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Question 1
Correct
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Which of the following is first-line for management of status epilepticus:
Your 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 2
Incorrect
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A patient suffers an injury to the nerve that innervates gluteus medius.
The gluteus medius muscle is innervated by which of the following nerves? Select ONE answer only.Your Answer: Inferior gluteal nerve
Correct Answer: Superior gluteal nerve
Explanation:Gluteus minimus is innervated by the superior gluteal nerve.
Gluteus medius is innervated by the superior gluteal nerve.
Gluteus maximus is innervated by the inferior gluteal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 3
Incorrect
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Which of the following best describes the popliteal artery's course?
Your Answer: After exiting the popliteal fossa continues down the posterior leg terminating at the level of the lateral malleolus
Correct Answer: After exiting the popliteal fossa terminates at the lower border of the popliteus muscle
Explanation:The popliteal artery divides into the anterior and posterior tibial arteries at the lower border of the popliteus after exiting the popliteal fossa between the gastrocnemius and popliteus muscles.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 4
Incorrect
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A 21-year-old student presents to the minors area of your Emergency Department with a laceration on his external nose that occurred during sparring in a kickboxing class. The area is bleeding profusely and will require suturing. Pressure is being applied. The laceration extends through some of the nasal muscles.
Motor innervation of the nasal muscles of facial expression is provided by which of the following ? Select ONE answer only.Your Answer: Trigeminal nerve
Correct Answer: Facial nerve
Explanation:The facial nerve (the labyrinthine segment) is the seventh cranial nerve, or simply CN VII. It emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue.
Motor innervation of the nasal muscles of facial expression is provided by the facial nerve (CN VII). -
This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 5
Correct
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A 47-year old male comes to the out-patient department for a painful, right-sided groin mass. Medical history reveals a previous appendectomy 10 years prior. On physical examination, the mass can be reduced superiorly. Also, the mass extends to the scrotum. The initial diagnosis is a hernia.
Among the types of hernia, which is the most likely diagnosis of the case above?Your Answer: Indirect inguinal hernia
Explanation:Inguinal hernias can present with an array of different symptoms. Most patients present with a bulge in the groin area, or pain in the groin. Some will describe the pain or bulge that gets worse with physical activity or coughing. Symptoms may include a burning or pinching sensation in the groin. These sensations can radiate into the scrotum or down the leg. It is important to perform a thorough physical and history to rule out other causes of groin pain. At times an inguinal hernia can present with severe pain or obstructive symptoms caused by incarceration or strangulation of the hernia sac contents. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. The exam is best performed with the patient standing. Visual inspection of the inguinal area is conducted first to rule out obvious bulges or asymmetry in groin or scrotum. Next, the examiner palpates over the groin and scrotum to detect the presence of a hernia. The palpation of the inguinal canal is completed last. The examiner palpates through the scrotum and towards the external inguinal ring. The patient is then instructed to cough or perform a Valsalva manoeuvre. If a hernia is present, the examiner will be able to palpate a bulge that moves in and out as the patient increases intra abdominal pressure through coughing or Valsalva.
Groin hernias are categorized into 2 main categories: inguinal and femoral.
Inguinal hernias are further subdivided into direct and indirect. An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum, and can be reduced superiorly then superolaterally. A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.
A femoral hernia is a protrusion into the femoral ring. The borders of the femoral ring are the femoral vein laterally, Cooper’s ligament posteriorly, the iliopubic tract/inguinal ligament anteriorly and lacunar ligament medially.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 6
Correct
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The pelvic bone is formed by which of the following:
Your Answer: Ilium, ischium and pubis
Explanation:Each pelvic bone is formed by three elements: the ilium (superiorly), the pubis (anteroinferiorly) and the ischium (posteroinferiorly).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 7
Incorrect
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Which of the following muscles inserts into the patella?
Your Answer: The hamstring muscles
Correct Answer: The quadriceps femoris complex
Explanation:The quadriceps femoris muscle translates to “four-headed muscle” from Latin. It bears this name because it consists of four individual muscles; rectus femoris, vastus medialis, vastus lateralis, and vastus intermedius. Out of all four muscles, only the rectus femoris crosses both the hip and knee joints. The others cross only the knee joint. These muscles differ in their origin, but share a common quadriceps femoris tendon which inserts into the patella. The function of the quadriceps femoris muscle is to extend the leg at the knee joint and to flex the thigh at the hip joint.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 8
Incorrect
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A 36-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 extension, but normal hip abduction.
Which of the following muscles was most likely injured in this case?Your Answer: Piriformis
Correct Answer: Gluteus maximus
Explanation:The primary hip extensors are the gluteus maximus and the hamstrings such as the long head of the biceps femoris, the semitendinosus, and the semimembranosus. The extensor head of the adductor magnus is also considered a primary hip extensor.
The hip abductor muscle group is located on the lateral thigh. The primary hip abductor muscles include the gluteus medius, gluteus minimus, and tensor fasciae latae.
The secondary hip abductors include the piriformis, sartorius, and superior fibres of the gluteus maximus. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 9
Correct
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Which of the following statements accurately describes the extensor indicis muscle?
Your Answer: It lacks the juncturae tendinum
Explanation:Extensor indicis is a narrow, elongated muscle found in the posterior compartment of the forearm. It belongs to the deep extensors of the forearm, together with supinator, abductor pollicis longus, extensor pollicis longus, and extensor pollicis brevis muscles. It lacks the juncturae tendinum, which connects the extensor digitorum on the dorsal aspect of the hand.
Extensor indicis can be palpated by applying deep pressure over the lower part of the ulna while the index finger is extended. The main function of extensor indicis involves the extension of the index finger at the metacarpophalangeal and interphalangeal joints. As the index finger is one of the few fingers that have their own separate extensor muscle, it is able to extend independently from other fingers. Additionally, extensor indicis muscle produces a weak extension of the wrist.
Extensor indicis receives its nervous supply from posterior interosseous nerve, a branch of the radial nerve derived from spinal roots C7 and C8. The skin overlying the muscle is supplied by the same nerve, with fibres that stem from the spinal roots C6 and C7.
The superficial surface of the extensor indicis receives arterial blood supply from posterior interosseous branch of the ulnar artery, whereas its deep surface receives blood from perforating branches of the anterior interosseous artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 10
Correct
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A 30-year-old man suffers from an open fracture of his forearm. As a consequence of his injury, the nerve that innervates the pronator quadratus muscle was severed.
Which of the following statements regarding the pronator quadratus muscle is considered correct?Your Answer: Its deep fibres bind the radius and ulna together
Explanation:Pronator quadratus is a deep-seated, short, flat, and quadrilateral muscle with fibres running in a parallel direction.
It arises from the oblique ridge on the anterior surface of the distal fourth of the Ulna. It is inserted in lateral border and anterior surface of the distal fourth of the radius. It is innervated by the anterior interosseous nerve, a branch of the median nerve (C8-T1). It is vascularized by the anterior interosseous artery.
The action of the pronator quadratus muscle along with the pronator teres result in the pronation of the radioulnar joint. Contraction of this muscle pulls the distal end of the radius over the ulna, resulting in the pronation of the radioulnar joint
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 11
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 12
Correct
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Question 13
Incorrect
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Regarding the accessory nerve, which of the following statements is INCORRECT:
Your Answer: The accessory nerve innervates the sternocleidomastoid and the trapezius muscle.
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.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 14
Correct
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A 64-year-old lady attends the emergency department with a known brain tumour. Her left eye is directed outwards and downwards, she can't open it, and her pupil is fixed and dilated. The tumour is most likely compressing which of the following structures:
Your Answer: Oculomotor nerve
Explanation:The oculomotor nerve is the third cranial nerve. It is the main source of innervation to the extraocular muscles and also contains parasympathetic fibres which relay in the ciliary ganglion. Damage to the third cranial nerve may cause diplopia, pupil mydriasis, and/or upper eyelid ptosis. The clinical manifestations of third cranial nerve dysfunction reflect its constituent parts.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 15
Incorrect
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Regarding the lumbar plexus, which of the following is a direct muscular branch?
Your Answer: Nerve to sartorius
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 16
Incorrect
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You are reviewing a patient complaining of loss of vision. Previous images shows a lesion at the optic chiasm. What type of visual field defect are you most likely to see in a lesion at the optic chiasm:
Your Answer: Homonymous hemianopia with macular sparing
Correct Answer: Bitemporal hemianopia
Explanation:A lesion at the optic chiasm will result in a bitemporal hemianopia.
A lesion of the optic nerve will result in ipsilateral monocular visual loss.
A lesion of the optic tract will result in a contralateral homonymous hemianopia. -
This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 17
Incorrect
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An X-ray of a 24-year-old female hockey player who arrives at the hospital with a left foot injury reveals an avulsion fracture of the fifth metatarsal tuberosity. Which of the following muscles is most likely responsible for the movement of the fractured fragment?
Your Answer: Fibularis longus
Correct Answer: Fibularis brevis
Explanation:An avulsion fracture of the base of the fifth metatarsal happens when the ankle is twisted inwards.
When the ankle is twisted inwards a muscle called the fibularis brevis contracts to stop the movement and protect the ligaments of the ankle.
The base of the fifth metatarsal is where this muscle is attached. The group of lateral leg muscles that function to plantarflex the foot includes the fibularis brevis and the fibularis longus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 18
Correct
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A fracture on which of the following structures is associated with a posterior elbow dislocation?
Your Answer: Radial head
Explanation:Fracture dislocations of the elbow appear extremely complex, and identification of the basic injury patterns can facilitate management. The simplest pattern of elbow fracture dislocation is posterior dislocation of the elbow with fracture of the radial head. Addition of a coronoid fracture, no matter how small, to elbow dislocation and radial head fracture is called the terrible triad of the elbow.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 19
Incorrect
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Regarding the abductor pollicis longus, which of the following statements is true?
Your Answer: Its tendons form the medial border of the anatomical snuffbox
Correct Answer: It extends the thumb at the carpometacarpal joint
Explanation:Abductor pollicis longus is a muscle found in the posterior compartment of the forearm. It is one of the five deep extensors in the forearm, along with the supinator, extensor pollicis brevis, extensor pollicis longus and extensor indicis.
Abductor pollicis longus is innervated by the posterior interosseous nerve (C7, C8), which is a continuation of the deep branch of the radial nerve. The radial nerve is a branch of the posterior cord of the brachial plexus.
Blood supply to the abductor pollicis longus muscle comes from the interosseous branches of the ulnar artery.
Acting alone or with abductor pollicis brevis, abductor pollicis longus pulls the thumb away from the palm. More specifically, it produces (mid-) extension and abduction of the thumb at the first metacarpophalangeal joint. This action is seen in activities such as bowling and shovelling.
Working together with the long and short extensors of the thumb, the muscle also helps to fully extend the thumb at the metacarpophalangeal joint. This action is important for loosening the hand grip, for example, when letting go of objects previously being held. Abductor pollicis longus also helps to abduct the hand (radial deviation) at the radiocarpal joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 20
Incorrect
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Which of the following accurately describes the extensor pollicis brevis muscle?
Your Answer: It flexes the thumb at the carpometacarpal joint
Correct Answer: It lies on the medial side of abductor pollicis longus
Explanation:Extensor pollicis brevis is a short and slender muscle located in the posterior compartment of the forearm, extending from the posterior surface of radius to the proximal phalanx of thumb. It is one of the deep extensors of the forearm, together with supinator, abductor pollicis longus, extensor pollicis longus and extensor indicis muscles.
Extensor pollicis brevis is a deep extensor of the thumb that lies deep to extensor digitorum muscle. It sits directly medial to abductor pollicis longus and posterolateral to extensor pollicis longus muscle. Just above the wrist, extensor pollicis brevis obliquely crosses the tendons of extensor carpi radialis brevis and extensor carpi radialis longus muscles.
Extensor pollicis brevis is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).
Extensor pollicis brevis receives its blood supply by posterior interosseous artery and perforating branches from the anterior interosseous artery, which are the branches of common interosseous artery. The common interosseous artery arises immediately below the tuberosity of radius from the ulnar artery.
Together with extensor pollicis longus, extensor pollicis brevis is in charge of extension of the thumb in the first metacarpophalangeal joint. It also extends the thumb in the carpometacarpal joint of the thumb. This movement is important in the anatomy of the grip, as it enables letting go of an object. As it crosses the wrist, extensor pollicis brevis also participates in the extension and abduction of this joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 21
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 22
Incorrect
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A tumour is discovered behind the pectinate line during an examination of a 72-year-old patient with rectal bleeding. Which of the following is the lymphatic drainage of the pectinate line?
Your Answer: Preaortic nodes
Correct Answer: Superficial inguinal nodes
Explanation:The pectinate line is known as the watershed line because it divides the anal canal into two sections. Below the pectinate line, lymphatic drainage drains to the superficial inguinal lymph nodes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 23
Correct
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A 43-year old male is taken to the Emergency Room for a lacerated wound on the abdomen, situated above the umbilicus. A short segment of the small bowel has herniated through the wound.
Which of these anatomic structures is the most superficial structure injured in the case above?Your Answer: Camper’s fascia
Explanation:The following structures are the layers of the anterior abdominal wall from the most superficial to the deepest layer:
Skin
Fatty layer of the superficial fascia (Camper’s fascia)
Membranous layer of the superficial fascia (Scarpa’s fascia)
Aponeurosis of the external and internal oblique muscles
Rectus abdominis muscle
Aponeurosis of the internal oblique and transversus abdominis
Fascia transversalis
Extraperitoneal fat
Parietal peritoneum -
This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 24
Incorrect
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A 55 year old man presents to ED complaining of leg weakness. Your colleague has examined the patient and suspects femoral nerve palsy. Which of the following clinical features would you LEAST expect to see on examination of this patient:
Your Answer: Weakness of hip flexion
Correct Answer: Weakness of hip extension
Explanation:Damage to the femoral nerve results in weakness of hip flexion and knee extension and loss of sensation over the anterior thigh and the anteromedial knee, medial leg and medial foot.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 25
Correct
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A 44 year old woman is brought to ED having fallen down the stairs and injured her right arm. On examination she is unable to abduct her arm normally, and has weakness of lateral rotation. She has sensory loss over the lateral aspect of her upper arm. Which of the following injuries is most likely to produce this pattern of injury:
Your Answer: Surgical neck of humerus fracture
Explanation:Damage to the axillary nerve will result in loss of abduction past about 15 degrees and weakness of lateral rotation due to paralysis of the deltoid and teres minor and loss of sensation over the regimental badge area on the upper lateral arm. The axillary nerve is most likely injured in fracture of the surgical neck of the humerus due to its course where it winds around this region together with the posterior humeral circumflex vessels.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 26
Incorrect
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Which of the following statements is true regarding a pleural aspiration?
Your Answer: The pleural cavity usually contains between 50-100 ml of lubricating fluid
Correct Answer: The needle should be inserted just above the upper border of the chosen rib
Explanation:Pleural aspiration describes a procedure whereby pleural fluid or air may be aspirated via a system inserted temporarily into the pleural space. This may be for diagnostic purposes (usually removing 20–50 ml fluid) or therapeutic to relieve symptoms. In the literature it is varyingly called thoracocentesis, thoracentesis or pleural aspiration.
In determining the correct patient position and site of insertion, it is important for the operator to be aware of the normal anatomy of the thorax and the pathology of the patient. Patient position is dependent on the operator preference and the site of the pathology. In the case of a posterior lying locule, this may be specific to the image-guided spot where fluid is most likely to be obtained. In most circumstances, however, the site of insertion of the needle is either in the triangle of safety or the second intercostal space in the midclavicular line. The patient may therefore either sit upright leaning forward with arms elevated but resting on a table or bed, thereby exposing the axilla, or lying on a bed in a position. The needle is inserted in the space just above the chosen rib to avoid damaging the neurovascular bundle. It is common practice to insert the needle more posteriorly for a pleural aspiration, but it should be noted that the neurovascular bundle may not be covered by the lower flange of the rib in this position and a more lateral or anterior site of insertion is considered safer.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 27
Correct
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In adults, there are normally how many teeth:
Your Answer: 32
Explanation:In adults, there are 32 teeth, 16 in the upper jaw and 16 in the lower jaw. On each side in both upper and lower arches, there are two incisors, one canine, two premolars and three molar teeth.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 28
Correct
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You suspect that your patient with polycystic kidney disease has developed a berry aneurysm as a complication of his disease. The patient complains of a sudden, severe headache. You are guessing subarachnoid haemorrhage secondary to a ruptured berry aneurysm as the cause of his severe headaches. What is the most likely location of his aneurysm?
Your Answer: Anterior communicating artery
Explanation:One of the complications that polycystic kidney disease may cause is the development of a brain aneurysm.
A berry aneurysm is the most common type of brain aneurysm.
The Circle of Willis, where the major blood vessels meet at the base of the brain, is where it usually appears. The most common junctions of the Circle of Willis where an aneurysm may occur include the anterior communicating artery (35%), internal carotid artery (30%), the posterior communicating artery and the middle cerebral artery (22%), and finally, the posterior circulation sites, most commonly the basilar artery tip.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 29
Incorrect
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A 30-year-old man suffers from an open femoral shaft fracture after being involved in a road traffic accident. As a consequence of his injury, the nerve that was damaged innervates the popliteus muscle.
In which of the following nerves is the popliteus muscle innervated by?Your Answer: Sciatic nerve
Correct Answer: Tibial nerve
Explanation:The popliteus muscle is innervated by the tibial nerve (L4, 5 and S1).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 30
Correct
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A 25 year old man has sustained a fracture to the surgical neck of the humerus after falling from his bike. Examination suggests an axillary nerve injury. The clinical features expected to be seen in this patient are:
Your Answer: Weakness of shoulder abduction
Explanation:Axillary nerve injury results in:
1. weakness of arm abduction (paralysis of deltoid),
2. weakness of lateral rotation of the arm (paralysis of teres minor)
3. loss of sensation over the regimental badge area. -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 31
Incorrect
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A patient suffers a stab wound to the neck. The entry point of the blade is situated within the anterior triangle of the neck.
Which of the following muscles is most likely to be involved? Select ONE answer only.Your Answer: Sternocleidomastoid
Correct Answer: Sternohyoid
Explanation:The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:
Muscles: thyrohyoid, sternothyroid, sternohyoid muscles
Organs: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid gland
Arteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteries
Veins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veins
Nerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerveThe posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.
Contents:
Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodes
Nerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus -
This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 32
Incorrect
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The most common site of ectopic pregnancy is?
Your Answer: Infundibulum of Fallopian tube
Correct Answer: Ampulla of Fallopian tube
Explanation:Nearly 95% of ectopic pregnancies are implanted in the various segments of the fallopian tube and give rise to fimbrial, ampullary, isthmic, or interstitial tubal pregnancies. The ampulla is the most frequent site, followed by the isthmus. The remaining 5% of non tubal ectopic pregnancies implant in the ovary, peritoneal cavity, cervix, or prior caesarean scar.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 33
Incorrect
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You are taking care of a 55-year-old male patient who is a weightlifter. He is suspected of having a direct inguinal hernia. Where would this hernia appear?
Your Answer: Lateral to the inferior epigastric artery
Correct Answer: Medial to the inferior epigastric artery
Explanation:A direct inguinal hernia is a form of groin hernia that occurs when abdominal viscera protrude through a weakness in the posterior wall of the inguinal canal, notably through Hesselbach’s triangle, medial to the inferior epigastric veins.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 34
Correct
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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.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 35
Incorrect
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A 35-year-old man suffers an open fracture of his forearm. The nerve that innervates the pronator quadratus muscle is damaged as a consequence of this injury.
Which of the following nerves has been damaged in this case? Select ONE answer only.Your Answer: The median nerve
Correct Answer: The anterior interosseous nerve
Explanation:Pronator quadratus is a small, square-shaped muscle that lies in the anterior compartment of the forearm. It arises from the distal fourth of the anterior surface of the ulna and inserts into the distal fourth of the anterior surface of the radius.
Pronator quadratus is innervated by the anterior interosseous nerve. It receives its blood supply from the anterior interosseous artery, which is a branch of the common interosseous artery, which in turn is a branch of the ulnar artery.
The main action of pronator quadratus is to assist pronator teres with pronation of the forearm. The deep fibres bind the radius and ulna together.
The pronator quadratus muscle highlighted in blue (adapted from Gray’s Anatomy) -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 36
Incorrect
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Which of the following nerves supply the superficial head of the flexor pollicis brevis muscle?
Your Answer: The anterior interosseous nerve
Correct Answer: The recurrent branch of the median nerve
Explanation:The two heads of the flexor pollicis brevis usually differ in their innervation. The superficial head of flexor pollicis muscle receives nervous supply from the recurrent branch of the median nerve, whereas the deep head receives innervation from the deep branch of the ulnar nerve, derived from spinal roots C8 and T1.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 37
Incorrect
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You have been asked to give a tutorial on common upper limb neurology to a group of medical students. You use the example of a man falling from a balcony onto spiked fencing, sustaining a puncture wound to the axilla. This results in an injury to the musculocutaneous nerve. Which of the following clinical features would you LEAST expect to see in this patient:
Your Answer: Loss of sensation to skin over the lateral forearm
Correct Answer: Weakness of forearm pronation
Explanation:Flexion of the arm and flexion and supination of the forearm are weakened but not lost entirely due to the actions of the pectoralis major and deltoid, the brachioradialis and the supinator muscles respectively. There is loss of sensation over the lateral aspect of the forearm. Forearm pronation would not be affected as this is primarily produced by the pronator quadratus and pronator teres muscles, innervated by the median nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 38
Correct
-
Which of the following is a well recognised adverse effect of prochlorperazine:
Your 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.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 39
Incorrect
-
Which coronary artery is mostly likely affected if an ECG shows a tombstone pattern in leads V2, V3 and V4?
Your Answer: Left circumflex artery
Correct Answer: Left anterior descending artery
Explanation:Tombstoning ST elevation myocardial infarction can be described as a STEMI characterized by tombstoning ST-segment elevation. This myocardial infarction is associated with extensive myocardial damage, reduced left ventricle function, serious hospital complications and poor prognosis. Tombstoning ECG pattern is a notion beyond morphological difference and is associated with more serious clinical results.
Studies have shown that tombstoning is more commonly found in anterior than non-anterior STEMI, thus, higher rates of left anterior descending artery disease are observed in patients with tombstoning pattern.
The following ECG leads determine the location and vessels involved in myocardial infarction:
ECG Leads Location Vessel involved
V1-V2 Septal wall Left anterior descending
V3-V4 Anterior wall Left anterior descending
V5-V6 Lateral wall Left circumflex artery
II, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%)
I, aVL High lateral wall Left circumflex artery
V1, V4R Right ventricle Right coronary artery
V7-V9 Posterior wall Right coronary artery -
This question is part of the following fields:
- Anatomy
- Thorax
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Question 40
Correct
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After an accidental fall, a 75-year-old patient complains of neck pain and weakness in his upper limbs. Select the condition that most likely caused the neck pain and weakness of the upper limbs of the patient.
Your Answer: Central cord syndrome
Explanation:The cervical spinal cord is the section of the spinal cord that goes through the bones of the neck.
It is injured incompletely in the central cord syndrome (CCS). This will result in arm weakness more than leg weakness.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 41
Incorrect
-
A 43-year-old woman presented to the emergency room after an incident of slipping and falling onto her back and left hip. Upon physical examination, it was noted that she has pain on hip abduction, but normal hip extension.
Which of the following muscles was most likely injured in this case?Your Answer: Gluteus maximus
Correct Answer: Gluteus medius
Explanation:The primary hip extensors are the gluteus maximus and the hamstrings such as the long head of the biceps femoris, the semitendinosus, and the semimembranosus. The extensor head of the adductor magnus is also considered a primary hip extensor.
The hip abductor muscle group is located on the lateral thigh. The primary hip abductor muscles include the gluteus medius, gluteus minimus, and tensor fasciae latae.
The secondary hip abductors include the piriformis, sartorius, and superior fibres of the gluteus maximus. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 42
Correct
-
The most important nerve for plantar flexion of the foot at the ankle joint is:
Your Answer: Tibial nerve
Explanation:Muscles of the posterior compartment of the leg, innervated by the tibial nerve, perform plantar flexion of the foot at the ankle joint. The fibularis longus (innervated by the superficial fibular nerve) assists in plantar flexion but is not the most important.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 43
Incorrect
-
A patient suffers a lower limb fracture that causes damage to the nerve that innervates peroneus brevis.
Peroneus brevis receives its innervation from which of the following nerves? Select ONE answer only.Your Answer: Deep peroneal nerve
Correct Answer: Superficial peroneal nerve
Explanation:Peroneus brevis is innervated by the superficial peroneal nerve.
Peroneus longus is innervated by the superficial peroneal nerve.
Peroneus tertius is innervated by the deep peroneal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 44
Incorrect
-
A 25-year-old footballer develops pain and stiffness in his thigh. A diagnosis of iliopsoas syndrome is made.
Iliacus is innervated by which of the following nerves? Select ONE answer only.Your Answer: Sciatic nerve
Correct Answer: Femoral nerve
Explanation:Iliacus is innervated by the femoral nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 45
Incorrect
-
Which of these drugs may reduce the efficacy of contraception?
Your Answer: Sodium valproate
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 46
Incorrect
-
After what time period should intravenous phenytoin be used as second-line treatment of status epilepticus?
Your Answer: 10 minutes
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 47
Incorrect
-
Which of the following statements is true regarding the extensor pollicis longus?
Your Answer:
Correct Answer: It is innervated by the posterior interosseous nerve
Explanation:Extensor pollicis longus is part of the deep extensors of the forearm together with extensor pollicis brevis, abductor pollicis longus, extensor indicis and supinator muscles. It is located on the posterior aspect of forearm, extending from the middle third of the ulna, and adjacent interosseous membrane, to the distal phalanx of the thumb.
Extensor digitorum is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).
Extensor pollicis brevis receives its blood supply from the posterior interosseous artery and perforating branches of the anterior interosseous artery.
The main action of extensor pollicis longus is extension of the thumb at the metacarpophalangeal and interphalangeal joints. Extension at the metacarpophalangeal joint occurs in synergy with extensor pollicis brevis muscle. When the thumb reaches the full extension or abduction, extensor pollicis longus can also assist in adduction of the thumb.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 48
Incorrect
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A 27-year-old man presents with a laceration of his forearm that severed the nerve that innervates flexor carpi radialis.
Which of the following nerves has been damaged in this case? Select ONE answer only.Your Answer:
Correct Answer: The median nerve
Explanation:Flexor carpi radialis is innervated by the median nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 49
Incorrect
-
A 29-year-old man has been complaining about his recent headaches. Detailed history was taken and a neurological examination was performed.
Which of the following cranial nerves is correctly paired with its lesion?Your Answer:
Correct Answer: The oculomotor nerve: the eye appears to look ‘down and out’
Explanation:The following are the lesions of the cranial nerves:
1. Olfactory nerve (I)
Reduced taste and smell, but not to ammonia which stimulates the pain fibres carried in the trigeminal nerve2. Optic nerve (II)
Manifested by visual field defects, pupillary abnormalities, optic neuritis, optic atrophy, papilledema3. Oculomotor nerve (III)
A fixed, dilated pupil which doesn’t accommodate, ptosis, complete internal ophthalmoplegia (masked by ptosis), unopposed lateral rectus causes outward deviation of the eye. If the ocular sympathetic fibres are also affected behind the orbit, the pupil will be fixed but not dilated.4. Trochlear nerve (IV)
Diplopia due to weakness of downward and inward eye movement. The most common cause of a pure vertical diplopia. The patient tends to compensate by tilting the head away from the affected side.5. Trigeminal nerve (V)
Reduced sensation or dysesthesia over the affected area. Weakness of jaw clenching and side-to-side movement. If there is a lower motor neuron (LMN) lesion, the jaw deviates to the weak side when the mouth is opened. There may be fasciculation of temporalis and masseter.6. Abducens nerve (VI)
Inability to look laterally. The eye is deviated medially because of unopposed action of the medial rectus muscle.7. Facial nerve (VII)
Facial weakness. In an LMN lesion the forehead is paralysed – the final common pathway to the muscles is destroyed; whereas the upper facial muscles are partially spared in an upper motor neurone (UMN) lesion because of alternative pathways in the brainstem. There appear to be different pathways for voluntary and emotional movement. CVAs usually weaken voluntary movement, often sparing involuntary movements (e.g., spontaneous smiling). The much rarer selective loss of emotional movement is called mimic paralysis and is usually due to a frontal or thalamic lesion.8. Vestibulocochlear nerve (VIII)
Unilateral sensorineural deafness, tinnitus. Slow-growing lesions seldom present with vestibular symptoms as compensation has time to occur.9. Glossopharyngeal nerve (IX)
Unilateral lesions do not cause any deficit because of bilateral corticobulbar connections. Bilateral lesions result in pseudobulbar palsy. These nerves are closely interlinked.10. Vagus nerve (X)
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’.11. Accessory nerve (XI)
Weakness and wasting of sternocleidomastoid and trapezius muscles12.Hypoglossal nerve (XII)
An LMN lesion produces wasting of the ipsilateral side of the tongue, with fasciculation; and on attempted protrusion the tongue deviates towards the affected side, but the tongue deviates away from the side of a central lesion. -
This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 50
Incorrect
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A 43-year old male is taken to the Emergency Room for a lacerated wound on the abdomen, situated above the umbilicus. A short segment of the small bowel has herniated through the wound.
Which of these anatomic structures is the deepest structure injured in the case above?Your Answer:
Correct Answer: Transversalis fascia
Explanation:The following structures are the layers of the anterior abdominal wall from the most superficial to the deepest layer:
Skin
Fatty layer of the superficial fascia (Camper’s fascia)
Membranous layer of the superficial fascia (Scarpa’s fascia)
Aponeurosis of the external and internal oblique muscles
Rectus abdominis muscle
Aponeurosis of the internal oblique and transversus abdominis
Fascia transversalis
Extraperitoneal fat
Parietal peritoneum -
This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 51
Incorrect
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Due to a traffic accident, a male patient was unable to lift his arm, indicating an injury at the glenohumeral joint. Based on the patient’s current condition, which nerve or nerves are may likely damaged?
Your Answer:
Correct Answer: Axillary and suprascapular nerve
Explanation:A suprascapular nerve injury causes numbness in the shoulder, as well as weakness in abduction and external rotation.
Damage to the axillary nerve can result in shoulder or arm muscle weakness, as well as difficulty lifting the arm. This is because the deltoid and supraspinatus muscles, which are innervated by the axillary and suprascapular nerves, are responsible for abduction of the arm at the shoulder joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 52
Incorrect
-
A well recognised adverse effect of metoclopramide is which of the following?
Your Answer:
Correct Answer: Acute dystonic reaction
Explanation:Side effects of metoclopramide are commonly associated with extrapyramidal effects and hyperprolactinemia. Therefore its use must be limited to short-term use. Metoclopramide can induce acute dystonic reactions which involve facial and skeletal muscle spasms and oculogyric crises. These dystonic effects are more common in the young girls and young women, and in the very old. These symptoms usually occur shortly after starting treatment with this drug and subside within 24 hours of stopping it. Abortion of dystonic attacks can be carried out by injection of an antiparkinsonian drug like procyclidine.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 53
Incorrect
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You are reviewing a patient following a fall from a horse. You suspect they may have an Erb's palsy as a result of a brachial plexus injury. Regarding Erb's palsy, which one of the following statements is CORRECT:
Your Answer:
Correct Answer: Erb's palsy may result in loss of sensation of the regimental badge area.
Explanation:Erb’s palsy is caused by damage to the C5 and C6 nerve roots and thus primarily involves the musculocutaneous, suprascapular and axillary nerves. It commonly result from an excessive increase in the angle between the neck and the shoulder e.g. a person thrown from a motorbike or horseback or during a difficult birth. There is loss or weakness of abduction, lateral rotation and flexion of the arm and flexion and supination of the forearm and loss of sensation on the lateral arm. A characteristic ‘Waiter’s tip’ deformity may be present where the limb hangs limply by the side, medially rotated by the unopposed action of pectoralis major with the forearm pronated due to paralysis of the biceps brachii.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 54
Incorrect
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Which of the following clinical features is most suggestive of a lesion of the occipital lobe:
Your Answer:
Correct Answer: Homonymous hemianopia
Explanation:Homonymous hemianopia is a visual field defect involving either the two right or the two left halves of the visual fields of both eyes. It is caused by lesions of the retrochiasmal visual pathways, ie, lesions of the optic tract, the lateral geniculate nucleus, the optic radiations, and the cerebral visual (occipital) cortex
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 55
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:
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 56
Incorrect
-
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:
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 57
Incorrect
-
Needle thoracentesis in a patient with a tension pneumothorax is performed at which anatomical landmark?
Your Answer:
Correct Answer: 4th or 5th intercostal space mid-axillary line
Explanation:Tension pneumothorax is a fatal disease causing acute and severe compromise of patients’ ventilation and circulation, in which case immediate decompression is necessary for better prognosis [6]. A previous study has shown that the incidence of tension pneumothorax varies from 0.2% to 1.7% in patients with prehospital trauma. Several trauma guidelines recommend needle thoracostomy as a life-saving intervention, with placement in the second intercostal space at the midclavicular line (second ICS-MCL), the fourth intercostal space at the anterior axillary line (fourth ICS-AAL), or the fifth intercostal space at the midaxillary line (fifth ICS-MAL) for tension pneumothorax in a prehospital environment.
In 2018, according to newly issued the Advanced Trauma Life Support (ATLS) guidelines, the fifth ICS-MAL was suggested as the preferred place, and an 8 cm needle rather than the common 5 cm needle was proved to increase success rate of adults’ decompression.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 58
Incorrect
-
A 12-year old boy is taken to the emergency room after accidentally falling off the monkey bars. Witnesses of the accident reported that, when the patient fell, he hit his right hand on a bar and a loud thump was heard. On examination, the hand is oedematous, tender and erythematous. On ultrasound, a rupture of the flexor carpi ulnaris is noted.
Which of the following statements is true regarding the flexor carpi ulnaris?Your Answer:
Correct Answer: It acts to adduct the hand at the wrist joint
Explanation:Flexor carpi ulnaris is a fusiform muscle located in the anterior compartment of the forearm. It belongs to the superficial flexors of the forearm, along with pronator teres, palmaris longus, flexor digitorum superficialis and flexor carpi radialis. Flexor carpi ulnaris is the most medial of the superficial flexors.
Innervation of the flexor carpi ulnaris muscle is from the brachial plexus via the ulnar nerve (C7-T1).
Flexor carpi ulnaris receives its arterial blood supply via three different routes. Proximally, a branch of the posterior ulnar recurrent artery supplies the muscle as it passes between the humeral and ulnar heads. Branches of the ulnar artery supply the middle and distal parts of the muscle, with an accessory supply also present distally via the inferior ulnar collateral artery.
Due to its position and direction in the forearm, flexor carpi ulnaris can move the hand sideways as well as flexing it. Contracting with flexor carpi radialis and palmaris longus, flexor carpi ulnaris produces flexion of the hand at the wrist joint. However, when it contracts alongside the extensor carpi ulnaris muscle in the posterior compartment, their counteracting forces produce adduction of the hand at the wrist, otherwise known as ulnar deviation or ulnar flexion
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 59
Incorrect
-
A 45-year old man presented to the emergency room with complains of chest pain and breathlessness. Upon history taking and examination, it was discovered that he had a right-sided spontaneous pneumothorax and had a failed attempt at pleural aspiration. The pneumothorax is still considerable in size, but he remains breathless. A Seldinger chest drain was inserted but it started to drain frank blood shortly after.
Which of the following complications is most likely to have occurred?Your Answer:
Correct Answer: Intercostal artery laceration
Explanation:Injury to the intercostal artery (ICA) is an infrequent but potentially life-threatening complication of all pleural interventions.
Traditional anatomy teaching describes the ICA as lying in the intercostal groove, protected by the flange of the rib. This is the rationale behind the recommendation to insert needles just above the superior border of the rib. Current recommendations for chest drain insertion suggest that drains should be inserted in the ‘safe triangle’ in order to avoid the heart and the mediastinum and be above the level of the diaphragm.
The safe triangle is formed anteriorly by the lateral border of the pectoralis major, laterally by the lateral border of the latissimus dorsi, inferiorly by the line of the fifth intercostal space and superiorly by the base of the axilla. Imaging guidance also aids in the safety of the procedure.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 60
Incorrect
-
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:
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 61
Incorrect
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A 30 year old man stabbed in the upper arm presents to the Emergency Department and you perform a vascular examination.
The brachial pulse can be best palpated at ?Your Answer:
Correct Answer: In the antecubital fossa, medial to the tendon of the biceps brachii
Explanation:The brachial artery can be palpated in the antecubital fossa, medial to the tendon of the biceps brachii muscle.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 62
Incorrect
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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:
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.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 63
Incorrect
-
Which segment of the colon is most likely to be affected in diverticulitis?
Your Answer:
Correct Answer: Sigmoid colon
Explanation:Diverticulitis refers to inflammation and infection associated with a diverticulum and is estimated to occur in 10% to 25% of people with diverticulosis. Peridiverticular and pericolic infection results from a perforation (either macroscopic or microscopic) of a diverticulum, which leads to contamination, inflammation, and infection. The spectrum of disease ranges from mild, uncomplicated diverticulitis that can be treated in the outpatient setting, to free perforation and diffuse peritonitis that requires emergency laparotomy. Most patients present with left sided abdominal pain, with or without fever, and leucocytosis. The most common location for diverticulitis is the sigmoid colon.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 64
Incorrect
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Following a road traffic collision, a patient sustains damage to the long thoracic nerve. Which of the following clinical findings would you most expect to see on examination:
Your Answer:
Correct Answer: Winged scapula deformity
Explanation:Damage to the long thoracic nerve results in weakness/paralysis of the serratus anterior muscle. Loss of function of this muscle causes the medial border, and particularly the inferior angle, of the scapula to elevate away from the thoracic wall, resulting in the characteristic ‘winging’ of the scapula. This deformity becomes more pronounced if the patient presses the upper limb against a wall. Furthermore, normal elevation of the arm is no longer possible.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 65
Incorrect
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A 36-year-old man who works in a farm presents with a deep laceration over the palm of his hand. A median nerve block was performed at his wrist to facilitate wound exploration and closure.
Which of the following statements regarding median nerve blocks at the wrist is considered correct?Your Answer:
Correct Answer: The needle should be inserted approximately 2.5 cm proximal to flexor retinaculum
Explanation:A median nerve block is a simple, safe, and effective method of obtaining anaesthesia to the palmar aspect of the thumb, index finger, middle finger, radial portion of the palm and ring finger. The median nerve lies deep to the flexor retinaculum and about one centimetre under the skin of the volar wrist.
The palmaris longus tendon lies superficial to the retinaculum and is absent in up to 20% of patients.
The median nerve is located slightly lateral (radial) to the palmaris longus tendon and medial (ulnar) to the flexor carpi radialis tendon.The procedure is as follows:
– Check sensation and motor function of the median nerve. Wear gloves and use appropriate barrier precautions.
– Locate the flexor carpi radialis and palmaris longus tendons, which become prominent when the patient flexes the wrist against resistance. The palmaris longus tendon is usually the more prominent of the two tendons.
– Needle-entry site: The needle will be inserted adjacent to the radial (lateral) border of the palmaris longus tendon just proximal to the proximal wrist crease. If the palmaris longus tendon is absent, the needle-entry site is about 1 cm ulnar to the flexor carpi radialis tendon.
– Cleanse the site with antiseptic solution. Place a skin wheal of anaesthetic, if one is being used, at the needle-entry site.
– Insert the needle perpendicularly through the skin and advance it slowly until a slight pop is felt as the needle penetrates the flexor retinaculum. When paraesthesia in the distribution of the median nerve confirms proper needle placement, withdraw the needle 1 to 2 mm.
– Aspirate to exclude intravascular placement and then slowly (i.e., over 30 to 60 seconds) inject about 3 mL of anaesthetic. If the patient does not feel paraesthesia, redirect the needle in an ulnar direction, under the palmaris longus tendon. If paraesthesia is still not felt, slowly inject 3 to 5 mL of anaesthetic in the proximity of the nerve 1 cm deep to the tendon.
– Allow about 5 to 10 minutes for the anaesthetic to take effect. -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 66
Incorrect
-
When inserting a Seldinger chest drain for management of pneumothorax, the 'safe triangle' should be identified. Which of the following forms the inferior border of the 'safe triangle'?
Your Answer:
Correct Answer: 5 th intercostal space
Explanation:Care and management of the thoracostomy tubes (chest tubes) are subject to the direction and practice pattern of the responsible physician. Therefore, it is difficult to make a “one size fits all” set of instructions about the specific management recommendations for all chest tubes. It is recommended to discuss specific expectations for management with the patient’s attending physician. Facility specific Clinical Practice Guidelines (CPGs) may provide further guidance for one’s practice.
Placement of the appropriately sized chest tube is performed on the affected side. The typical landmark for placement is the 4th or 5th intercostal space (nipple line for males, inframammary fold for females) at the anterior axillary line. The space above the 5th intercostal space and below the base of the axilla that is bordered posteriorly by the trapezius and anteriorly by the pectoralis muscle has recently been described as the safe triangle. Tubes are positioned anteriorly for pneumothoraces and posteriorly for fluid processes.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 67
Incorrect
-
Elevation of the eyeball is primarily produced by which of the following muscles:
Your Answer:
Correct Answer: Superior rectus and inferior oblique
Explanation:Elevation of the eyeball is produced by the superior rectus and the inferior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 68
Incorrect
-
Which of the following movements does the iliacus muscle produce?
Your Answer:
Correct Answer: Flexion of the thigh at the hip joint
Explanation:The iliacus flexes the thigh at the hip joint when the trunk is stabilised. It flexes the trunk against gravity when the body is supine.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 69
Incorrect
-
A man presents to the emergency department with an injury that has damaged the opponens pollicis muscle.
Which of the following statements regarding the opponens pollicis muscle is considered correct?Your Answer:
Correct Answer: It flexes the first metacarpal bone at the carpometacarpal joint
Explanation:Opponens pollicis is a muscle of thenar eminence, it is triangular in shape and lies deep to flexor pollicis brevis and abductor pollicis brevis. It originates from the flexor retinaculum, tubercles of scaphoid and trapezium, abductor pollicis longus tendon.
Its insertion is in the radial side of the base of proximal phalanx of thumb. It is supplied by the median nerve (C8, T1). It receives blood supply from superficial arch.
It flexes the metacarpal bone medially across the palm, also rotating it medially, causing opposition, the palmar aspect of the terminal segment of thumb contacts the flexor aspects of any other digit.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 70
Incorrect
-
Regarding the intervertebral disc, which of the following statements is CORRECT:
Your Answer:
Correct Answer: In L4 - L5 disc herniation, the L5 spinal nerve root is the most commonly affected.
Explanation:A posterolateral herniation of the disc at the L4 – L5 level would be most likely to damage the fifth lumbar nerve root, not the fourth lumbar nerve root, due to more oblique descending of the fifth lumbar nerve root within the subarachnoid space.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 71
Incorrect
-
CSF is reabsorbed from subarachnoid space via which of the following structures:
Your Answer:
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 72
Incorrect
-
Which of the following is a contraindication for aspirin?
Your Answer:
Correct Answer: Children under 16 years
Explanation:Aspirin contraindications include: hypersensitivity to NSAIDs; asthma, rhinitis, and nasal polyps; and usage in children or teens.
There is little evidence of allergic cross-reactivity for salicylates. However, due to similarities in chemical structure and/or pharmacologic activities, the possibility of cross-sensitivity cannot be completely ruled out. -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 73
Incorrect
-
Which of the following is a contraindication to the use of opioid analgesics:
Your Answer:
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 74
Incorrect
-
A 35 year old patient presents to ED having sustained an injury to his right hand whilst playing cricket. He is unable to fully straighten his right middle finger as the distal phalanx remains flexed. Which of the following structures within the digit was most likely injured:
Your Answer:
Correct Answer: Insertion of terminal extensor digitorum tendon
Explanation:Damage to the insertion of the terminal extensor digitorum tendon would result in loss of extension at the distal interphalangeal joint causing a fixed flexion deformity, called the Mallet deformity.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 75
Incorrect
-
A 34-year-old man presented to the emergency room after being involved in a road traffic accident. Upon observation and examination, it was noted that he was hypotensive and has muffled heart sounds. It was suspected that he has pericardial effusion, so an emergency pericardiocentesis was to be performed.
In performing pericardiocentesis for suspected pericardial effusion, which of the following anatomical sites are at risk of being punctured?Your Answer:
Correct Answer: 1 cm below the left xiphocostal angle
Explanation:Pericardiocentesis is a procedure done to remove fluid build-up in the sac around the heart known as the pericardium. The pericardium can be tapped from almost any reasonable location on the chest wall. However, for the usual blind pericardiocentesis, the subxiphoid approach is preferred. Ideally, 2-D echocardiography is used to guide needle insertion and the subsequent path of the needle/catheter.
In the subxiphoid approach, the needle is inserted 1 cm inferior to the left xiphocostal angle with an angle of 30 degrees from the patient’s chest with a direction towards the left mid-clavicle.
The fingers may sense a distinct give when the needle penetrates the parietal pericardium. Successful removal of fluid confirms the needle’s position.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 76
Incorrect
-
A 24-year-old waiter cuts his hand on a dropped plate that smashed and damages the nerve that innervates opponens digiti minimi.
The opponens digiti minimi muscle is innervated by which of the following nerves? Select ONE answer only.Your Answer:
Correct Answer: The deep branch of the ulnar nerve
Explanation:Opponens digiti minimi is a triangular-shaped muscle in the hand that forms part of the hypothenar eminence. It originates from the hook of the hamate bone and the flexor retinaculum and inserts into the medial border of the 5thmetacarpal.
Opponens digiti minimi is innervated by the deep branch of the ulnar nerve and receives its blood supply from the ulnar artery.
Opponens digiti minimi draws the fifth metacarpal bone anteriorly and rotates it, bringing the fifth digiti into opposition with the thumb. -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 77
Incorrect
-
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:
Correct 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 78
Incorrect
-
A 16-year old boy is brought to the emergency room after suffering a traffic accident. Upon examination, there is noted ipsilateral loss of proprioception and vibration, ipsilateral motor loss, and contralateral loss of pain and temperature sensation. A spinal cord injury is given as a diagnosis.
Which of the following is the most probable cause of this manifestation?Your Answer:
Correct Answer: Brown-Séquard syndrome
Explanation:Brown-Sequard Hemicord Syndrome consists of ipsilateral weakness (corticospinal tract) and loss of joint position and vibratory sense (posterior column), with contralateral loss of pain and temperature sense (spinothalamic tract) one or two levels below the lesion. Segmental signs, such as radicular pain, muscle atrophy, or loss of a deep tendon reflex, are unilateral. Partial forms are more common than the fully developed syndrome.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 79
Incorrect
-
The 'pump handle' movement of the thoracic wall describes which of the following movements:
Your Answer:
Correct Answer: The anterior ends of the ribs moving upwards and forwards
Explanation:Because the anterior ends of the ribs are inferior to the posterior ends, when the ribs are elevated, the anterior end moves upwards and forwards, moving the sternum upwards and forwards in turn. This ‘pump handle’ upwards and forwards movement changes the anteroposterior (AP) dimension of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 80
Incorrect
-
A patient presents with a laceration on his hand and wrist that has cut the nerve that innervates opponens pollicis.
The opponens pollicis muscle is innervated by which of the following nerves? Select ONE answer only.Your Answer:
Correct Answer: The recurrent branch of the median nerve
Explanation:Opponens pollicis is a small, triangular muscle that forms part of the thenar eminence. It originates from the flexor retinaculum and the tubercle of trapezium bone and inserts into the whole length of the first metacarpal bone on its radial side.
Opponens pollicis is innervated by the recurrent branch of the median nerve and receives its blood supply from the superficial palmar arch.
The main action of opponens pollicis is to flex the first metacarpal bone at the carpometacarpal joint, which opposes the thumb towards the centre of the palm. It also medially rotates the first metacarpal bone at the carpometacarpal joint. -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 81
Incorrect
-
What is the main mechanism of action of cyclizine:
Your Answer:
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 82
Incorrect
-
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 83
Incorrect
-
A patient presents with pain in the wrist and a tingling in the hand. On examination Tinel's test is positive and you diagnose carpal tunnel syndrome. Regarding the carpal tunnel, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: The tendons of the flexor digitorum profundus, flexor digitorum superficialis and flexor pollicis longus lie within a single synovial sheath.
Explanation:Free movement of the tendons in the carpal tunnel is facilitated by synovial sheaths, which surround the tendons. All of the tendons of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) are contained within a single synovial sheath with a separate sheath enclosing the tendon of the flexor pollicis longus (FPL).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 84
Incorrect
-
Which of the following clinical features would you NOT expect to see in a tibial nerve palsy:
Your Answer:
Correct Answer: Weakened eversion of the foot
Explanation:Damage to the tibial nerve results in loss of plantarflexion of the ankle and weakness of inversion of the foot resulting in a shuffling gait, clawing of the toes and loss of sensation in its cutaneous distribution.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 85
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:
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.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 86
Incorrect
-
Compression of this nerve can cause weakness in the left leg while walking and thigh adduction weakness at the hip joint.
Your Answer:
Correct Answer: Obturator nerve
Explanation:The obturator nerve is a sensory and motor nerve that emerges from the lumbar plexus and innervates the thigh.
This nerve supplies motor innervation to the medial compartment of the thigh, making it necessary for thigh adduction.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 87
Incorrect
-
Most of the lymph from vessels that drain the breast is collected in which of the following lymph nodes?
Your Answer:
Correct Answer: Axillary nodes
Explanation:Lymph is the fluid that flows through the lymphatic system.
Axillary lymph nodes are near the breasts. They are often the first location to which breast cancer spreads if it moves beyond the breast tissue. They receive approximately 75% of lymph drainage from the breast via lymphatic vessels, laterally and superiorly.
The lymph usually first drains to the anterior axillary nodes, and from here, through the central axillary, apical, and supraclavicular nodes in sequence.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 88
Incorrect
-
A 30-year old male is taken to the emergency room after suffering a blunt trauma to the abdomen. He is complaining of severe abdominal pain, however all his other vital signs remain stable. A FAST scan is performed to assess for hemoperitoneum.
If hemoperitoneum is present, it is most likely to be observed in which of the following areas?Your Answer:
Correct Answer: Liver
Explanation:The Focused Assessment with Sonography in Trauma (FAST) is an ultrasound protocol developed to assess for hemoperitoneum and hemopericardium. Numerous studies have demonstrated sensitivities between 85% to 96% and specificities exceeding 98%.
The FAST exam evaluates four regions for pathologic fluid: (1) the right upper quadrant, (2) the subxiphoid (or subcostal) view, (3) the left upper quadrant, and (4) the suprapubic region.
The right upper quadrant (RUQ) visualizes the hepatorenal recess, also known as Morrison’s pouch, the right paracolic gutter, the hepato-diaphragmatic area, and the caudal edge of the left liver lobe. The probe is positioned in the sagittal orientation along the patient’s flank at the level of the 8 to 11 rib spaces. The hand is placed against the bed to ensure visualization of the retroperitoneal kidney. The RUQ view is the most likely to detect free fluid with an overall sensitivity of 66%. Recent retrospective evidence suggests the area along the caudal edge of the left lobe of the liver has the highest sensitivity, exceeding 93%.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 89
Incorrect
-
An injury to the brachial plexus can cause Erb's palsy. The following is expected to happen to a patient suffering from this condition, except for which one:
Your Answer:
Correct Answer: Weakness of medial rotation of the arm
Explanation:Erb’s palsy can be caused by a traumatic force downward on the upper arm and shoulder that damages the upper root of the brachial plexus.
The patient will lose shoulder abduction (deltoid, supraspinatus), shoulder external rotation (infraspinatus), and elbow flexion as a result of this condition (biceps, brachialis).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 90
Incorrect
-
Regarding antiemetics, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Of the antiemetics, cyclizine is most commonly associated with acute dystonic reactions.
Explanation:Cyclizine acts by inhibiting histamine pathways and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. Metoclopramide is a dopamine-receptor antagonist which acts both peripherally in the GI tract and centrally within the chemoreceptor trigger zone. Prochlorperazine is a dopamine-D2 receptor antagonist and acts centrally by blocking the chemoreceptor trigger zone. Metoclopramide and prochlorperazine are both commonly associated with extrapyramidal effects, such as acute dystonic reaction. Cyclizine may rarely cause extrapyramidal effects.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 91
Incorrect
-
Which of the following occurs at the transverse thoracic plane:
Your Answer:
Correct Answer: Bifurcation of the trachea
Explanation:A way to help remember the structures transected by the transverse thoracic plane is CLAPTRAP:
C: cardiac plexus
L: ligamentum arteriosum
A: aortic arch (inner concavity)
P: pulmonary trunk
T: tracheal bifurcation (carina)
R: right-to-left movement of the thoracic duct (posterior to the oesophagus)
A: azygos vein drains into superior vena cava
P: pre-vertebral fascia and pre-tracheal fascia end -
This question is part of the following fields:
- Anatomy
- Thorax
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Question 92
Incorrect
-
Which of the following cervical nerves is likely to be affected if your patient is complaining of elbow extension weakness and loss of sensation in her middle finger? She also has pain and tenderness in her cervical region, which is caused by a herniated disc, all after a whiplash-type injury in a car accident.
Your Answer:
Correct Answer: C7
Explanation:A C7 spinal nerve controls elbow extension and some finger extension.
Damage to this nerve can result in a burning pain in the shoulder blade or back of the arms. The ability to extend shoulders, arms, and fingers may also be affected. Dexterity may also be compromised in the hands or fingers.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 93
Incorrect
-
Which of the following statements is correct with regards to Horner's syndrome?
Your Answer:
Correct Answer: Miosis occurs due to paralysis of the dilator pupillae muscle.
Explanation:The characteristics of Horner’s syndrome are pupil constriction, partial ptosis and anhidrosis.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 94
Incorrect
-
A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke.
Branches of which of the following arteries are most likely implicated in the case?Your Answer:
Correct Answer: Anterior spinal artery
Explanation:Medial medullary syndrome is a form of stroke that affects the medial medulla of the brain. It is caused by a lesion in the medial part of the medulla, which is due to an infraction of vertebral arteries and/or paramedian branches of the anterior spinal artery.
It is characterized by contralateral paralysis of the upper and lower limb of the body, a contralateral decrease in proprioception, vibration, and/or fine touch sensation, paresthesias or less commonly dysesthesias in the contralateral trunk and lower limb, and loss of position and vibration sense with proprioceptive dysfunction. Ipsilateral deviation of the tongue due to ipsilateral hypoglossal nerve damage can also be seen.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 95
Incorrect
-
Which of these is NOT a lithium side effect:
Your Answer:
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 96
Incorrect
-
Which of the following muscles are primarily involved in passive inspiration:
Your Answer:
Correct Answer: Diaphragm and external intercostal muscles
Explanation:Passive inspiration is produced by contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs). In inspiration, elevation of the sternal ends of the ribs (‘pump handle’ movement), elevation of the lateral shafts of the ribs (‘bucket handle’ movement) and depression of the diaphragm result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in an increased intrathoracic volume and decreased intrathoracic pressure and thus air is drawn into the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 97
Incorrect
-
The parasympathetic supply to the rectum is from which of the following:
Your Answer:
Correct Answer: Pelvic splanchnic nerves
Explanation:Parasympathetic supply is from the pelvic splanchnic nerves (S2 – S4) and inferior hypogastric plexus.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 98
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:
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.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 99
Incorrect
-
A patient has suffered a nerve injury that has caused weakness of the pectoralis minor muscle.
Pectoralis minor receives its innervation from which of the following nerves? Select ONE answer only.Your Answer:
Correct Answer: Medial pectoral nerve
Explanation:Pectoralis minor is a thin, triangular muscle that is situated in the upper chest. It is thinner and smaller than pectoralis major. It is innervated by the medial pectoral nerve.
The origin of pectoralis minor is the 3rdto the 5thribs, near the costal cartilages. It inserts into the medial border and superior surface of the coracoid process of the scapula.
The main action of pectoralis minor is to draw the scapula inferiorly and anteriorly against the thoracic wall. This serves to stabilise the scapula. -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 100
Incorrect
-
A 33-year-old heavily muscled man presents with left-sided chest pain. After taking part in a powerlifting competition, he felt a painful snap at the front of his shoulder and chest. There is also the presence of bruising and swelling over the left side of his chest. A ruptured pectoralis major muscle was suspected upon examining the injured area.
Which of the following statements regarding the surface markings of the pectoralis major muscle is considered correct?Your Answer:
Correct Answer: It inserts into the lateral lip of the bicipital groove of the humerus
Explanation:The pectoralis major is the superior most and largest muscle of the anterior chest wall. It is a thick, fan-shaped muscle that lies underneath the breast tissue and forms the anterior wall of the axilla.
Its origin lies anterior surface of the medial half of the clavicle, the anterior surface of the sternum, the first 7 costal cartilages, the sternal end of the sixth rib, and the aponeurosis of the external oblique of the anterior abdominal wall.
The insertion of the pectoralis major is at the lateral lip of the intertubercular sulcus of the humerus. There are 2 heads of the pectoralis major, the clavicular and the sternocostal, which reference their area of origin.
The function of the pectoralis major is 3-fold and dependent on which heads of muscles are involved:
– Flexion, adduction and medial rotation of the arm at the glenohumeral joint
– Clavicular head causes flexion of the extended arm
– Sternoclavicular head causes extension of the flexed armArterial supply of the pectoralis major, the pectoral artery, arises from the second branch of the axillary artery, the thoracoacromial trunk.
The 2 heads of the pectoralis major have different nervous supplies. The clavicular head derives its nerve supply from the lateral pectoral nerve. The medial pectoral nerve innervates the sternocostal head. The lateral pectoral nerve arises directly from the lateral cord of the brachial plexus, and the medial pectoral nerve arises from the medial cord.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 101
Incorrect
-
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:
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 102
Incorrect
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A patient suffers an injury to the nerve that innervates piriformis.
The piriformis muscle is innervated by which of the following nerves? Select ONE answer only.Your Answer:
Correct Answer: Nerve to piriformis
Explanation:Piriformis is innervated by the nerve to piriformis, which is a direct branch from the sacral plexus (S1 and S2).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 103
Incorrect
-
A patient presents to ED complaining of pins and needles over the lateral three and a half digits. You suspect carpal tunnel syndrome. Which of the following clinical features would you most expect to see on examination:
Your Answer:
Correct Answer: Inability to touch the pad of the little finger with the thumb
Explanation:Compression of the median nerve in the carpal tunnel will result in weakness and atrophy of the thenar muscles – resulting in weakness of opposition, abduction and flexion of the thumb at the metacarpophalangeal joint and anaesthesia or paraesthesia over the distribution of the palmar digital branch of the median nerve (skin over the palmar surface and fingertips of the lateral three and a half digits). The adductor pollicis muscle is innervated by the ulnar nerve, and abduction of the fingers is produced by the interossei, also innervated by the ulnar nerve. Flexion of the interphalangeal joint of the thumb is produced by the flexor pollicis longus, and flexion of the distal interphalangeal joint of the index finger is produced by the flexor digitorum profundus. Median nerve injury at the wrist will not affect the long flexors of the forearm as these are innervated by the anterior interosseous nerve which arises in the proximal forearm.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 104
Incorrect
-
A lesion to which part of the optic radiation will result in contralateral homonymous inferior quadrantanopia?
Your Answer:
Correct 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 105
Incorrect
-
You are examining the lower limbs of a 54 year old man who presented after falling from a ladder at home. During your neurological assessment you note a weakness of hip flexion. Which of the following nerves is the most important for flexion of the thigh at the hip joint:
Your Answer:
Correct Answer: Femoral nerve
Explanation:Flexion of the thigh at the hip joint is produced by the sartorius, psoas major, iliacus and pectineus muscles, assisted by the rectus femoris muscle, all innervated by the femoral nerve (except for the psoas major, innervated by the anterior rami of L1 – 3).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 106
Incorrect
-
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 107
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:
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.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 108
Incorrect
-
The sensory innervation of the oropharynx is provided by which of the following nerves:
Your Answer:
Correct Answer: Glossopharyngeal nerve
Explanation:Each subdivision of the pharynx has a different sensory innervation:the nasopharynx is innervated by the maxillary nervethe oropharynx is innervated by the glossopharyngeal nervethe laryngopharynx 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 109
Incorrect
-
Regarding the abductor digiti minimi, which of the following statements is false?
Your Answer:
Correct Answer: It assists with flexion of the fifth finger at the middle phalanx
Explanation:Abductor digiti minimi is a short intrinsic muscle of the hand. It belongs to the group of muscles collectively called hypothenar muscles due to their acting on the 5th finger. Besides abductor digiti minimi, other hypothenar muscles include flexor digiti minimi brevis and opponens digiti minimi.
The main function of abductor digiti minimi involves abduction of the 5th finger, as well as flexion of its proximal phalanx. Along with other hypothenar muscles, this muscle forms the hypothenar eminence on the medial side of the palm.
Like other hypothenar muscles, abductor digiti minimi receives nervous supply from the deep branch of the ulnar nerve, derived from root values C8 and T1.
Abductor digiti minimi receives arterial blood supply from the palmar branch of ulnar artery, palmar digital artery, as well as branches of the ulnar side of the superficial palmar arch. The venous blood from the muscle is drained via the venous networks of the palm into the deep veins of the arm (vv. ulnares).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 110
Incorrect
-
External haemorrhoids may cause anal pain. When explaining to your patient why it does so, which of the following nerves will you point out as being affected?
Your Answer:
Correct Answer: Pudendal nerve
Explanation:The pain associated with external haemorrhoids is carried by a branch of the pudendal nerve, specifically the somatic fibres (S2-S4).
It innervates the external anal sphincter and most of the skin over the perineum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 111
Incorrect
-
You assess a patient that has suffered a nerve injury that has paralysed her left latissimus dorsi muscle.
Latissimus dorsi receives its innervation from which of the following nerves? Select ONE answer only.Your Answer:
Correct Answer: Thoracodorsal nerve
Explanation:Latissimus dorsi originates from the lower part of the back, where it covers a wide area. It lies underneath the inferior fibres of trapezius superiorly, and trapezius is the most superficial back muscle.
Superficial muscles of the back showing latissimus dorsi (from Gray’s Anatomy)
Latissimus dorsi has a broad origin, arising from the spinous processes of T6-T12, the thoracolumbar fascia, the iliac crest and the inferior 3 or 4 ribs. The fibres converge into a tendon that inserts into the intertubercular groove of the humerus.
Latissimus dorsi is innervated by the thoracodorsal nerve.
Latissimus dorsi acts to extend, adduct and medially rotate the humerus. It, therefore, raises the body towards the arm during climbing. -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 112
Incorrect
-
Which of the following nerves has been damaged when a patient presents with a foot drop?
Your Answer:
Correct Answer: Common peroneal nerve
Explanation:The common peroneal nerve often referred to as the common fibular nerve, is a major nerve that innervates the lower extremity. It is one of the two major branches off the sciatic nerve and receives fibres from the posterior divisions of L4 through S2 nerve roots. The common peroneal nerve separates from the sciatic nerve in the distal posterior thigh proximal to the popliteal fossa. After branching off of the sciatic nerve, it continues down the thigh, running posteroinferior to the biceps femoris muscle, and crosses laterally to the head of the lateral gastrocnemius muscle through the posterior intermuscular septum. The nerve then curves around the fibular neck before dividing into two branches, the superficial peroneal nerve (SPN) and the deep peroneal nerve (DPN). The common peroneal nerve does not have any motor innervation before dividing; however, it provides sensory innervation to the lateral leg via the lateral sural nerve.
The superficial peroneal nerve innervates the lateral compartment of the leg, and the deep peroneal nerve innervates the anterior compartment of the leg and the dorsum of the foot. These two nerves are essential in the eversion of the foot and dorsiflexion of the foot, respectively. The superficial and deep peroneal nerves provide both motor and sensory innervation.
The most common presentation with common peroneal nerve injury or palsy is acute foot drop, although symptoms may be progressive and can include sensory loss or pain. Weakness in foot eversion may occur if the superficial peroneal nerve component is involved.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 113
Incorrect
-
Which of the following muscles is least likely to be involved in forceful expiration:
Your Answer:
Correct Answer: External intercostal muscles
Explanation:Forceful expiration is primarily produced by the deeper thoracic muscles (internal and innermost intercostal muscles, subcostals and transversus thoracis) aided by contraction of the abdominal wall muscles which increase intra-abdominal pressure thus further reducing the volume of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 114
Incorrect
-
A 30 year old man presents to ED after a road traffic accident. Free intraperitoneal fluid is found on FAST (Focussed assessment for sonography in trauma) done in the supine position.
Which of these is most likely to be affected?
Your Answer:
Correct Answer: Hepatorenal recess
Explanation:Fluid accumulates most often in the hepatorenal pouch (of Morrison) in a supine patient. The hepatorenal pouch is located behind the liver and anterior to the right kidney and is the lowest space in the peritoneal cavity in the supine position.
Although the vesicouterine and rectouterine spaces are also potential spaces for fluid accumulation, fluid accumulation in them occur in the erect position.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 115
Incorrect
-
Regarding the hard palate, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Lymphatic vessels from the palate usually drain into deep cervical lymph nodes.
Explanation:Lymphatic vessels from the pharynx and palate drain into the deep cervical lymph nodes.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 116
Incorrect
-
Which of the following is true regarding respiration?
Your Answer:
Correct Answer: The diaphragm is responsible for abdominal breathing
Explanation:The following are the mechanisms of breathing during inspiration and expiration, whether normal or forced.
Normal inspiration is an active process, with the diaphragm as the main muscle. The diaphragm descends, ribs move upward and outward, and the lungs become wider and taller.
In forced inspiration, which commonly occurs during exercise, the external intercostals and accessory muscles, such as the sternocleidomastoid, anterior serrati, scalenes, alae nasi, genioglossus and arytenoid are involved. The ribs move upward and outward, and the abdominal contents move downward.
Normal expiration is a passive process, while in forced expiration, the internal intercostals and abdominal muscles, such as the rectus abdominis, internal and external obliques and transversus abdominis are involved. The ribs move downward and inward, and the abdominal contents move upward.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 117
Incorrect
-
Which of the following movements is controlled by the pectoralis major muscle?
Your Answer:
Correct 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.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 118
Incorrect
-
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 119
Incorrect
-
A 62 year old man has sustained a penetrating injury to the submandibular triangle. On examination, his tongue is weak and when protruded deviates to the left. Which of the following nerves has most likely been injured:
Your Answer:
Correct Answer: Left hypoglossal nerve
Explanation:Damage to the hypoglossal nerve results in weakness of the tongue, with deviation of the tongue towards the weak side on protrusion.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 120
Incorrect
-
A 26-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.
Which of the following is NOT an action of the gluteus maximus muscle? Select ONE answer only.Your Answer:
Correct Answer: Hip abduction
Explanation:Gluteus maximus is the main extensor muscle of the hip and assists with lateral rotation of the thigh at the hip joint. It also acts as a hip adductor, steadies the thigh, and assists in raising the trunk from a flexed position.
Gluteus maximus is innervated by the inferior gluteal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 121
Incorrect
-
A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke.
Which of the following is considered the best diagnosis for the case presented above?Your Answer:
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 122
Incorrect
-
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:
Correct 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.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 123
Incorrect
-
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:
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 124
Incorrect
-
Which lobe of the prostate gland is most commonly affected in prostatic carcinoma?
Your Answer:
Correct Answer: Posterior
Explanation:The periurethral portion of the prostate gland increases in size during puberty and after the age of 55 years due to the growth of non-malignant cells in the transition zone of the prostate that surrounds the urethra. Most cancers develop in the posterior lobe, and cancers in this location may be palpated during a digital rectal examination (DRE).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 125
Incorrect
-
A patient suffers from an injury to his hip and thigh. As a consequence of his injury, the nerve that was damaged innervates the obturator externus muscle.
In which of the following nerves is the obturator externus muscle innervated by?Your Answer:
Correct Answer: Posterior branch of the obturator nerve
Explanation:The obturator externus is innervated by the posterior branch of the obturator nerve, L2-L4.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 126
Incorrect
-
A foot drop is a sign of damage to which of the following nerves?
Your Answer:
Correct Answer: Deep fibular nerve
Explanation:The deep fibular nerve was previously referred to as the anterior tibial nerve.
It starts at the common fibular nerve bifurcation, between the fibula and the proximal part of the fibularis longus. Damage to this nerve can cause foot drop or loss of dorsiflexion since this nerve controls the anterior leg muscles.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 127
Incorrect
-
A 70-year-old man has a resting tremor, rigidity, bradykinesia, and a shuffling gait. Parkinson's disease is caused by one of the following mechanisms:
Your Answer:
Correct Answer: Loss of dopaminergic neurons in the substantia nigra
Explanation:Parkinson’s disease (PD) is one of the most common neurologic disorders, affecting approximately 1% of individuals older than 60 years and causing progressive disability that can be slowed but not halted, by treatment. The 2 major neuropathologic findings in Parkinson’s disease are loss of pigmented dopaminergic neurons of the substantia nigra pars compacta and the presence of Lewy bodies and Lewy neurites. See the images below.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 128
Incorrect
-
A 55-year-old woman was complaining of headaches. On examination, the patient is found to have weakness on the left side of her body and her eyes are deviated towards the right hand side. These are signs of damage to which of the following areas?
Your Answer:
Correct Answer: Frontal lobe
Explanation:Some potential symptoms of frontal lobe damage can include loss of movement, either partial or complete, on the opposite side of the body.
In the patient’s case, it is a result of motor cortex damage on the right side since her left side of the body is affected. The conjugate eye deviation symptom towards the side of the lesion is a result of damage to the frontal eye field.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 129
Incorrect
-
A patient sustains an injury to the proximal median nerve after falling through a glass door. Which of the following muscles would you not expect to be affected:
Your Answer:
Correct Answer: Flexor carpi ulnaris
Explanation:All of the muscles in the anterior forearm are innervated by the median nerve, except for the flexor carpi ulnaris and the medial half of the flexor digitorum profundus which are innervated by the ulnar nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 130
Incorrect
-
The 'bucket handle' movement of the thoracic wall describes which of the following movements:
Your Answer:
Correct Answer: The middles of the shafts of the ribs moving upwards and laterally
Explanation:Because the middles of the shafts of the ribs are lower than either the anterior or posterior end, elevation of the ribs also moves the middles of the shafts laterally. This ‘bucket handle’ upwards and lateral movement increases the lateral dimensions of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 131
Incorrect
-
Which of the following is an adverse effect of carbamazepine:
Your Answer:
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
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Question 132
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:
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.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 133
Incorrect
-
What type of visual field defect are you likely to see in a lesion of the visual cortex:
Your Answer:
Correct Answer: Contralateral homonymous hemianopia with macular sparing
Explanation:A lesion of the visual cortex will 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 134
Incorrect
-
During quiet respiration, position of the right oblique fissure can be marked by a line drawn on the thoracic wall that:
Your Answer:
Correct 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.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 135
Incorrect
-
Elevation of the mandible is produced primarily by which of the following muscles:
Your Answer:
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 136
Incorrect
-
A 25-year-old man suffers from a shoulder injury that damaged the nerve that innervates the infraspinatus muscle.
Which of the following nerves may most likely be affected?Your Answer:
Correct Answer: The suprascapular nerve
Explanation:The suprascapular nerve (C5-C6) innervates the infraspinatus. It originates at the superior trunk of the brachial plexus. It runs laterally across the lateral cervical region to supply the infraspinatus and also the supraspinatus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 137
Incorrect
-
A 60-year-old man with trauma to his cervical spine suffers from damage to the ansa cervicalis, resulting to paresis of his infrahyoid muscles.
All of the following are considered infrahyoid muscles, except:Your Answer:
Correct Answer: Mylohyoid
Explanation:Infrahyoid muscles are also known as “strap muscles” which connect the hyoid, sternum, clavicle and scapula. They are located below the hyoid bone on the anterolateral surface of the thyroid gland and are involved in movements of the hyoid bone and thyroid cartilage during vocalization, swallowing and mastication. They are composed of four paired muscles, organized into two layers.
Superficial layer consists of the sternohyoid and omohyoid
Deep layer consists of the sternothyroid and thyrohyoid. -
This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 138
Incorrect
-
Which of the following muscles acts as an extensor of the shoulder joint?
Your Answer:
Correct Answer: Teres major
Explanation:The glenohumeral joint possesses the capability of allowing an extreme range of motion in multiple planes.
Flexion – Defined as bringing the upper limb anterior in the sagittal plane. The usual range of motion is 180 degrees. The main flexors of the shoulder are the anterior deltoid, coracobrachialis, and pectoralis major. Biceps brachii also weakly assists in this action.
Extension—Defined as bringing the upper limb posterior in a sagittal plane. The normal range of motion is 45 to 60 degrees. The main extensors of the shoulder are the posterior deltoid, latissimus dorsi, and teres major.
Internal rotation—Defined as rotation toward the midline along a vertical axis. The normal range of motion is 70 to 90 degrees. The internal rotation muscles are the subscapularis, pectoralis major, latissimus dorsi, teres major, and the anterior aspect of the deltoid.
External rotation – Defined as rotation away from the midline along a vertical axis. The normal range of motion is 90 degrees. Primarily infraspinatus and teres minor are responsible for the motion.
Adduction – Defined as bringing the upper limb towards the midline in the coronal plane. Pectoralis major, latissimus dorsi, and teres major are the muscles primarily responsible for shoulder adduction.
Abduction – Defined as bringing the upper limb away from the midline in the coronal plane. The normal range of motion is 150 degrees. Due to the ability to differentiate several pathologies by the range of motion of the glenohumeral joint in this plane of motion, it is essential to understand how different muscles contribute to this action.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 139
Incorrect
-
Which coronary artery is mostly likely affected if an ECG shows ST segment elevation in leads II, III and aVF, and ST segment depression in V1-V3?
Your Answer:
Correct Answer: Right coronary artery
Explanation:A posterior wall MI occurs when posterior myocardial tissue (now termed inferobasilar), usually supplied by the posterior descending artery — a branch of the right coronary artery in 80% of individuals — acutely loses blood supply due to intracoronary thrombosis in that vessel. This frequently coincides with an inferior wall MI due to the shared blood supply.
The ECG findings of an acute posterior wall MI include the following:
1. ST segment depression (not elevation) in the septal and anterior precordial leads (V1-V4). This occurs because these ECG leads will see the MI backwards; the leads are placed anteriorly, but the myocardial injury is posterior.
2. A R/S wave ratio greater than 1 in leads V1 or V2.
3. ST elevation in the posterior leads of a posterior ECG (leads V7-V9). Suspicion for a posterior MI must remain high, especially if inferior ST segment elevation is also present.
4. ST segment elevation in the inferior leads (II, III and aVF) if an inferior MI is also present.The following ECG leads determine the location and vessels involved in myocardial infarction:
ECG Leads Location Vessel involved
V1-V2 Septal wall Left anterior descending
V3-V4 Anterior wall Left anterior descending
V5-V6 Lateral wall Left circumflex artery
II, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%)
I, aVL High lateral wall Left circumflex artery
V1, V4R Right ventricle Right coronary artery
V7-V9 Posterior wall Right coronary artery -
This question is part of the following fields:
- Anatomy
- Thorax
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Question 140
Incorrect
-
The least likely feature expected to be seen in a lesion of the frontal lobe is which of the following?
Your Answer:
Correct Answer: Loss of two-point discrimination
Explanation:Lesions in different areas give rise to different symptoms.
Lesions of the parietal lobe give rise to loss of two-point discrimination.
Lesions to Broca’s area give rise to expressive dysphasia results from damage
Lesions to the primary motor cortex give rise to contralateral weakness of the face and arm.
Lesions to the prefrontal cortex give rise to personality change.
Lesions to the frontal eye field give rise to conjugate eye deviation towards side of lesion. -
This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 141
Incorrect
-
Which of the following muscles is NOT involved in depression of the mandible:
Your Answer:
Correct Answer: Masseter
Explanation:Depression of the mandible is generated by the digastric, geniohyoid, mylohyoid and lateral pterygoid muscles on both side, assisted by gravity. The lateral pterygoid muscles are also involved as this movement also involves protraction of the mandible. The masseter muscle is a powerful elevator of the mandible.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 142
Incorrect
-
A patient suffers from an injury and as a consequence, is unable to externally rotate his femur when his hip is extended. You suspect a nerve injury to the obturator internus muscle. Which of the following nerves innervate the obturator internus muscle?
Your Answer:
Correct Answer: Obturator internus nerve
Explanation:The obturator internus is innervated by the obturator internus nerve (L5–S2), a branch of sacral plexus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 143
Incorrect
-
A 30-year old male is brought to the emergency room after a terrible fall during a photoshoot. The patient reported falling on his right forearm. There is evident swelling and tenderness on the affected area, with notable weakness of the flexor pollicis longus muscle. Radiographic imaging showed a fracture on the midshaft of the right radius.
Which of the following nerves is most likely injured in the case above?Your Answer:
Correct Answer: The anterior interosseous nerve
Explanation:Flexor pollicis longus receives nervous supply from the anterior interosseous branch of median nerve, derived from spinal roots C7 and C8.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 144
Incorrect
-
Which of the following nerves is most important for eversion of the foot:
Your Answer:
Correct Answer: Superficial fibular nerve
Explanation:Eversion of the foot is primarily produced by the fibularis longus and fibularis brevis, both innervated by the superficial fibular nerve. The fibularis tertius, innervated by the deep fibular nerve, also assists in this action.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 145
Incorrect
-
At which opioid receptors do opioid analgesics act primarily?
Your Answer:
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.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 146
Incorrect
-
Which of the following nerves provides cutaneous innervation to the posterior surface of the scrotum?
Your Answer:
Correct Answer: Branch of the perineal nerve
Explanation:The following nerves provide cutaneous innervation to the scrotum, and other anatomic structures:
The perineal nerve supplies the muscles in the urogenital triangle, and the skin on the posterior surface of the scrotum (or labia majora).
The genital branch of the genitofemoral nerve supplies the cremaster muscle, the skin over the anterior surface of the thigh, and the anterolateral surface of the scrotum.
The ilioinguinal nerve supplies the external oblique, internal oblique, transversus abdominis, skin of the upper medial aspect of thigh, the root of the penis and the anterior surface of the scrotum in the male, and the mons pubis and labia majora in the female.
The posterior cutaneous nerve of the thigh, or posterior femoral cutaneous nerve, supplies the skin over the lower medial quadrant of the buttock, the inferior skin of the scrotum or labium majus, and the back of the thigh and the upper part of the leg.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 147
Incorrect
-
You are about to perform an emergency pericardiocentesis on a 26-year-old male who was involved in a car accident and is suspected of having cardiac tamponade due to signs of hypotension, muffled heart sounds, and distended neck veins. Where should you insert the needle to relieve tamponade?
Your Answer:
Correct Answer: Inferior and to the left of the xiphochondral junction
Explanation:Pericardiocentesis is a procedure that removes excess fluid from the pericardium. As a result, it’s used in cases of cardiac tamponade, which occurs when there’s too much fluid in the space around the heart.
During the procedure, a needle and a small catheter are inserted 1 to 2 cm inferior and to the left of the xiphochondral junction into the pericardial cavity.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 148
Incorrect
-
The following statements are not true of the flexor digiti minimi brevis, except?
Your Answer:
Correct Answer: It is situated on the radial border of abductor digiti minimi
Explanation:Flexor digiti minimi brevis muscle is located on the ulnar side of the palm, lying on the radial border of the abductor digiti minimi. Together with the abductor digiti minimi and opponens digiti minimi muscles, it forms the hypothenar eminence. The muscle is situated inferior and lateral to adductor digiti minimi muscle and superior and medial to opponens digiti minimi muscle. The proximal parts of flexor digiti minimi brevis and abductor digiti minimi muscles form a gap through which deep branches of the ulnar artery and ulnar nerve pass.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 149
Incorrect
-
Which of the following statements concerning the facial nerve is INCORRECT?
Your Answer:
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 150
Incorrect
-
A 30-year-old rugby player suffers from an anterior cruciate ligament tear while pivoting to attempt to run around another player. An MRI was performed and showed that his injury caused two other structures in the knee joint to be injured.
Which of the following structures is most likely also injured?Your Answer:
Correct Answer: Medial meniscus
Explanation:The O’Donoghue unhappy triad or terrible triad often occurs in contact and non-contact sports, such as basketball, football, or rugby, when there is a lateral force applied to the knee while the foot is fixated on the ground. This produces an abduction-external rotation mechanism of injury.
The O’Donoghue unhappy triad comprises three types of soft tissue injury that frequently tend to occur simultaneously in knee injuries. O’Donoghue described the injuries as: anterior cruciate ligament tear, medial collateral ligament injury, and medial meniscal tear (lateral compartment bone bruise).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 151
Incorrect
-
Which of the following nerves innervates the gastrocnemius muscle?
Your Answer:
Correct Answer: Tibial nerve
Explanation:The gastrocnemius is innervated by the anterior rami of S1 and S2 spinal nerves, carried by the tibial nerve into the posterior compartment of the leg.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 152
Incorrect
-
In inserting a nasogastric tube, which area is least likely to be a site of resistance when the tube goes from the nose to the stomach?
Your Answer:
Correct Answer: In the posterior mediastinum where the oesophagus is crossed by the pulmonary trunk
Explanation:In the posterior mediastinum where the oesophagus is crossed by the pulmonary trunk offers the least resistance when nasogastric tube is inserted from the nose to the stomach.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 153
Incorrect
-
At rest, the left dome of the diaphragm normally reaches as high as which of the following:
Your Answer:
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.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 154
Incorrect
-
Which of the following statements is true about anterior cord syndrome?
Your Answer:
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 155
Incorrect
-
A 22 year old professional athlete sustains an inversion injury to her left ankle during the 800m. Which of the following ligaments is most likely injured:
Your Answer:
Correct Answer: Anterior talofibular ligament
Explanation:Inversion injuries at the ankle in plantarflexion (such as when wearing high heels) are common, and typically result in damage to the lateral collateral ligament of the ankle, made up of the anterior talofibular, the calcaneofibular and the posterior talofibular ligaments. The anterior talofibular and the calcaneofibular ligaments are most commonly injured, and the posterior talofibular ligament rarely. The spring ligament supports the head of the talus, the deltoid ligament supports the medial aspect of the ankle joint, and the long and short plantar ligaments are involved in maintaining the lateral longitudinal arch of the foot.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 156
Incorrect
-
Which of the following is NOT a typical cerebellar sign:
Your Answer:
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 157
Incorrect
-
A patient suffers a stab wound to the neck. The entry point of the blade is situated within the posterior triangle of the neck.
Which of the following muscles is LEAST likely to be involved? Select ONE answer only.Your Answer:
Correct Answer: Sternohyoid
Explanation:The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:
Muscles: thyrohyoid, sternothyroid, sternohyoid muscles
Organs: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid gland
Arteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteries
Veins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veins
Nerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerveThe posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.
Contents:
Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodes
Nerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus -
This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 158
Incorrect
-
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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Question 159
Incorrect
-
An 18-year-old patient was brought to the ER after falling off of his skateboard. He is unable to flex the distal interphalangeal joint of his index finger. You suspect that he suffers from a supracondylar fracture. Which of the following conditions would confirm supracondylar fracture?
Your Answer:
Correct Answer: Inability to oppose the thumb
Explanation:A supracondylar fracture is a fracture that occurs through the thin section of the distal humerus above the growth plate.
A supracondylar fracture is most usually associated with median nerve injury. A medial nerve damage causes paralysis of the thenar muscles, as well as loss of thumb opposition.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 160
Incorrect
-
Which of the following is NOT a typical feature of a lesion to the vestibulocochlear nerve:
Your Answer:
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 161
Incorrect
-
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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Question 162
Incorrect
-
What kind of function loss do you anticipate in a 22-year-old guy who had a laceration to his arm, resulting in nerve damage in the antecubital fossa?
Your Answer:
Correct Answer: Opposition of thumb
Explanation:The symptoms of median nerve injury include tingling or numbness in the forearm, thumb, and three adjacent fingers, as well as gripping weakness and the inability to move the thumb across the palm.
Because the thenar muscles and the flexor pollicis longus are paralyzed, flexion, abduction, and opposition of the thumb at the MCPJ and IPJ are gone.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 163
Incorrect
-
Which lobe of the prostate gland is most commonly affected in benign prostatic hypertrophy?
Your Answer:
Correct Answer: Median
Explanation:Benign enlargement of the prostate is common in men older than 50 years. The cause is possibly an imbalance in the hormonal control of the gland. The median lobe of the gland enlarges upward and encroaches within the sphincter vesicae, located at the neck of the bladder. The leakage of urine into the prostatic urethra causes an intense reflex desire to micturate. The enlargement of the median and lateral lobes of the gland produces elongation and lateral compression and distortion of the urethra so that the patient experiences difficulty in passing urine and the stream is weak. Back-pressure effects on the ureters and both kidneys are a common complication. The enlargement of the uvula vesicae (owing to the enlarged median lobe) results in the formation of a pouch of stagnant urine behind the urethral orifice within the bladder. The stagnant urine frequently becomes infected, and the inflamed bladder (cystitis) adds to the patient’s symptoms.
In all operations on the prostate, the surgeon regards the prostatic venous plexus with respect. The veins have thin walls, are valveless, and are drained by several large trunks directly into the internal iliac veins. Damage to these veins can result in a severe haemorrhage.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 164
Incorrect
-
A patient suffers an injury to his thigh that damages the nerve that innervates pectineus.
Which of the following nerves has been damaged in this case? Select ONE answer only.Your Answer:
Correct Answer: Femoral nerve
Explanation:Pectineus is innervated by the femoral nerve. It may also receive a branch from the obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 165
Incorrect
-
The muscles of the soft palate (other than the tensor veli palatini) are innervated by which of the following nerves:
Your Answer:
Correct Answer: Vagus nerve
Explanation:All of the muscles of the soft palate are innervated by the vagus nerve (from the pharyngeal plexus), except for the tensor veli palatini, which is innervated by a branch of the mandibular nerve.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 166
Incorrect
-
A 27-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.
In which of the following nerves is the gluteus maximus muscle innervated by?Your Answer:
Correct Answer: Inferior gluteal nerve
Explanation:The gluteal muscles are a group of muscles that make up the buttock area. These muscles include: gluteus maximus, gluteus medius. and gluteus minimus.
The gluteus maximus is the most superficial as well as largest of the three muscles and makes up most of the shape and form of the buttock and hip area. It is a thick, fleshy muscle with a quadrangular shape. It is a large muscle and plays a prominent role in the maintenance of keeping the upper body erect.
The innervation of the gluteus maximus muscle is from the inferior gluteal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 167
Incorrect
-
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:
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 168
Incorrect
-
The most common complication of paracetamol overdose is:
Your Answer:
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 169
Incorrect
-
The sensation produced by touching the arm with a vibrating tuning fork during a neurological examination is mediated by which of the following spinal tracts:
Your Answer:
Correct Answer: Posterior column
Explanation:Fine-touch, proprioception and vibration sensation are mediated by the posterior column-medial lemniscus pathway.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 170
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:
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.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 171
Incorrect
-
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:
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 172
Incorrect
-
Which of the following would you NOT expect from a deep fibular nerve palsy:
Your Answer:
Correct Answer: Loss of sensation over heel
Explanation:Damage to the deep fibular nerve results in loss of dorsiflexion of the ankle, with resultant foot drop with high-stepping gait, loss of toe extension, weakness of foot inversion and loss of sensation over the webspace between the 1st and 2nd toes.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 173
Incorrect
-
Which of the following tracts must be affected if a patient presents with decreased pain and temperature sensation in both lower extremities?
Your Answer:
Correct Answer: The lateral spinothalamic tract
Explanation:The main function of the spinothalamic tract is to carry pain and temperature via the lateral part of the pathway and crude touch via the anterior part. The spinothalamic tract pathway is an imperative sensory pathway in human survival because it enables one to move away from noxious stimuli by carrying pain and temperature information from the skin to the thalamus where it is processed and transmitted to the primary sensory cortex. The primary sensory cortex communicates with the primary motor cortex, which lies close to it, to generate rapid movement in response to potentially harmful stimuli. Furthermore, the spinothalamic tract has a role in responding to pruritogens, causing us to itch. Interestingly, itching suppresses the spinothalamic tract neuron response to the histamine effect.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 174
Incorrect
-
Regarding the penis, which of the following statements is CORRECT:
Your Answer:
Correct Answer: The corpus spongiosum is ventral in the erect penis.
Explanation:Because the anatomical position of the penis is erect, the paired corpora cavernosa are defined as dorsal in the body of the penis and the single corpus spongiosum as ventral. The nerves and vessels lie superficial to the corpus cavernosum. The urethra lies within the corpus spongiosum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 175
Incorrect
-
Injury to which nerve can lead to weakness or paralysis of the brachialis muscle?
Your Answer:
Correct Answer: The musculocutaneous nerve
Explanation:The brachialis muscle is a prime flexor of the forearm at the elbow joint. It is fusiform in shape and located in the anterior (flexor) compartment of the arm, deep to the biceps brachii. The brachialis is a broad muscle, with its broadest part located in the middle rather than at either of its extremities. It is sometimes divided into two parts, and may fuse with the fibres of the biceps brachii, coracobrachialis, or pronator teres muscles. It also functions to form part of the floor of the cubital fossa.
The brachialis is primarily supplied by the musculocutaneous nerve (C5, C6). In addition, a small lateral portion of the muscle is innervated by the radial nerve (C7).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 176
Incorrect
-
Regarding the trachea, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: A cricothyrotomy involves making an opening in the neck inferior to the cricoid cartilage.
Explanation:A cricothyrotomy involves making an opening in the median cricothyroid ligament (the medial part of the cricothyroid membrane), between the cricoid cartilage below and the thyroid cartilage above.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 177
Incorrect
-
Regarding the lacrimal apparatus, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
Explanation:Lacrimal fluid is drained from the eyeball through the lacrimal punctum.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 178
Incorrect
-
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:
Correct 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 179
Incorrect
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A 63-year-old man presents with severe abdominal pain and vomiting of blood. An endoscopy was performed and a peptic ulcer was found to have eroded into an artery nearby.
Which of the following most likely describes the location of the ulcer?Your Answer:
Correct Answer: The posterior duodenum
Explanation:The most common cause of upper gastrointestinal bleeding is peptic ulcer disease, particularly gastric and duodenal ulcers. Duodenal ulcers are most commonly associated with bleeding compared with gastric ulcers. Posterior duodenal ulcers are considered to be the most likely to cause severe bleeding because of its proximity to the branches of the gastroduodenal artery (GDA).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 180
Incorrect
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Question 181
Incorrect
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A 26-year-old man is involved in a motorcycle accident that results in an open fracture of his tibia and fibula. The nerve that innervates peroneus tertius is damaged as a consequence of his injuries.
Peroneus tertius receives its innervation from which of the following nerves? Select ONE answer only.Your Answer:
Correct Answer: Deep peroneal nerve
Explanation:Peroneus brevis is innervated by the superficial peroneal nerve.
Peroneus longus is innervated by the superficial peroneal nerve.
Peroneus tertius is innervated by the deep peroneal nerve. -
This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 182
Incorrect
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Regarding the lung roots, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Generally the pulmonary arteries lie superior to the pulmonary veins in the lung root.
Explanation:Each lung root contains a pulmonary artery, two pulmonary veins, a main bronchus, bronchial vessels, nerves and lymphatics. Generally the pulmonary artery is superior in the lung root, the pulmonary veins are inferior and the bronchi are somewhat posterior in position. The vagus nerves pass posterior to the lung roots while the phrenic nerves pass anterior to them.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 183
Incorrect
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All of the following typically occurs as part of normal passive expiration except:
Your Answer:
Correct Answer: Contraction of the internal intercostal muscles
Explanation:Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) in addition to the elastic recoil of the lungs.
In expiration, several movements occur. There are:
1. depression of the sternal ends of the ribs (‘pump handle’ movement),
2. depression of the lateral shafts of the ribs (‘bucket handle’ movement) and
3. elevation of the diaphragm.
These result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. There is then a decreased intrathoracic volume and increased intrathoracic pressure and air is forced out of the lungs. -
This question is part of the following fields:
- Anatomy
- Thorax
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Question 184
Incorrect
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Which of the following clinical features is NOT typical of a facial nerve palsy:
Your Answer:
Correct Answer: Inability to raise the eyelid
Explanation:Facial nerve palsy can result in inability to close the eye due to paralysis of the orbicularis oculi muscle. Elevation of the eyelid in eye opening is a function of the levator palpebrae superioris muscle and the superior tarsal muscle, innervated by the oculomotor nerve and the sympathetic chain respectively.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 185
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:
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 186
Incorrect
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Which of the following is where the rectovesical fascia is located:
Your Answer:
Correct Answer: Between the fundus of the bladder and the ampulla of the rectum
Explanation:In a triangular area between the vasa deferentia, the bladder and rectum are separated only by rectovesical fascia, commonly known as Denonvillier’s fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 187
Incorrect
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An 11-year-old boy was brought to the emergency room due to fever and pain in the ears. Upon physical examination, it was observed that the mastoid area is erythematous and there is a presence of a boggy, tender mass. A diagnosis of acute mastoiditis was made.
Which of the following parts of the temporal bone is most likely involved?Your Answer:
Correct Answer: Petrous part
Explanation:Mastoiditis is the inflammation of a portion of the temporal bone referred to as the mastoid air cells. The mastoid air cells are epithelium lined bone septations that are continuous with the middle ear cavity.
The temporal bone is composed of four parts: the mastoid process, the petrous pyramid, the squamous, and tympanic portions. The mastoid process and the petrous pyramid are the portions of particular interest because of the prevalence of suppurations within these parts of the temporal bone.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 188
Incorrect
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Which of the following is NOT a contraindication to treatment with aspirin at analgesic doses:
Your Answer:
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 189
Incorrect
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A patient suffered from a chest injury while working out in the gym. As a consequence of his injury, his pectoralis minor muscle was damaged.
Which of the following statements regarding the pectoralis minor muscle is considered correct?Your Answer:
Correct Answer: It stabilises the scapula
Explanation:The pectoralis minor, in comparison to the pectoralis major, is much thinner and triangular in shape and resides below the major. It originates from the margins of the third to fifth ribs adjacent to the costochondral junction. The fibres consequently pass upward and laterally to insert into the medial border and superior surface of the coracoid process. It is crucial in the stabilization of the scapula by pulling it downward and anteriorly against the thoracic wall.
Arterial supply to the pectoralis minor also derives from the pectoral branch of the thoracoacromial trunk. Nerve supply of the pectoralis minor is a function of the lateral pectoral nerve and the medial pectoral nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 190
Incorrect
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A 30-year-old man presents with piriformis syndrome pain, tingling, and numbness in her buttocks. He noted that the pain gets worse upon sitting down. He was seen by a physiotherapist and a diagnosis of piriformis syndrome was made.
Which of the following nerves becomes irritated in piriformis syndrome?Your Answer:
Correct Answer: Sciatic nerve
Explanation:Piriformis syndrome is a clinical condition of sciatic nerve entrapment at the level of the ischial tuberosity. While there are multiple factors potentially contributing to piriformis syndrome, the clinical presentation is fairly consistent, with patients often reporting pain in the gluteal/buttock region that may shoot, burn or ache down the back of the leg (i.e. sciatic-like pain). In addition, numbness in the buttocks and tingling sensations along the distribution of the sciatic nerve is not uncommon.
The sciatic nerve runs just adjacent to the piriformis muscle, which functions as an external rotator of the hip. Hence, whenever the piriformis muscle is irritated or inflamed, it also affects the sciatic nerve, which then results in sciatica-like pain.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 191
Incorrect
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During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.
Which of the following is expected to undergo atrophy in carpal tunnel syndrome?
Your Answer:
Correct Answer: The thenar eminence
Explanation:Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.
The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:
L– lateral two lumbricals
O– Opponens pollicis
A– Abductor pollicis
F– Flexor pollicis brevisIn the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.
Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 192
Incorrect
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An 82 year old man has fever, left sided abdominal and back pain and presents to the emergency room. Imaging reveals a large perinephric abscess. Which of the following most likely describes the fluid location:
Your Answer:
Correct Answer: Between the renal capsule and the renal fascia
Explanation:The perinephric fat is immediately external to the renal capsule and completely surrounds the kidney. The renal fascia surrounds the perinephric fat and the paranephric fat is external to the renal fascia. The location of a perinephric abscess is in the perinephric fat between the renal capsule and the renal fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 193
Incorrect
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What type of visual field defect are you most likely to see in a lesion of the parietal optic radiation:
Your Answer:
Correct Answer: Contralateral homonymous inferior quadrantanopia
Explanation:A lesion of the parietal optic radiation will result in a contralateral homonymous inferior quadrantanopia.
A lesion of the temporal optic radiation will result in a contralateral homonymous superior quadrantanopia. -
This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 194
Incorrect
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A 70-year-old woman presents with right-sided loss of pain and temperature sense on the body as well as left-sided loss of pain and temperature sense on the face. She also has complaints of vertigo, nausea, and tinnitus. Further examination of her cranial nerves suggest the presence of Horner's Syndrome. An MRI and CT scan was ordered and results showed that she is suffering from a left-sided stroke.
Branches of which of the following arteries are most likely implicated in the case?Your Answer:
Correct Answer: Posterior inferior cerebellar artery
Explanation:Wallenberg syndrome is also known as lateral medullary syndrome and posterior inferior cerebellar artery syndrome. It is the most common posterior circulation ischemic stroke syndrome. The primary pathology of Wallenberg syndrome is occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches.
It is characterized by vertigo with nystagmus, nausea and vomiting, and sometimes hiccups, dysphonia, dysarthria, and dysphagia often present with ipsilateral loss of gag reflex, ipsilateral ataxia with a tendency to fall to the ipsilateral side, pain and numbness with impaired facial sensation on the face, impaired taste sensation, and impaired pain and temperature sensation in the arms and legs.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 195
Incorrect
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Which of the following is true about the extensor carpi radialis longus?
Your Answer:
Correct Answer: It assists with abduction of the hand at the wrist
Explanation:The majority of extensor carpi radialis longus originates from the lateral supracondylar ridge of humerus (distal third) and anterior aspect of the lateral intermuscular septum of the arm. A small portion of its fibres originate from the common extensor tendon attached to the lateral epicondyle of humerus. The fibres unite into a muscle belly which extends approximately to the middle of the forearm. The muscle belly is then replaced by a flat tendon that travels distally along the lateral surface of the radius, together with the tendon of extensor carpi radialis brevis. Both tendons course towards the radial styloid process, deep to the tendons of abductor pollicis longus and extensor pollicis brevis muscles. Proximal to the wrist, the tendons of extensor carpi radialis longus and brevis pass behind the radial styloid process within a common synovial sheath and continue along the radial groove deep to the extensor retinaculum of the wrist. At this level, the tendon of extensor carpi radialis longus is crossed by the tendon of extensor pollicis longus, after which it inserts on the posterior aspect of the base of the second metacarpal bone. Some tendon slips can insert into the first and third metacarpal bones.
Extensor carpi radialis longus receives innervation from the radial nerve, with contributions mainly from spinal nerves C5-C8. The radial nerve is a branch of the brachial plexus.
Extensor carpi radialis longus receives blood supply mainly from the radial artery. It directly supplies the distal part of the muscle, while the rest of the muscle receives blood from one of its radial recurrent branches. The brachial artery also supplies a small portion of the muscle via the radial collateral artery.
Extensor carpi radialis longus primarily acts on the wrist joint to produce two major actions: (1) wrist extension by working synergistically with extensor carpi radialis brevis and extensor carpi ulnaris, and (2) hand abduction (radial deviation), with the help of flexor carpi radialis.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 196
Incorrect
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A 22 year old male has been stabbed and is brought to the ED with a stab wound to his upper limb. On examination, the patient is unable to flex the distal interphalangeal joints of the ring and little finger. However, the proximal interphalangeal joint is intact. The most likely affected nerve is which of the following, and at which level is this occurring?
Your Answer:
Correct Answer: Ulnar nerve at elbow
Explanation:The medial half of the flexor digitorum profundus is innervated by the ulnar nerve. Paralysis of this muscle results in loss of flexion at the distal interphalangeal joint of the ring and little finger.
Flexion at the proximal interphalangeal joint is preserved as this is a function of the flexor digitorum superficialis which is innervated by the median nerve.
The ulnar nerve is not correct as ulnar nerve injury at the wrist would not affect the long flexors, and the injury must have been more proximal. -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 197
Incorrect
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Which of the following statements is correct about the extensor digitorum muscle?
Your Answer:
Correct Answer: It extends the medial four digits at the metacarpophalangeal joints
Explanation:Extensor digitorum is a long muscle located in the posterior compartment of the forearm. Together with the extensor carpi ulnaris and extensor digiti minimi, extensor carpi radialis longus and brevis as well as the brachioradialis, it belongs to the group of superficial extensors of the forearm. These muscles can be easily palpated in the lateral aspect of the posterior forearm, especially during the extension of hand when they are contracted.
Extensor digitorum runs from the lateral epicondyle of humerus to the medial four phalanges of the hand. In this way, it generates the pull for the extension of the four medial fingers in their metacarpophalangeal and both interphalangeal joints. Extensor digitorum also participates in the extension of the wrist.
Extensor digitorum is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).
Extensor digitorum is vascularized by the branches of three different arteries: (1) posterior interosseous artery, (2) radial recurrent artery, and (3) anterior interosseous artery. Anterior and posterior interosseous arteries are the branches of the common interosseous artery that arises from the ulnar artery. The radial recurrent artery is a branch of the radial artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 198
Incorrect
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A 27 year old woman presents to ED having sustained a deep laceration to the dorsum of her ring finger whilst cooking. Her proximal interphalangeal joint is fixed in flexion and the distal interphalangeal joint is hyperextended. Which of the following structures in the digit has most likely been injured:
Your Answer:
Correct Answer: Insertion of the central slip of the extensor tendon
Explanation:Damage to the central slip of the extensor digitorum tendon would result in loss of extension at the proximal interphalangeal joint resulting in a fixed flexion deformity of this joint, and hyperextension of the distal interphalangeal joint due to a loss of balancing forces. This is called the Boutonniere deformity.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 199
Incorrect
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If a patient dislocated his right shoulder and has been referred to the orthopaedic outpatient department for a follow-up after a successful reduction, which of the following is the most important position for him to avoid holding his arm in until he is seen in the clinic?
Your Answer:
Correct Answer: Arm at 90 degrees to side with palm up
Explanation:The arm should be placed in a poly-sling that should be worn for about two weeks. A physiotherapist may give gentle movements for the arm to help in reducing stiffness and in relieving the pain. It is important that the patient must avoid positions that could cause re-dislocation.
The most important position to avoid is the arm being held out at 90 degrees to the side with the palm facing upwards, especially if a force is being applied. -
This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 200
Incorrect
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Regarding cortical areas, which one is found in the posterior part of the inferior frontal gyrus?
Your Answer:
Correct Answer: Broca’s area
Explanation:Broca’s area is involved in the expressive aspects of spoken and written language (production of sentences constrained by the rules of grammar and syntax). It corresponds to the opercular and triangular parts of the inferior frontal gyrus (BA 44 and 45). These areas are defined by two rami (branches) of the lateral sulcus (one ascending, one horizontal) which ‘slice into’ the inferior frontal gyrus. In keeping with its role in speech and language, Broca’s area is immediately anterior to the motor and premotor representations of the face, tongue and larynx. A homologous area in the opposite hemisphere is involved in non-verbal communication such as facial expression, gesticulation and modulation of the rate, rhythm and intonation of speech.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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SESSION STATS - PERFORMANCE PER SPECIALTY
