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Question 1
Correct
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A 70-year-old man who was previously healthy develops a rapidly progressing neurological deficit. A MRI reveals a large, poorly defined mass with central necrosis in his left temporal lobe. What is the most likely diagnosis?
Your Answer: Glioblastoma multiforme
Explanation:Glioblastoma multiforme, or grade 4 astrocytoma, is the most common and aggressive primary brain tumour. They are formed by small areas of necrotising tissue surrounded by highly anaplastic cells. Most of them arise from the deep white matter of the brain and quickly infiltrate it, becoming very large before they are symptomatic. The most common symptom is progressive memory, personality or neurological deficit due to temporal and frontal lobe involvement. It is most common in men, and risk factors include: neurofibromatosis, tuberous sclerosis, Von Hippel-Lindau disease, Li-Fraumeni syndrome, and Turcot syndrome.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 2
Correct
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Which structure holds the duodenojejunal flexure in place?
Your Answer: Suspensory ligament (of Treitz)
Explanation:The duodenum is connected to the diaphragm by the suspensory ligament called the ligament of Treitz. It is a slip of skeletal muscle from the right crus of the diaphragm and a fibromuscular band of smooth muscle from the 3rd and 4th parts of the duodenum. It is an important landmark, used to divide the gastrointestinal tract into the upper and lower parts. Contraction of this ‘ligament’ leads to opening of the duodenojejunal flexure allowing the flow of chyme.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 3
Correct
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The Brunner glands secrete an alkaline product that helps maintain an optimal pH for pancreatic enzyme activity. Where are these glands located?
Your Answer: Submucosa of the duodeneum
Explanation:The Brunner glands are located in the submucosa of the duodenum. These glands are connected to the interstitial lumen by ducts that open into certain crypts. They secrete an alkaline product that protects the duodenal mucosa from the acidic chyme and helps achieve an optimal pH for the enzymes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 4
Correct
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Where do the seminal vesicles lie?
Your Answer: Base of the bladder and rectum
Explanation:The seminal vesicles are two lobulated membranous pouches situated between the fundus of the bladder and rectum and act as a reservoir for the semen and secrete a fluid that is added to the seminal fluid. Each sac is pyramidal in shape but they all vary in size not only in different individuals but also in the same individuals. The anterior surface is in contact with the fundus of the bladder, extending from near the termination of the ureter to the base of the prostate. Each vesicle consist of single tube, which gives off several irregular caecal diverticula. These separate coils and the diverticula are connected by fibrous tissue.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 5
Correct
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The stomach is an organ that is divided into several important anatomical parts. These parts of the stomach have varied arterial blood supply that ensure that the whole organ receive oxygenated blood. Which of the following arteries if ligated, will not render any portion of the stomach ischaemic?
Your Answer: Superior mesenteric
Explanation:The blood supply to the stomach is through the following arteries:
– The superior mesenteric artery supplies blood to the lower part of the duodenum, pancreas and two-thirds of the transverse colon. Thus ligation of the superior mesenteric artery would not affect the stomach.
– The right and the left gastroepiploic arteries supply the greater curvature of the stomach – along its edges.
– The short gastric artery supplies blood to the upper portion of the of the greater curvature and the fundus of the stomach.
– The gastroduodenal artery supplies blood to the distal part of the stomach (the pyloric sphincter) and the proximal end of the duodenum.
– The left gastroepiploic and the short gastric are branches of the splenic artery and therefore ligation of the splenic artery would directly affect the stomach.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 6
Incorrect
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A neurotransmitter of the nigrostriatal pathway is:
Your Answer: Gamma-aminobutyric acid (GABA)
Correct Answer: Dopamine
Explanation:Dopamine acts as a neurotransmitter in the brain, activating dopamine receptors. It is also a neurohormone released from the hypothalamus. It plays an important role in the reward system. It is believed that dopamine provides a teaching signal to parts of the brain responsible for acquiring new motor sequences (behaviours), by activation of dopamine neurons when an unexpected reward is presented. Loss of dopamine neurones in the nigrostriatal pathway causes Parkinson’s disease. In the frontal lobes, dopamine controls the flow of information from other areas of the brain, and thus, dopamine disorders in this region can cause a decline in neurocognitive functions, especially memory, attention and problem solving. Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention-deficit disorder and some symptoms of schizophrenia. Dopamine is also the primary neuroendocrine regulator of the secretion of prolactin from the anterior pituitary gland. Dopamine is also commonly associated with the pleasure system of the brain. This plays a key role in understanding the mechanism of action of drugs (such as cocaine and the amphetamines), which seem to be directly or indirectly related to the increase of dopamine.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 7
Correct
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Which of the following structures is derived from the dorsal mesogastrium of the stomach during the development of the gut?
Your Answer: Greater omentum
Explanation:In a developing foetus, the stomach has two mesogastria from which most of the abdominal ligaments develop. These two mesogastria are the; ventral mesogastrium and the dorsal mesogastrium. During the embryological development of the gut, different organs develop in each mesogastrium; the spleen and pancreas in the dorsal mesogastrium while the liver in the ventral mesogastrium (with their associated ligaments). In the dorsal mesogastrium the following structures develop; the greater omentum (containing the gastrophrenic ligament and the gastrocolic ligament), gastrosplenic ligament, mesentery, splenorenal ligament and phrenicocolic ligament. The structures that develop from the ventral mesogastrium include the; lesser omentum (containing the hepatoduodenal ligament and the hepatogastric ligament) in association with the liver; the coronary ligament (left triangular ligament, right triangular ligament and hepatorenal ligament) and the falciform ligament (round ligament of liver and ligamentum venosum within).
There are also folds that develop from the dorsal mesogastrium which include; umbilical folds, supravesical fossa, medial inguinal fossa, lateral umbilical fold, lateral inguinal fossa and Ileocecal fold.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 8
Incorrect
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Which of the following statements regarding aqueous humour is correct?
Your Answer: Is the only source of nutrients for the iris
Correct Answer: Is the only source of nutrients for the lens of the eye
Explanation:The aqueous humour is a transparent, watery fluid similar to plasma, but containing low protein concentrations. It is secreted from the ciliary epithelium and fills both the anterior and the posterior chambers of the eye. It maintains the intraocular pressure and inflates the globe of the eye. It is this hydrostatic pressure which keeps the eyeball in a roughly spherical shape and keeps the walls of the eyeball taut. It provides nutrition (e.g. amino acids and glucose) for the avascular ocular tissues; posterior cornea, trabecular meshwork, lens, and anterior vitreous. It may serve to transport ascorbate into the anterior segment to act as an antioxidant agent. The presence of immunoglobulins indicate its role in immune response to defend against pathogens.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 9
Incorrect
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What is the innervation of the tensor tympani muscle?
Your Answer: Glossopharyngeal nerve
Correct Answer: Trigeminal nerve
Explanation:The tensor veli palatini is innervated by the medial pterygoid nerve, a branch of mandibular nerve, the third branch of the trigeminal nerve (CN V3) – the only muscle of the palate not innervated by the pharyngeal plexus, which is formed by the vagal and glossopharyngeal nerves.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 10
Correct
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upon stroking the plantar surface of a patient's foot, extension of toes was noted. This is likely to be accompanied with:
Your Answer: Spasticity
Explanation:An upper motor neuron lesion affects the neural pathway above the anterior horn cell or motor nuclei of the cranial nerves, whereas a lower motor neurone lesion affects nerve fibres travelling from the anterior horn of the spinal cord to the relevant muscles. An upper motor neurone lesions results in the following:
– Spasticity in the extensor muscles (lower limbs) or flexor muscles (upper limbs).
– ‘clasp-knife’ response where initial resistance to movement is followed by relaxation
– Weakness in the flexors (lower limbs) or extensors (upper limbs) with no muscle wasting
– Brisk tendon jerk reflexes
– Positive Babinski sign (on stimulation of the sole of the foot, the big toe is raised rather than curled downwards)
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This question is part of the following fields:
- Neurology
- Physiology
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Question 11
Correct
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A drug abuser developed an infection which spread from the dorsum of the hand to the medial side of the arm along the course of the large cutaneous vein. Which vein is involved?
Your Answer: Basilic
Explanation:The basilic vein is one of two veins found in the forearm, the other is the cephalic vein. These veins originate from the deep venous arch of the hand. The cephalic vein ascends along the lateral side of the forearm, and the basilic vein runs up the medial side of the forearm.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
Correct
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A 20-year old college student was diagnosed with meningitis that had developed due to an acute cavernous sinus thrombosis from an ear infection. Which of the following superficial venous routes is the usual path that an infected blood clot takes to reach the cavernous sinus?
Your Answer: Facial vein
Explanation:The facial vein is the usual communication between the cavernous sinus and the pterygoid sinus. It is through this vein that an infected clot can travel to the cavernous sinus and cause infection. The pterygoid plexus is a venous plexus that is situated between the temporalis muscle and lateral pterygoid muscle, and partly between the two pterygoid muscles. The pterygoid plexus is connected to the facial vein by the deep facial vein. This connection is what makes this area where this sinus and the facial vein are located a danger zone. The danger zone or triangle of the face is the area from the corners of the mouth to the nose bridge. The sinus connection in this area makes it possible for infection to reach the cavernous sinus and at times cause meningitis.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 13
Correct
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After a cerebral infarction, which of these histopathogical findings is most likely to be found?
Your Answer: Liquefactive necrosis
Explanation:The brain has a high lipid content and typically undergoes liquefaction with ischaemic injury, because it contains little connective tissue but high amounts of digestive enzymes.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 14
Incorrect
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A sudden loud sound is more likely to result in cochlear damage than a slowly developing loud sound. This is because:
Your Answer: The tympanic membrane becomes flaccid as a sound becomes louder
Correct Answer: There is a latent period before the attenuation reflex can occur
Explanation:On transmission of a loud sound into the central nervous system, an attenuation reflex occurs after a latent period of 40-80 ms. This reflex contracts the two muscles that pull malleus and stapes closer, developing a high degree of rigidity in the entire ossicular chain. This reduces the ossicular conduction of low frequency sounds to the cochlea by 30-40 decibels. In this way, the cochlea is protected from damage due to loud sounds (these are low frequency sounds) when they develop slowly.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 15
Correct
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Which nuclei of the posterior grey column of the spinal cord are likely affected in a patient who has lost the sensation of pain and temperature?
Your Answer: Substantia gelatinosa
Explanation:Substantia gelatinosa is one of the nuclei in the posterior grey column along side other posterior grey column nuclei like the nucleus dorsalis, nucleus proprius, and posteromarginal nucleus. These nuclei are a collection of cells in the posterior grey area found in throughout the spinal cord. The substantia gelatinosa receives direct input from the dorsal nerve roots (sensory), especially from thermoreceptors and nociceptors (receptors for temperature and pain).
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This question is part of the following fields:
- Anatomy
- Neurology
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Question 16
Correct
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The superior rectal artery is a continuation of the:
Your Answer: Inferior mesenteric artery
Explanation:The superior rectal artery or superior haemorrhoidal artery is the continuation of the inferior mesenteric artery. It descends into the pelvis between the layers of the mesentery of the sigmoid colon, crossing the left common iliac artery and vein.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 17
Correct
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Which of the following structures lying posterior to the ovary are at risk of injury in excision of a malignant tumour in the right ovary?
Your Answer: Ureter
Explanation:The ovaries are two nodular structures situated one on either side of the uterus in relation to the lateral wall of the pelvis and attached to the back of the broad ligament of the uterus, lying posteroinferiorly to the fallopian tubes. Each ovary has a lateral and medial surface. The ureter is at greater risk of iatrogenic injury at this location.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 18
Correct
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Which of these infectious agents tends to affect people under 20 and over 40 years old, can cause acute encephalitis with cerebral oedema and petechial haemorrhages, along with haemorrhagic lesions of the temporal lobe. A lumbar puncture will reveal clear cerebrospinal fluid with an elevated lymphocyte count?
Your Answer: Herpes simplex virus
Explanation:Haemorrhagic lesions of the temporal lobe are typical of Herpes simplex encephalitis (HSE). It tends to affect patients aged under 20 or over 40 years, and is often fatal if left untreated. In acute encephalitis, cerebral oedema and petechial haemorrhages occur and direct viral invasion of the brain usually damages neurones. The majority of cases of herpes encephalitis are caused by herpes simplex virus-1 (HSV-1), and about 10% of cases of herpes encephalitis are due to HSV-2, which is typically spread through sexual contact.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 19
Correct
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A man came to the hospital complaining of a sensation of pins and needles in the dorsum of the thumb and digits 1 and 2. On further examination they found that he had weakness in wrist dorsiflexion and finger extension. Which nerve do you think is injured in this case?
Your Answer: Radial
Explanation:The radial nerve can be injured in multiple sites along its course in the upper limb, and each site has its own presentation. The major complaint is wrist drop which if high above the elbow, can cause numbness of the forearm and hand. It can last for several days or weeks. The most common site of compression for the radial nerve is at the proximal forearm in the area of the supinator muscles.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 20
Correct
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A man was stabbed in the thigh following a bar brawl. A superficial vein was injured which terminates in the femoral vein. This superficial vein is?
Your Answer: Great saphenous
Explanation:The great saphenous vein is considered the longest vein in the body. It terminates in the femoral vein nearly 3cm below the inguinal ligament. It begins at the dorsum of the foot in the medial marginal vein and ascends at the medial side of the leg in relation with the saphenous nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 21
Correct
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A patient who underwent emergency appendicectomy complains of having numbness (paraesthesia) of the skin at the pubic region. Which nerve was most likely injured in the operation?
Your Answer: Iliohypogastric
Explanation:The iliohypogastric nerve comes from L1 and emerges from the upper part of the lateral border of the psoas major. It then crosses obliquely in front of the quadratus lumborum to the iliac crest where it perforates the posterior part of transversus abdominis and divides between that muscle and the internal oblique into a lateral and an anterior cutaneous branch. This provides sensory innervation to the skin of the lower abdominal wall, upper hip and upper thigh.
The genitofemoral nerve also comes from the lumbar plexus that innervates the skin of the anterior scrotum or labia majora and upper medial thigh.
The subcostal nerve is the ventral primary ramus of T12 providing sensory innervation to the anterolateral abdominal wall in an area superior to the pubic region.
A spinal nerve owing to their deep location would not have been injured in the procedure.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 22
Correct
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Which muscle extends to form the cremasteric muscle?
Your Answer: Internal abdominal oblique muscle
Explanation:The cremasteric muscle is a thin layer of muscle composed of several fasciculi that originate from the middle of the inguinal ligament. At its point of origin the fibres are continuous with the fibres of internal oblique and sometimes with the transversus abdominis. It then passes along the lateral side of the spermatic cord and descends with it through the superficial inguinal ring on the front and sides of the cord.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 23
Incorrect
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Which of the following foramina will the ophthalmic artery pass through in order to reach the eye?
Your Answer: Superior orbital fissure
Correct Answer: Optic canal
Explanation:The optic foramen is the opening to the optic canal. The canal is located in the sphenoid bone; it is bounded medially by the body of the sphenoid and laterally by the lesser wing of the sphenoid. The superior surface of the sphenoid bone is bounded behind by a ridge, which forms the anterior border of a narrow, transverse groove, the chiasmatic groove (optic groove). The groove ends on either side in the optic foramen, which transmits the optic nerve and ophthalmic artery into the orbital cavity. Compared to the optic nerve, the ophthalmic artery is located inferolaterally within the canal.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 24
Correct
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From which source does the lingual artery originate?
Your Answer: External carotid
Explanation:The lingual artery arises from the external carotid between the superior thyroid artery and facial artery. It can be located easily on the lower surface of the tongue. The terminal branch of the lingual artery is the deep lingual artery. On its course the lingual artery gives off side branches: dorsal lingual branches that supply the dorsum of the tongue till the epiglottis; sublingual artery that supplies the sublingual gland.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 25
Correct
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A patient with a long standing lower motor neuron lesion will have:
Your Answer: Muscle wasting
Explanation:Lower motor neurons (LMNs) connect the brainstem and spinal cord to muscle fibres. Damage to lower motor neurons is indicated by abnormal electromyographic potentials, fasciculations, paralysis, weakening and wasting of skeletal muscles.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 26
Correct
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The nasolacrimal duct is a membranous canal. It extends from the lower part of the lacrimal sac and drains into which structure?
Your Answer: Inferior meatus
Explanation:The nasolacrimal duct carries tears from the lacrimal sac of the eye into the nasal cavity. The duct begins in the eye socket between the maxillary and lacrimal bones, from where it passes downwards and backwards. The opening of the nasolacrimal duct into the inferior nasal meatus of the nasal cavity is partially covered by a mucosal fold (valve of Hasner or plica lacrimalis). Excess tears flow through the nasolacrimal duct which drains into the inferior nasal meatus.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 27
Correct
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A terrorist running away from the police was shot in the back. The bullet hit his left lung halfway between its apex and the diaphragmatic surface. Which part of the lung was most likely to be injured?
Your Answer: Inferior lobe
Explanation:The oblique fissure of the left lung is so sharp that the posterior surface of the left lung is mostly composed of the inferior lobe so that the point halfway between the apex and the diaphragmatic surface of the lung would result in injury to the inferior lobe.
The hilum is the point on the medial surface of the lung where the structures that form the root of the lung enter and leave the lung.
The lingual on the other hand is part of the superior lobe of the left lung and it is part of the anterior and superior sides of the lung.
The middle lobe is only found on the right lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 28
Incorrect
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Into which vein does the left and right inferior thyroid veins drain?
Your Answer: Internal jugular vein
Correct Answer: Brachiocephalic vein
Explanation:The brachiocephalic vein is formed by the confluence of the subclavian and internal jugular veins. In addition it receives drainage from: the left and right internal thoracic veins (also called internal mammary veins), left and right inferior thyroid veins and the left superior intercostal vein.
The superior thyroid veins and middle thyroid veins drain into the internal jugular vein. The right and left inferior thyroid veins to drain into their respective brachiocephalic veins (right and left). -
This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 29
Correct
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A victim of mob justice was brought to the A & E with a stab wound in the anterior chest 2 cm lateral to the left sternal border. He underwent an emergency thoracotomy that revealed clots in the pericardium, with a puncture wound in the right ventricle. To evacuate the clots from the pericardial cavity the surgeon slipped his hand behind the heart at its apex. He extended his finger upwards until its tip was stopped by a line of pericardial reflection which forms the:
Your Answer: Oblique pericardial sinus
Explanation:Transverse sinus: part of pericardial cavity that is behind the aorta and pulmonary trunk and in front of the superior vena cava separating the outflow vessels from the inflow vessels.
Oblique pericardial sinus: is behind the left atrium where the visceral pericardium reflects onto the pulmonary veins and the inferior vena cava. Sliding a finger under the heart will take you to this space.
Cardiac notch: indentation of the ‘of the heart’ on the superior lobe of the left lung.
Hilar reflection: the reflection of the pleura onto the root of the lung to continue as mediastinal pleura.
Costomediastinal recess: part of the pleural sac where the costal pleura transitions to become the mediastinal pleura.
Sulcus terminalis: a groove between the right atrium and the vena cava
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 30
Correct
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A 40 year old man sustained a fracture to the surgical neck of his left humerus. Which of the following arteries is suspected to be injured in this case?
Your Answer: Posterior humeral circumflex
Explanation:The posterior humeral circumflex artery arises from the axillary artery and runs with the axillary nerve through the quadrangular space which is bounded laterally by the surgical neck of the humerus. After winding around the surgical neck of the humerus, it is distributed to the deltoid muscle and the shoulder joint. Thus fractures in the surgical neck of the humerus could result in an injury to this artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 31
Correct
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A 20 year lady is brought to the A&E following a road accident. She is hypotensive and a CT scan of the abdomen reveals a shattered spleen. An emergency splenectomy is performed where the splenic artery is ligated right at its origin. Which of the following arteries will have a diminished blood flow owing to ligation of the splenic artery at its origin?
Your Answer: Left gastroepiploic
Explanation:Ligation of the splenic artery right at its point of origin should cut off blood flow in its branches. The following are the branches of the splenic artery: pancreatic branches, short gastric branches and left gastroepiploic arteries.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 32
Correct
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A correct statement about the RECTUM:
Your Answer: It is an important anastomotic site for the portal and caval (systemic) venous systems
Explanation:The rectum is part of the gastrointestinal tract that is continuous above with the sigmoid colon and below with the anal canal. It contains both longitudinal and circular smooth muscles. These are supplied by the enteric nervous system. It is about 12 cm long. It has no sacculations comparable with those of the colon. It has three permanent transverse folds called the valves of Houston. The peritoneum is related to the upper two thirds of the rectum only whereas the lower part is not covered by peritoneum. It is supplied by the superior rectal (hemorrhoidal) branch of the inferior mesenteric artery and the median sacral artery that is a direct branch from the abdominal aorta. It is drained by veins that begin as a plexus that surround the anus. These veins form anastomoses with the portal system (portocaval anastomoses).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 33
Correct
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The following organs would be expected to lie within the right lower quadrant of the abdomen, assuming that the gastrointestinal tract is rotated normally:
Your Answer: Distal jejunum, caecum, vermiform appendix
Explanation:The abdomen is divided by theoretical anatomic lines into four quadrants. The median plane follows the linea alba and extends from the xiphoid process to the pubic symphysis and splits the abdomen in half. The transumbilical plane is a horizontal line that runs at the level of the umbilicus. This forms the upper right and left quadrants and the lower right and left quadrants. Structures in the right lower quadrant include: caecum, appendix, part of the small intestine, ascending colon, the right half of the female reproductive system, right ureter. Pain in this region is most commonly associated with appendicitis.
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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 these laboratory findings will indicate a fetal neural tube defect when done between 15 and 20 weeks of pregnancy?
Your Answer: Increased alpha-fetoprotein
Explanation:Maternal serum screening during the second trimester is a non-invasive way of identifying women at increased risk of having children with a neural tube defect and should be offered to all pregnant women. The results are most accurate when the sample is taken between 15 and 20 weeks of gestation. Elevated levels of alpha-fetoprotein suggest open spina bifida, anencephaly, risk of pregnancy complications, or multiple pregnancy.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 35
Incorrect
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A 60-year-old woman complains of left sided headaches which have been recurring for several years. She recently suffered from a focal seizure for the first time a few days ago. A CT scan shows a mass in the left hemisphere of the brain. The most likely diagnosis is:
Your Answer: Metastatic carcinoma
Correct Answer: Meningioma
Explanation:Meningiomas are a common benign intracranial tumour, and their incidence is higher in women between the ages of 40-60 years old. Many of these tumours are asymptomatic and are diagnosed incidentally, although some of them may have malignant presentations (less than 2% of cases). These benign tumours can develop wherever there is dura, over the convexities near the venous sinuses, along the base of the skull, in the posterior fossa and, within the ventricles.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 36
Correct
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In relation to the muscles of facial expression, It is true to say:
Your Answer: They are in the same subcutaneous plane as the platysma muscle
Explanation:The facial muscles generally originate from the facial bones and attach to the skin, in the same plane as the platysma muscle. They are all innervated by cranial nerve VII (the facial nerve). The occipitofrontalis muscle consists of two parts: The occipital belly, near the occipital bone, and the frontal belly, near the frontal bone.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 37
Correct
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Following nerve injury, paralysis of the quadriceps femoris muscle occurs. Which of the following movements will be affected?
Your Answer: Extension of the leg
Explanation:The quadriceps muscle is a great extensor of the thigh. Therefore, following nerve injury or cutting nerve supply to the quadriceps will affect extension of the thigh
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 38
Incorrect
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The cranial nerves of the brain provide motor and sensory innervation to the structures of the head and neck. Which of the following cranial nerves provide only motor innervation?
Your Answer: Facial
Correct Answer: Abducens
Explanation:The cranial nerves emerge directly from the brain and the brain stem. They provide sensory, motor or both motor and sensory innervation. Here is a summary of the cranial nerves and their function:
Olfactory – Purely sensory
Optic – Sensory
Oculomotor – Mainly motor
Trochlear – Motor
Trigeminal – Both sensory and motor
Abducens – Mainly motor
Facial – Both sensory and motor
Vestibulocochlear – Mostly sensory
Glossopharyngeal – Both sensory and motor
Vagus – Both sensory and motor
Accessory – Mainly motor
Hypoglossal – Mainly motor
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 39
Correct
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The superior pancreaticoduodenal artery, the artery that supplies blood to the pancreas and the duodenum, is a branch of the:
Your Answer: Gastroduodenal artery
Explanation:The superior pancreaticoduodenal artery together with the right gastroepiploic artery form the two branches of the gastroduodenal artery which divides at the lower border of the duodenum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 40
Incorrect
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The petrous part of the internal carotid artery is located inside of which cranial bone?
Your Answer: Sphenoid
Correct Answer: Temporal
Explanation:The petrous segment, or C2, of the internal carotid is that which is inside the petrous part of the temporal bone. This segment extends until the foramen lacerum. The petrous portion classically has three sections: an ascending, or vertical portion; the genu, or bend; and the horizontal portion.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 41
Incorrect
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A lesion involving the lateral portion of the dorsal columns at the level of the nape of the neck will most likely affect:
Your Answer: Sweating of the ipsilateral face
Correct Answer: Vibratory sensations from the ipsilateral arm
Explanation:At the level mentioned in the question, the lateral portion of dorsal columns comprises of the fasciculus cuneatus. Axons carrying the sensations of touch, vibration and proprioception from the ipsilateral arm enter the spinal cord and ascend in the fasciculus cuneatus, synapsing in the nucleus cuneatus of the caudal medulla. Secondary neurons from this nucleus give rise to internal arcuate fibres, which decussate and ascend to the thalamus as the medial lemniscus. Tertiary neurons from there project to the ipsilateral somatosensory cortex. Thus, any damage to the fasciculus cuneatus will result in a deficit in tactile, proprioceptive and vibratory sensations in the ipsilateral arm, and not the contralateral arm.
Fine motor control of the fingers is mainly carried by the ipsilateral lateral corticospinal tract in the lateral funiculus of the cord. Motor control of the contralateral foot is carried by the ipsilateral corticospinal tract in the lateral funiculus of the cord. Lack of sweating of the face could be produced by interruption of sympathetic innervation. Proprioception from the ipsilateral leg is carried by the fasciculus gracilis in the medial part of the dorsal columns.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 42
Correct
-
What is the linea aspera:
Your Answer: Serves as an attachment for adductors of the thigh
Explanation:The linea aspera is a prominent longitudinal ridge or crest on the middle third of the femur. It has a medial and a lateral lip and a narrow, rough, intermediate line. The vastus medialis arises from the medial lip of the linea aspera and has superior and inferior prolongations. The vastus lateralis takes origin from the lateral lip . The adductor magnus is inserted into the linea aspera. Two muscles are attached between the vastus lateralis and the adductor magnus: the gluteus maximus is inserted above and the short head of the biceps femoris arises below. Four muscles are inserted between the adductor magnus and the vastus medialis: the iliacus and pectineus superiorly, and the adductor brevis and adductor longus inferiorly.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 43
Correct
-
The rotator cuff surrounds the shoulder joint and consists of the supraspinatus, infraspinatus, subscapularis and which one other muscle?
Your Answer: Teres minor
Explanation:The correct answer is the teres minor muscle. These group of muscles play an important role in protecting the shoulder joint and keeping the head of the humerus in the glenoid fossa of the scapula. This fossa is somehow shallow and needs support to allow for the full mobility that the shoulder joint has.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 44
Correct
-
Identify which of the following muscles acts on two joints?
Your Answer: Sartorius
Explanation:The sartorius muscle, the longest muscle in the body, is one of the two jointed or biarticular muscles. It originates from the anterior superior iliac spine and part of the notch between the anterior superior iliac spine and anterior inferior iliac spine and crosses both the hip joint and the knee joint. At the hip joint the sartorius flexes and rotates the thigh at the hip joint and flexes the leg at the knee joint.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 45
Correct
-
In the adult heart, the sinus venosus gives rise to the:
Your Answer: Coronary sinus
Explanation:The sinus venosus is a large quadrangular cavity which precedes the atrium on the venous side of the chordate heart. It exists distinctly only in the embryonic heart (where it is found between the two venae cavae); however, the sinus venosus persists in the adult. In the adult, it is incorporated into the wall of the right atrium to form a smooth part called the sinus venarum, which is separated from the rest of the atrium by a ridge of fibres called the crista terminalis. The sinus venosus also forms the SA node and the coronary sinus.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 46
Incorrect
-
The primary area involved in the pathology of Parkinson's disease is:
Your Answer: Motor cortex
Correct Answer: Substantia nigra
Explanation:Parkinson’s disease is a degenerative, movement disorder of the central nervous system, and is typically characterized by muscle rigidity, tremor and bradykinesia (in extreme cases, akinesia). Secondary symptoms include high-level cognitive dysfunction and subtle language problems.
Parkinson’s disease is also called ‘primary Parkinsonism’ or ‘idiopathic Parkinson’s disease and is the most common cause of Parkinsonism, a group of similar symptoms. The disorder is caused due to loss of pigmented dopaminergic cells in the pars compacta region of the substantia nigra.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 47
Correct
-
An 80 year-old quadriplegic man has been lying supine for 7 weeks in a critical care ward. He develops a right lung abscess that is draining by gravity to a particular region of the lung. Which is the most likely site of pus collection?
Your Answer: Superior segment of the lower lobe
Explanation:The superior segmental bronchus of the lower lobe of the right lung branches posteriorly off the intermediate bronchus or the inferior lobe bronchus. It is therefore more likely to receive fluid or foreign bodies that enter the right main bronchus especially when the patient is supine.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 48
Correct
-
The circle of Willis is an arterial anastomosis in the base of the brain and is one of the cerebrovascular safeguards in the brain. Where is the circle of Willis contained?
Your Answer: Cisterna basalis
Explanation:Cisterns refers to a system of intercommunicating pools formed by the subarachnoid space at the base of the brain and around the brainstem. Cisterna basalis/basal cistern (interpeduncular cistern) is found at the base of the brain between the two temporal lobes and it contains the arterial circle of Willis. The lumbar cistern is contained in the spinal canal while the foramen magna refers to the opening at the base of the skull though which the spinal cord enters into the skull.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 49
Correct
-
Which of the following muscles are involved in abduction of the wrist?
Your Answer: Extensor carpi radialis brevis and flexor carpi radialis
Explanation:The muscle of the wrist that cause abduction of the wrist otherwise also know as radial flexion of the wrist are the following:
-Abductor Pollicis Longus
-Flexor Carpi Radialis
-Extensor Carpi Radialis Longus
-Extensor Carpi Radialis Brevis
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 50
Incorrect
-
Muscles and tendons in the planter region of the foot mainly take blood supply from:
Your Answer: Anterior tibial artery
Correct Answer: Posterior tibial artery
Explanation:The posterior tibial artery is the main source of blood supply to 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 51
Incorrect
-
Rapid eye movement (REM) sleep is likely to be affected by a lesion in the:
Your Answer: Basal ganglia
Correct Answer: Pons
Explanation:Rapid eye movement (REM) sleep is also known as paradoxical sleep, as the summed activity of the brain’s neurons is quite similar to that during waking hours. Characterised by rapid movements of the eyes, most of the vividly recalled dreams occur during this stage of sleep. The total time of REM sleep for an adult is about 90–120 min per night.
Certain neurones in the brainstem, known as REM sleep-on cells, which are located in the pontine tegmentum, are particularly active during REM sleep and are probably responsible for its occurrence. The eye movements associated with REM are generated by the pontine nucleus with projections to the superior colliculus and are associated with PGO (pons, geniculate, occipital) waves.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 52
Incorrect
-
A 40-year old woman with portal hypertension has impaired venous drainage of the anal canal above the pectinate line. Thus, there might be an increase in blood flow downward to the systemic venous system via anastomoses with the inferior rectal vein. This is a tributary of?
Your Answer: Inferior mesenteric vein
Correct Answer: Internal pudendal vein
Explanation:The inferior rectal vein drains into the internal pudendal vein. In addition the external iliac vein is one of the two branches of the common iliac vein however the internal iliac vein and it’s tributaries (including the pudendal vein) are much more important in draining the pelvic structures.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 53
Incorrect
-
What is correct regarding the obturator artery?
Your Answer: It exits through the greater sciatic foramen
Correct Answer: It is found in the medial compartment of the thigh
Explanation:The obturator artery is a branch of the internal iliac artery, which passes antero-inferiorly on the lateral wall of the pelvis, to the upper part of the obturator foramen. The posterior branch follows the posterior margin of the foramen and turns forward on the inferior ramus of the ischium. It also supplies an articular branch, which enters the hip joint through the acetabular notch, sending a branch along the ligamentum teres to the head of the femur. It is the main source of arterial supply to the medial compartment of the thigh
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 54
Correct
-
Which of the following veins empties into the left renal vein?
Your Answer: Left suprarenal
Explanation:The left suprarenal vein empties into the left renal vein which crosses the vertebral column to reach the inferior vena cava. The left renal vein also receives the left gonadal vein.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 55
Correct
-
A 16 year-old boy was stabbed in the right supraclavicular fossa. The sharp object punctured the portion of the parietal pleura that extends above the first rib. What is the name of this portion of the parietal pleura?
Your Answer: Cupola
Explanation:Endothoracic fascia: the connective tissue (fascia) that is between the costal parietal pleura and the inner wall of the chest wall.
Costomediastinal recess: the point where the costal pleura becomes mediastinal pleura.
Costodiaphragmatic recess: is the lowest point of the pleural sac where the costal pleura becomes diaphragmatic pleura.
Cupola: the part of the parietal pleura that extends above the first rib level into the root of the neck.
Costocervical recess: this is a made-up term.
Peritracheal fascia: a layer of connective tissue that invests the trachea.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 56
Incorrect
-
Which of the following is true about myasthenia gravis?
Your Answer: The patient should be given α-bungarotoxin to determine the number of acetylcholine binding sites at the post junctional membrane
Correct Answer: Response of skeletal muscle to nerve stimulation is weakened
Explanation:An autoimmune disorder, myasthenia gravis leads to progressive muscle weakness. It occurs due to formation of antibodies against the nicotinic acetylcholine (ACh) receptor of the motor endplate, which leads to impaired neuromuscular transmission. Thus, nerve stimulation will lead to a weakened muscle response, but direct electrical stimulation will bring about a normal response. Diagnostic test includes improvement of muscle weakness by small doses of acetylcholinesterase inhibitors (physostigmine or edrophonium). However, a large dose of physostigmine worsens the weakness due to desensitisation of the endplate to persistent Ach. One of the investigative tools includes radiolabelled snake venom α-bungarotoxin. It is an in vitro study performed on muscle biopsy specimens and used to quantify the number of ACh receptors at the motor endplate.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 57
Correct
-
A 45-year old male patient with a long history of alcoholism developed liver cirrhosis that has led to portal hypertension. Which of the following plexuses of veins is most likely dilated in this patient?
Your Answer: Haemorrhoidal plexus
Explanation:The haemorrhoidal plexus or also known as the rectal plexus is a venous plexus that surrounds the rectum. This venous plexus in males communicates anteriorly with the vesical plexus and uterovaginal plexus in females. This venous plexus forms a site of free communication between the portal and systemic venous systems. In the case of portal hypertension this plexus would most likely dilate due to the increased pressure.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 58
Incorrect
-
An old woman complains of a lack of sensation halfway down the anterior surface of the thigh. The cause of this:
Your Answer: Could be the result of nerve damage during surgical procedures in the femoral sheath
Correct Answer: Would result from damage to the nerve that innervates the pectineus muscle
Explanation:The pectineus is supplied by the second, third and fourth lumbar nerves through the femoral nerve and by the third lumbar through the accessory obturator when it exists. The anterior surface of the thigh receives its innervation from the femoral nerve as well, thus this is the nerve most likely to be injured
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 59
Correct
-
Which best describes the suprascapular nerve?
Your Answer: It contains nerve fibres from C5 and C6 spinal cord segments
Explanation:The suprascapular nerve arises from the cervical spinal nerves 5 and 6 after coming together to form common trunk. This nerve supplies the supraspinatus and infraspinatus muscles giving off branches to the shoulder joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 60
Incorrect
-
Which of the following bones was most likely fractured following an injury in the medial side of the foot between the navicular behind and base of the first metatarsal in front?
Your Answer: Cuboid
Correct Answer: First cuneiform
Explanation:The first cuneiform bone is the largest of the three cuneiforms. It is situated at the medial side of the foot, between the navicular behind and the base of the first metatarsal in front.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 61
Correct
-
A 70-year old man who is suspected to have a perforated colonic diverticulum is explored in theatre through a midline incision. This incision will be through the:
Your Answer: Linea alba
Explanation:The linea alba is the point where this incision was made. It is a tendinous raphe in the midline of the abdomen extending between the xiphoid process and the symphysis pubis. It is placed between the medial borders of the recti and is formed by the blending of the aponeuroses of the external and internal obliques and transversi.
The linea aspera is a vertical ridge on the posterior surface of the femur.
The arcuate line is the inferior border of the posterior rectus sheath behind the rectus abdominis muscle.
The semilunar line is the lateral margin of the rectus abdominis.
The iliopectineal line is a line on the pelvic bones formed by the arcuate line of the ilium and the pectineal line of the pubis.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 62
Correct
-
The principal motor and sensory nerve of the perineum is the?
Your Answer: Pudendal
Explanation:The pudendal nerve is formed by S1,2,4 anterior branches. It gives off the inferior haemorrhoid nerve before dividing terminally into the perineal nerve and the dorsal nerve of the clitoris or the penis. Thus, it is the principal motor and sensory nerve of the perineum.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 63
Correct
-
During a case presentation, a 26 year old is said to have fractured his pelvis and shattered his coccyx following a motorbike accident. It is mentioned that he is likely to have lacerated his middle sacral artery from this kind of injury. Where does the middle sacral artery branch from?
Your Answer: Abdominal aorta
Explanation:The middle sacral artery arises from behind the aorta a little above the point of its bifurcation to descend down in front of L4,5, the sacrum and coccyx.
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This question is part of the following fields:
- Abdomen
- Anatomy
-
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Question 64
Incorrect
-
Which of the following muscles may be affected by a fracture to the tuberosity on the medial surface of the right navicular bone?
Your Answer: Flexor hallucis longus
Correct Answer: Tibialis posterior
Explanation:The navicular bone is situated at the medial side of the tarsus, between the talus and the cuneiform bones. Its medial surface presents a rounded tuberosity, the lower part of which gives attachment to part of the tendon of the tibialis posterior.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 65
Incorrect
-
To reach the oral vestibule, the parotid duct must pierce this muscle:
Your Answer: Superior pharyngeal constrictor muscle
Correct Answer: Buccinator muscle
Explanation:The parotid duct or Stensen duct is a duct and the route that saliva takes from the major salivary gland, the parotid gland into the mouth. The parotid duct is formed when several interlobular ducts—the largest ducts inside the parotid gland join. It emerges from the gland and runs forward along the lateral side of the masseter muscle. In this course, the duct is surrounded by the buccal fat pad. It takes a steep turn at the border of the masseter and passes through the buccinator muscle, opening into the vestibule of the mouth, between the cheek and the gums, at the parotid papilla, which lies across the second superior molar tooth.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 66
Incorrect
-
The Carpal tunnel does NOT contain:
Your Answer: Flexor pollicis longus
Correct Answer: Flexor carpi ulnaris
Explanation:The contents of the carpal tunnel include:
– Median nerve
– Flexor digitorum supervicialis
– Flexor digitorum profundus
– Flexor policis longus
– Flexor carpi radialis
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 67
Correct
-
Which of the deep fasciae located in the anterolateral abdominal wall form the inguinal ligament?
Your Answer: External abdominal oblique aponeurosis
Explanation:The inguinal ligament is the inferior border of the aponeurosis of the external oblique abdominis and extends from the anterior superior iliac spine to the pubic tubercle from whence it is reflected backward and laterally to attach to the pectineal line and form the lacunar ligament.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 68
Correct
-
Which lymph nodes are most likely to enlarge due to the spread of infection through the lymphatic channels in a patient with a boil on his scrotum?
Your Answer: Superficial inguinal nodes
Explanation:The superficial inguinal nodes drain the perineum and the external genitalia which include the scrotum and the labia majora. The testes, however, drain to the lumbar nodes.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 69
Incorrect
-
From which branchial (pharyngeal) pouch does the inferior parathyroid gland arise?
Your Answer: 2nd
Correct Answer: 3rd
Explanation:The following structures arise from each branchial pouch:
1st pouch – eustachian tube, middle ear, mastoid, and inner layer of the tympanic membrane
2nd pouch – middle ear, palatine tonsils
3rd pouch – inferior parathyroid glands, thymus
4th pouch – superior parathyroid glands, ultimobranchial body which forms the parafollicular C-cells of the thyroid gland, musculature and cartilage of larynx (along with the sixth pharyngeal pouch)
5th pouch – rudimentary structure
6th pouch – along with the fourth pouch, contributes to the formation of the musculature and cartilage of the larynx.
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This question is part of the following fields:
- Anatomy
- Endocrine; Embryology
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Question 70
Correct
-
A 40 year old man from Japan was diagnosed with cancer of the oesophagus. He is to undergo esophagectomy. While mobilizing the oesophagus in the neck, for resection and anastomosis with the stomach tube on the left side, the surgeon must be cautious not to injure a vital structure. Which of the following is it?
Your Answer: Thoracic duct
Explanation:The oesophagus is divided into 3 portions: cervical (part that is in the neck), thoracic portion and the abdominal portion. The cervical part is bordered by the trachea anteriorly and the prevertebral fascia covering the bodies of the 6,7 and 8th vertebra posteriorly. The thoracic duct lies on the left side at the level of the sixth cervical vertebra. The carotid sheath with its contents and lower poles of the lateral lobes of thyroid gland are lateral. The thoracic duct is the structure most likely to be injured.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 71
Correct
-
Which muscle is most likely to be affected following an injury to the thoracodorsal nerve (C6-C8)?
Your Answer: Latissimus dorsi
Explanation:Latissimus dorsi is a triangular, flat muscle that covers the lumbar region and the lower half of the thoracic region. It is supplied by the sixth, seventh and eighth cervical nerves through the thoracodorsal (long subscapular) nerve.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 72
Incorrect
-
An old man presented with atrophy of the thenar eminence despite the sensation over it still being intact. What is the injured nerve in this case?
Your Answer: Radial nerve
Correct Answer: Median nerve
Explanation:Atrophy of the thenar muscles means injury to the motor supply of these muscles. The nerve that sends innervation to it is the median nerve. But the median nerve does not provide sensory innervation to the overlying skin so sensation is spared.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 73
Correct
-
The basilar artery arises from the confluence of which two arteries?
Your Answer: Vertebral
Explanation:The basilar artery is part of the vertebrobasilar system. It is formed by the confluence of the two vertebral arteries which arise from the subclavian arteries. These two vertebral arteries merge at the level of cranial nerve VI at the junction between the pons and the medulla oblangata to form what is know as the basilar artery. This vertebrobasilar system supplies the upper spinal cord, brainstem, cerebellum, and posterior part of brain.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 74
Correct
-
During a clinical rotation in the ENT clinic, you observe a flexible bronchoscopy. As the scope is passed down the trachea, you see a cartilaginous structure that resembles a ship's keel and separates the right and the left main stem bronchi. This structure is the:
Your Answer: Carina
Explanation:The carina (a keel-like cartilage) is found at the bifurcation of the trachea separating the right from the left main stem bronchi. It is a little more to the left than to the right.
The cricoid cartilage is the inferior and posterior cartilage of the larynx.
The costal cartilage on the other hand elongates the ribs anteriorly and contribute to the elasticity of the thoracic cage.
The pulmonary ligament is a fold of pleura located below the root of the lung.
Tracheal rings are rings of cartilage that support the trachea.
Peritracheal fascia is a layer of connective tissue that invests the trachea from the outside and is not visible on bronchoscopy.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 75
Incorrect
-
What is the name of the cutaneous branch of the posterior primary ramus of C2?
Your Answer: Superior ramus of the ansa cervicalis
Correct Answer: Greater occipital nerve
Explanation:The dorsal primary ramus of the spinal nerve C2 is the greater occipital nerve which provides cutaneous innervation to the skin of the back of the head. The ventral primary ramus gives off the great auricular nerve, the lesser occipital nerve and the ansa cervicalis.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 76
Correct
-
The midgut loop, also called the primary intestinal loop in a developing embryo, is formed when the midgut bends around which of the following arteries?
Your Answer: Superior mesenteric
Explanation:In a developing foetus, the midgut develops to form most of the intestines. During this development process, the midgut usually bends around the superior mesenteric artery and forms what is referred to as the midgut loop.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 77
Correct
-
A teacher had varicosities in the region of the small saphenous vein. Which of the following is true about that vein?
Your Answer: Has nine to twelve valves
Explanation:It is known that the small saphenous vein has nine to twelve valves along its course. This vein begins as a direct continuation of the lateral marginal vein posterior to the lateral malleolus. It is superficially situated but closer to its termination, perforates the deep fascia in the lower part of the popliteal fossa to end in the popliteal vein.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 78
Incorrect
-
A 50-year old gentleman who suffered a stroke was brought to the emergency department by his relatives. The patient however denied the presence of paralysis of his left upper and lower limbs. What is the most likely site of the lesion in this patient?
Your Answer: Right postcentral gyrus
Correct Answer: Right posterior parietal cortex
Explanation:A large injury to the non-dominant parietal cortex can make the patient neglect or refuse to acknowledge the presence of paralysis on the contralateral side. This can also involve the perception of the external world. Smaller injuries in this area which involve the precentral gyrus (primary motor cortex) or postcentral gyrus (primary sensory cortex) cause contralateral spastic paralysis or contralateral loss of tactile sensation respectively. A lesion in posterior inferior gyrus of the dominant frontal lobe results in motor aphasia. Involvement of the posterior superior gyrus of the dominant frontal lobe produces sensory aphasia.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 79
Incorrect
-
What is expected from complete transection of the inferior gluteal nerve when it emerges from the greater sciatic foramen?
Your Answer: Abduction of the thigh would be eliminated
Correct Answer: Extension of the thigh would be the action most affected
Explanation:As the inferior gluteal nerve emerges from the greater sciatic foramen below the piriformis muscle, it divides into branches and enters the gluteus maximus muscle which extends the femur and bends the thigh in line with the body.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 80
Incorrect
-
A young man in a motor vehicle accident sustained a spinal injury at C8 level. What would likely be seen in this patient?
Your Answer: The muscles innervated by the radial nerve that would most likely be affected would be the most proximal ones
Correct Answer: The hypothenar muscles would be completely paralysed
Explanation:The eighth cervical nerve is one of the contributors of the ulnar nerve. The ulnar nerve supplies the hypothenar muscles which include the opponens digiti minimi, abductor digiti minimi, flexor digiti minimi brevis, and palmaris brevis.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 81
Correct
-
When a patient is standing erect, pleural fluid would tend to accumulate in which part of the pleural space?
Your Answer: Costodiaphragmatic recess
Explanation:The costo-diaphragmatic recess is the lowest extent of the pleural cavity or sac. Any fluid in the pleura will by gravity accumulate here when a patient is standing erect.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 82
Incorrect
-
Which of the following diseases causes abrupt vertigo, nausea, vomiting, tinnitus, and nystagmus?
Your Answer:
Correct Answer: Vestibular neuronitis
Explanation:Vestibular neuronitis or labyrinthitis causes a self-limited episode of vertigo, presumably due to inflammation of the vestibular division of cranial nerve VIII. Its causes are unknown, It may be due to a virus, but it can be related to a bacterial infection, head injury, stress, allergy, or as a reaction to medication. Symptoms can last up to 7-10 days.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 83
Incorrect
-
During an exploratory laparotomy of an acute abdomen, the surgeon identified an inflamed Meckel's diverticulum. This is:
Your Answer:
Correct Answer: Is a site of ectopic pancreatic tissue
Explanation:Meckel’s diverticulum is an outpouching of the small intestine. It usually occurs about 0.6 m (2 feet) before the junction with the caecum. It can be lined with the mucosa of the stomach and may ulcerate. It may also be lined by ectopic pancreatic tissue. It represents the remains of the vitelline duct in early fetal life.
An abnormal persistence of the urachus is called a urachal fistula.
Failure of the midgut loop to return to the abdominal cavity is called an omphalocele.
Polyhydramnios is often caused by anencephaly or oesophageal fistula.
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This question is part of the following fields:
- Abdomen
- Anatomy
-
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Question 84
Incorrect
-
A space defined by the teres major muscle, the teres minor muscle, long head of the triceps brachii muscle and surgical neck of the humerus contains the axillary nerve and the?
Your Answer:
Correct Answer: Posterior circumflex humeral artery
Explanation:This quadrangular space transmits the posterior circumflex humeral vessels and the axillary nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 85
Incorrect
-
A 68-year-old woman complains of headaches, dizziness, and memory loss. About a month ago, she fell from a staircase but only suffered mild head trauma. What is the most likely diagnosis in this case?
Your Answer:
Correct Answer: Chronic subdural haematoma
Explanation:A quarter to a half of patients with chronic subdural haematoma have no identifiable history of head trauma. If a patient does have a history of head trauma, it usually is mild. The average time between head trauma and chronic subdural haematoma diagnosis is 4–5 weeks. Symptoms include decreased level of consciousness, balance problems, cognitive dysfunction and memory loss, motor deficit (e.g. hemiparesis), headache or aphasia. Some patients present acutely. They usually result from tears in bridging veins which cross the subdural space, and may cause an increase in intracranial pressure (ICP).
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This question is part of the following fields:
- Neurology
- Pathology
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Question 86
Incorrect
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This structure divides the space between the lens and the cornea into the anterior and posterior chambers of the eye:
Your Answer:
Correct Answer: The iris
Explanation:The iris divides the space between the lens and the cornea into an anterior and a posterior chamber. The anterior cavity is filled with watery aqueous fluid, and the posterior cavity with a gel-like vitreous fluid. The anterior chamber of the eye is bounded in front by the posterior surface of the cornea; behind by the front of the iris and the central part of the lens. The posterior chamber is a narrow gap behind the peripheral part of the iris and in front of the suspensory ligament of the lens and the ciliary processes.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 87
Incorrect
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The posterior boundary of the carotid triangle is bounded by which of the following muscles?
Your Answer:
Correct Answer: Sternocleidomastoid
Explanation:The carotid triangle is a portion of the anterior triangle of the neck. It is bounded superiorly by the posterior belly of the digastric muscle, antero-inferiorly by the superior belly of omohyoid and posteriorly by the sternocleidomastoid. The floor is formed by the thyrohyoid, hyoglossus, middle and inferior pharyngeal constrictors and the roof is formed by the skin, superficial fascia, platysma and deep fascia.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 88
Incorrect
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Destruction of the ventromedial nucleus of the hypothalamus will result in:
Your Answer:
Correct Answer: Loss of satiety
Explanation:The ventromedial nucleus of the hypothalamus is divided into an anterior and a superior part. The anterior part controls the female sexual drive, whereas the superior part is responsible for satiety. Destruction of the superior part of the nucleus will result in overeating, as no signal tells the body that it is satisfied.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 89
Incorrect
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A 54 year old man fell off his bicycle. He felt a severe pain in his hand and wasn't able to move it. It was found that a carpal bone in the distal row was fractured. Which is the most likely bone?
Your Answer:
Correct Answer: Trapezium
Explanation:There are eight carpal bones which are arranged in two rows, proximal and distal; scaphoid, lunate, triquetral and pisiform are of proximal row. Trapezium, trapezoid, capitate and hamate are of the distal row.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 90
Incorrect
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Enlargement of the spleen as seen in Gaucher's disease pushes the spleen downward and medially. What structure limits the straight-vertical-downward movement?
Your Answer:
Correct Answer: Left colic flexure
Explanation:The left colic flexure (also known as the splenic flexure), is the point where the colon takes a sharp turn downwards. It is the point where the transverse colon ends and the descending colon begins. It is located immediately inferior to the spleen so an enlarged spleen must move medially to avoid this colic flexure.
The left suprarenal gland is retroperitoneal.
The Ligament of Treitz suspends the fourth part of the duodenum from the posterior abdominal wall.
The stomach, pancreas and liver lie medial to the spleen and thus would not prevent a vertical downward movement.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 91
Incorrect
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Which best describes the sartorius muscle?
Your Answer:
Correct Answer: Will flex the leg at the knee joint
Explanation:The sartorius muscle arises from tendinous fibres from the superior iliac spine. It passes obliquely across the thigh from lateral to medial and is inserted into the upper part of the medial side of the tibia. When the sartorius muscle contracts it will flex the leg at the knee joint.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 92
Incorrect
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A surgeon performing a thymectomy to remove a malignant thymoma is careful to avoid damaging an important nerve lying around the arch of the aorta. Which nerve is the surgeon trying to preserve?
Your Answer:
Correct Answer: Left Vagus
Explanation:The left vagus nerve lies on the lateral surface of the aortic arch. The left recurrent laryngeal nerve arises from the vagus and loops around the arch of the aorta. This nerve is at risk of injury during surgery.
The right and left phrenic nerves, being lateral to the vagus, do not loop around the arch of the aorta.
The sympathetic trunks, both right and left, are located in the posterior chest; not near the aortic arch.
The right vagus: not involved with the aortic arch.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 93
Incorrect
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Due to a plantarflexion–inversion ankle sprain, which is the first ligament to rupture?
Your Answer:
Correct Answer: Anterior talofibular ligament
Explanation:The anterior talofibular ligament passes from the anterior margin of the fibular malleolus. It is the most commonly injured ligament, as part of the lateral ligament of the ankle.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 94
Incorrect
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A 60-year old woman who has a left sided post-pneumonic effusion, was to have some pleural fluid aspirated for culture and sensitivity. If the medical intern in charge of the procedure decided to aspirate while the patient is sitting up on her bed, where in the pleural cavity would the fluid tend to accumulate?
Your Answer:
Correct Answer: Costodiaphragmatic recess
Explanation:The lowest part of the pleural cavity is the costodiaphragmatic recess and it the space in which the pleural fluid will accumulate when the patient sits up.
The cupola is part of the pleural cavity that extends into the root of the neck above the first rib.
The costomediastinal recess is the junction at which the costal pleura becomes the mediastinal pleura.
The middle mediastinum is the part of the mediastinum that is occupied by the heart.
The hilar reflection is the point where the mediastinal pleura is reflected to continue on as the visceral pleura.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 95
Incorrect
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A 66-year-old man complains of constant headaches. On physical examination, the only relevant sign is a dark brown mole located on left his arm which has grown in size over the years and is itchy and painful. A MRI of the brain revealed a solitary lesion at the grey-white junction in the right frontal lobe, without ring enhancement. This lesion is most likely to be:
Your Answer:
Correct Answer: Metastatic carcinoma
Explanation:The location of the mass at the grey–white junction is typical of a metastasis. The most frequent types of metastatic brain tumours originate in the lung, skin, kidney, breast and colon. These tumour cells reach the brain via the bloodstream. This patient is likely to have skin cancer, which caused the metastatic brain tumour.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 96
Incorrect
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A CT-scan of the lung shows a tumour crossing the minor (horizontal) fissure. This fissure separates:
Your Answer:
Correct Answer: The middle lobe from the upper lobe
Explanation:The horizontal fissure separates the upper lobe from the middle lobe. The oblique fissure on the other hand separates the lower lobe from both the middle and upper lobes. The lingula is found only on the left lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 97
Incorrect
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A patient at the time of her second delivery opted for a bilateral pudendal nerve block. In order to inject the anaesthetic agent near the pudendal nerve a anaesthetic consultant had to insert a finger into the vagina and press laterally to palpate which landmark?
Your Answer:
Correct Answer: Ischial spine
Explanation:The ischial spine is always palpated through the walls of the vagina when performing a transvaginal pudendal nerve block and can easily be palpated on the lateral wall of the vagina.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 98
Incorrect
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A 38 year old man is to undergo excision of the base of the prostate for malignant growth, which of the following structures is directly related to the base of the prostate?
Your Answer:
Correct Answer: Urinary bladder
Explanation:The prostate is situated in the pelvic cavity and is also located immediately below the internal urethral orifice at the commencement of the urethra. It is held in position by the puboprostatic ligaments, the superior fascia of the urogenital diaphragm and the anterior portions of the levatores ani. The base of the prostate is directed upward and is attached to the inferior surface of the urinary bladder while the apex is directed downward and is in contact with the superior fascia of the urogenital diaphragm.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 99
Incorrect
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The superior ulnar collateral artery is a direct branch of this artery:
Your Answer:
Correct Answer: Brachial
Explanation:The brachial artery gives rise to a small branch at the middle of the arm, which is the superior collateral artery. It descends accompanied by the ulnar nerve and anastomoses with the posterior ulnar recurrent and inferior ulnar collateral.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 100
Incorrect
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An intern is attempting to put in an arterial line in an ICU patients left foot. Which is the best site to feel for the pulsation of the dorsalis pedis artery in the foot?
Your Answer:
Correct Answer: Just lateral to the tendon of extensor hallucis longus
Explanation:The dorsalis pedis artery is the continuation of the anterior tibial artery. The pulse of the posterior tibial artery, which comes from the posterior compartment of the leg, may be felt behind the medial malleolus just lateral to the tendon of the extensor hallucis longus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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