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  • Question 1 - A 27-year-old man presents with a laceration of his forearm that severed the...

    Correct

    • A 27-year-old man presents with a laceration of his forearm that severed the nerve that innervates flexor carpi radialis.
      Which of the following nerves has been damaged in this case? Select ONE answer only.

      Your Answer: The median nerve

      Explanation:

      Flexor carpi radialis is innervated by the median nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      13.6
      Seconds

  • Question 2 - Regarding the abductor digiti minimi, which of the following statements is false? ...

    Incorrect

    • Regarding the abductor digiti minimi, which of the following statements is false?

      Your Answer: It receives its blood supply from the ulnar artery

      Correct Answer: It assists with flexion of the fifth finger at the middle phalanx

      Explanation:

      Abductor digiti minimi is a short intrinsic muscle of the hand. It belongs to the group of muscles collectively called hypothenar muscles due to their acting on the 5th finger. Besides abductor digiti minimi, other hypothenar muscles include flexor digiti minimi brevis and opponens digiti minimi.

      The main function of abductor digiti minimi involves abduction of the 5th finger, as well as flexion of its proximal phalanx. Along with other hypothenar muscles, this muscle forms the hypothenar eminence on the medial side of the palm.

      Like other hypothenar muscles, abductor digiti minimi receives nervous supply from the deep branch of the ulnar nerve, derived from root values C8 and T1.

      Abductor digiti minimi receives arterial blood supply from the palmar branch of ulnar artery, palmar digital artery, as well as branches of the ulnar side of the superficial palmar arch. The venous blood from the muscle is drained via the venous networks of the palm into the deep veins of the arm (vv. ulnares).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      18.9
      Seconds

  • Question 3 - In which part of the gastrointestinal tract is Meckel's diverticulum commonly located? ...

    Incorrect

    • In which part of the gastrointestinal tract is Meckel's diverticulum commonly located?

      Your Answer: Ascending colon

      Correct Answer: Ileum

      Explanation:

      Meckel’s diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract, affecting approximately 2% of the general population. Meckel’s diverticulum are designated true diverticula because their walls contain all the layers found in normal small intestine. Their location varies among individual patients, but they are usually found in the ileum within 100 cm of the ileocecal valve.

      Approximately 60% of Meckel’s diverticulum contain heterotopic mucosa, of which over 60% consist of gastric mucosa. Pancreatic acini are the next most common; others include Brunner’s glands, pancreatic islets, colonic mucosa, endometriosis, and hepatobiliary tissues.

      A useful, although crude, mnemonic describing Meckel’s diverticulum is the “rule of twos”: 2% prevalence, 2:1 male predominance, location 2 feet proximal to the ileocecal valve in adults, and half of those who are symptomatic are under 2 years of age.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      41.1
      Seconds

  • Question 4 - A 22 year old male has been stabbed and is brought to the...

    Incorrect

    • A 22 year old male has been stabbed and is brought to the ED with a stab wound to his upper limb. On examination, the patient is unable to flex the distal interphalangeal joints of the ring and little finger. However, the proximal interphalangeal joint is intact. The most likely affected nerve is which of the following, and at which level is this occurring?

      Your Answer: Median nerve at elbow

      Correct Answer: Ulnar nerve at elbow

      Explanation:

      The medial half of the flexor digitorum profundus is innervated by the ulnar nerve. Paralysis of this muscle results in loss of flexion at the distal interphalangeal joint of the ring and little finger.
      Flexion at the proximal interphalangeal joint is preserved as this is a function of the flexor digitorum superficialis which is innervated by the median nerve.
      The ulnar nerve is not correct as ulnar nerve injury at the wrist would not affect the long flexors, and the injury must have been more proximal.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      10.7
      Seconds

  • Question 5 - A 70-year old male is taken to the Emergency Room after suffering a...

    Incorrect

    • A 70-year old male is taken to the Emergency Room after suffering a traumatic fall while showering. Upon physical examination, the attending physician noted a hyperextended neck, 1/5 muscle strength in both upper extremities, 4/5 muscle strength in both lower extremities, and variable loss in sensation. The patient is placed in the wards for monitoring. For the next 24 hours, anuria is noted.

      Which of the following spinal cord injuries is the most likely diagnosis?

      Your Answer: Complete cervical injury

      Correct Answer: Central cord syndrome

      Explanation:

      Central cord syndrome is the most common type of incomplete cord injury and almost always occurs due to a traumatic injury. It results in motor deficits that are worse in the upper extremities as compared to the lower extremities. It may also cause bladder dysfunction (retention) and variable sensory deficits below the level of injury.

      The majority of these patients will be older and present with symptoms after a fall with hyperextension of their neck. On examination, patients will have more significant strength impairments in the upper extremities (especially the hands) compared to the lower extremities. Patients often complain of sensory deficits below the level of injury, but this is variable. Pain and temperature sensations are typically affected, but the sensation of light touch can also be impaired. The most common sensory deficits are in a cape-like distribution across their upper back and down their posterior upper extremities. They will often have neck pain at the site of spinal cord impingement.

      Bladder dysfunction (most commonly urinary retention) and priapism can also be signs of upper motor neuron dysfunction. The sacral sensation is usually preserved, but the clinician should assess the rectal tone to evaluate the severity of the compression.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      43
      Seconds

  • Question 6 - A 65-year-old man complains of severe vertigo, nausea, and tinnitus. Upon presenting himself...

    Incorrect

    • A 65-year-old man complains of severe vertigo, nausea, and tinnitus. Upon presenting himself to the emergency room, it was observed that he is exhibiting ataxia, right-sided loss of pain and temperature sense on the face, and left-sided sensory loss to the body. An MRI and CT scan was ordered and the results showed that he is suffering from a right-sided stroke.

      Branches of which of the following arteries are most likely implicated in the case?

      Your Answer: Superior cerebellar artery

      Correct Answer: Basilar artery

      Explanation:

      The lateral pontine syndrome occurs due to occlusion of perforating branches of the basilar and anterior inferior cerebellar (AICA) arteries. It is also known as Marie-Foix syndrome or Marie-Foix-Alajouanine syndrome. It is considered one of the brainstem stroke syndromes of the lateral aspect of the pons.

      It is characterized by ipsilateral limb ataxia, loss of pain and temperature sensation of the face, facial weakness, hearing loss, vertigo and nystagmus, hemiplegia/hemiparesis, and loss of pain and temperature sensation.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      20.6
      Seconds

  • Question 7 - Which of the following is first-line for management of status epilepticus: ...

    Incorrect

    • Which of the following is first-line for management of status epilepticus:

      Your Answer:

      Correct Answer: Intravenous lorazepam

      Explanation:

      First-line treatment is with intravenous lorazepam if available. Intravenous diazepam is effective but it carries a high risk of thrombophlebitis so should only be used if intravenous lorazepam is not immediately available. Absorption of diazepam from intramuscular injection or from suppositories is too slow for treatment of status epilepticus. When facilities for resuscitation are not immediately available or if unable to secure immediate intravenous access, diazepam can be administered as a rectal solution or midazolam oromucosal solution can be given into the buccal cavity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 8 - A 26-year-old man is involved in a motorcycle accident that results in an...

    Incorrect

    • A 26-year-old man is involved in a motorcycle accident that results in an open fracture of his tibia and fibula. The nerve that innervates peroneus tertius is damaged as a consequence of his injuries.
      Peroneus tertius receives its innervation from which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: Deep peroneal nerve

      Explanation:

      Peroneus brevis is innervated by the superficial peroneal nerve.
      Peroneus longus is innervated by the superficial peroneal nerve.
      Peroneus tertius is innervated by the deep peroneal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 9 - A 30 year old man presents to ED after a road traffic accident....

    Incorrect

    • A 30 year old man presents to ED after a road traffic accident. Free intraperitoneal fluid is found on FAST (Focussed assessment for sonography in trauma) done in the supine position.

      Which of these is most likely to be affected?

      Your Answer:

      Correct Answer: Hepatorenal recess

      Explanation:

      Fluid accumulates most often in the hepatorenal pouch (of Morrison) in a supine patient. The hepatorenal pouch is located behind the liver and anterior to the right kidney and is the lowest space in the peritoneal cavity in the supine position.

      Although the vesicouterine and rectouterine spaces are also potential spaces for fluid accumulation, fluid accumulation in them occur in the erect position.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 10 - Which coronary artery is mostly likely affected if an ECG shows ST segment...

    Incorrect

    • Which coronary artery is mostly likely affected if an ECG shows ST segment elevation in leads II, III and aVF, and ST segment depression in V1-V3?

      Your Answer:

      Correct Answer: Right coronary artery

      Explanation:

      A posterior wall MI occurs when posterior myocardial tissue (now termed inferobasilar), usually supplied by the posterior descending artery — a branch of the right coronary artery in 80% of individuals — acutely loses blood supply due to intracoronary thrombosis in that vessel. This frequently coincides with an inferior wall MI due to the shared blood supply.

      The ECG findings of an acute posterior wall MI include the following:

      1. ST segment depression (not elevation) in the septal and anterior precordial leads (V1-V4). This occurs because these ECG leads will see the MI backwards; the leads are placed anteriorly, but the myocardial injury is posterior.
      2. A R/S wave ratio greater than 1 in leads V1 or V2.
      3. ST elevation in the posterior leads of a posterior ECG (leads V7-V9). Suspicion for a posterior MI must remain high, especially if inferior ST segment elevation is also present.
      4. ST segment elevation in the inferior leads (II, III and aVF) if an inferior MI is also present.

      The following ECG leads determine the location and vessels involved in myocardial infarction:

      ECG Leads Location Vessel involved
      V1-V2 Septal wall Left anterior descending
      V3-V4 Anterior wall Left anterior descending
      V5-V6 Lateral wall Left circumflex artery
      II, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%)
      I, aVL High lateral wall Left circumflex artery
      V1, V4R Right ventricle Right coronary artery
      V7-V9 Posterior wall Right coronary artery

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 11 - All of the muscles of the tongue (other than the palatoglossus) are innervated...

    Incorrect

    • All of the muscles of the tongue (other than the palatoglossus) are innervated by which of the following nerves:

      Your Answer:

      Correct Answer: Hypoglossal nerve

      Explanation:

      All of the muscles of the tongue are innervated by the hypoglossal nerve, except for the palatoglossus, which is innervated by the vagus nerve.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      0
      Seconds

  • Question 12 - Which of the following statements is true about anterior cord syndrome? ...

    Incorrect

    • Which of the following statements is true about anterior cord syndrome?

      Your Answer:

      Correct Answer: There is preservation of proprioception

      Explanation:

      Anterior cord syndrome is an incomplete cord syndrome that predominantly affects the anterior 2/3 of the spinal cord, characteristically resulting in motor paralysis below the level of the lesion as well as the loss of pain and temperature at and below the level of the lesion. The patient presentation typically includes these two findings; however, there is variability depending on the portion of the spinal cord affected. Other findings include back pain, or autonomic dysfunction such as hypotension, neurogenic bowel or bladder, and sexual dysfunction. The severity of motor dysfunction can vary, typically resulting in paraplegia or quadriplegia.

      Proprioception, vibratory sense, two-point discrimination, and fine touch are not affected in anterior cord syndrome. These sensations are under the control of the dorsal column of the spinal cord, which is supplied by two posterior spinal arteries running in the posterior lateral sulci.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
      0
      Seconds

  • Question 13 - Which coronary artery is mostly likely affected if an ECG shows a tombstone...

    Incorrect

    • Which coronary artery is mostly likely affected if an ECG shows a tombstone pattern in leads V2, V3 and V4?

      Your Answer:

      Correct Answer: Left anterior descending artery

      Explanation:

      Tombstoning ST elevation myocardial infarction can be described as a STEMI characterized by tombstoning ST-segment elevation. This myocardial infarction is associated with extensive myocardial damage, reduced left ventricle function, serious hospital complications and poor prognosis. Tombstoning ECG pattern is a notion beyond morphological difference and is associated with more serious clinical results.

      Studies have shown that tombstoning is more commonly found in anterior than non-anterior STEMI, thus, higher rates of left anterior descending artery disease are observed in patients with tombstoning pattern.

      The following ECG leads determine the location and vessels involved in myocardial infarction:

      ECG Leads Location Vessel involved
      V1-V2 Septal wall Left anterior descending
      V3-V4 Anterior wall Left anterior descending
      V5-V6 Lateral wall Left circumflex artery
      II, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%)
      I, aVL High lateral wall Left circumflex artery
      V1, V4R Right ventricle Right coronary artery
      V7-V9 Posterior wall Right coronary artery

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 14 - The parasympathetic supply to the rectum is from which of the following: ...

    Incorrect

    • The parasympathetic supply to the rectum is from which of the following:

      Your Answer:

      Correct Answer: Pelvic splanchnic nerves

      Explanation:

      Parasympathetic supply is from the pelvic splanchnic nerves (S2 – S4) and inferior hypogastric plexus.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 15 - Which of the following statements concerning the facial nerve is INCORRECT? ...

    Incorrect

    • Which of the following statements concerning the facial nerve is INCORRECT?

      Your Answer:

      Correct Answer: Forehead sparing in facial nerve palsy is indicative of a lower motor neuron lesion.

      Explanation:

      In facial nerve palsy, LMN damage will involve the forehead and there will be an inability to close the eyes due to paralysis of the orbicularis oculi or raise the eyebrows due to paralysis of the occipitofrontalis muscle.
      UMN damage causes sparing of the forehead as the occipitofrontalis and orbicularis oculi muscles have bilateral cortical representation.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      0
      Seconds

  • Question 16 - A patient with a stab wound to the axilla arrives to the emergency...

    Incorrect

    • A patient with a stab wound to the axilla arrives to the emergency department. You notice weakness in elbow flexion and forearm supination during your assessment. Which of these nerves has been affected:

      Your Answer:

      Correct Answer: Musculocutaneous nerve

      Explanation:

      The musculocutaneous nerve is relatively protected in the axilla, hence injury to it is uncommon. A stab wound in the axilla is the most prevalent source of damage. Because of the activities of the pectoralis major and deltoid, the brachioradialis, and the supinator muscles, arm flexion and forearm flexion and supination are diminished but not completely lost. Over the lateral part of the forearm, there is a lack of sensation.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 17 - Which lobe of the prostate gland is most commonly affected in benign prostatic...

    Incorrect

    • Which lobe of the prostate gland is most commonly affected in benign prostatic hypertrophy?

      Your Answer:

      Correct Answer: Median

      Explanation:

      Benign enlargement of the prostate is common in men older than 50 years. The cause is possibly an imbalance in the hormonal control of the gland. The median lobe of the gland enlarges upward and encroaches within the sphincter vesicae, located at the neck of the bladder. The leakage of urine into the prostatic urethra causes an intense reflex desire to micturate. The enlargement of the median and lateral lobes of the gland produces elongation and lateral compression and distortion of the urethra so that the patient experiences difficulty in passing urine and the stream is weak. Back-pressure effects on the ureters and both kidneys are a common complication. The enlargement of the uvula vesicae (owing to the enlarged median lobe) results in the formation of a pouch of stagnant urine behind the urethral orifice within the bladder. The stagnant urine frequently becomes infected, and the inflamed bladder (cystitis) adds to the patient’s symptoms.

      In all operations on the prostate, the surgeon regards the prostatic venous plexus with respect. The veins have thin walls, are valveless, and are drained by several large trunks directly into the internal iliac veins. Damage to these veins can result in a severe haemorrhage.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      0
      Seconds

  • Question 18 - A 25 year old man presents to the emergency room with abdominal pain,...

    Incorrect

    • A 25 year old man presents to the emergency room with abdominal pain, vomiting and constipation. A CT scan is done which is suggestive of Meckel's diverticulum. Where does the blood supply of the Meckel's diverticulum originate?

      Your Answer:

      Correct Answer: Superior mesenteric artery

      Explanation:

      Meckel’s diverticulum has certain classic characteristics.
      1. It lies on the antimesenteric border of the middle-to-distal ileum
      2. It is approximately 2 feet proximal to the ileocaecal junction
      3. It appears as a blind-ended tubular outpouching of bowel
      4. It is about 2 inches long,
      5. It occurs in about 2% of the population,
      6. It may contain two types of ectopic tissue (gastric and pancreatic).
      7. The diverticulum is supplied by the superior mesenteric artery.
      8. Proximal to the major duodenal papilla the duodenum is supplied by the gastroduodenal artery (branch of the coeliac trunk)
      9. Distal to the major duodenal papilla it is supplied by the inferior pancreaticoduodenal artery (branch of superior mesenteric artery).
      10. The arterial supply to the jejunoileum is from the superior mesenteric artery.

    • This question is part of the following fields:

      • Abdomen
      • Anatomy
      0
      Seconds

  • Question 19 - A patient suffers an injury to the nerve that innervates gluteus medius.​
    The gluteus...

    Incorrect

    • A patient suffers an injury to the nerve that innervates gluteus medius.​
      The gluteus medius muscle is innervated by which of the following nerves? Select ONE answer only.

      Your Answer:

      Correct Answer: Superior gluteal nerve

      Explanation:

      Gluteus minimus is innervated by the superior gluteal nerve.
      Gluteus medius is innervated by the superior gluteal nerve.
      Gluteus maximus is innervated by the inferior gluteal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
      0
      Seconds

  • Question 20 - The fracture of the medial epicondyle will cause damage to the ulnar nerve....

    Incorrect

    • The fracture of the medial epicondyle will cause damage to the ulnar nerve. Which of the following motions would be impaired by this type of injury?

      Your Answer:

      Correct Answer: Adduction of the thumb

      Explanation:

      Fracture of the medial epicondyle is most likely to result in damage to the ulnar nerve.

      The three hypothenar muscles, two medial lumbricals, seven interossei, the adductor pollicis, and the deep head of the flexor pollicis brevis are all innervated by the deep branch of the ulnar nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 21 - Carbamazepine is indicated for all of the following EXCEPT for: ...

    Incorrect

    • Carbamazepine is indicated for all of the following EXCEPT for:

      Your Answer:

      Correct Answer: Myoclonic seizures

      Explanation:

      Carbamazepine is a drug of choice for simple and complex focal seizures and is a first-line treatment option for generalised tonic-clonic seizures. It is also used in trigeminal neuralgia and diabetic neuropathy. Carbamazepine may exacerbate tonic, atonic, myoclonic and absence seizures and is therefore not recommended if these seizures are present.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 22 - Which of the following classes of drugs may predispose to lithium toxicity: ...

    Incorrect

    • Which of the following classes of drugs may predispose to lithium toxicity:

      Your Answer:

      Correct Answer: Thiazide diuretics

      Explanation:

      Excretion of lithium may be reduced by thiazide diuretics, NSAIDs, and ACE inhibitors thus predisposing to lithium toxicity. Loop diuretics also cause lithium retention but are less likely to result in lithium toxicity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 23 - A well recognised adverse effect of metoclopramide is which of the following? ...

    Incorrect

    • A well recognised adverse effect of metoclopramide is which of the following?

      Your Answer:

      Correct Answer: Acute dystonic reaction

      Explanation:

      Side effects of metoclopramide are commonly associated with extrapyramidal effects and hyperprolactinemia. Therefore its use must be limited to short-term use. Metoclopramide can induce acute dystonic reactions which involve facial and skeletal muscle spasms and oculogyric crises. These dystonic effects are more common in the young girls and young women, and in the very old. These symptoms usually occur shortly after starting treatment with this drug and subside within 24 hours of stopping it. Abortion of dystonic attacks can be carried out by injection of an antiparkinsonian drug like procyclidine.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
      0
      Seconds

  • Question 24 - The following statements are not true of the extensor carpi radialis brevis muscle,...

    Incorrect

    • The following statements are not true of the extensor carpi radialis brevis muscle, except?

      Your Answer:

      Correct Answer: It receives its blood supply from the radial artery

      Explanation:

      Extensor carpi radialis brevis is a fusiform muscle found in the lateral part of the posterior forearm. Together with anconaeus, brachioradialis, extensor carpi radialis longus, extensor digitorum, extensor digiti minimi and extensor carpi ulnaris, it belongs to the superficial forearm extensor group. Extensor carpi radialis brevis originates from the lateral epicondyle of humerus via the common extensor tendon. This is a common origin that it shares with the extensor digitorum, extensor digiti minimi and extensor carpi ulnaris muscles. Some fibres also originate from the lateral intermuscular septum, a thick aponeurosis that covers the muscle itself, and from the radial collateral ligament.

      The muscle courses inferiorly, giving off a long tendon in the middle of the forearm which descends towards the dorsal hand. The tendon passes through a groove on the posterior surface of radius, deep to the extensor retinaculum. After traversing the extensor retinaculum space, the tendon inserts into the posterior aspect of the base of the third metacarpal bone.

      Extensor carpi radialis brevis is innervated directly by the radial nerve (C5- C8), or sometimes from its deep branch/posterior interosseous nerve. The radial nerve stems from the posterior cord of the brachial plexus.

      The muscle is vascularized by the radial recurrent artery, radial artery and deep brachial artery (via its radial collateral branch).

      Extensor carpi radialis brevis works together with extensor carpi ulnaris and extensor carpi radialis longus to extend the hand at the wrist joint. This action is vital in a sequence of muscle contractions needed for clenching a fist or making a grip. When performing these functions, wrist extension blocks the flexor muscles from on acting upon the hand. Instead, flexors act only on the digits, thereby flexing them and producing an effective hand grip, such as that seen in a tennis backhand. When the extensor carpi radialis brevis muscle contracts together with extensor carpi radialis longus and flexor carpi radialis, it contributes to producing hand abduction (radial deviation).

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
      0
      Seconds

  • Question 25 - A 35-year-old lady has suffered a serious brain injury. Her uvula has deviated...

    Incorrect

    • A 35-year-old lady has suffered a serious brain injury. Her uvula has deviated to the right, according to inspection. Which of the following nerves is likely to be affected?

      Your Answer:

      Correct Answer: Left vagus nerve

      Explanation:

      When the vagus nerve is damaged, the soft palate is paralyzed and the uvula is shifted away from the affected side. The vagus nerve innervates the uvulae muscle, which forms the uvula’s core. If only one side is innervated, contraction of the active muscle will draw the uvula towards it.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
      0
      Seconds

  • Question 26 - A 47-year old male comes to the out-patient department for a painful, right-sided...

    Incorrect

    • A 47-year old male comes to the out-patient department for a painful, right-sided groin mass. Medical history reveals a previous appendectomy 10 years prior. On physical examination, the mass can be reduced superiorly. Also, the mass extends to the scrotum. The initial diagnosis is a hernia.

      Among the types of hernia, which is the most likely diagnosis of the case above?

      Your Answer:

      Correct Answer: Indirect inguinal hernia

      Explanation:

      Inguinal hernias can present with an array of different symptoms. Most patients present with a bulge in the groin area, or pain in the groin. Some will describe the pain or bulge that gets worse with physical activity or coughing. Symptoms may include a burning or pinching sensation in the groin. These sensations can radiate into the scrotum or down the leg. It is important to perform a thorough physical and history to rule out other causes of groin pain. At times an inguinal hernia can present with severe pain or obstructive symptoms caused by incarceration or strangulation of the hernia sac contents. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. The exam is best performed with the patient standing. Visual inspection of the inguinal area is conducted first to rule out obvious bulges or asymmetry in groin or scrotum. Next, the examiner palpates over the groin and scrotum to detect the presence of a hernia. The palpation of the inguinal canal is completed last. The examiner palpates through the scrotum and towards the external inguinal ring. The patient is then instructed to cough or perform a Valsalva manoeuvre. If a hernia is present, the examiner will be able to palpate a bulge that moves in and out as the patient increases intra abdominal pressure through coughing or Valsalva.

      Groin hernias are categorized into 2 main categories: inguinal and femoral.

      Inguinal hernias are further subdivided into direct and indirect. An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum, and can be reduced superiorly then superolaterally. A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.

      A femoral hernia is a protrusion into the femoral ring. The borders of the femoral ring are the femoral vein laterally, Cooper’s ligament posteriorly, the iliopubic tract/inguinal ligament anteriorly and lacunar ligament medially.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
      0
      Seconds

  • Question 27 - The 'bucket handle' movement of the thoracic wall describes which of the following movements:...

    Incorrect

    • The 'bucket handle' movement of the thoracic wall describes which of the following movements:

      Your Answer:

      Correct Answer: The middles of the shafts of the ribs moving upwards and laterally

      Explanation:

      Because the middles of the shafts of the ribs are lower than either the anterior or posterior end, elevation of the ribs also moves the middles of the shafts laterally. This ‘bucket handle’ upwards and lateral movement increases the lateral dimensions of the thorax.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
      0
      Seconds

  • Question 28 - In adults, the conus medullaris of the spinal cord lies at which of...

    Incorrect

    • In adults, the conus medullaris of the spinal cord lies at which of the following vertebral levels:

      Your Answer:

      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
      0
      Seconds

  • Question 29 - Gallstones are commonly found lodged in which of the following parts of the...

    Incorrect

    • Gallstones are commonly found lodged in which of the following parts of the gallbladder?

      Your Answer:

      Correct Answer: Neck

      Explanation:

      There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.

    • This question is part of the following fields:

      • Abdomen And Pelvis
      • Anatomy
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  • Question 30 - Which of the following nerves provides sensory innervation to the anteromedial and anterosuperior...

    Incorrect

    • Which of the following nerves provides sensory innervation to the anteromedial and anterosuperior aspects of the external ear?

      Your Answer:

      Correct Answer: Auriculotemporal nerve

      Explanation:

      Sensory innervation to the external ear is supplied by both cranial and spinal nerves. Branches of the trigeminal, facial, and vagus nerves (CN V, VII, X) are the cranial nerve components, while the lesser occipital (C2, C3) and greater auricular (C2, C3) nerves are the spinal nerve components involved. The lateral surface of the tympanic membrane, the external auditory canal, and the external acoustic meatus are all innervated by nervus intermedius (a branch of CN VII), the auriculotemporal nerve (CN V3), and the auricular branch of the vagus nerve. The concha receives split innervation from nervus intermedius, the auricular branch of the vagus nerve, and the greater auricular (spinal) nerve. Beyond the concha, the anteromedial and anterosuperior parts of the pinna are innervated by the auriculotemporal nerve, and a portion of the lateral helix by the lesser occipital nerve. The greater auricular nerve provides innervation to the area of the pinna inferolateral to the lobule.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
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  • Question 31 - A suicidal patient had lacerated his wrist, which resulted in an ulnar nerve...

    Incorrect

    • A suicidal patient had lacerated his wrist, which resulted in an ulnar nerve injury. Which of the following will confirm the presence of an ulnar nerve injury?

      Your Answer:

      Correct Answer: Claw hand appearance

      Explanation:

      An ulnar injury may result in abnormal sensations in the little finger and ring finger, usually on the palm side, weakness, and loss of coordination of the fingers.

      A claw like deformity of the hand and wrist is present. Pain, numbness, decreased sensation, tingling, or burning sensation in the areas controlled by the nerve are also possible.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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      Seconds

  • Question 32 - Which of the following nerves supplies innervation to the extensor hallucis longus? ...

    Incorrect

    • Which of the following nerves supplies innervation to the extensor hallucis longus?

      Your Answer:

      Correct Answer: Deep peroneal nerve

      Explanation:

      Extensor hallucis longus is innervated by the deep fibular nerve (root value L5 and S1).

    • This question is part of the following fields:

      • Anatomy
      • Lower Limb
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      Seconds

  • Question 33 - A man working as a waiter cuts his arm on a glass while...

    Incorrect

    • A man working as a waiter cuts his arm on a glass while he was working. The palmaris longus muscle was damaged as a consequence of his injury.

      Which of the following statements regarding the palmaris longus muscle is considered correct?

      Your Answer:

      Correct Answer: It receives its blood supply from the ulnar artery

      Explanation:

      The palmaris longus is a small, fusiform-shaped muscle located on the anterior forearm of the human upper extremity. The palmaris longus muscle is commonly present but may be absent in a small percentage of the population, ranging from 2.5% to 26% of individuals, depending on the studied population.

      The palmaris longus belongs to the anterior forearm flexor group in the human upper extremity. The muscle attaches proximally to the medial humeral epicondyle and distally to the palmar aponeurosis and flexor retinaculum. The blood supply to the palmaris longus muscle is via the ulnar artery, a branch of the brachial artery in the human upper extremity.

      The palmaris longus muscle receives its innervation via branches of the median nerve containing nerve roots C5-T1. Median nerve injury at or above the elbow joint (including brachial plexus and nerve root injury) can lead to deficits in the palmaris longus and other forearm flexor muscles, leading to weakened elbow flexion, wrist flexion, radial deviation, finger flexion, thumb opposition, flexion, and abduction, in addition to the loss of sensory function in the distribution of the median nerve.

    • This question is part of the following fields:

      • Anatomy
      • Upper Limb
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      Seconds

  • Question 34 - Regarding the intervertebral disc, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the intervertebral disc, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: In L4 - L5 disc herniation, the L5 spinal nerve root is the most commonly affected.

      Explanation:

      A posterolateral herniation of the disc at the L4 – L5 level would be most likely to damage the fifth lumbar nerve root, not the fourth lumbar nerve root, due to more oblique descending of the fifth lumbar nerve root within the subarachnoid space.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
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  • Question 35 - A 4-year old boy is taken to the emergency room after a sudden...

    Incorrect

    • A 4-year old boy is taken to the emergency room after a sudden onset of coughing and wheezing. Further investigation reveals that he was drawing quietly in his room, when suddenly, he became anxious and started coughing. The parents also noted that the eraser on top of the pencil was missing.

      A plain radiographic chest imaging is conducted, and confirmed foreign body aspiration.

      Which of the following areas in the tracheobronchial tree is the most probable location of the aspirated eraser?

      Your Answer:

      Correct Answer: Right main bronchus

      Explanation:

      In foreign body aspiration, the foreign body is more likely to enter the right main bronchus because it is shorter, wider and more vertical than the left main bronchus. In a patient who is standing or sitting, the foreign body tends to become lodged in the posterobasal segment of the inferior lobe of the right lung.

    • This question is part of the following fields:

      • Anatomy
      • Thorax
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  • Question 36 - A 53-year-old man arrives at the emergency department complaining of visual impairment in...

    Incorrect

    • A 53-year-old man arrives at the emergency department complaining of visual impairment in his right eye. On examination, you notice that neither his right nor left pupil constricts when you shine a light in his right eye. When you flash a light in his left eye, the pupils of both his left and right eyes constrict. Which of the following nerves is the most likely to be affected:

      Your Answer:

      Correct Answer: Optic nerve

      Explanation:

      In full optic nerve palsy, the afferent pupillary light reflex is lost. Because the afferent optic nerve does not sense light flashed in the afflicted eye, the ipsilateral direct and contralateral consensual reflexes are gone. However, the contralateral direct and ipsilateral consensual reflexes are intact because the efferent oculomotor nerve is normal.

    • This question is part of the following fields:

      • Anatomy
      • Cranial Nerve Lesions
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      Seconds

  • Question 37 - Regarding the lacrimal apparatus, which of the following statements is CORRECT: ...

    Incorrect

    • Regarding the lacrimal apparatus, which of the following statements is CORRECT:

      Your Answer:

      Correct Answer: Lacrimal fluid is drained from the eyeball through the lacrimal punctum.

      Explanation:

      Lacrimal fluid is drained from the eyeball through the lacrimal punctum.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      0
      Seconds

  • Question 38 - A 33-year-old woman demonstrates right-sided superior homonymous quadrantanopia upon visual field testing. A...

    Incorrect

    • A 33-year-old woman demonstrates right-sided superior homonymous quadrantanopia upon visual field testing. A diagnosis of a brain tumour has been established.

      Which of the following anatomical points in the visual pathway has the lesion occurred?

      Your Answer:

      Correct Answer: Lower optic radiation

      Explanation:

      Homonymous quadrantanopia is not a disease; it is a clinical finding that points towards a lesion of the optic radiations coursing through the temporal lobe.
      Homonymous superior quadrantanopia is caused by damage to the contralateral inferior parts of the posterior visual pathway: the inferior optic radiation (temporal Meyer loop), or the inferior part of the occipital visual cortex below the calcarine fissure.

    • This question is part of the following fields:

      • Anatomy
      • Central Nervous System
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  • Question 39 - Regarding codeine, which of the following statements is INCORRECT: ...

    Incorrect

    • Regarding codeine, which of the following statements is INCORRECT:

      Your Answer:

      Correct Answer: There is a reduced risk of toxicity in patients who are ultra-rapid metabolisers of codeine.

      Explanation:

      Codeine phosphate is a weak opioid and can be used for the relief of mild to moderate pain where other painkillers such as paracetamol or ibuprofen have proved ineffective.Codeine is metabolised to morphine which is responsible for its therapeutic effects. Codeine 240 mg is approximately equivalent to 30 mg of morphine. The capacity to metabolise codeine can vary considerably between individuals; there is a marked increase in morphine toxicity in people who are ultra rapid metabolisers, and reduced therapeutic effect in poor codeine metabolisers. Codeine is contraindicated in patients of any age who are known to be ultra-rapid metabolisers of codeine (CYP2D6 ultra-rapid metabolisers).Codeine is also contraindicated in children under 12, and in children of any age who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea due to reports of morphine toxicity.

    • This question is part of the following fields:

      • Central Nervous System
      • Pharmacology
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      Seconds

  • Question 40 - Which of the following statements is correct with regards to Horner's syndrome? ...

    Incorrect

    • Which of the following statements is correct with regards to Horner's syndrome?

      Your Answer:

      Correct Answer: Miosis occurs due to paralysis of the dilator pupillae muscle.

      Explanation:

      The characteristics of Horner’s syndrome are pupil constriction, partial ptosis and anhidrosis.

    • This question is part of the following fields:

      • Anatomy
      • Head And Neck
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Anatomy (1/5) 20%
Upper Limb (1/2) 50%
Abdomen And Pelvis (0/1) 0%
Central Nervous System (1/1) 100%
Pharmacology (1/1) 100%
Abdomen (0/1) 0%
Thorax (0/1) 0%
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