-
Question 1
Incorrect
-
Regarding aspirin at analgesic doses, which of the following statements is CORRECT:
Your Answer: The increased production of prostaglandins can irritate gastric mucosa.
Correct Answer: It is contraindicated in patients with severe heart failure.
Explanation:Aspirin (at analgesic doses) is contraindicated in severe heart failure. Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes resulting in decreased production of prostaglandins (which can lead to irritation of the gastric mucosa). The analgesic dose is greater than the antiplatelet dose, and taken orally it has a duration of action of about 4 hours. Clinical features of salicylate toxicity in overdose include hyperventilation, tinnitus, deafness, vasodilatation, and sweating.
-
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 2
Incorrect
-
Which of the following is NOT a contraindication to treatment with aspirin at analgesic doses:
Your Answer: Previous peptic ulceration
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.
-
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 3
Correct
-
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: 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
-
-
Question 4
Correct
-
A 28-year-old woman with history of blunt thoracic trauma develops hypotension chest pain, and breathlessness. A bedside echocardiogram was performed and revealed a large pericardial effusion. Due to this finding, a pericardiocentesis was to be performed.
Which of the following statements is considered true regarding pericardiocentesis?Your Answer: The needle should be aimed at the midpoint of the left clavicle
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.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 5
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: Popliteal fossa
Correct Answer: Neck of fibula
Explanation:Dorsiflexion and eversion of the foot are innervated by the deep fibular nerve and the superficial fibular nerve, respectively.
The common fibular nerve runs obliquely downward along the lateral border of the popliteal fossa (medial to the biceps femoris) before branching at the neck of the fibula.
Thus, it is prone to being affected during an impact injury or fracture to the bone or leg. Casts that are placed too high can also compress the fibular nerve.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 6
Correct
-
Aside from the inability to extend the leg above the knee, which of the following clinical symptoms should you anticipate seeing in a patient who had a pelvic and right leg injury as well as femoral nerve damage?
Your Answer: Loss of sensation over the anterior thigh
Explanation:The femoral nerve runs down the front of the leg from the pelvis. It gives the front of the thigh and a portion of the lower leg sensation.
Extension of the leg at the knee joint, flexion of the thigh at the hip are produced by muscles that is primarily innervated by the femoral nerve.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 7
Incorrect
-
The extensor digitorum longus is supplied by which nerve?
Your Answer: Sciatic nerve
Correct Answer: Deep peroneal nerve
Explanation:The extensor digitorum longus is innervated by the deep fibular nerve (L5, S1), a branch of the common fibular nerve.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 8
Correct
-
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.
-
This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
-
-
Question 9
Incorrect
-
Which of the following statements concerning the facial nerve is INCORRECT?
Your Answer: The facial nerve carries parasympathetic fibres to the lacrimal glands.
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
-
-
Question 10
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: Anterior spinothalamic tract
Correct Answer: Posterior column
Explanation:Fine-touch, proprioception and vibration sensation are mediated by the posterior column-medial lemniscus pathway.
-
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 11
Incorrect
-
A patient complains of headache and visual loss. CT scan demonstrates a lesion of the temporal lobe. What type of visual field defect would you most expect to see in this patient:
Your Answer: Homonymous hemianopia with macular sparing
Correct Answer: Contralateral homonymous superior quadrantanopia
Explanation:Axons from the lateral geniculate nucleus (LGN) carry visual information, via the upper and lower optic radiations, to the visual cortex in the occipital lobe:
The upper optic radiation carries fibres from the superior retinal quadrants (corresponding to the inferior visual field quadrants) and travels through the parietal lobe to reach the visual cortex.
The lower optic radiation carries fibres from the inferior retinal quadrants (corresponding to the superior visual field quadrants) and travels through the temporal lobe to reach the visual cortex of the occipital lobe. -
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 12
Incorrect
-
Elevation of the eyeball is primarily produced by which of the following muscles:
Your Answer: Superior rectus and superior oblique
Correct Answer: Superior rectus and inferior oblique
Explanation:Elevation of the eyeball is produced by the superior rectus and the inferior oblique muscles.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 13
Incorrect
-
Which of the following clinical features is most suggestive of a lesion of the temporal lobe:
Your Answer: Expressive dysphasia
Correct Answer: Receptive dysphasia
Explanation:Damage to the Wernicke’s speech area in the temporal lobe can result in a receptive dysphasia. Hemispatial neglect is most likely to occur in a lesion of the parietal lobe. Homonymous hemianopia is most likely to occur in a lesion of the occipital lobe. Expressive dysphasia is most likely to occur in a lesion of the Broca speech area in the frontal lobe. Conjugate eye deviation towards the side of the lesion is most likely to occur in a lesion of the frontal lobe.
-
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 14
Incorrect
-
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 adduction
Correct 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
-
-
Question 15
Correct
-
Which of the following is NOT an adverse effect of amitriptyline:
Your Answer: Hypokalaemia
Explanation:Adverse effects include:
Antimuscarinic effects: Dry mouth, Blurred vision, Constipation, Urinary retention, Sedation, Confusion
Cardiovascular effects: Heart block, Arrhythmias, Tachycardia, Postural hypotension, QT-interval prolongation, Hepatic impairment, Narrow-angle glaucoma -
This question is part of the following fields:
- Central Nervous System
- Pharmacology
-
-
Question 16
Incorrect
-
Which of the following nerves innervates the gastrocnemius muscle?
Your Answer: Sciatic nerve
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.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 17
Incorrect
-
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: Axillary and long thoracic nerve
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.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 18
Incorrect
-
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: It is innervated by the long thoracic nerve
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.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 19
Incorrect
-
Which of the following clinical features would you least expect to see in a lesion of the frontal lobe:
Your Answer: Incontinence
Correct Answer: Contralateral homonymous hemianopia with macular sparing
Explanation:Contralateral homonymous hemianopia with macular sparing results from damage to the primary visual cortex of the occipital lobe. Incontinence may occur due to damage of the cortical micturition centre in the prefrontal cortex. Primitive reflexes and inability to problem solve may occur due to damage to the prefrontal cortex. Motor weakness of the contralateral limb with UMN signs may occur due to damage of the primary motor cortex.
-
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 20
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: Optic nerve
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
-
-
Question 21
Correct
-
Which of the following nerves has been damaged when a patient presents with a foot drop?
Your 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.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 22
Incorrect
-
A 25-year-old athlete suffers an injury to the nerve that innervates the gluteus minimus muscle.
Which of the following nerves innervates the gluteus minimus muscle?Your Answer: Inferior gluteal nerve
Correct Answer: Superior gluteal nerve
Explanation:Gluteus minimus is the smallest muscle of the glutei. It is located just beneath the gluteus medius muscle. Gluteus minimus predominantly acts as a hip stabilizer and abductor of the hip.
The superior gluteal nerve innervates the gluteus minimus. -
This question is part of the following fields:
- Anatomy
- Lower Limb
-
-
Question 23
Incorrect
-
Which of the following is true regarding respiration?
Your Answer: The ‘bucket handle’ action of the ribs is their downward and lateral movement
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.
-
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 24
Incorrect
-
All of the following typically occurs as part of normal inspiration except:
Your Answer: Contraction of the diaphragm
Correct Answer: Contraction of the internal intercostal muscles
Explanation:Passive inspiration is a result of contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs).
In inspiration, several movements occur. These are:
1. elevation of the sternal ends of the ribs (‘pump handle’ movement),
2. elevation of the lateral shafts of the ribs (‘bucket handle’ movement)
3. depression of the diaphragm.
These result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. There is an increased intrathoracic volume and decreased intrathoracic pressure and air is drawn into the lungs. -
This question is part of the following fields:
- Anatomy
- Thorax
-
-
Question 25
Incorrect
-
In adults, the conus medullaris of the spinal cord lies at which of the following vertebral levels:
Your Answer: T12/L1
Correct Answer: L1/L2
Explanation:At birth, the conus medullaris lies at L3. By the age of 21, it sits at L1/L2.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 26
Incorrect
-
Regarding the intervertebral disc, which of the following statements is CORRECT:
Your Answer: Herniation of the intervertebral disc occurs when the outer fibrous layer herniates through vertebral bodies.
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.
-
This question is part of the following fields:
- Anatomy
- Head And Neck
-
-
Question 27
Incorrect
-
Regarding the abductor pollicis longus, which of the following statements is true?
Your Answer: It forms part of the thenar eminence
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.
-
This question is part of the following fields:
- Anatomy
- Upper Limb
-
-
Question 28
Correct
-
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: 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
-
-
Question 29
Incorrect
-
A 70-year-old woman presents with right-sided loss of pain and temperature sense on the body as well as left-sided loss of pain and temperature sense on the face. She also has complaints of vertigo, nausea, and tinnitus. Further examination of her cranial nerves suggest the presence of Horner's Syndrome. An MRI and CT scan was ordered and results showed that she is suffering from a left-sided stroke.
Branches of which of the following arteries are most likely implicated in the case?Your Answer: Basilar artery
Correct Answer: Posterior inferior cerebellar artery
Explanation:Wallenberg syndrome is also known as lateral medullary syndrome and posterior inferior cerebellar artery syndrome. It is the most common posterior circulation ischemic stroke syndrome. The primary pathology of Wallenberg syndrome is occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches.
It is characterized by vertigo with nystagmus, nausea and vomiting, and sometimes hiccups, dysphonia, dysarthria, and dysphagia often present with ipsilateral loss of gag reflex, ipsilateral ataxia with a tendency to fall to the ipsilateral side, pain and numbness with impaired facial sensation on the face, impaired taste sensation, and impaired pain and temperature sensation in the arms and legs.
-
This question is part of the following fields:
- Anatomy
- Central Nervous System
-
-
Question 30
Incorrect
-
Which nerve supplies the muscle flexor hallucis longus?
Your Answer: Obturator nerve
Correct Answer: Tibial nerve
Explanation:Flexor hallucis longus is innervated by the tibial nerve, composed of spinal roots L4, L5, S1, S2, and S3.
-
This question is part of the following fields:
- Anatomy
- Lower Limb
-
SESSION STATS - PERFORMANCE PER SPECIALTY
