adverse effects include drowsiness and antimuscarinic effects such as blurred vision, dry mouth, urinary retention, constipation and confusion.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      20.5
      Seconds
  • Question 27 - 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
      4.4
      Seconds
  • Question 28 - The most common complication of paracetamol overdose is: ...

    Correct

    • The most common complication of paracetamol overdose is:

      Your Answer: Hepatic failure

      Explanation:

      The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      84.5
      Seconds
  • Question 29 - A 55-year-old woman was complaining of headaches. On examination, the patient is found...

    Incorrect

    • A 55-year-old woman was complaining of headaches. On examination, the patient is found to have weakness on the left side of her body and her eyes are deviated towards the right hand side. These are signs of damage to which of the following areas?

      Your Answer: Cerebellum

      Correct Answer: Frontal lobe

      Explanation:

      Some potential symptoms of frontal lobe damage can include loss of movement, either partial or complete, on the opposite side of the body.

      In the patient’s case, it is a result of motor cortex damage on the right side since her left side of the body is affected. The conjugate eye deviation symptom towards the side of the lesion is a result of damage to the frontal eye field.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      31.3
      Seconds
  • Question 30 - Regarding codeine, which of the following statements is INCORRECT: ...

    Incorrect

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

      Your Answer:

      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
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (12/17) 71%
Central Nervous System (23/29) 79%
Pharmacology (11/12) 92%
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