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Question 1
Incorrect
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Regarding the intervertebral disc, which of the following statements is CORRECT:
Your Answer: Herniation of the intervertebral disc occurs when the outer fibrous layer herniates through vertebral bodies.
Correct Answer: In L4 - L5 disc herniation, the L5 spinal nerve root is the most commonly affected.
Explanation:A posterolateral herniation of the disc at the L4 – L5 level would be most likely to damage the fifth lumbar nerve root, not the fourth lumbar nerve root, due to more oblique descending of the fifth lumbar nerve root within the subarachnoid space.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 2
Incorrect
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Which of the following muscles laterally rotates the hip?
Your Answer: Semimembranosus
Correct Answer: Gluteus maximus
Explanation:External (lateral) rotation at the hip joint is produced by the gluteus maximus together with a group of 6 small muscles (lateral rotators): piriformis, obturator internus, superior and inferior gemelli, quadratus femoris and obturator externus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 3
Correct
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Which of the following is NOT a typical side effect of opioid analgesics:
Your Answer: Diarrhoea
Explanation:All opioids have the potential to cause:Gastrointestinal effects – Nausea, vomiting, constipation, difficulty with micturition (urinary retention), biliary spasmCentral nervous system effects – Sedation, euphoria, respiratory depression, miosisCardiovascular effects – Peripheral vasodilation, postural hypotensionDependence and tolerance
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 4
Incorrect
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All of the following predisposes to lithium toxicity in patients taking long-term therapy EXCEPT:
Your Answer: Co-administration of NSAIDs
Correct Answer: Hypernatraemia
Explanation:A common complication of long term lithium therapy results in most cases of lithium intoxication. It is caused by reduced excretion of the drug which can be due to several factors including deterioration of renal function, dehydration, hyponatraemia, infections, and co-administration of diuretics or NSAIDs or other drugs that may interact.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 5
Incorrect
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A 26 year old horse rider has a bad fall and sustains a neck injury which displays the following signs:- ability to extend the wrist against gravity- paralysis of the hands, trunk, and legs- absent sensation in the fingers and medial upper arms- normal sensation over the thumbs- absent sensation in chest, abdomen, and legsWhat is the neurological level of the injury?
Your Answer: C5
Correct Answer: C6
Explanation:C1 – C4 INJURYMost severe of the spinal cord injury levels; paralysis in arms, hands, trunk and legs; patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements; ability to speak is sometimes impaired or reducedC5 INJURYPerson can raise his or her arms and bend elbows; likely to have some or total paralysis of wrists, hands, trunk and legs; can speak and use diaphragm, but breathing will be weakenedC6 INJURYNerves affect wrist extension; paralysis in hands, trunk and legs, typically; should be able to bend wrists back; can speak and use diaphragm, but breathing will be weakenedC7 INJURYNerves control elbow extension and some finger extension; most can straighten their arm and have normal movement of their shouldersC8 INJURYNerves control some hand movement; should be able to grasp and release objectsC5 – Elbow flexors (biceps, brachialis)C6 – Wrist extensors (extensor carpi radialis longus and brevis)C7 – Elbow extensors (triceps)C8 – Finger flexors (flexor digitorum profundus) to the middle fingerC5 – Elbow flexed at 90 degrees, arm at the patient’s side and forearm supinatedC6 – Wrist in full extensionC7 – Shoulder is neutral rotation, adducted and in 90 degrees of flexion with elbow in 45 degrees of flexionC8 –Full flexed position of the distal phalanx with the proximal finger joints stabilized in a extended position
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 6
Correct
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What is the main mechanism of action of cyclizine:
Your Answer: Histamine-H1 antagonist
Explanation:Antihistamines e.g. cyclizine, are effective against nausea and vomiting caused by many different conditions, including motion sickness and vertigo. These agents act by inhibiting histamine pathways, and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. There is no evidence that any one antihistamine is superior to another but their duration of action and incidence of adverse effects differ. Adverse effects include drowsiness and antimuscarinic effects such as blurred vision, dry mouth, urinary retention, constipation and confusion.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 7
Incorrect
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A 25-year-old athlete suffers an injury to the nerve that innervates the gluteus minimus muscle.Which of the following nerves innervates the gluteus minimus muscle?
Your Answer: Femoral nerve
Correct Answer: Superior gluteal nerve
Explanation:Gluteus minimus is the smallest muscle of the glutei. It is located just beneath the gluteus medius muscle. Gluteus minimus predominantly acts as a hip stabilizer and abductor of the hip. The superior gluteal nerve innervates the gluteus minimus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 8
Incorrect
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Which of the following clinical features is most suggestive of a lesion of the temporal lobe:
Your Answer: Homonymous hemianopia
Correct Answer: Receptive dysphasia
Explanation:Damage to the Wernicke’s speech area in the temporal lobe can result in a receptive dysphasia. Hemispatial neglect is most likely to occur in a lesion of the parietal lobe. Homonymous hemianopia is most likely to occur in a lesion of the occipital lobe. Expressive dysphasia is most likely to occur in a lesion of the Broca speech area in the frontal lobe. Conjugate eye deviation towards the side of the lesion is most likely to occur in a lesion of the frontal lobe.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 9
Correct
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Which of the following movements does the iliacus muscle produce?
Your Answer: Flexion of the thigh at the hip joint
Explanation:The iliacus flexes the thigh at the hip joint when the trunk is stabilised. It flexes the trunk against gravity when the body is supine.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 10
Correct
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What is the main mechanism of action of metoclopramide:
Your Answer: Dopamine antagonist
Explanation:Metoclopramide is a dopamine-receptor antagonist. Blockade of inhibitory dopamine receptors in the GI tract may allow stimulatory actions of ACh at muscarinic synapses to predominate. Metoclopramide also blocks dopamine D2-receptors within the chemoreceptor trigger zone (CTZ). At high doses, it is also thought to have some 5-HT3antagonist activity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 11
Correct
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At which opioid receptors do opioid analgesics act primarily?
Your Answer: Mu
Explanation:Opioid receptors are widely distributed throughout the central nervous system. Opioid analgesics mimic endogenous opioid peptides by causing prolonged activation of these receptors, mainly the mu(μ)-receptors which are the most highly concentrated in brain areas involved in nociception.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 12
Correct
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Which of the following muscles inserts into the patella?
Your Answer: The quadriceps femoris complex
Explanation:The quadriceps femoris muscle translates to “four-headed muscle” from Latin. It bears this name because it consists of four individual muscles; rectus femoris, vastus medialis, vastus lateralis, and vastus intermedius. Out of all four muscles, only the rectus femoris crosses both the hip and knee joints. The others cross only the knee joint. These muscles differ in their origin, but share a common quadriceps femoris tendon which inserts into the patella. The function of the quadriceps femoris muscle is to extend the leg at the knee joint and to flex the thigh at the hip joint.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 13
Incorrect
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You are reviewing a patient following a fall from a horse. You suspect they may have an Erb's palsy as a result of a brachial plexus injury. Regarding Erb's palsy, which one of the following statements is CORRECT:
Your Answer: Erb's palsy characteristically results in Waiter's tip deformity where the arm is held in lateral rotation.
Correct Answer: Erb's palsy may result in loss of sensation of the regimental badge area.
Explanation:Erb’s palsy is caused by damage to the C5 and C6 nerve roots and thus primarily involves the musculocutaneous, suprascapular and axillary nerves. It commonly result from an excessive increase in the angle between the neck and the shoulder e.g. a person thrown from a motorbike or horseback or during a difficult birth. There is loss or weakness of abduction, lateral rotation and flexion of the arm and flexion and supination of the forearm and loss of sensation on the lateral arm. A characteristic ‘Waiter’s tip’ deformity may be present where the limb hangs limply by the side, medially rotated by the unopposed action of pectoralis major with the forearm pronated due to paralysis of the biceps brachii.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 14
Correct
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A 42-year-old man presented to the emergency room after an incident of slipping and falling onto his back and left hip. Upon physical examination, it was noted that he has pain on hip adduction, but normal hip flexion. Which of the following muscles was most likely injured in this case?
Your Answer: Pectineus
Explanation:The hip adductors are a group of five muscles located in the medial compartment of the thigh. These muscles are the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus.The hip flexors consist of 5 key muscles that contribute to hip flexion: iliacus, psoas, pectineus, rectus femoris, and sartorius.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 15
Incorrect
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Which of the following is NOT a typical feature of a lesion to the vestibulocochlear nerve:
Your Answer: Nystagmus
Correct Answer: Hyperacusis
Explanation:Hyperacusis is increased acuity of hearing with hypersensitivity to low tones resulting from paralysis of the stapedius muscle, innervated by the facial nerve. General sensation to the face and to the anterior two-thirds of the tongue is carried by the divisions of the trigeminal nerve (although taste to the anterior two-thirds of the tongue is supplied by the facial nerve). Eye movements are mediated by the oculomotor, trochlear and abducens nerve. Ptosis results from paralysis of the levator palpebrae superioris, innervated by the oculomotor nerve, or the superior tarsal muscle, innervated by the sympathetic chain.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 16
Correct
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A 34-year-old man presented to the emergency room after being involved in a road traffic accident. Upon observation and examination, it was noted that he was hypotensive and has muffled heart sounds. It was suspected that he has pericardial effusion, so an emergency pericardiocentesis was to be performed.In performing pericardiocentesis for suspected pericardial effusion, which of the following anatomical sites are at risk of being punctured?
Your Answer: 1 cm below the left xiphocostal angle
Explanation:Pericardiocentesis is a procedure done to remove fluid build-up in the sac around the heart known as the pericardium. The pericardium can be tapped from almost any reasonable location on the chest wall. However, for the usual blind pericardiocentesis, the subxiphoid approach is preferred. Ideally, 2-D echocardiography is used to guide needle insertion and the subsequent path of the needle/catheter.In the subxiphoid approach, the needle is inserted 1 cm inferior to the left xiphocostal angle with an angle of 30 degrees from the patient’s chest with a direction towards the left mid-clavicle. The fingers may sense a distinct give when the needle penetrates the parietal pericardium. Successful removal of fluid confirms the needle’s position.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 17
Correct
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Which of the following is NOT a side effect of phenytoin:
Your Answer: Ototoxicity
Explanation:Adverse effects of phenytoin include:Nausea and vomitingDrowsiness, lethargy, and loss of concentrationHeadache, dizziness, tremor, nystagmus and ataxiaGum enlargement or overgrowthCoarsening of facial features, acne and hirsutismSkin rashesBlood disorders
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 18
Incorrect
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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: Posterior cerebral 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.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 19
Incorrect
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Regarding codeine, which of the following statements is INCORRECT:
Your Answer: Codeine is contraindicated in children under 12 years old.
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.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 20
Correct
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A 27-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.In which of the following nerves is the gluteus maximus muscle innervated by?
Your Answer: Inferior gluteal nerve
Explanation:The gluteal muscles are a group of muscles that make up the buttock area. These muscles include: gluteus maximus, gluteus medius. and gluteus minimus.The gluteus maximus is the most superficial as well as largest of the three muscles and makes up most of the shape and form of the buttock and hip area. It is a thick, fleshy muscle with a quadrangular shape. It is a large muscle and plays a prominent role in the maintenance of keeping the upper body erect.The innervation of the gluteus maximus muscle is from the inferior gluteal nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 21
Correct
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Carbamazepine is contraindicated in which of the following:
Your Answer: Atrioventricular block
Explanation:Carbamazepine is contraindicated in:- People with known hypersensitivity to carbamazepine or structurally related drugs- People with atrioventricular block (may suppress AV conduction and ventricular automaticity)- People with a history of bone marrow depression (risk of agranulocytosis and aplastic anaemia)- People with a history of acute porphyrias- People taking a monoamine oxidase inhibitor (risk of serotonin syndrome)
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 22
Correct
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Which of the following nerves provides cutaneous innervation to the posterior surface of the scrotum?
Your Answer: Branch of the perineal nerve
Explanation:The following nerves provide cutaneous innervation to the scrotum, and other anatomic structures:The perineal nerve supplies the muscles in the urogenital triangle, and the skin on the posterior surface of the scrotum (or labia majora).The genital branch of the genitofemoral nerve supplies the cremaster muscle, the skin over the anterior surface of the thigh, and the anterolateral surface of the scrotum.The ilioinguinal nerve supplies the external oblique, internal oblique, transversus abdominis, skin of the upper medial aspect of thigh, the root of the penis and the anterior surface of the scrotum in the male, and the mons pubis and labia majora in the female.The posterior cutaneous nerve of the thigh, or posterior femoral cutaneous nerve, supplies the skin over the lower medial quadrant of the buttock, the inferior skin of the scrotum or labium majus, and the back of the thigh and the upper part of the leg.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 23
Incorrect
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An injury to the brachial plexus can cause Erb's palsy. The following is expected to happen to a patient suffering from this condition, except for which one:
Your Answer: Weakness of abduction of the arm
Correct Answer: Weakness of medial rotation of the arm
Explanation:Erb’s palsy can be caused by a traumatic force downward on the upper arm and shoulder that damages the upper root of the brachial plexus. The patient will lose shoulder abduction (deltoid, supraspinatus), shoulder external rotation (infraspinatus), and elbow flexion as a result of this condition (biceps, brachialis).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 24
Incorrect
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Regarding the flexor digitorum profundus muscle, which of the following is true?
Your Answer: The medial aspect of the muscle is innervated by the median nerve
Correct Answer: The medial aspect of the muscle is innervated by the ulnar nerve
Explanation:Flexor digitorum profundus is a fusiform muscle located deep within the anterior (flexor) compartment of the forearm. Along with the flexor pollicis longus and pronator quadratus muscles, it comprises the deep flexor compartment of the forearm.Flexor digitorum profundus has a dual innervation:(1) The medial part of the muscle, that inserts to the fourth and fifth digits, is innervated by the ulnar nerve (C8-T1);(2) The lateral part, that inserts to the second and third digits, is innervated by the median nerve, via anterior interosseous branch (C8-T1).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 25
Incorrect
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If a lesion is observed in Broca's area, which function is expected to become affected?
Your Answer: Comprehension of speech
Correct Answer: Formation of words
Explanation:The primary functions of the Broca area are both language production and comprehension. While the exact role in the production is still unclear, many believe that it directly impacts the motor movements to allow for speech. Although originally thought to only aid in speech production, lesions in the area can rarely be related to impairments in the comprehension of language. Different regions of the Broca area specialize in various aspects of comprehension. The anterior portion helps with semantics, or word meaning, while the posterior is associated with phonology, or how words sound. The Broca area is also necessary for language repetition, gesture production, sentence grammar and fluidity, and the interpretation of others’ actions.Broca’s aphasia is a non-fluent aphasia in which the output of spontaneous speech is markedly diminished and there is a loss of normal grammatical structure. Specifically, small linking words, conjunctions, such as and, or, and but, and the use of prepositions are lost. Patients may exhibit interjectional speech where there is a long latency, and the words that are expressed are produced as if under pressure. The ability to repeat phrases is also impaired in patients with Broca’s aphasia. Despite these impairments, the words that are produced are often intelligible and contextually correct. In pure Broca’s aphasia, comprehension is intact.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 26
Incorrect
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Regarding aspirin at analgesic doses, which of the following statements is CORRECT:
Your Answer: The increased production of prostaglandins can irritate gastric mucosa.
Correct Answer: It is contraindicated in patients with severe heart failure.
Explanation:Aspirin (at analgesic doses) is contraindicated in severe heart failure. Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes resulting in decreased production of prostaglandins (which can lead to irritation of the gastric mucosa). The analgesic dose is greater than the antiplatelet dose, and taken orally it has a duration of action of about 4 hours. Clinical features of salicylate toxicity in overdose include hyperventilation, tinnitus, deafness, vasodilatation, and sweating.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 27
Correct
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The lymph drainage of the anal canal above the pectinate line is initially to the:
Your Answer: Internal iliac nodes
Explanation:Above the pectinate line, the anal canal drains to the internal iliac lymph nodes which subsequently drain to the lumbar (para-aortic) nodes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 28
Incorrect
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A patient with diplopia is found to have eye deviation downwards and outwards. The likely nerves that are affected are:
Your Answer: Trochlear nerve
Correct Answer: Oculomotor nerve
Explanation:The results of an oculomotor (CN III) nerve palsy are a depressed and abducted (down and out) eye, ptosis, diplopia, and a fixed and dilated pupil.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 29
Correct
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What type of visual field defect are you likely to see in a lesion of the visual cortex:
Your Answer: Contralateral homonymous hemianopia with macular sparing
Explanation:A lesion of the visual cortex will result in a contralateral homonymous hemianopia with macular sparing.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 30
Incorrect
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Regarding the brachioradialis muscle, which of the following statements is true?
Your Answer: It receives its blood supply from the brachial artery
Correct Answer: It assists with supination of the forearm at the radioulnar joints
Explanation:Brachioradialis is a fusiform muscle located in the lateral part of the posterior forearm. Along with extensor carpi radialis brevis and extensor carpi radialis longus, it comprises the radial group of forearm muscles, which belong to the superficial layer of posterior forearm muscles. Although anatomically part of the posterior forearm muscles, which are known to be forearm extensors, brachioradialis’ fibre orientation enables it to rather flex the forearm, and aids in supination of the forearm at the radioulnar joint.The brachioradialis muscle originates from the upper two-thirds of the lateral supracondylar ridge of humerus and the anterior surface of the lateral intermuscular septum of the arm. It slides over the lateral surface of the elbow joint, entering the anterolateral cubital area. The muscle fibres course inferiorly down the radial part of the anterior forearm, forming a thick tendon in approximately the middle of the forearm. This tendon then traverses the remainder of the forearm, inserting near the wrist, just proximal to the styloid process of radius.Brachioradialis is innervated by the radial nerve (from the root values C5-C6) that stems from the posterior cord of the brachial plexus. Blood supply to the brachioradialis muscle comes from branches of the radial artery, radial recurrent artery and the radial collateral branch of the deep brachial artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 31
Incorrect
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The least likely feature expected to be seen in a lesion of the frontal lobe is which of the following?
Your Answer: Expressive dysphasia
Correct Answer: Loss of two-point discrimination
Explanation:Lesions in different areas give rise to different symptoms. Lesions of the parietal lobe give rise to loss of two-point discrimination. Lesions to Broca’s area give rise to expressive dysphasia results from damage Lesions to the primary motor cortex give rise to contralateral weakness of the face and arm. Lesions to the prefrontal cortex give rise to personality change. Lesions to the frontal eye field give rise to conjugate eye deviation towards side of lesion.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 32
Correct
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A man presents to the emergency department with an injury that has damaged the opponens pollicis muscle.Which of the following statements regarding the opponens pollicis muscle is considered correct?
Your Answer: It flexes the first metacarpal bone at the carpometacarpal joint
Explanation:Opponens pollicis is a muscle of thenar eminence, it is triangular in shape and lies deep to flexor pollicis brevis and abductor pollicis brevis. It originates from the flexor retinaculum, tubercles of scaphoid and trapezium, abductor pollicis longus tendon.Its insertion is in the radial side of the base of proximal phalanx of thumb. It is supplied by the median nerve (C8, T1). It receives blood supply from superficial arch.It flexes the metacarpal bone medially across the palm, also rotating it medially, causing opposition, the palmar aspect of the terminal segment of thumb contacts the flexor aspects of any other digit.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 33
Incorrect
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Which of the following clinical features is most suggestive of a lesion of the occipital lobe:
Your Answer: Conjugate eye deviation
Correct Answer: Homonymous hemianopia
Explanation:Homonymous hemianopia is a visual field defect involving either the two right or the two left halves of the visual fields of both eyes. It is caused by lesions of the retrochiasmal visual pathways, ie, lesions of the optic tract, the lateral geniculate nucleus, the optic radiations, and the cerebral visual (occipital) cortex
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 34
Incorrect
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The most important nerves for inversion of the foot are:
Your Answer: Deep fibular and superficial fibular nerve
Correct Answer: Tibial and deep fibular nerve
Explanation:Inversion of the foot is achieved by the tibialis anterior which is innervated by the deep fibular nerves, and the tibialis posterior muscles which is innervated by the tibial nerve respectively.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 35
Incorrect
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A 30-year-old man suffers from an open femoral shaft fracture after being involved in a road traffic accident. As a consequence of his injury, the nerve that was damaged innervates the popliteus muscle.In which of the following nerves is the popliteus muscle innervated by?
Your Answer: Femoral nerve
Correct Answer: Tibial nerve
Explanation:The popliteus muscle is innervated by the tibial nerve (L4, 5 and S1).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 36
Correct
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A 30 year old man stabbed in the upper arm presents to the Emergency Department and you perform a vascular examination. The brachial pulse can be best palpated at ?
Your Answer: In the antecubital fossa, medial to the tendon of the biceps brachii
Explanation:The brachial artery can be palpated in the antecubital fossa, medial to the tendon of the biceps brachii muscle.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 37
Incorrect
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Which of the following is NOT a typical cerebellar sign:
Your Answer: Hypotonia
Correct Answer: Resting tremor
Explanation:An intention tremor is characteristic of cerebellar dysfunction. Resting tremor may be seen in Parkinsonism.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 38
Incorrect
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Which of the following is NOT a contraindication to treatment with aspirin at analgesic doses:
Your Answer: Severe cardiac failure
Correct Answer: Myasthenia gravis
Explanation:Aspirin (at analgesic doses) is contraindicated in:People with a history of true hypersensitivity to aspirin or salicylates (symptoms of hypersensitivity to aspirin or salicylates include bronchospasm, urticaria, angioedema, and vasomotor rhinitis)People with active or previous peptic ulcerationPeople with haemophilia or another bleeding disorderChildren younger than 16 years of age (risk of Reye’s syndrome)People with severe cardiac failurePeople with severe hepatic impairmentPeople with severe renal impairmentN.B. Owing to an association with Reye’s syndrome, aspirin-containing preparations should not be given to children under 16 years, unless specifically indicated, e.g. for Kawasaki disease.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 39
Incorrect
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During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.Which of the following is expected to undergo atrophy in carpal tunnel syndrome?
Your Answer: The wrist extensors
Correct Answer: The thenar eminence
Explanation:Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:L– lateral two lumbricalsO– Opponens pollicisA– Abductor pollicisF– Flexor pollicis brevisIn the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 40
Correct
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Regarding the abductor pollicis longus, which of the following statements is true?
Your Answer: It extends the thumb at the carpometacarpal joint
Explanation:Abductor pollicis longus is a muscle found in the posterior compartment of the forearm. It is one of the five deep extensors in the forearm, along with the supinator, extensor pollicis brevis, extensor pollicis longus and extensor indicis.Abductor pollicis longus is innervated by the posterior interosseous nerve (C7, C8), which is a continuation of the deep branch of the radial nerve. The radial nerve is a branch of the posterior cord of the brachial plexus.Blood supply to the abductor pollicis longus muscle comes from the interosseous branches of the ulnar artery.Acting alone or with abductor pollicis brevis, abductor pollicis longus pulls the thumb away from the palm. More specifically, it produces (mid-) extension and abduction of the thumb at the first metacarpophalangeal joint. This action is seen in activities such as bowling and shovelling.Working together with the long and short extensors of the thumb, the muscle also helps to fully extend the thumb at the metacarpophalangeal joint. This action is important for loosening the hand grip, for example, when letting go of objects previously being held. Abductor pollicis longus also helps to abduct the hand (radial deviation) at the radiocarpal joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 41
Incorrect
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Which of the following occurs at the transverse thoracic plane:
Your Answer: Thoracic duct crosses from left to right hand side
Correct Answer: Bifurcation of the trachea
Explanation:A way to help remember the structures transected by the transverse thoracic plane is CLAPTRAP:C: cardiac plexusL: ligamentum arteriosumA: aortic arch (inner concavity)P: pulmonary trunkT: tracheal bifurcation (carina)R: right-to-left movement of the thoracic duct (posterior to the oesophagus)A: azygos vein drains into superior vena cavaP: pre-vertebral fascia and pre-tracheal fascia end
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 42
Correct
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A 36-year-old man who works in a farm presents with a deep laceration over the palm of his hand. A median nerve block was performed at his wrist to facilitate wound exploration and closure.Which of the following statements regarding median nerve blocks at the wrist is considered correct?
Your Answer: The needle should be inserted approximately 2.5 cm proximal to flexor retinaculum
Explanation:A median nerve block is a simple, safe, and effective method of obtaining anaesthesia to the palmar aspect of the thumb, index finger, middle finger, radial portion of the palm and ring finger. The median nerve lies deep to the flexor retinaculum and about one centimetre under the skin of the volar wrist.The palmaris longus tendon lies superficial to the retinaculum and is absent in up to 20% of patients.The median nerve is located slightly lateral (radial) to the palmaris longus tendon and medial (ulnar) to the flexor carpi radialis tendon.The procedure is as follows:- Check sensation and motor function of the median nerve. Wear gloves and use appropriate barrier precautions.- Locate the flexor carpi radialis and palmaris longus tendons, which become prominent when the patient flexes the wrist against resistance. The palmaris longus tendon is usually the more prominent of the two tendons.- Needle-entry site: The needle will be inserted adjacent to the radial (lateral) border of the palmaris longus tendon just proximal to the proximal wrist crease. If the palmaris longus tendon is absent, the needle-entry site is about 1 cm ulnar to the flexor carpi radialis tendon.- Cleanse the site with antiseptic solution. Place a skin wheal of anaesthetic, if one is being used, at the needle-entry site.- Insert the needle perpendicularly through the skin and advance it slowly until a slight pop is felt as the needle penetrates the flexor retinaculum. When paraesthesia in the distribution of the median nerve confirms proper needle placement, withdraw the needle 1 to 2 mm.- Aspirate to exclude intravascular placement and then slowly (i.e., over 30 to 60 seconds) inject about 3 mL of anaesthetic. If the patient does not feel paraesthesia, redirect the needle in an ulnar direction, under the palmaris longus tendon. If paraesthesia is still not felt, slowly inject 3 to 5 mL of anaesthetic in the proximity of the nerve 1 cm deep to the tendon.- Allow about 5 to 10 minutes for the anaesthetic to take effect.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 43
Incorrect
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Which nerve innervates the brachioradialis muscle?
Your Answer: The posterior interosseous nerve
Correct Answer: The radial nerve
Explanation:Brachioradialis is innervated by the radial nerve (from the root values C5-C6) that stems from the posterior cord of the brachial plexus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 44
Incorrect
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Which of the following is first-line for management of status epilepticus:
Your Answer: Rectal diazepam
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.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 45
Correct
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The muscles of the soft palate (other than the tensor veli palatini) are innervated by which of the following nerves:
Your Answer: Vagus nerve
Explanation:All of the muscles of the soft palate are innervated by the vagus nerve (from the pharyngeal plexus), except for the tensor veli palatini, which is innervated by a branch of the mandibular nerve.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 46
Incorrect
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Which of the following muscles are primarily involved in passive inspiration:
Your Answer: Internal and innermost intercostal muscles
Correct Answer: Diaphragm and external intercostal muscles
Explanation:Passive inspiration is produced by contraction of the diaphragm (depressing the diaphragm) and the external intercostal muscles (elevating the ribs). In inspiration, elevation of the sternal ends of the ribs (‘pump handle’ movement), elevation of the lateral shafts of the ribs (‘bucket handle’ movement) and depression of the diaphragm result in expansion of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in an increased intrathoracic volume and decreased intrathoracic pressure and thus air is drawn into the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 47
Incorrect
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A paediatric patient comes to the emergency room with complaints of right lower quadrant pain. The attending physician is considering appendicitis. Inside the operating room, the surgeon asks the medical student to locate the McBurney's point prior to the first incision.Which of the following is the surface anatomy of the McBurney's point?
Your Answer: One-third of the distance from the posterior superior iliac spine to the umbilicus
Correct Answer: One-third of the distance from the anterior superior iliac spine to the umbilicus
Explanation:Inflammation of the appendix is a significant public health problem with a lifetime incidence of 8.6% in men and 6.7% in women, with the highest incidence occurring in the second and third decade of life. While the rate of appendectomy in developed countries has decreased over the last several decades, it remains one of the most frequent emergent abdominal operations. Appendicitis can often result in anorexia, nausea, vomiting, and fever.McBurney’s point, which is found one-third of the distance between the anterior superior iliac spine and the umbilicus, is often the point of maximal tenderness in a patient with an anatomically normal appendix. A McBurney’s incision is chiefly used for cecostomy and appendectomy. It gives a limited exposure only, and should any doubt arise about the diagnosis, an infraumbilical right paramedian incision should be used instead.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 48
Incorrect
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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: Left anterior descending artery
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 involvedV1-V2 Septal wall Left anterior descendingV3-V4 Anterior wall Left anterior descendingV5-V6 Lateral wall Left circumflex arteryII, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%)I, aVL High lateral wall Left circumflex arteryV1, V4R Right ventricle Right coronary arteryV7-V9 Posterior wall Right coronary artery
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 49
Incorrect
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The 'bucket handle' movement of the thoracic wall describes which of the following movements:
Your Answer: The posterior ends of the ribs moving upwards and backwards
Correct Answer: The middles of the shafts of the ribs moving upwards and laterally
Explanation:Because the middles of the shafts of the ribs are lower than either the anterior or posterior end, elevation of the ribs also moves the middles of the shafts laterally. This ‘bucket handle’ upwards and lateral movement increases the lateral dimensions of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 50
Incorrect
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This anatomic part lies at the heart of the tooth.
Your Answer:
Correct Answer: The pulp cavity
Explanation:Within the central portion of the tooth lies the dental pulp. The pulp chamber provides mechanical support and functions as a barrier from external stimuli and the oral microbiome. The dental pulp is a unique tissue that is richly innervated and has an extensive microvascular network. Maintaining its vitality increases both the mechanical resistance of the tooth and the long-term survival. The junctional epithelium forms a band around the tooth at the base of the gingival sulcus, sealing off the periodontal tissues from the oral cavity.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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SESSION STATS - PERFORMANCE PER SPECIALTY
