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Question 1
Correct
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Which of the following anatomical structures is most likely the cause of oedema and erythema of the arm in a patient who underwent modified radical mastectomy and radiotherapy?
Your Answer: Axillary lymph nodes
Explanation:Arm oedema is one of the sequelae after breast cancer surgery and radiation therapy. Arm oedema in the breast cancer patient is caused by interruption of the axillary lymphatic system by surgery or radiation therapy, which results in the accumulation of fluid in subcutaneous tissue in the arm, with decreased distensibility of tissue around the joints and increased weight of the extremity. Chronic inflammatory changes result in both subcutaneous and lymph vessel fibrosis.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 2
Correct
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A patient presents complaining of visual loss. On examination you note a contralateral homonymous hemianopia. Where is the most likely site of the lesion:
Your Answer: Optic tract
Explanation:At the optic chiasm, fibres from the medial (nasal) half of each retina crossover, forming the right and left optic tracts.
The left optic tract contains fibres from the left lateral (temporal) retina and the right medial retina.
The right optic tract contains fibres from the right lateral retina and the left medial retina.
Each optic tract travels to its corresponding cerebral hemisphere to reach its lateral geniculate nucleus (LGN) located in the thalamus where the fibres synapse.
A lesion of the optic tract will cause a contralateral homonymous hemianopia. -
This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 3
Incorrect
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A 29 year old man presents to ED followed an alleged assault whilst out drinking. He received blunt trauma to his right axilla. He is complaining of difficulty abducting his right arm above the level of his shoulder, and on inspection, the inferior angle of his right scapula protrudes more than that of his left scapula. Which of the following nerves has most likely been affected:
Your Answer: Dorsal scapular nerve
Correct Answer: Long thoracic nerve
Explanation:Damage to the long thoracic nerve results in weakness/paralysis of the serratus anterior muscle causing difficulty abducting the upper limb above 90 degrees and giving a ‘winged ‘ scapula appearance where the medial border, particularly the inferior angle, of the scapula moves laterally and posteriorly away from the thoracic wall (this becomes more pronounced if the patient presses the upper limb against a wall).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 4
Incorrect
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Regarding the lumbar plexus, which of the following is a direct muscular branch?
Your Answer:
Correct Answer: Nerve to quadratus lumborum
Explanation:The lumbar plexus gives rise to several branches which supply various muscles and regions of the posterior abdominal wall and lower limb. These branches include the Iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral and obturator nerves.
In addition, the lumbar plexus gives off muscular branches from its roots, a branch to the lumbosacral trunk and occasionally an accessory obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 5
Incorrect
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After what time period should intravenous phenytoin be used as second-line treatment of status epilepticus?
Your Answer:
Correct Answer: 25 minutes
Explanation:If seizures recur or fail to respond after initial treatment with benzodiazepines within 25 minutes of onset, phenytoin sodium, fosphenytoin sodium, or phenobarbital sodium should be used.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 6
Incorrect
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A patient with diplopia is found to have eye deviation downwards and outwards. The likely nerves that are affected are:
Your Answer:
Correct Answer: Oculomotor nerve
Explanation:The results of an oculomotor (CN III) nerve palsy are a depressed and abducted (down and out) eye, ptosis, diplopia, and a fixed and dilated pupil.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 7
Incorrect
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A 25-year-old athlete suffers an injury to the nerve that innervates the gluteus minimus muscle.
Which of the following nerves innervates the gluteus minimus muscle?Your Answer:
Correct Answer: Superior gluteal nerve
Explanation:Gluteus minimus is the smallest muscle of the glutei. It is located just beneath the gluteus medius muscle. Gluteus minimus predominantly acts as a hip stabilizer and abductor of the hip.
The superior gluteal nerve innervates the gluteus minimus. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 8
Incorrect
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Which of the following statements accurately describes the flexor digitorum superficialis muscle?
Your Answer:
Correct Answer: It flexes the middle phalanges of the medial four fingers at the proximal interphalangeal joints
Explanation:Flexor digitorum superficialis is the largest muscle of the anterior compartment of the forearm. It belongs to the superficial flexors of the forearm, together with pronator teres, flexor carpi radialis, flexor carpi ulnaris and palmaris longus. Some sources alternatively classify this muscle as an independent middle/intermediate layer of the anterior forearm, found between the superficial and deep groups.
Flexor digitorum superficialis is innervated by muscular branches of the median nerve, derived from roots C8 and T1 that arises from the medial and lateral cords of the brachial plexus. The skin that overlies the muscle is supplied by roots C6-8 and T1.
The primary arterial blood supply to the flexor digitorum superficialis is derived from the ulnar artery and its anterior recurrent branch. In addition to branches of the ulnar artery, the anterior and lateral surfaces of the muscle are supplied by branches of the radial artery; and its posterior surface also receives branches from the median artery.
The main function of flexor digitorum superficialis is flexion of the digits 2-5 at the proximal interphalangeal and metacarpophalangeal joints. Unlike the flexor digitorum profundus, flexor digitorum superficialis has independent muscle slips for all four digits. This allows it to flex the digits individually at their proximal interphalangeal joints. In addition, flexor digitorum superficialis aids the aids flexion of the wrist.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 9
Incorrect
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A 45-year-old obese patient goes to the emergency department with a fever and significant right upper quadrant pain. The pain radiates to her right shoulder tip. Murphy's sign is positive and acute cholecystitis is diagnosed. The pain referred to the shoulder tip is caused by one of the following nerves:
Your Answer:
Correct Answer: Phrenic nerve
Explanation:Gallbladder inflammation can cause pain in the right upper quadrant and right shoulder, which is caused by irritation of the diaphragmatic peritoneum. Pain from areas supplied by the phrenic nerve is often referred to other somatic regions served by spinal nerves C3-C5.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 10
Incorrect
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A 45-year-old man had a painless superficial inguinal lymphadenopathy. It was later found to be malignant. Which of the following parts of the body is most likely the origin of this cancerous lymph node?
Your Answer:
Correct Answer: Anal canal
Explanation:A cancer of the anal canal below the pectinate line would spread to the superficial inguinal lymph nodes.
Anal cancer often spreads through lymphatic drainage to the internal iliac lymph nodes in lesions above the pectinate line and to the superficial inguinal lymph nodes in lesions below the pectinate line.
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This question is part of the following fields:
- Abdomen
- Anatomy
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