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Question 1
Correct
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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: 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 2
Incorrect
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The orbicularis oculi us a muscle that closes the eyelids. What is the motor innervation of this muscle?
Your Answer: A branch of the same nerve that innervates the orbicularis oris muscle
Correct Answer: A branch of a nerve that exits through the stylomastoid foramen
Explanation:The orbicularis oculi is a muscle in the face that closes the eyelids. It is supplied by zygomatic branch of the facial nerve (cranial nerve VII), which exits through the stylomastoid foramen.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 3
Correct
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Which Statement is true of the brachial plexus?
Your Answer: The posterior cord continues as the axillary nerve
Explanation:The lateral cord continues as the musculocutaeous nerve.
The medial cord continues as the ulnar nerve.
The posterior cord continues as the radial nerve and the axillary nerve.
The nerve to subclavius muscle is a branch of the C6 root.
The suprascapular nerve is a branch from the upper trunk.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 4
Correct
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A lesion involving the suprachiasmatic nucleus of hypothalamus is likely to affect:
Your Answer: Regulation of circadian rhythm
Explanation:The suprachiasmatic nucleus (SCN) in the hypothalamus is responsible for controlling endogenous circadian rhythms and destruction of the SCN leads to a loss of circadian rhythm.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 5
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 6
Correct
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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: 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 7
Correct
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An old woman complains of a lack of sensation halfway down the anterior surface of the thigh. The cause of this:
Your 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 8
Correct
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A neonate is diagnosed with cryptorchidism of the right side (undescended testis). Which is the LEAST likely place to find the testis?
Your Answer: Perineum
Explanation:Embryologically the testes are retroperitoneal structures in the posterior abdominal wall, attached to the anterolateral abdominal wall by the gubernaculum. The gubernaculum ‘pulls’ the testes through the deep inguinal ring, inguinal canal and superficial inguinal ring and over the pelvic brim. The gubernaculum is preceded by the processus vaginalis that is derived from the peritoneum anterior to the testes. The processus vaginalis pushes the muscle and fascial layers. These eventually make up the canal and the spermatic cord, into the scrotum. The gubernaculum persists as the scrotal ligament while part of the processus vaginalis remains as a bursa-like sac i.e. the tunica vaginalis testes. The testes therefore could be caught in any one of these places along its path of descending. The testes are never in the perineum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 9
Correct
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Which of these illnesses is most likely to precede Guillain-Barré syndrome?
Your Answer: Viral pneumonia
Explanation:Guillain–Barré syndrome (GBS) is characterized by a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. In about two-thirds of patients, the syndrome begins 5 days to 3 weeks after an infectious disease, surgery or vaccination. Infection is the trigger in over 50% of patients; common pathogens include Campylobacter jejuni, enteric viruses, herpesviruses (including cytomegalovirus and those causing infectious mononucleosis) and Mycoplasma species. The underlying mechanism involves an autoimmune disorder in which the body’s immune system mistakenly attacks the peripheral nerves and damages their myelin insulation, although the cause for this is still unknown.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 10
Correct
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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 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 11
Correct
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Which one of the following groups of lymph nodes is most likely to be inflamed due to paronychia involving the big toe?
Your Answer: Vertical group of superficial inguinal lymph nodes
Explanation:Paronychia affecting the big toe will result in inflammation of the superficial inguinal lymph nodes as it drains lymph from the big toe.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 12
Incorrect
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The dural venous sinuses are venous channels that drain blood from the brain. This sinuses are located between which structures?
Your Answer: Periosteal and meningeal layers of the arachnoid mater
Correct Answer: Meningeal and periosteal layers of the dura mater
Explanation:The dural venous sinuses lies between the periosteal and meningeal layer of the dura mater. Dural venous sinuses is unique because it does not run parallel with arteries and allows bidirectional flow of blood intracranially as it is valve-less.
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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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A previously healthy 40-year-old housewife suddenly complains of a headache and loses consciousness. A CT scan reveals subarachnoid haemorrhage. Which of the following is the most probable cause?
Your Answer: Ruptured berry aneurysm
Explanation:Saccular aneurysms, also known as berry aneurysms, appear as a round outpouching and are the most common form of cerebral aneurysm. They are a congenital intracranial defect, and haemorrhage can occur at any age, but is most common between the ages of 40-65 years. A second rupture (rebleeding) sometimes occurs, most often within about 7 days of the first bleed.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 14
Correct
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A 45-year old with sarcoidosis has enlarged tracheobronchial lymph nodes. Which nerve is most likely to be irritated in this patient?
Your Answer: Left recurrent laryngeal
Explanation:Tracheobronchial lymph nodes are located at the bifurcation of the trachea and are in three groups i.e. the right superior, left superior and inferior. The aorta arches over the left bronchus near the point of tracheal bifurcation. Thus, the nerves that are closely associated with the aorta might be irritated if these nodes become inflamed. The left recurrent laryngeal nerve is such a nerve. The phrenic nerves, both the left and the right, are lateral and thus would not be affected. The right recurrent nerve loops around the right subclavian artery and is distant from this area. The right vagus artery is not associated with the aorta and the sympathetic chain is located in the posterior chest parallel to the vertebra, also not associated with the tracheobronchial tree.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 15
Incorrect
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In which of the following compartments of the femoral sheath is the femoral artery located?
Your Answer: Medial compartment
Correct Answer: Lateral compartment
Explanation:The femoral sheath also known as the crural sheath is made up of three compartments; lateral, intermediate and the medial. The femoral artery is contained in the lateral compartment of the femoral sheath while the femoral vein is in the intermediate compartment.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 16
Correct
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What is the chief ligament preventing posterior sliding of the tibia on the femur ?
Your Answer: Posterior cruciate
Explanation:The posterior cruciate ligament is attached to the posterior intercondyloid fossa of the tibia and the lateral and front part of the medial condyle of the femur. It resists sliding of the tibia posteriorly.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 17
Incorrect
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Which of the following diseases causes abrupt vertigo, nausea, vomiting, tinnitus, and nystagmus?
Your Answer: Cerebral oedema
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 18
Correct
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A patient presents with loss of pain and temperature sensation in the left leg. He is likely to have a lesion involving:
Your Answer: Right lateral spinothalamic tract
Explanation:The spinothalamic tract is a sensory pathway originating in the spinal cord that transmits information to the thalamus. There are two main parts of the spinothalamic tract: the lateral spinothalamic tract transmits pain and temperature and the anterior spinothalamic tract transmits touch (crude touch). The decussation of this pathway occurs at the level of the spinal cord. Hence, a unilateral lesion of the lateral spinothalamic tract causes contralateral loss of pain and temperature.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 19
Correct
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An episiotomy is indicated for a woman during a difficult vaginal delivery. Whilst the registrar was performing this procedure she made a median cut too far through the perineal body cutting the structure immediately posterior. Which structure is this?
Your Answer: External anal sphincter
Explanation:An episiotomy is an incision that is made whenever there is a risk of a tear during vaginal deliver. A posterolateral incision, as opposed to a median incision is preferred. Of the options given, the external anal sphincter lies right posterior to the perineal body. The sacrospinous and the sacrotuberous ligaments are deep in the perineum that they should not be involved in this.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 20
Correct
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A neurotransmitter of the nigrostriatal pathway is:
Your 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 21
Correct
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A mechanic sustained a deep laceration to his right cubital fossa which resulted in him unable to move the proximal radioulnar joint of his right arm. Which muscles was affected?
Your Answer: Pronator teres
Explanation:The correct answer is the pronator teres muscle. This muscle arises from 2 heads of origin: the humerus and ulnar. Between the 2 heads is the site of entrance of median nerve to the forearm. This muscle acts on the proximal radio-ulnar joint to rotate the radius on the ulna, otherwise known as pronation. It also assists in forearm flexion if the radius is fixed.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 22
Correct
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What forms the pelvic diaphragm?
Your Answer: Levator ani and coccygeus muscles
Explanation:The pelvic diaphragm is formed by the levator ani and the coccygeus muscles. The levator ani forms the greater part of the pelvic floor supporting the viscera in the pelvic cavity.
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This question is part of the following fields:
- Anatomy
- Pelvis
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Question 23
Correct
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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 24
Incorrect
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A lesion involving the lateral geniculate nucleus of the thalamus is likely to affect:
Your Answer: Hearing
Correct Answer: Vision
Explanation:The lateral geniculate nucleus (LGN) of the thalamus is the primary processor of visual information in the central nervous system. The LGN receives information directly from the retina and sends projections directly to the primary visual cortex. The LGN likely helps the visual system focus its attention on the most important information.
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This question is part of the following fields:
- Neurology
- Physiology
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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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A 20-year old gentleman was brought to the emergency department with headache and nausea for 2 days. He also complained of intolerance to bright light and loud sounds. Lumbar puncture showed glucose < 45 mg/dl, protein > 5 mg/dl and neutrophil leucocytosis. The likely diagnosis is:
Your Answer: Meningitis
Explanation:Diagnosis of meningitis can be carried out with examination of cerebrospinal fluid (CSF) with a lumbar puncture (LP). In a case of bacterial meningitis, the CSF analysis will show:
– Opening pressure: > 180 mmH2O
– White blood cell count: 10–10 000/μl with neutrophil predominance
– Glucose: < 40 mg/dl – CSF glucose to serum glucose ratio: < 0.4 – Protein: > 4.5 mg/dl
– Gram stain: positive in > 60%
– Culture: positive in > 80%
– Latex agglutination: may be positive in meningitis due to Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Escherichia coli and group B streptococci
– Limulus, lysates: positive in Gram-negative meningitis
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This question is part of the following fields:
- Neurology
- Physiology
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Question 27
Incorrect
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Rapid Eye Movement (REM) sleep is typically associated with:
Your Answer: Somnambulism
Correct Answer: Penile erections
Explanation:Normal sleep comprises of alternate cycles between slow-wave sleep (non-REM sleep) and REM sleep. REM sleep is characterized by increased metabolic brain activity and EEG desynchronization. Somnambulism (sleepwalking), enuresis (bedwetting) and night terrors all occur during slow-wave sleep or during arousal from slow-wave sleep. In comparison, REM sleep is characterized by hypotonia of major muscle groups (excluding ocular muscles), dreams, nightmares and penile erection.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 28
Correct
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A CT scan of 65 year old male patient at an outpatient clinic suggested a bone tumour at the stylomastoid foramen. Which of the following cranial nerves is likely to be affected with this tumour?
Your Answer: VII
Explanation:Cranial nerve VII, the facial nerve, is found in the internal acoustic canal and runs through this canal into the facial canal before exiting through the stylomastoid foramen. In the case of a bone tumour at the stylomastoid process, the facial nerve is the nerve that will most likely be affected.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 29
Incorrect
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A patients sciatic nerve has been severed following a stab injury. What would be affected?
Your Answer: The long head of the biceps femoris muscle would be affected but not the short head
Correct Answer: There would still be cutaneous sensation over the anteromedial surface of the thigh
Explanation:The sciatic nerve supplies nearly all of the sensation of the skin of the leg and the muscles of the back of the thigh, leg and foot. A transection of the sciatic nerve at its exit from the pelvis will affect all the above-mentioned functions except cutaneous sensation over the anteromedial surface of the thigh, which comes from the femoral nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 30
Correct
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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 31
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 32
Incorrect
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Question 33
Correct
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Which of the following structures is affected or damaged when the 'anterior drawer test' is positive?
Your Answer: Anterior cruciate ligament
Explanation:The anterior drawer test is an important orthopaedic test that is used to test weakness of the anterior cruciate ligament. The test is done by having the patient sit in a supine position with his/her knees flexed at 90 degrees. An examiner stabilises the patients feet and softly pulls or pushes on the proximal tibia. The test is positive if there is translational movement of the tibia in relation to the femur, indicating a weakened anterior cruciate ligament. The anterior cruciate ligament prevents the tibia from sliding out in front of the femur.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 34
Correct
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With respect to far accommodation, which of the following is a TRUE statement?
Your Answer: The ciliary muscles are relaxed
Explanation:Myopia or near-sightedness is a disease due to elongated eyeballs or too strong a lens. For far accommodation (focus of a distant object onto the retina), the lens needs to decrease its refractive power, or in other words, increase its focal length. This is done by relaxation of ciliary muscles which tightens the zonular fibres and flattening of the lens. Relaxation of the zonular fibres, rounding of the lens, shortening of the focal length and constriction of the pupil occurs during near accommodation.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 35
Correct
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Destruction of the ventromedial nucleus of the hypothalamus will result in:
Your 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 36
Incorrect
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A young man came to the emergency room after an accident. The anterior surface of his wrist was lacerated with loss of sensation over the thumb side of his palm. Which nerves have been damaged?
Your Answer: Radial
Correct Answer: Median
Explanation:The median nerve provides cutaneous innervation to the skin of the palmar radial three and a half fingers. Also the site of injury indicates that the medial nerve may have been injured as it passes into the hand by crossing over the anterior wrist.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 37
Correct
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The dilator pupillae muscle is innervated by postganglionic sympathetic fibres. Where do the postganglionic sympathetic fibres originate?
Your Answer: Superior cervical ganglion
Explanation:The postganglionic sympathetic axons are derived from the superior cervical ganglion and innervate the eye and lacrimal gland allowing for vasoconstriction of the iris and sclera, pupillary dilation, widening of the palpebral fissure, and a reduction in tear production.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 38
Correct
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Which of the following structure contains the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle?
Your Answer: Edinger–Westphal nucleus
Explanation:The Edinger–Westphal nucleus (accessory oculomotor nucleus) is the parasympathetic pre-ganglionic nucleus that innervates the iris sphincter muscle and the ciliary muscle.
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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 parasympathetic fibres of the oculomotor nerve was impinged due to a growing tumour. The function of which of the following structures will be affected?
Your Answer: Ciliary muscle
Explanation:The oculomotor nerve is the third cranial nerve (CNIII). It offers motor and parasympathetic innervation to many of the ocular structures. The motor fibres innervate a number of the extraocular muscles. While the parasympathetic fibres supply the sphincter pupillae and the ciliary muscles of the eye, and the sympathetic fibres innervates the superior tarsal muscles.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 40
Incorrect
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Which of these structures is most likely to be damaged if a patient loses consciousness days or weeks after an otherwise insignificant head trauma, especially in elderly patients?
Your Answer: Middle meningeal artery
Correct Answer: Dural bridging vein
Explanation:A subdural haematoma is a type of hematoma, usually associated with traumatic brain injury, in which blood collects between the dura mater and the pia-arachnoid mater. Symptoms of subdural haemorrhage have a slower onset than those of epidural haemorrhages because the lower pressure veins bleed more slowly than arteries. These injuries are more common in elderly patients, especially those taking antiplatelet or anticoagulant drugs. Oedema and increased intracranial pressure are unusual.
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This question is part of the following fields:
- Neurology
- Pathology
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Question 41
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 42
Correct
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What best describes the muscles of the posterior compartment of the leg?
Your Answer: One of the posterior compartment leg muscles laterally rotates the femur
Explanation:The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris and are the chief extensors of the foot at the ankle joint. Deep muscles include the tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 43
Correct
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In which situation is a stretch reflex such as knee jerk likely to be exaggerated?
Your Answer: In upper motor neuron lesion
Explanation:A stretch reflex is a monosynaptic reflex that causes muscle contraction in response to stretching within that muscle. The sensory apparatus in a muscle that are sensitive to stretch are the muscle spindles. The patellar (knee jerk) reflex is an example. In upper motor neuron lesions, the stretch reflexes tend to be brisk due to loss of inhibitory signals on gamma neurons through the lateral reticulospinal tract.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 44
Correct
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Dysarthria, nystagmus and a tremor worsening with directed movement are likely to be seen in:
Your Answer: Cerebellar disease
Explanation:The given symptoms are seen in diseases affecting the cerebellum. A cerebellar tremor is a slow tremor that occurs at the end of a purposeful movement. It is seen in cerebellar disease, such as multiple sclerosis or some inherited degenerative disorders and chronic alcoholism. Classically, tremors are produced in the same side of the body as a one-sided lesion. Cerebellar disease can also result in a wing-beating’ type of tremor called rubral or Holmes’ tremor – a combination of rest, action and postural tremors. Other signs of cerebellar disease include dysarthria (speech problems), nystagmus (rapid, involuntary rolling of the eyes), gait problems and postural tremor of the trunk and neck.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 45
Correct
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Which of the following statements is true regarding the umbilical cord?
Your Answer: Is filled with jelly of Wharton
Explanation:The umbilical cord that connects the fetus to the placenta is about 50cm long. This tissue consists of the body stalk and vitelline duct. The former containing the allantoic diverticulum and the umbilical vessels. The latter contains the connection linking the digestive tube and the yolk sac. This cord is wrapped by stratum of ectoderm and gelatinous tissue or jelly of Wharton. The right umbilical vein plus the vitelline vessels and ducts disappear and this at birth the cord has three vessels which are the umbilical vein and two umbilical arteries.
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This question is part of the following fields:
- Anatomy
- Embryology
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Question 46
Correct
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Which muscles are attached to the tibial tuberosity?
Your Answer: Vastus intermedius
Explanation:The tuberosity of the tibia is the site of attachment to the ligamentum patella (the tendon of the quadriceps femoris muscle which include four heads: rectus femoris, vastus medialis, intermedius and lateralis).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 47
Correct
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Which of the following will show decreased hearing when tested by air conduction but normal hearing when tested by bone conduction?
Your Answer: Fibrosis causing fixation of the ossicles
Explanation:As the cochlea is embedded into bone, the vibrations from the bone are transmitted directly to the fluid in the cochlea. Hence, any damage to the ossicles or tympanic membrane will not show an abnormal result on bone conduction test.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 48
Correct
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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 49
Correct
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The primary area involved in the pathology of Parkinson's disease is:
Your 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 50
Correct
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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: 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 51
Correct
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A 25 year old male patient who had sustained a stab wound in the middle of the posterior aspect of the left thigh, was discharged from hospital after dressing and antibiotic prophylaxis. Later on the patient developed bleeding through the wound and upon review, the source was discovered to be an artery that is the direct source of the medial and lateral circumflex arteries. Which is this artery that was injured?
Your Answer: Profunda femoris artery
Explanation:The medial and lateral circumflex arteries are direct branches of the Profunda femoris artery otherwise also known as the deep artery of the thigh. The Profunda femoris artery arises from the femoral artery just below the inguinal ligament (approximately 2-5cm below it).
The following are the branches of the deep artery of the thigh:
Lateral circumflex femoral artery
Medial circumflex femoral artery
Perforating arteries
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 52
Correct
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When one is silently counting, what part of his brain will show increased regional cerebral blood flow (rCBF)?
Your Answer: Supplementary motor area
Explanation:Regional cerebral blood flow (rCBF) increases in the superior speech cortex (supplementary motor area) during periods of silent counting, whereas speaking aloud will do so in the motor cortex and medial temporal lobe, along with the superior speech cortex.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 53
Correct
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Which of the following is a true statement regarding the pupil?
Your Answer: Phentolamine causes pupil constriction
Explanation:A balance between the sympathetic tone to the radial fibres of the iris and parasympathetic tone to the pupillary sphincter muscle determines the pupil size. Phentolamine (α-adrenergic receptor blocker) causes pupillary constriction. Dilatation of the pupil occurs with increased sympathetic activity, decreased parasympathetic activity during darkness or block of muscarinic receptors by atropine.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 54
Correct
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Thalamic syndrome will most likely result in:
Your Answer: Hyperaesthesia
Explanation:Signs and symptoms of thalamic syndrome include contralateral hemi anaesthesia, burning or aching sensation in one half of a body (hyperaesthesia), often accompanied by mood swings.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 55
Correct
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The annular ligament in the forearm:
Your Answer: Encircles the head of the radius
Explanation:The annular ligament forms about four-fifths of the osseofibrous ring and is attached to the anterior and posterior margins of the radial notch. It is a strong band of fibres which encircles the head of the radius retaining it in contact with the radial notch of the ulna. When it comes to its upper border, it blends with the anterior and posterior ligament of the elbow.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 56
Correct
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A 40 year old patient with an history of obesity has been diagnosed with meralgia parasthetica. The condition was discovered to be caused by the pinching of the lateral femoral cutaneous nerve. Injuries at what spinal levels usually affect this nerve?
Your Answer: L2, L3
Explanation:The lateral femoral cutaneous nerve of the thigh arises from the dorsal division of the lumbar plexus of the second and the third lumbar nerves (L2 – L3). Spinal injuries at this level are likely to affect the lateral femoral cutaneous nerve. The lateral femoral cutaneous nerve innervates the skin on the lateral aspect of the thigh.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 57
Correct
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Where is the foramen ovale located?
Your Answer: Sphenoid
Explanation:The foramen ovale is an oval shaped opening in the middle cranial fossa located at the posterior base of the greater wing of the sphenoid bone, lateral to the lingula. It transmits the mandibular division of the trigeminal nerve (CN Vc), accessory meningeal artery, emissary veins between the cavernous sinuses and pterygoid plexus, otic ganglion, and occasionally the nervus spinosus and lesser petrosal nerve.
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This question is part of the following fields:
- Anatomy
- Head & Neck
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Question 58
Incorrect
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Regarding the posterior compartment of the leg, which is correct?
Your Answer: The muscles dorsiflex the foot and are innervated by the deep fibular nerve
Correct Answer: The muscles plantarflex the foot and are innervated by the tibial nerve
Explanation:The muscles of the back of the leg are subdivided into two groups: superficial and deep. Superficial muscles include gastrocnemius, soleus and plantaris. Deep muscles include tibialis posterior, flexor hallucis longus, flexor digitorum longus and popliteus. The superficial ( calf muscles) which are responsible for plantarflexion of the foot are supplied by the tibial nerve as follows: the gastrocnemius and soleus muscles are supplied by the first and second sacral nerves and the plantaris by the fourth and fifth lumbar and first sacral nerve (the tibial nerve).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 59
Correct
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If a 55-year old gentleman who has suffered a stroke, develops a tremor in his fingers that worsens on reaching for an object, what part of his brain is likely to be involved?
Your Answer: Cerebellum
Explanation:The cerebellum plays an important role in the integration of sensory perception and motor output. Multiple neural pathways link the cerebellum with the motor cortex and the spinocerebellar tract. The cerebellum uses the constant feedback on body position to fine-tune the movements and integrates these pathways. The patient described here has a characteristic cerebellar tremor that is a slow, broad tremor of the extremities and occurs at the end of a purposeful movement.
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This question is part of the following fields:
- Neurology
- Physiology
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Question 60
Correct
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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: 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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