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  • Question 1 - 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
      1556.2
      Seconds
  • Question 2 - 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
      63.6
      Seconds
  • Question 3 - A 52-year old male comes to the out-patient department for a groin mass...

    Incorrect

    • 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: Sport's hernia

      Correct 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
      18.5
      Seconds
  • Question 4 - A 69-year-old man presents with a painful groin swelling on the right side....

    Incorrect

    • A 69-year-old man presents with a painful groin swelling on the right side. The suspected diagnosis is an inguinal hernia.

      Which of the following examination features make it more likely to be an indirect inguinal hernia?

      Your Answer: It appears rapidly after the patient stands

      Correct Answer: It can be controlled by pressure over the deep inguinal ring

      Explanation:

      The reduced indirect inguinal hernia can be controlled by pressure over the internal ring; a direct inguinal hernia cannot.

      An indirect inguinal hernia can be reduced superiorly then superolaterally, while a direct inguinal hernia can be reduced superiorly then posteriorly.

      An indirect inguinal hernia takes time to reach full size, but a direct inguinal hernia appears immediately upon standing.

      Indirect inguinal hernias are seen as elliptical swelling, while direct inguinal hernias appear as symmetric, circular swelling.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      12.3
      Seconds
  • Question 5 - At which opioid receptors do opioid analgesics act primarily? ...

    Incorrect

    • At which opioid receptors do opioid analgesics act primarily?

      Your Answer: Kappa

      Correct Answer: Mu

      Explanation:

      Opioid receptors are widely distributed throughout the central nervous system. Opioid analgesics mimic endogenous opioid peptides by causing prolonged activation of these receptors, mainly the mu(μ)-receptors which are the most highly concentrated in brain areas involved in nociception.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      43.7
      Seconds
  • Question 6 - Which of the following describes the site of a Meckel's diverticulum: ...

    Correct

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

      Your 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
      58.5
      Seconds
  • Question 7 - A paediatric patient comes to the emergency room with complaints of right lower...

    Incorrect

    • A paediatric patient comes to the emergency room with complaints of right lower quadrant pain. The attending physician is considering appendicitis. Inside the operating room, the surgeon asks the medical student to locate the McBurney's point prior to the first incision.

      Which of the following is the surface anatomy of the McBurney's point?

      Your Answer: One-third of the distance from the posterior superior iliac spine to the umbilicus

      Correct Answer: One-third of the distance from the anterior superior iliac spine to the umbilicus

      Explanation:

      Inflammation of the appendix is a significant public health problem with a lifetime incidence of 8.6% in men and 6.7% in women, with the highest incidence occurring in the second and third decade of life. While the rate of appendectomy in developed countries has decreased over the last several decades, it remains one of the most frequent emergent abdominal operations. Appendicitis can often result in anorexia, nausea, vomiting, and fever.

      McBurney’s point, which is found one-third of the distance between the anterior superior iliac spine and the umbilicus, is often the point of maximal tenderness in a patient with an anatomically normal appendix. A McBurney’s incision is chiefly used for cecostomy and appendectomy. It gives a limited exposure only, and should any doubt arise about the diagnosis, an infraumbilical right paramedian incision should be used instead.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      34.6
      Seconds
  • Question 8 - The medial and lateral pterygoid muscles are innervated by which of the following...

    Incorrect

    • The medial and lateral pterygoid muscles are innervated by which of the following nerves:

      Your Answer: Maxillary division of the trigeminal nerve

      Correct Answer: Mandibular division of the trigeminal nerve

      Explanation:

      Both the medial and lateral pterygoids are innervated by the mandibular division of the trigeminal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      61.1
      Seconds
  • Question 9 - The common bile duct drains into the duodenum in which of the following...

    Incorrect

    • The common bile duct drains into the duodenum in which of the following regions:

      Your Answer: Duodenojejunal flexure

      Correct Answer: Second part of the duodenum

      Explanation:

      As the common bile duct descends, it passes posterior to the first part of the duodenum before joining with the pancreatic duct from the pancreas, forming the hepatopancreatic ampulla (ampulla of Vater) at the major duodenal papilla, located in the second part of the duodenum. Surrounding the ampulla is the sphincter of Oddi, a collection of smooth muscle which can open to allow bile and pancreatic fluid to empty into the duodenum.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      414.4
      Seconds
  • Question 10 - What is the main mechanism of action of metoclopramide: ...

    Correct

    • What is the main mechanism of action of metoclopramide:

      Your 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
      26.4
      Seconds
  • Question 11 - 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
      15.3
      Seconds
  • Question 12 - A 25-year-old guy who has had a knee-high plaster cast on his left...

    Incorrect

    • 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: Anterior compartment of leg

      Correct 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
      246
      Seconds
  • Question 13 - A 42-year-old man presented to the emergency room after an incident of slipping...

    Incorrect

    • 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: Iliacus

      Correct 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
      81.6
      Seconds
  • Question 14 - A 32 year old man is brought to ED having been thrown off...

    Correct

    • A 32 year old man is brought to ED having been thrown off his motorbike. Following initial resuscitation and ruling out life-threatening injuries, you establish the patient has weakness of hip flexion. Which of the following nerves has most likely been injured:

      Your Answer: Femoral nerve

      Explanation:

      Flexion of the hip is produced by the iliacus, the psoas major, the sartorius, rectus femoris and the pectineus muscles. The femoral nerve innervates the iliacus, pectineus, sartorius and quadriceps femoris muscles, and supplies skin on the anterior thigh, anteromedial knee and medial leg.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      404.2
      Seconds
  • Question 15 - Which of the following statements is correct regarding paracetamol? ...

    Correct

    • Which of the following statements is correct regarding paracetamol?

      Your 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
      42.4
      Seconds
  • Question 16 - 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
      48.2
      Seconds
  • Question 17 - Which of the following is an adverse effect of carbamazepine: ...

    Incorrect

    • Which of the following is an adverse effect of carbamazepine:

      Your Answer: Ototoxicity

      Correct Answer: Aplastic anaemia

      Explanation:

      Common adverse effects include nausea and vomiting, sedation, dizziness, headache, blurred vision and ataxia. These adverse effects are dose related and are most common at the start of treatment.
      Other adverse effects include:
      Allergic skin reactions (and rarely, more serious dermatological conditions)
      Hyponatraemia (avoid concomitant use with diuretics)
      Leucopenia, thrombocytopenia and other blood disorders including aplastic anaemia
      Hepatic impairment

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      67.4
      Seconds
  • Question 18 - A man working as a waiter cuts his arm on a glass while...

    Incorrect

    • A man working as a waiter cuts his arm on a glass while he was working. The palmaris longus muscle was damaged as a consequence of his injury.

      Which of the following statements regarding the palmaris longus muscle is considered correct?

      Your Answer: It is innervated by the radial nerve

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

      Explanation:

      The palmaris longus is a small, fusiform-shaped muscle located on the anterior forearm of the human upper extremity. The palmaris longus muscle is commonly present but may be absent in a small percentage of the population, ranging from 2.5% to 26% of individuals, depending on the studied population.

      The palmaris longus belongs to the anterior forearm flexor group in the human upper extremity. The muscle attaches proximally to the medial humeral epicondyle and distally to the palmar aponeurosis and flexor retinaculum. The blood supply to the palmaris longus muscle is via the ulnar artery, a branch of the brachial artery in the human upper extremity.

      The palmaris longus muscle receives its innervation via branches of the median nerve containing nerve roots C5-T1. Median nerve injury at or above the elbow joint (including brachial plexus and nerve root injury) can lead to deficits in the palmaris longus and other forearm flexor muscles, leading to weakened elbow flexion, wrist flexion, radial deviation, finger flexion, thumb opposition, flexion, and abduction, in addition to the loss of sensory function in the distribution of the median nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      302.1
      Seconds
  • Question 19 - 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: Early clinical features in overdose include hypoventilation and respiratory depression.

      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
      220.9
      Seconds
  • Question 20 - A 64-year-old woman had a humerus midshaft fracture due to tripping on a...

    Incorrect

    • A 64-year-old woman had a humerus midshaft fracture due to tripping on a curb and falling on her left arm. She might also have damaged which of the following structures?

      Your Answer: Axillary nerve and posterior humeral circumflex artery

      Correct Answer: Radial nerve and deep brachial artery

      Explanation:

      The radial nerve and brachial artery are most likely to be damaged in humerus fractures. They are tethered together to the bone and cannot withstand the forces applied to it as a result of the displacement.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      155.4
      Seconds
  • Question 21 - A 65-year-old man complains of severe vertigo, nausea, and tinnitus. Upon presenting himself...

    Correct

    • 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: 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
      14.3
      Seconds
  • Question 22 - Regarding paracetamol, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding paracetamol, which of the following statements is CORRECT:

      Your Answer: It has anti-inflammatory action.

      Correct Answer: It has anti-pyretic action.

      Explanation:

      Paracetamol is a non-opioid analgesic, similar in efficacy to aspirin, with antipyretic properties but no anti-inflammatory properties. It is well absorbed orally and does not cause gastric irritation. Paracetamol is a suitable first-line choice for most people with mild-to-moderate pain, and for combination therapy.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      39.5
      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
      112
      Seconds
  • Question 24 - Which of the following is a well recognised adverse effect of prochlorperazine: ...

    Incorrect

    • Which of the following is a well recognised adverse effect of prochlorperazine:

      Your Answer: Respiratory depression

      Correct Answer: Acute dystonic reaction

      Explanation:

      Adverse actions include anticholinergic effects such as drowsiness, dry mouth, and blurred vision, extrapyramidal effects, and postural hypotension. Phenothiazines can all induce acute dystonic reactions such as facial and skeletal muscle spasms and oculogyric crises; children (especially girls, young women, and those under 10 kg) are particularly susceptible.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      13.6
      Seconds
  • Question 25 - In the emergency room, a 28-year-old woman complains of wobbly and slurred speech,...

    Incorrect

    • In the emergency room, a 28-year-old woman complains of wobbly and slurred speech, is unable to do the heel-shin test, and has nystagmus. The following signs are most likely related to damage to which of the following areas:

      Your Answer: Frontal lobe

      Correct Answer: Cerebellum

      Explanation:

      Cerebellar injury causes delayed and disorganized motions. When walking, people with cerebellar abnormalities sway and stagger.

      Damage to the cerebellum can cause asynergia, the inability to judge distance and when to stop, dysmetria, the inability to perform rapid alternating movements or adiadochokinesia, movement tremors, staggering, wide-based walking or ataxic gait, a proclivity to fall, weak muscles or hypotonia, slurred speech or ataxic dysarthria, and abnormal eye movements or nystagmus.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      73.3
      Seconds
  • Question 26 - The most common complication of paracetamol overdose is: ...

    Incorrect

    • The most common complication of paracetamol overdose is:

      Your Answer: Lactic acidosis

      Correct 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
      507.9
      Seconds
  • Question 27 - Regarding the accessory nerve, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding the accessory nerve, which of the following statements is INCORRECT:

      Your Answer: The nerve exits the skull through the jugular foramen.

      Correct Answer: Accessory nerve palsy results in the inability to nod the head

      Explanation:

      Accessory nerve palsy results in inability to shrug the shoulders and to rotate the head to look at the opposite side to the lesion.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      39.8
      Seconds
  • Question 28 - A 35 year old man presents with a deep laceration to the proximal...

    Incorrect

    • A 35 year old man presents with a deep laceration to the proximal part of the forearm. On further assessment, the patient is unable to flex the metacarpophalangeal joints and interphalangeal joints of the index, middle finger and the thumb.

      The ring and little fingers are intact but there is weakness at the proximal interphalangeal joint.

      There is also loss of sensation over the lateral palm and the palmar surface of the lateral three and a half fingers.

      Which of these nerve(s) has most likely been affected?

      Your Answer: Ulnar nerve

      Correct Answer: Median nerve

      Explanation:

      A median nerve injury affecting the extrinsic and intrinsic muscles of the hand will present with:

      Loss of sensation to the lateral palm and the lateral three and a half fingers.

      Weakness of flexion at the metacarpophalangeal joints of the index and middle finger. This is because of paralysis of the lateral two lumbricals.

      Weakness of flexion of the proximal interphalangeal joints of all four fingers due to paralysis of the flexor digitorum superficialis

      Weakness of flexion at the distal interphalangeal joints of the index and middle finger following paralysis of the lateral half of the flexor digitorum profundus.
      Weakness of thumb flexion, abduction and opposition due to paralysis of the flexor pollicis longus and thenar muscles

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      108.2
      Seconds
  • Question 29 - At rest, the left dome of the diaphragm normally reaches as high as...

    Incorrect

    • At rest, the left dome of the diaphragm normally reaches as high as which of the following:

      Your Answer: Seventh intercostal space

      Correct Answer: Fifth intercostal space

      Explanation:

      At rest the right dome of the diaphragm lies slightly higher than the left; this is thought to be due to the position of the liver. In normal expiration, the normal upper limits of the superior margins are the fifth rib for the right dome, the fifth intercostal space for the left dome and the xiphoid process for the central tendon.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      29.4
      Seconds
  • Question 30 - A 25-year old male is brought to the emergency room after a traffic...

    Correct

    • A 25-year old male is brought to the emergency room after a traffic accident. Upon examination, there was tenderness and erythema on the right acromioclavicular joint, with notable step deformity. On radiographic imaging, there is a superior elevation of the clavicle, a twice than normal coracoclavicular distance, and absence of fracture.

      Which of the following structure/s is/are likely to have ruptured?

      Your Answer: Acromioclavicular ligament, coracoclavicular ligament and joint capsule

      Explanation:

      Acromioclavicular joint injuries account for more than forty percent of all shoulder injuries. Mild injuries are not associated with any significant morbidity, but severe injuries can lead to significant loss of strength and function of the shoulder. Acromioclavicular injuries may be associated with a fractured clavicle, impingement syndromes, and more rarely neurovascular insults.

      The AC joint is a diarthrodial joint defined by the lateral process of the clavicle articulating with the acromion process as it projects anteriorly off the scapula. The joint is primarily stabilized by the acromioclavicular ligament, which is composed of an anterior, posterior, inferior, and superior component. Of note, the superior portion of the AC ligament is the most important component for the stability of the AC joint. Supporting structures include two coracoclavicular ligaments (trapezoid and conoid ligaments), which provide vertical stability, as well as the coracoacromial ligament.

      Patients with an AC joint injury typically present with anterosuperior shoulder pain and will describe a mechanism of injury of blunt trauma to the abducted shoulder or landing on an outstretched arm, suggestive of this type of injury. They may describe pain radiating to the neck or shoulder, which is often worse with movement or when they try to sleep on the affected shoulder. On examination, the clinician may observe swelling, bruising, or a deformity of the AC joint, depending on the degree of injury. The patient will be tender at that location. They may have a restriction in the active and passive range of motion secondary to pain. Piano key sign may be seen, with an elevation of the clavicle that rebounds after inferior compression.

      Standard X-rays are adequate to make a diagnosis of acromioclavicular joint injury and should be used to evaluate for other causes of traumatic shoulder pain.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (14/21) 67%
Upper Limb (5/6) 83%
Abdomen And Pelvis (2/3) 67%
Central Nervous System (9/12) 75%
Pharmacology (7/9) 78%
Abdomen (2/2) 100%
Thorax (0/2) 0%
Head And Neck (0/1) 0%
Lower Limb (3/3) 100%
Cranial Nerve Lesions (0/1) 0%
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