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Question 1
Correct
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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.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 2
Incorrect
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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: Weber’s 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.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 3
Correct
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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: 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
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 4
Incorrect
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All of the muscles of the tongue (other than the palatoglossus) are innervated by which of the following nerves:
Your Answer: Vagus nerve
Correct Answer: Hypoglossal nerve
Explanation:All of the muscles of the tongue are innervated by the hypoglossal nerve, except for the palatoglossus, which is innervated by the vagus nerve.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 5
Incorrect
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A 7-year old boy is referred to the Paediatrics Department due to slurred speech. Upon further examination, the attending physician noted the presence of dysdiadochokinesia, intention tremors, and nystagmus. An MRI is taken, which revealed a brain tumour.
Which of the following options is the most probable diagnosis given the clinical features of the patient?Your Answer: Astrocytoma of frontal lobe
Correct Answer: Astrocytoma of cerebellum
Explanation:Pilocytic astrocytoma (PCA), previously known as cystic cerebellar astrocytoma or juvenile pilocytic astrocytoma, was first described in 1931 by Harvey Cushing, based on a case series of cerebellar astrocytomas; though he never used these terms but rather described a spongioblastoma. They are low-grade, and usually well-circumscribed tumours, which tend to occur in young patients. By the World Health Organization (WHO) classification of central nervous system tumours, they are considered grade I gliomas and have a good prognosis.
PCA most commonly occurs in the cerebellum but can also occur in the optic pathway, hypothalamus, and brainstem. They can also occur in the cerebral hemispheres, although this tends to be the case in young adults. Presentation and treatment vary for PCA in other locations. Glial cells include astrocytes, oligodendrocytes, ependymal cells, and microglia. Astrocytic tumours arise from astrocytes and are the most common tumour of glial origin. The WHO 2016 categorized these tumours as either diffuse gliomas or other astrocytic tumours. Diffuse gliomas include grade II and III diffuse astrocytomas, grade IV glioblastoma, and diffuse gliomas of childhood. The other astrocytic tumours group include PCA, pleomorphic xanthoastrocytoma, subependymal giant cell astrocytoma, and anaplastic pleomorphic xanthoastrocytoma.
PCA can present with symptoms secondary to the posterior fossa mass effect. This may include obstructive hydrocephalus, with resultant headache, nausea and vomiting, and papilledema. If hydrocephalus occurs before the fusion of the cranial sutures (<18-months-of-age), then an increase in head circumference will likely occur. Lesions of the cerebellar hemisphere result in peripheral ataxia, dysmetria, intention tremor, nystagmus, and dysarthria. In contrast, lesions of the vermis cause a broad-based gait, truncal ataxia, and titubation. Posterior fossa lesions can also cause cranial nerve palsies. Diplopia may occur due to abducens palsy from the stretching of the nerve. They may also have blurred vision due to papilledema. Seizures are rare with posterior fossa lesions.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 6
Incorrect
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Which of the following statements is true about anterior cord syndrome?
Your Answer: It is the least common form of spinal cord infarction
Correct Answer: There is preservation of proprioception
Explanation:Anterior cord syndrome is an incomplete cord syndrome that predominantly affects the anterior 2/3 of the spinal cord, characteristically resulting in motor paralysis below the level of the lesion as well as the loss of pain and temperature at and below the level of the lesion. The patient presentation typically includes these two findings; however, there is variability depending on the portion of the spinal cord affected. Other findings include back pain, or autonomic dysfunction such as hypotension, neurogenic bowel or bladder, and sexual dysfunction. The severity of motor dysfunction can vary, typically resulting in paraplegia or quadriplegia.
Proprioception, vibratory sense, two-point discrimination, and fine touch are not affected in anterior cord syndrome. These sensations are under the control of the dorsal column of the spinal cord, which is supplied by two posterior spinal arteries running in the posterior lateral sulci.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 7
Incorrect
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CSF is reabsorbed from subarachnoid space via which of the following structures:
Your Answer: Subarachnoid cisterns
Correct Answer: Arachnoid granulations
Explanation:From the subarachnoid cisterns in the subarachnoid space, CSF is reabsorbed via arachnoid granulations which protrude into the dura mater, into the dural venous sinuses and from here back into the circulation.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 8
Incorrect
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Which of the following is NOT a typical feature of a lesion to the vestibulocochlear nerve:
Your Answer: Impaired hearing
Correct Answer: Hyperacusis
Explanation:Hyperacusis is increased acuity of hearing with hypersensitivity to low tones resulting from paralysis of the stapedius muscle, innervated by the facial nerve. General sensation to the face and to the anterior two-thirds of the tongue is carried by the divisions of the trigeminal nerve (although taste to the anterior two-thirds of the tongue is supplied by the facial nerve). Eye movements are mediated by the oculomotor, trochlear and abducens nerve. Ptosis results from paralysis of the levator palpebrae superioris, innervated by the oculomotor nerve, or the superior tarsal muscle, innervated by the sympathetic chain.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 9
Incorrect
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What is the main mechanism of action of metoclopramide:
Your Answer: Serotonin-5HT3 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.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 10
Incorrect
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Which of the following statements concerning the facial nerve is INCORRECT?
Your Answer: The facial nerve exits the skull via the stylomastoid foramen.
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
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Question 11
Incorrect
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Which of these drugs may reduce the efficacy of contraception?
Your Answer: Ethosuxamide
Correct Answer: Carbamazepine
Explanation:Antiepileptic medications such as carbamazepine (Tegretol), topiramate (Topamax), and phenytoin (Dilantin) are widely known for reducing the contraceptive effectiveness of OCPs.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 12
Correct
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At which vertebral level does the spinal cord normally end in adults?
Your Answer: L1/L2
Explanation:The spinal cord starts at the foramen magnum, where it is continuous with the medulla oblongata, which is the most caudal portion of the brainstem.
It then extends inferiorly through the vertebral canal. In adults, it usually ends at the level of the first or second lumbar vertebra.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 13
Incorrect
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Which of the following is most likely to cause a bitemporal hemianopia:
Your Answer: Stroke
Correct 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.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 14
Incorrect
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What is the main mechanism of action of cyclizine:
Your Answer: Serotonin-5HT3 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.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 15
Correct
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A 39-year-old guy comes to the emergency room with a persistent nasal bleed. You suspect the bleeding is coming from Little's area based on your examination. Which of the blood vessels listed below is most likely to be involved:
Your Answer: Sphenopalatine and superior labial arteries
Explanation:The Kiesselbach plexus is a vascular network formed by five arteries that supply oxygenated blood to the nasal septum, which refers to the wall separating the right and left sides of the nose. The five arteries that form the Kiesselbach plexus: the sphenopalatine artery, which branches from the maxillary artery originating behind the jawbone; the anterior ethmoidal artery, which branches from the ophthalmic artery behind the eye; the posterior ethmoidal artery, which also branches from the ophthalmic artery; the septal branch of the superior labial artery, which is a branch of the facial artery supplying blood to all of the superficial features of the face; and finally, the greater palatine artery, which is a terminal branch of the maxillary artery.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 16
Incorrect
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In the emergency department, a 50-year-old female appears with a lack of sensation over the front two-thirds of her tongue. Taste and salivation are both present. The patient might have damage which of her nerves?
Your Answer: Glossopharyngeal nerve
Correct Answer: Lingual nerve
Explanation:The lingual nerve, a branch of the mandibular nerve, transmits sensation to the anterior two-thirds of the tongue.
The chorda tympani, a branch of the facial nerve, transmits taste to the front two-thirds of the tongue as well as secretomotor innervation to the submandibular and sublingual glands.
As a result, any damage to the lingual nerve can cause changes in salivary secretion on the affected side, as well as a loss of taste in the anterior two-thirds of the tongue and temporary or permanent sensory changes in the anterior two-thirds of the tongue and the floor of the mouth.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 17
Incorrect
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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 meninges are two layers of protective tissue that envelop the brain and spinal cord
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
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Question 18
Correct
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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.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 19
Correct
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A lesion to which part of the optic radiation will result in contralateral homonymous inferior quadrantanopia?
Your Answer: Right parietal lobe
Explanation:A visual loss in the lower left quadrant in both visual fields is an indication of an inferior homonymous. This is due to a lesion of the superior fibres of the optic radiation in the parietal lobe on the contralateral side of the visual pathway.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 20
Incorrect
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In which of the following cases is intravenous phenytoin contraindicated?
Your Answer: Renal impairment
Correct Answer: Second degree heart block
Explanation:Phenytoin Contraindications include:
Hypersensitivity
Sinus bradycardia
Sinoatrial block
Second and third degree A-V block
Adams-Stokes syndrome
Concurrent use with delavirdine
History of prior acute hepatotoxicity attributable to phenytoin -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 21
Incorrect
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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: Bitemporal 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
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Question 22
Incorrect
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Which of the following is first-line for management of status epilepticus:
Your Answer: Rectal diazepam
Correct Answer: Intravenous lorazepam
Explanation:First-line treatment is with intravenous lorazepam if available. Intravenous diazepam is effective but it carries a high risk of thrombophlebitis so should only be used if intravenous lorazepam is not immediately available. Absorption of diazepam from intramuscular injection or from suppositories is too slow for treatment of status epilepticus. When facilities for resuscitation are not immediately available or if unable to secure immediate intravenous access, diazepam can be administered as a rectal solution or midazolam oromucosal solution can be given into the buccal cavity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 23
Correct
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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 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.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 24
Incorrect
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A 65-year-old man complains of severe vertigo, nausea, and tinnitus. Upon presenting himself to the emergency room, it was observed that he is exhibiting ataxia, right-sided loss of pain and temperature sense on the face, and left-sided sensory loss to the body. An MRI and CT scan was ordered and the results showed that he is suffering from a right-sided stroke.
Branches of which of the following arteries are most likely implicated in the case?Your Answer: Posterior cerebral artery
Correct Answer: Basilar artery
Explanation:The lateral pontine syndrome occurs due to occlusion of perforating branches of the basilar and anterior inferior cerebellar (AICA) arteries. It is also known as Marie-Foix syndrome or Marie-Foix-Alajouanine syndrome. It is considered one of the brainstem stroke syndromes of the lateral aspect of the pons.
It is characterized by ipsilateral limb ataxia, loss of pain and temperature sensation of the face, facial weakness, hearing loss, vertigo and nystagmus, hemiplegia/hemiparesis, and loss of pain and temperature sensation.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 25
Incorrect
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Thyroid cancer has spread to the regional lymph nodes of a patient as seen in a staging CT scan.
The lymph from the thyroid gland will drain directly to which of the following nodes?Your Answer: Jugulodigastric lymph nodes
Correct Answer: Deep lateral cervical lymph nodes
Explanation:Lymphatic drainage of the thyroid gland involves the lower deep cervical, prelaryngeal, pretracheal, and paratracheal nodes. The paratracheal and lower deep cervical nodes, specifically, receive lymphatic drainage from the isthmus and the inferior lateral lobes. The superior portions of the thyroid gland drain into the superior pretracheal and cervical nodes.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 26
Incorrect
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A 23-year-old student presents with a fever and sore throat. Upon physical examination, it was observed that he had bilaterally enlarged tonsils that are covered in large amounts of exudate. A diagnosis of tonsillitis was made.
The lymph from the tonsils will drain to which of the following nodes?Your Answer: Posterior auricular lymph nodes
Correct Answer: Deep cervical lymph nodes
Explanation:The tonsils are collections of lymphatic tissue located within the pharynx. They collectively form a ringed arrangement, known as Waldeyer’s ring: pharyngeal tonsil, 2 tubal tonsils, 2 palatine tonsils, and the lingual tonsil.
Lymphatic fluid from the lingual tonsil drains into the jugulodigastric and deep cervical lymph nodes.
Lymphatic fluid from the pharyngeal tonsil drains into the retropharyngeal nodes (which empty into the deep cervical chain), and directly into deep cervical nodes within the parapharyngeal space.
The retropharyngeal and the deep cervical lymph nodes drain the tubal tonsils.
The palatine tonsils drain to the jugulodigastric node, a node of the deep cervical lymph nodes, located inferior to the angle of the mandible.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 27
Incorrect
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Which of the following is a contraindication to the use of opioid analgesics:
Your Answer: Folate deficiency
Correct Answer: Raised intracranial pressure
Explanation:Opioids should be avoided in people who have:
A risk of paralytic ileus (opioids reduce gastric motility)
Acute respiratory depressionAn acute exacerbation of asthma (opioids can aggravate bronchoconstriction as a result of histamine release)
Conditions associated with increased intracranial pressure including head injury (opioids can interfere with pupillary response making neurological assessment difficult and may cause retention of carbon dioxide aggravating the increased intracranial pressure) -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 28
Incorrect
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Which of the following nerves is responsible for the symptoms of a patient who presented with ophthalmic herpes zoster and a few vesicles on the nose?
Your Answer: Olfactory nerve
Correct Answer: Trigeminal nerve
Explanation:Hutchinson sign relates to involvement of the tip of the nose from facial herpes zoster. It implies involvement of the external nasal branch of the nasociliary nerve which is a branch of the ophthalmic division of the trigeminal nerve.
The nasociliary branch of the trigeminal nerve innervates the apex and lateral aspect of the nose, as well as the cornea. Therefore, lesions on the side or tip of the nose should raise suspicion of ocular involvement.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 29
Incorrect
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When the breast cancer of a 60-year old patient metastasizes and compresses the intervertebral foramina between the fourth and fifth cervical vertebrae, as well as the fourth and fifth thoracic vertebrae, this causes back pain. Which pair of nerves is most likely affected?
Your Answer: Fourth cervical and fifth thoracic nerves
Correct Answer: Fifth cervical and fourth thoracic nerves
Explanation:The fifth cervical nerve passes between the fourth and fifth cervical vertebrae, and the fourth thoracic nerve passes between the fourth and fifth thoracic vertebrae. Therefore, when the cancer metastasizes in this area, they are most likely affected.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 30
Incorrect
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Which of the following is NOT a typical cerebellar sign:
Your Answer: Slurred speech
Correct Answer: Resting tremor
Explanation:An intention tremor is characteristic of cerebellar dysfunction. Resting tremor may be seen in Parkinsonism.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 31
Incorrect
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In a patient with an ongoing seizure, after what time period should treatment be commenced?
Your Answer: 1 minute
Correct Answer: 5 minutes
Explanation:Immediate emergency care and treatment should be given to children, young people and adults who have prolonged or repeated convulsive seizures.
Prolonged seizures last 5 minutes or more.
Repeated seizures refer to 3 or more seizures in an hour. -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 32
Incorrect
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A patient diagnosed with cranial nerve palsy exhibits asymmetrical movement of the palate, nasal regurgitation of food, and nasal quality to the voice.
Which of the following cranial nerves is most likely responsible for the aforementioned features?Your Answer: Facial nerve
Correct Answer: Vagus nerve
Explanation:The vagus nerve, ‘the wanderer’, contains motor fibres (to the palate and vocal cords), sensory components (posterior and floor of external acoustic meatus) and visceral afferent and efferent fibres.
Palatal weakness can cause nasal speech and nasal regurgitation of food. The palate moves asymmetrically when the patient says ‘ahh’. Recurrent nerve palsy results in hoarseness, loss of volume and ‘bovine cough’.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 33
Incorrect
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Elevation of the mandible is produced primarily by which of the following muscles:
Your Answer: Temporalis, geniohyoid and mylohyoid
Correct Answer: Temporalis, masseter and medial pterygoid
Explanation:Elevation of the mandible is generated by the temporalis, masseter and medial pterygoid muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 34
Incorrect
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A 76-year-old man presents with complaints of double vision. Upon physical examination, it was observed that he exhibits left-sided hemiplegia and left-sided loss of joint position sense, vibratory sense and discriminatory touch. In addition, he has the inability to abduct his right eye and is holding his head towards the right side. A CT scan was ordered and showed that he has suffered a right-sided stroke.
Branches of which of the following arteries are most likely implicated in the case?Your Answer: Inferior cerebellar artery
Correct Answer: Basilar artery
Explanation:Inferior medial pontine syndrome, also known as Foville syndrome, is one of the brainstem stroke syndromes which occurs when there is infarction of the medial inferior aspect of the pons due to occlusion of the paramedian branches of the basilar artery.
It is characterized by ipsilateral sixth nerve palsy, facial palsy, contralateral hemiparesis, contralateral loss of proprioception and vibration, ipsilateral ataxia, ipsilateral facial weakness, and lateral gaze paralysis and diplopia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 35
Incorrect
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A patient who has a nerve injury has sparing of the upper half of the orbicularis oculi muscle but not the lower half. Which branch of the facial nerve supplies the lower half of the orbicularis oculi?
Your Answer: Buccal branch
Correct Answer: Zygomatic branch
Explanation:The facial nerve divides into five terminal branches once in the parotid gland.
1. The temporal branch innervates muscles in the temple, forehead and supraorbital areas.
2. The zygomatic branch innervates muscles in the infraorbital area, the lateral nasal area and the upper lip.
3. The buccal branch innervates muscles in the cheek, the upper lip and the corner of the mouth.
4. The marginal mandibular branch innervates muscles of the lower lip and chin.
5. The cervical branch innervates the platysma muscle. -
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 36
Incorrect
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A 26 year old horse rider has a bad fall and sustains a neck injury which displays the following signs:
- ability to extend the wrist against gravity
- paralysis of the hands, trunk, and legs
- absent sensation in the fingers and medial upper arms
- normal sensation over the thumbs
- absent sensation in chest, abdomen, and legs
What is the neurological level of the injury?Your Answer: C7
Correct Answer: C6
Explanation:C1 – C4 INJURY
Most severe of the spinal cord injury levels; paralysis in arms, hands, trunk and legs; patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements; ability to speak is sometimes impaired or reducedC5 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 weakenedC6 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 weakenedC7 INJURY
Nerves control elbow extension and some finger extension; most can straighten their arm and have normal movement of their shouldersC8 INJURY
Nerves control some hand movement; should be able to grasp and release objectsC5 – 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 fingerC5 – 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
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Question 37
Incorrect
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Which of the following is NOT a side effect of phenytoin:
Your Answer: Ataxia
Correct Answer: Ototoxicity
Explanation:Adverse effects of phenytoin include:
Nausea and vomiting
Drowsiness, lethargy, and loss of concentration
Headache, dizziness, tremor, nystagmus and ataxia
Gum enlargement or overgrowth
Coarsening of facial features, acne and hirsutism
Skin rashes
Blood disorders -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 38
Incorrect
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Depression of the eyeball is primarily produced by which of the following muscles:
Your Answer: Inferior rectus and inferior oblique
Correct Answer: Inferior rectus and superior oblique
Explanation:Depression of the eyeball is produced by the inferior rectus and the superior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 39
Incorrect
-
A suspicious growth on the posterior tongue of a 40-year-old man was discovered by his dentist and was immediately referred for possible oral cancer.
The lymph from the posterior tongue will drain to which of the following nodes?Your Answer: Inferior cervical nodes
Correct Answer: Deep cervical nodes
Explanation:Lymph from the medial anterior two thirds of the tongue travels to the deep cervical lymph nodes.
Lymph from the lateral anterior tongue goes to the submandibular nodes. -
This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 40
Incorrect
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Which of the following is NOT a contraindication to treatment with aspirin at analgesic doses:
Your Answer: Haemophilia
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 impairmentN.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.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 41
Correct
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A 24-year-old man goes to the emergency department with a fever, headache, and swollen parotid glands that are excruciating. You have a suspicion that it is mumps. Which of the following nerves is causing the discomfort the patient is experiencing:
Your Answer: Auriculotemporal nerve
Explanation:The auriculotemporal nerve is irritated by mumps, which results in significant discomfort due to inflammation and swelling of the parotid gland, as well as the stretching of its capsule. Compression caused by swallowing or chewing exacerbates pain.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 42
Correct
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Oculomotor (CN III) palsy with sparing of the pupillary reflex is most likely caused by which of the following:
Your 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.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 43
Incorrect
-
This anatomic part lies at the heart of the tooth.
Your Answer: The root
Correct Answer: The pulp cavity
Explanation:Within the central portion of the tooth lies the dental pulp. The pulp chamber provides mechanical support and functions as a barrier from external stimuli and the oral microbiome. The dental pulp is a unique tissue that is richly innervated and has an extensive microvascular network. Maintaining its vitality increases both the mechanical resistance of the tooth and the long-term survival. The junctional epithelium forms a band around the tooth at the base of the gingival sulcus, sealing off the periodontal tissues from the oral cavity.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 44
Incorrect
-
Which of the following is NOT a typical feature of an abducens nerve palsy:
Your Answer: Convergent squint at rest
Correct Answer: Inability to look up
Explanation:CN VI palsies result in a convergent squint at rest (eye turned inwards) with inability to abduct the eye because of unopposed action of the rectus medialis. The patient complains of horizontal diplopia when looking towards the affected side. With complete paralysis, the eye cannot abduct past the midline.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 45
Incorrect
-
Which cervical interspace is most likely injured if a patient presents with difficulty of shoulder abduction and elbow flexion, pain in the right shoulder and lateral arm, and decreased sensation over the deltoid and lateral arm?
Your Answer: C1-C2
Correct Answer: C4-C5
Explanation:In the setting of cervical radiculopathy, because the nerve root of a spinal nerve is compressed or otherwise impaired, the pain and symptomatology can spread far from the neck and radiates to arm, neck, chest, upper back and/or shoulders. Often muscle weakness and impaired deep tendon reflexes are noted along the course of the spinal nerve.
Cervical radiculopathy is almost always unilateral, although, in rare cases, both nerves at a given level may be impacted. Those rare presentations can confound physical diagnosis and require acceleration to advanced imaging especially in cases of trauma. If there is nerve impingement, the affected side will be reduced relative to the unaffected side. Reduction in strength of muscles innervated by the affected nerve is also significant physical finding.
For a C4-C5 injury, the following symptoms may present:
Weakness in the deltoid muscle (front and side of the shoulder) and upper arm
Shoulder pain
Numbness along the outside of the upper arm -
This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 46
Incorrect
-
Carbamazepine is contraindicated in which of the following:
Your Answer: Pheochromocytoma
Correct Answer: Atrioventricular block
Explanation:Carbamazepine is contraindicated in:
– People with known hypersensitivity to carbamazepine or structurally related drugs
– People with atrioventricular block (may suppress AV conduction and ventricular automaticity)
– People with a history of bone marrow depression (risk of agranulocytosis and aplastic anaemia)
– People with a history of acute porphyrias
– People taking a monoamine oxidase inhibitor (risk of serotonin syndrome) -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 47
Incorrect
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The most common complication of paracetamol overdose is:
Your Answer: Respiratory depression
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.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 48
Incorrect
-
A patient presents with an adducted eye at rest which cannot abduct past the midline, which of the following cranial nerves is most likely to be affected:
Your Answer: Trochlear nerve
Correct Answer: Abducens nerve
Explanation:Abducens nerve palsies result in a convergent squint at rest (eye turned inwards) with inability to abduct the eye because of unopposed action of the rectus medialis. The patient complains of horizontal diplopia when looking towards the affected side. With complete paralysis, the eye cannot abduct past the midline.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 49
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
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Question 50
Incorrect
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A 18 year old student presents to ED with a headache, fever and photophobia. You suspect meningitis and agree to observe your junior performing a lumbar puncture. What is the highest safest vertebral level to perform lumbar puncture in adults:
Your Answer:
Correct Answer: L3/L4
Explanation:In adults, the spinal cord typically ends between L1/L2 whereas the subarachnoid space extends to approximately the lower border of vertebra S2. Lumbar puncture is performed in the intervertebral space L4/L5 or L3/L4.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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SESSION STATS - PERFORMANCE PER SPECIALTY
