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  • Question 1 - A 58-year-old man, previously diagnosed with small cell lung cancer, visits his GP...

    Correct

    • A 58-year-old man, previously diagnosed with small cell lung cancer, visits his GP complaining of a recent onset headache, nausea, and vomiting that have been worsening over the past week. He reports feeling dizzy when the headache starts and an unusual increase in appetite, resulting in weight gain. Despite his history of little appetite due to his lung cancer, he has been insatiable lately. Which part of the hypothalamus is likely affected by the metastasis of his lung cancer, causing these symptoms?

      Your Answer: Ventromedial nucleus

      Explanation:

      The ventromedial nucleus of the hypothalamus is responsible for regulating satiety, and therefore, damage to this area can result in hyperphagia.

      The posterior nucleus plays a role in stimulating the sympathetic nervous system and body heat, and lesions in this area can lead to autonomic dysfunction and poikilothermia.

      The lateral nucleus is responsible for stimulating appetite, and damage to this area can cause a decrease in appetite and anorexia.

      The paraventricular nucleus produces oxytocin and ADH, and lesions in this area can result in diabetes insipidus.

      The dorsomedial nucleus is responsible for stimulating aggressive behavior and can lead to savage behavior if damaged.

      The hypothalamus is a part of the brain that plays a crucial role in maintaining the body’s internal balance, or homeostasis. It is located in the diencephalon and is responsible for regulating various bodily functions. The hypothalamus is composed of several nuclei, each with its own specific function. The anterior nucleus, for example, is involved in cooling the body by stimulating the parasympathetic nervous system. The lateral nucleus, on the other hand, is responsible for stimulating appetite, while lesions in this area can lead to anorexia. The posterior nucleus is involved in heating the body and stimulating the sympathetic nervous system, and damage to this area can result in poikilothermia. Other nuclei include the septal nucleus, which regulates sexual desire, the suprachiasmatic nucleus, which regulates circadian rhythm, and the ventromedial nucleus, which is responsible for satiety. Lesions in the paraventricular nucleus can lead to diabetes insipidus, while lesions in the dorsomedial nucleus can result in savage behavior.

    • This question is part of the following fields:

      • Neurological System
      25.5
      Seconds
  • Question 2 - Which one of the following structures is not at the level of the...

    Incorrect

    • Which one of the following structures is not at the level of the infrapyloric plane?

      Your Answer: Hilum left kidney

      Correct Answer: Cardioesophageal junction

      Explanation:

      The cardioesophageal junction is located at the level of T11, which is a frequently tested anatomical knowledge. The oesophagus spans from the lower border of the cricoid cartilage at C6 to the cardioesophageal junction at T11. It is important to note that in newborns, the oesophagus extends from C4 or C5 to T9.

      Anatomical Planes and Levels in the Human Body

      The human body can be divided into different planes and levels to aid in anatomical study and medical procedures. One such plane is the transpyloric plane, which runs horizontally through the body of L1 and intersects with various organs such as the pylorus of the stomach, left kidney hilum, and duodenojejunal flexure. Another way to identify planes is by using common level landmarks, such as the inferior mesenteric artery at L3 or the formation of the IVC at L5.

      In addition to planes and levels, there are also diaphragm apertures located at specific levels in the body. These include the vena cava at T8, the esophagus at T10, and the aortic hiatus at T12. By understanding these planes, levels, and apertures, medical professionals can better navigate the human body during procedures and accurately diagnose and treat various conditions.

    • This question is part of the following fields:

      • Neurological System
      11.8
      Seconds
  • Question 3 - A 28-year-old woman visits her GP after experiencing a sudden deterioration of vision...

    Incorrect

    • A 28-year-old woman visits her GP after experiencing a sudden deterioration of vision in her left eye 10 days ago. She reports that her vision became blurry and has only partially improved since. Additionally, the patient describes intermittent sensations of pain and burning around her left eye. She has no significant medical history.

      During the examination, the direct pupillary light reflex is weaker in her left eye. Her left eye has a visual acuity of 6/12, while her right eye has a visual acuity of 6/6. The patient experiences pain when her left eye is abducted.

      What is the most frequent cause of this presentation?

      Your Answer: Myasthenia gravis

      Correct Answer: Multiple sclerosis

      Explanation:

      Optic neuritis, which is characterized by unilateral vision loss and pain, is most commonly caused by multiple sclerosis. This is an inflammatory disease that affects the central nervous system and is more prevalent in individuals of white ethnicity living in northern latitudes. Behcet’s disease, a rare vasculitis, can also cause optic neuritis but is less strongly associated with the condition. Conjunctivitis, on the other hand, does not cause vision loss and is characterized by redness and irritation of the outer surface of the eye. Myasthenia gravis, an autoimmune condition that causes muscle weakness, does not cause optic neuritis but can affect ocular muscles and lead to symptoms such as drooping eyelids and double vision.

      Understanding Optic Neuritis: Causes, Features, Investigation, Management, and Prognosis

      Optic neuritis is a condition that causes a decrease in visual acuity in one eye over a period of hours or days. It is often associated with multiple sclerosis, diabetes, or syphilis. Other features of optic neuritis include poor discrimination of colors, pain that worsens with eye movement, relative afferent pupillary defect, and central scotoma.

      To diagnose optic neuritis, an MRI of the brain and orbits with gadolinium contrast is usually performed. High-dose steroids are the primary treatment for optic neuritis, and recovery typically takes 4-6 weeks.

      The prognosis for optic neuritis is dependent on the number of white-matter lesions found on an MRI. If there are more than three lesions, the five-year risk of developing multiple sclerosis is approximately 50%. Understanding the causes, features, investigation, management, and prognosis of optic neuritis is crucial for early diagnosis and effective treatment.

    • This question is part of the following fields:

      • Neurological System
      46
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  • Question 4 - A 14-month-old infant is undergoing investigation by community paediatrics for developmental delay. The...

    Correct

    • A 14-month-old infant is undergoing investigation by community paediatrics for developmental delay. The mother has observed that the child has poor balance, cannot take steps alone, and walks on tiptoes with support. The infant was delivered via c-section at 28 weeks gestation and weighed 1400 grams at birth.

      During the assessment, the infant exhibits hyperreflexia, increased tone in the lower limbs, and sustained clonus in both ankles. The suspected diagnosis is cerebral palsy.

      What type of cerebral palsy is likely to be present in this infant based on the observed symptoms?

      Your Answer: Spastic cerebral palsy

      Explanation:

      Understanding Cerebral Palsy

      Cerebral palsy is a condition that affects movement and posture due to damage to the motor pathways in the developing brain. It is the most common cause of major motor impairment and affects 2 in 1,000 live births. The causes of cerebral palsy can be antenatal, intrapartum, or postnatal. Antenatal causes include cerebral malformation and congenital infections such as rubella, toxoplasmosis, and CMV. Intrapartum causes include birth asphyxia or trauma, while postnatal causes include intraventricular hemorrhage, meningitis, and head trauma.

      Children with cerebral palsy may exhibit abnormal tone in early infancy, delayed motor milestones, abnormal gait, and feeding difficulties. They may also have associated non-motor problems such as learning difficulties, epilepsy, squints, and hearing impairment. Cerebral palsy can be classified into spastic, dyskinetic, ataxic, or mixed types.

      Managing cerebral palsy requires a multidisciplinary approach. Treatments for spasticity include oral diazepam, oral and intrathecal baclofen, botulinum toxin type A, orthopedic surgery, and selective dorsal rhizotomy. Anticonvulsants and analgesia may also be required. Understanding cerebral palsy and its management is crucial in providing appropriate care and support for individuals with this condition.

    • This question is part of the following fields:

      • Neurological System
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  • Question 5 - A 75-year-old woman has experienced a TIA during her hospital stay. An ultrasound...

    Incorrect

    • A 75-year-old woman has experienced a TIA during her hospital stay. An ultrasound revealed an 80% blockage in one of her carotid arteries, leading to a carotid endarterectomy. After the procedure, the doctor examines the patient and notices that when asked to stick out her tongue, it deviates towards the left side.

      Which cranial nerve has been affected in this scenario?

      Your Answer: Left hypoglossal nerve

      Correct Answer: Right hypoglossal nerve

      Explanation:

      When the hypoglossal nerve is damaged, the tongue deviates towards the side of the lesion. This is because the genioglossus muscle, which normally pushes the tongue to the opposite side, is weakened. In the case of a carotid endarterectomy, the hypoglossal nerve may be damaged as it passes through the hypoglossal canal and down the neck. A good memory aid is the tongue never lies as it points towards the side of the lesion. The correct answer in this case is the right hypoglossal nerve, as the patient’s tongue deviates towards the right. Lesions of the left glossopharyngeal nerve, right glossopharyngeal nerve, left hypoglossal nerve, and left trigeminal nerve would result in different symptoms and are therefore incorrect answers.

      Cranial nerves are a set of 12 nerves that emerge from the brain and control various functions of the head and neck. Each nerve has a specific function, such as smell, sight, eye movement, facial sensation, and tongue movement. Some nerves are sensory, some are motor, and some are both. A useful mnemonic to remember the order of the nerves is Some Say Marry Money But My Brother Says Big Brains Matter Most, with S representing sensory, M representing motor, and B representing both.

      In addition to their specific functions, cranial nerves also play a role in various reflexes. These reflexes involve an afferent limb, which carries sensory information to the brain, and an efferent limb, which carries motor information from the brain to the muscles. Examples of cranial nerve reflexes include the corneal reflex, jaw jerk, gag reflex, carotid sinus reflex, pupillary light reflex, and lacrimation reflex. Understanding the functions and reflexes of the cranial nerves is important in diagnosing and treating neurological disorders.

    • This question is part of the following fields:

      • Neurological System
      22.1
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  • Question 6 - An unconscious 18-year-old male has been airlifted to the hospital following a dirt...

    Incorrect

    • An unconscious 18-year-old male has been airlifted to the hospital following a dirt bike accident. The trauma team quickly takes him to the CT scanner where they notice signs of increased intracranial pressure. To manage this, they decide to administer a diuretic that is freely filtered through the renal tubules but not reabsorbed. Which diuretic would be appropriate in this situation? The team is awaiting the opinion of the neurosurgical team.

      Your Answer: Acetazolamide (carbonic anhydrase inhibitor)

      Correct Answer: Mannitol (osmotic diuretic)

      Explanation:

      Patients with head injuries should be managed according to ATLS principles and extracranial injuries should be managed alongside cranial trauma. Different types of traumatic brain injury include extradural hematoma, subdural hematoma, and subarachnoid hemorrhage. Primary brain injury may be focal or diffuse, while secondary brain injury occurs when cerebral edema, ischemia, infection, tonsillar or tentorial herniation exacerbates the original injury. Management may include IV mannitol/furosemide, decompressive craniotomy, and ICP monitoring. Pupillary findings can provide information on the location and severity of the injury.

    • This question is part of the following fields:

      • Neurological System
      27.7
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  • Question 7 - You are working on a medical ward and you are asked to review...

    Correct

    • You are working on a medical ward and you are asked to review a patient for painful red eyes. He is a 55-year-old man who is a current inpatient being investigated for unstable angina. His eyes have been intermittently gritty and painful for several months. He denies itch, decreased vision or recent coryzal symptoms. On examination, you find bilaterally injected conjunctivae, low tear film volume and diffuse corneal staining with fluorescein dye. His lid margin appears crusted with misdirected eyelashes.

      What is the most appropriate first-line treatment?

      Your Answer: Lid hygiene

      Explanation:

      Dry eye is a prevalent chronic condition that affects a significant portion of the population. The primary treatment for dry eye is lid hygiene.

      When patients present with bilateral eye discomfort and redness, they often have both dry eye syndrome and blepharitis. Dry eye syndrome is a chronic condition that results in poor-quality tear film production, leading to the rapid breakdown of the protective tear layer. This can cause irritation due to small particles or evaporation from the corneal surface. While the cause of the disease is unclear, meibomian gland dysfunction may contribute to a significant portion of the disease burden.

      Timolol is a topical beta-blocker that is typically used to reduce high intraocular pressure in conditions such as open-angle glaucoma. It is not an appropriate treatment for dry eye.

      Ibuprofen is a non-steroidal anti-inflammatory drug that has little to no role in managing dry eye or blepharitis. There is no ocular topical preparation of ibuprofen.

      Cyclizine is an antiemetic medication from the antihistamine family. It is not commonly used to manage ocular conditions.

      Lid hygiene is a safe and effective first-line treatment for both dry eye and blepharitis. Daily warm compresses and gentle massage can help improve and control symptoms as long as the practice is continued.

      Understanding Dry Eyes

      Dry eye syndrome is a condition that causes discomfort in both eyes, with symptoms such as dryness, grittiness, and soreness that worsen throughout the day. Wind exposure can also cause watering of the eyes. If the symptoms are worse upon waking up, with eyelids sticking together, and redness of the eyelids, it may be caused by Meibomian gland dysfunction. In some cases, dry eye syndrome can lead to complications such as conjunctivitis or corneal ulceration, which can cause severe pain, photophobia, redness, and loss of visual acuity.

      Although there may be no abnormalities found during examination, eyelid hygiene is the most appropriate management step for dry eye syndrome. This helps to control blepharitis, which is a common condition associated with dry eye syndrome. By understanding the symptoms and appropriate management steps, individuals with dry eye syndrome can find relief and improve their overall eye health.

    • This question is part of the following fields:

      • Neurological System
      32.4
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  • Question 8 - Which one of the following is not a content of the cavernous sinus?...

    Correct

    • Which one of the following is not a content of the cavernous sinus?

      Your Answer: Optic nerve

      Explanation:

      Cavernous sinus contents mnemonic: OTOM CAT

      Understanding the Cavernous Sinus

      The cavernous sinuses are a pair of structures located on the sphenoid bone, running from the superior orbital fissure to the petrous temporal bone. They are situated between the pituitary fossa and the sphenoid sinus on the medial side, and the temporal lobe on the lateral side. The cavernous sinuses contain several important structures, including the oculomotor, trochlear, ophthalmic, and maxillary nerves, as well as the internal carotid artery and sympathetic plexus, and the abducens nerve.

      The lateral wall components of the cavernous sinuses include the oculomotor, trochlear, ophthalmic, and maxillary nerves, while the contents of the sinus run from medial to lateral and include the internal carotid artery and sympathetic plexus, and the abducens nerve. The blood supply to the cavernous sinuses comes from the ophthalmic vein, superficial cortical veins, and basilar plexus of veins posteriorly. The cavernous sinuses drain into the internal jugular vein via the superior and inferior petrosal sinuses.

      In summary, the cavernous sinuses are important structures located on the sphenoid bone that contain several vital nerves and blood vessels. Understanding their location and contents is crucial for medical professionals in diagnosing and treating various conditions that may affect these structures.

    • This question is part of the following fields:

      • Neurological System
      6.9
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  • Question 9 - A 48-year-old man arrives at the Emergency Department with facial drooping and slurred...

    Correct

    • A 48-year-old man arrives at the Emergency Department with facial drooping and slurred speech. You perform a cranial nerves examination and find that his glossopharyngeal nerve has been affected. What sign would you anticipate observing in this patient?

      Your Answer: Loss of gag reflex

      Explanation:

      The correct answer is loss of gag reflex, which is caused by a lesion in the glossopharyngeal nerve (CN IX). This nerve is responsible for taste in the posterior 1/3 of the tongue, salivation, and swallowing. Lesions in this nerve may also result in a hypersensitive carotid sinus reflex.

      Loss of taste on the anterior 2/3 of the tongue is incorrect, as this is controlled by the facial nerve (CN VII), which also controls facial movements, lacrimation, and salivation. Lesions in this nerve may result in flaccid paralysis of the upper and lower face, loss of corneal reflex, loss of taste on the anterior 2/3 of the tongue, and hyperacusis.

      Paralysis of the facial muscles or mastication muscles is also incorrect. The facial nerve controls facial movements, while the trigeminal nerve (CN V) controls the muscles of mastication and facial sensation via its ophthalmic, maxillary, and mandibular branches.

      Cranial nerves are a set of 12 nerves that emerge from the brain and control various functions of the head and neck. Each nerve has a specific function, such as smell, sight, eye movement, facial sensation, and tongue movement. Some nerves are sensory, some are motor, and some are both. A useful mnemonic to remember the order of the nerves is Some Say Marry Money But My Brother Says Big Brains Matter Most, with S representing sensory, M representing motor, and B representing both.

      In addition to their specific functions, cranial nerves also play a role in various reflexes. These reflexes involve an afferent limb, which carries sensory information to the brain, and an efferent limb, which carries motor information from the brain to the muscles. Examples of cranial nerve reflexes include the corneal reflex, jaw jerk, gag reflex, carotid sinus reflex, pupillary light reflex, and lacrimation reflex. Understanding the functions and reflexes of the cranial nerves is important in diagnosing and treating neurological disorders.

    • This question is part of the following fields:

      • Neurological System
      15.2
      Seconds
  • Question 10 - A 55-year-old male with a history of cirrhosis presents to the neurology clinic...

    Incorrect

    • A 55-year-old male with a history of cirrhosis presents to the neurology clinic with his spouse. The spouse reports observing rapid, involuntary jerky movements in the patient's body, which you suspect to be chorea. What is the most probable cause of this?

      Your Answer: Alcohol

      Correct Answer: Wilson's disease

      Explanation:

      Wilson’s disease can cause chorea, which is characterised by involuntary, rapid, jerky movements that move from one area of the body to the next. Parkinson’s disease, hypothyroidism, and cerebellar syndrome have different symptoms and are not associated with chorea.

      Chorea: Involuntary Jerky Movements

      Chorea is a medical condition characterized by involuntary, rapid, and jerky movements that can occur in any part of the body. Athetosis, on the other hand, refers to slower and sinuous movements of the limbs. Both conditions are caused by damage to the basal ganglia, particularly the caudate nucleus.

      There are various underlying causes of chorea, including genetic disorders such as Huntington’s disease and Wilson’s disease, autoimmune diseases like systemic lupus erythematosus (SLE) and anti-phospholipid syndrome, and rheumatic fever, which can lead to Sydenham’s chorea. Certain medications like oral contraceptive pills, L-dopa, and antipsychotics can also trigger chorea. Other possible causes include neuroacanthocytosis, pregnancy-related chorea gravidarum, thyrotoxicosis, polycythemia rubra vera, and carbon monoxide poisoning.

      In summary, chorea is a medical condition that causes involuntary, jerky movements in the body. It can be caused by various factors, including genetic disorders, autoimmune diseases, medications, and other medical conditions.

    • This question is part of the following fields:

      • Neurological System
      20.1
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  • Question 11 - A 63-year-old man is being evaluated on the medical ward after undergoing surgery...

    Incorrect

    • A 63-year-old man is being evaluated on the medical ward after undergoing surgery to remove a suspicious thyroid nodule. His vital signs are stable, his pain is adequately managed, and he is able to consume soft foods and drink oral fluids. He reports feeling generally fine, but has observed a hoarseness in his voice.

      What is the probable reason for his hoarseness?

      Your Answer: Damage to superior laryngeal nerve

      Correct Answer: Damage to recurrent laryngeal nerve

      Explanation:

      Hoarseness is often linked to recurrent laryngeal nerve injury, which can affect the opening of the vocal cords by innervating the posterior arytenoid muscles. This type of damage can result from surgery, such as thyroidectomy, or compression from tumors. On the other hand, glossopharyngeal nerve damage is more commonly associated with swallowing difficulties. Since the patient is able to consume food orally, a dry throat is unlikely to be the cause of her hoarseness. While intubation trauma could cause vocal changes, the absence of pain complaints makes it less likely. Additionally, the lack of other symptoms suggests that an upper respiratory tract infection is not the cause.

      The Recurrent Laryngeal Nerve: Anatomy and Function

      The recurrent laryngeal nerve is a branch of the vagus nerve that plays a crucial role in the innervation of the larynx. It has a complex path that differs slightly between the left and right sides of the body. On the right side, it arises anterior to the subclavian artery and ascends obliquely next to the trachea, behind the common carotid artery. It may be located either anterior or posterior to the inferior thyroid artery. On the left side, it arises left to the arch of the aorta, winds below the aorta, and ascends along the side of the trachea.

      Both branches pass in a groove between the trachea and oesophagus before entering the larynx behind the articulation between the thyroid cartilage and cricoid. Once inside the larynx, the recurrent laryngeal nerve is distributed to the intrinsic larynx muscles (excluding cricothyroid). It also branches to the cardiac plexus and the mucous membrane and muscular coat of the oesophagus and trachea.

      Damage to the recurrent laryngeal nerve, such as during thyroid surgery, can result in hoarseness. Therefore, understanding the anatomy and function of this nerve is crucial for medical professionals who perform procedures in the neck and throat area.

    • This question is part of the following fields:

      • Neurological System
      10.2
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  • Question 12 - A 55-year-old male is seen in an outpatient neurology clinic after experiencing a...

    Incorrect

    • A 55-year-old male is seen in an outpatient neurology clinic after experiencing a stroke 3 weeks ago. He reports sudden, uncontrollable flailing movements in his right arm and leg. The movements are strong and involuntary, originating from the proximal sections of his limbs.

      What area of the brain is likely to be impacted in this scenario?

      Your Answer: Substantia nigra of the basal ganglia

      Correct Answer: Subthalamic nucleus of the basal ganglia

      Explanation:

      Hemiballism is a rare hyperkinetic movement disorder that can be caused by a lesion to the subthalamic nucleus of the basal ganglia. This patient is exhibiting symptoms of hemiballism, including intense, flailing movements of the limbs that originate in the proximal area of the limb. It is important to distinguish hemiballism from chorea, which originates in the distal area of the limb.

      Kluver-Bucy syndrome is associated with a lesion to the amygdala and presents with symptoms such as hypersexuality, hyperorality, hyperphagia, and visual agnosia.

      Gait ataxia, characterized by an unsteady and uncoordinated gait, is associated with midline cerebellar lesions. However, this would not account for the hyperkinetic movements seen in this patient.

      A stroke affecting the substantia nigra of the basal ganglia can cause Parkinson’s disease, which is characterized by bradykinesia, resting tremor, and shuffling gait.

      A lesion to the temporal lobe can result in Wernicke’s aphasia, which is characterized by disorderly but fluent speech due to damage to Broca’s area.

      Brain lesions can be localized based on the neurological disorders or features that are present. The gross anatomy of the brain can provide clues to the location of the lesion. For example, lesions in the parietal lobe can result in sensory inattention, apraxias, astereognosis, inferior homonymous quadrantanopia, and Gerstmann’s syndrome. Lesions in the occipital lobe can cause homonymous hemianopia, cortical blindness, and visual agnosia. Temporal lobe lesions can result in Wernicke’s aphasia, superior homonymous quadrantanopia, auditory agnosia, and prosopagnosia. Lesions in the frontal lobes can cause expressive aphasia, disinhibition, perseveration, anosmia, and an inability to generate a list. Lesions in the cerebellum can result in gait and truncal ataxia, intention tremor, past pointing, dysdiadokinesis, and nystagmus.

      In addition to the gross anatomy, specific areas of the brain can also provide clues to the location of a lesion. For example, lesions in the medial thalamus and mammillary bodies of the hypothalamus can result in Wernicke and Korsakoff syndrome. Lesions in the subthalamic nucleus of the basal ganglia can cause hemiballism, while lesions in the striatum (caudate nucleus) can result in Huntington chorea. Parkinson’s disease is associated with lesions in the substantia nigra of the basal ganglia, while lesions in the amygdala can cause Kluver-Bucy syndrome, which is characterized by hypersexuality, hyperorality, hyperphagia, and visual agnosia. By identifying these specific conditions, doctors can better localize brain lesions and provide appropriate treatment.

    • This question is part of the following fields:

      • Neurological System
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  • Question 13 - A 38-year-old male comes to his GP complaining of recurring episodes of abdominal...

    Correct

    • A 38-year-old male comes to his GP complaining of recurring episodes of abdominal pain. He characterizes the pain as dull, affecting his entire abdomen, and accompanied by intermittent diarrhea and constipation. He has observed that his symptoms have intensified since his wife departed, and he has been under work-related stress. The physician suspects that he has irritable bowel syndrome.

      What are the nerve fibers that are stimulated to produce his pain?

      Your Answer: C fibres

      Explanation:

      Neurons and Synaptic Signalling

      Neurons are the building blocks of the nervous system and are made up of dendrites, a cell body, and axons. They can be classified by their anatomical structure, axon width, and function. Neurons communicate with each other at synapses, which consist of a presynaptic membrane, synaptic gap, and postsynaptic membrane. Neurotransmitters are small chemical messengers that diffuse across the synaptic gap and activate receptors on the postsynaptic membrane. Different neurotransmitters have different effects, with some causing excitation and others causing inhibition. The deactivation of neurotransmitters varies, with some being degraded by enzymes and others being reuptaken by cells. Understanding the mechanisms of neuronal communication is crucial for understanding the functioning of the nervous system.

    • This question is part of the following fields:

      • Neurological System
      22.1
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  • Question 14 - A 50-year-old woman visits her doctor with concerns about her vision. She reports...

    Incorrect

    • A 50-year-old woman visits her doctor with concerns about her vision. She reports experiencing double vision and had a recent fall while descending the stairs at her home. She denies experiencing any eye pain.

      Which cranial nerve is most likely responsible for her symptoms?

      Your Answer: Optic nerve

      Correct Answer: Trochlear nerve

      Explanation:

      If you experience worsened vision while descending stairs, it may be indicative of 4th nerve palsy, which is characterized by vertical diplopia. This is because the 4th nerve is responsible for downward eye movement.

      Understanding Fourth Nerve Palsy

      Fourth nerve palsy is a condition that affects the superior oblique muscle, which is responsible for depressing the eye and moving it inward. One of the main features of this condition is vertical diplopia, which is double vision that occurs when looking straight ahead. This is often noticed when reading a book or going downstairs. Another symptom is subjective tilting of objects, also known as torsional diplopia. Patients may also develop a head tilt, which they may or may not be aware of. When looking straight ahead, the affected eye appears to deviate upwards and is rotated outwards. Understanding the symptoms of fourth nerve palsy can help individuals seek appropriate treatment and management for this condition.

    • This question is part of the following fields:

      • Neurological System
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  • Question 15 - A woman falls onto her neck and examination elicits signs of lateral medullary...

    Incorrect

    • A woman falls onto her neck and examination elicits signs of lateral medullary syndrome. Which description provides the correct findings?

      Your Answer: Ipsilateral loss of light tough proprioception and contra lateral loss of pain and temperature

      Correct Answer: Ipsilateral loss of pain and temperature in the face with dysphagia and ataxia and contra lateral loss in the body

      Explanation:

      The lateral medullary syndrome is characterized by damage to the structures in the lateral medulla, which is supplied by the posterior inferior cerebellar artery. This can result in various examination findings, including ataxia from damage to the inferior cerebellar peduncle, dysphagia from damage to the nucleus ambiguus, and ipsilateral loss of pain and temperature from the face due to damage to the spinal trigeminal nucleus. Additionally, there may be contralateral loss of pain and temperature in the body from damage to the lateral spinothalamic tract.

      In contrast, Brown-Sequard syndrome, which results from cord hemisection, is characterized by ipsilateral loss of light touch proprioception and contralateral loss of pain and temperature. Pontine stroke may present with hypertonia and contralateral neglect, while the triad of gait disturbance, urinary incontinence, and dementia is seen in normal pressure hydrocephalus. Medial medullary syndrome may present with ipsilateral tongue deviation, contralateral limb weakness, and contralateral loss of proprioception.

      Understanding Lateral Medullary Syndrome

      Lateral medullary syndrome, also referred to as Wallenberg’s syndrome, is a condition that arises when the posterior inferior cerebellar artery becomes blocked. This condition is characterized by a range of symptoms that affect both the cerebellum and brainstem. Cerebellar features of the syndrome include ataxia and nystagmus, while brainstem features include dysphagia, facial numbness, and cranial nerve palsy such as Horner’s. Additionally, patients may experience contralateral limb sensory loss. Understanding the symptoms of lateral medullary syndrome is crucial for prompt diagnosis and treatment.

    • This question is part of the following fields:

      • Neurological System
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  • Question 16 - What is the incorrect pairing in the following options? ...

    Correct

    • What is the incorrect pairing in the following options?

      Your Answer: Termination of dural sac and L4

      Explanation:

      Sorry, your input is not clear. Please provide more information or context for me to understand what you want me to do.

      Anatomical Planes and Levels in the Human Body

      The human body can be divided into different planes and levels to aid in anatomical study and medical procedures. One such plane is the transpyloric plane, which runs horizontally through the body of L1 and intersects with various organs such as the pylorus of the stomach, left kidney hilum, and duodenojejunal flexure. Another way to identify planes is by using common level landmarks, such as the inferior mesenteric artery at L3 or the formation of the IVC at L5.

      In addition to planes and levels, there are also diaphragm apertures located at specific levels in the body. These include the vena cava at T8, the esophagus at T10, and the aortic hiatus at T12. By understanding these planes, levels, and apertures, medical professionals can better navigate the human body during procedures and accurately diagnose and treat various conditions.

    • This question is part of the following fields:

      • Neurological System
      12.6
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  • Question 17 - A 25-year-old male presents to the GP with complaints of throbbing headaches on...

    Incorrect

    • A 25-year-old male presents to the GP with complaints of throbbing headaches on the right side of his head for the past month. The pain lasts for approximately 10 hours and is preceded by visual disturbances. He also experiences nausea without vomiting and reports taking paracetamol for relief. You decide to prescribe sumatriptan for acute attacks.

      What is the mechanism of action of sumatriptan?

      Your Answer: Serotonin receptor antagonist

      Correct Answer: Serotonin receptor agonists

      Explanation:

      Triptans, including sumatriptan, are drugs that act as agonists for serotonin receptors 5-HT1B and 5-HT1D. These drugs are commonly used to manage acute migraines and cluster headaches. Based on the patient’s symptoms, it is likely that they are experiencing migraines, which are characterized by unilateral headaches, pre-aura symptoms, and a specific time frame. While the exact cause of migraines is not fully understood, it is believed to involve inflammation and dilation of cerebral arteries. Triptans work by binding to serotonin receptors, causing vasoconstriction and reducing blood flow, which can alleviate migraine symptoms. Other receptors are targeted by different drugs for various purposes.

      Understanding Triptans for Migraine Treatment

      Triptans are a type of medication used to treat migraines. They work by activating specific receptors in the brain called 5-HT1B and 5-HT1D. Triptans are usually the first choice for acute migraine treatment and are often used in combination with other pain relievers like NSAIDs or paracetamol.

      It is important to take triptans as soon as possible after the onset of a migraine headache, rather than waiting for the aura to begin. Triptans are available in different forms, including oral tablets, orodispersible tablets, nasal sprays, and subcutaneous injections.

      While triptans are generally safe and effective, they can cause some side effects. Some people may experience what is known as triptan sensations, which can include tingling, heat, tightness in the throat or chest, heaviness, or pressure.

      Triptans are not suitable for everyone. People with a history of or significant risk factors for ischaemic heart disease or cerebrovascular disease should not take triptans.

    • This question is part of the following fields:

      • Neurological System
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  • Question 18 - A 29-year-old female is being followed up in the epilepsy clinic after switching...

    Incorrect

    • A 29-year-old female is being followed up in the epilepsy clinic after switching from lamotrigine to carbamazepine for her generalised tonic-clonic seizures. What is the mechanism of action of her new medication?

      Your Answer: Binds to potassium channels to promote potassium efflux

      Correct Answer: Binds to sodium channels to increase their refractory period

      Explanation:

      Carbamazepine binds to voltage-gated sodium channels in the neuronal cell membrane, blocking their action in the inactive form. This results in a longer time for the neuron to depolarize, increasing the absolute refractory period and raising the threshold for seizure activity. It does not bind to potassium channels or GABA receptors. Blocking potassium efflux would increase the refractory period, while promoting potassium efflux would hyperpolarize the cell and also increase the refractory period. Benzodiazepines bind allosterically to GABAA receptors, hyperpolarizing the cell and increasing the refractory period.

      Understanding Carbamazepine: Uses, Mechanism of Action, and Adverse Effects

      Carbamazepine is a medication that is commonly used in the treatment of epilepsy, particularly partial seizures. It is also used to treat trigeminal neuralgia and bipolar disorder. Chemically similar to tricyclic antidepressant drugs, carbamazepine works by binding to sodium channels and increasing their refractory period.

      However, there are some adverse effects associated with carbamazepine use. It is known to be a P450 enzyme inducer, which can affect the metabolism of other medications. Patients may also experience dizziness, ataxia, drowsiness, headache, and visual disturbances, especially diplopia. In rare cases, carbamazepine can cause Steven-Johnson syndrome, leucopenia, agranulocytosis, and hyponatremia secondary to syndrome of inappropriate ADH secretion.

      It is important to note that carbamazepine exhibits autoinduction, which means that when patients start taking the medication, they may experience a return of seizures after 3-4 weeks of treatment. Therefore, it is crucial for patients to be closely monitored by their healthcare provider when starting carbamazepine.

    • This question is part of the following fields:

      • Neurological System
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  • Question 19 - A 54 year old female who has undergone a hysterectomy presents to the...

    Incorrect

    • A 54 year old female who has undergone a hysterectomy presents to the clinic with complaints of pain and decreased sensation on the inner part of her thigh. Upon examination, weak thigh adduction is noted. What nerve injury is most probable?

      Your Answer: Femoral nerve

      Correct Answer: Obturator nerve

      Explanation:

      The adductor nerve is responsible for providing sensation to the inner part of the thigh and facilitating adduction and internal rotation of the thigh. This nerve is commonly damaged during surgeries involving the pelvic or abdominal region. It is improbable for the L3 spinal cord to be compressed in such cases.

      Anatomy of the Obturator Nerve

      The obturator nerve is formed by branches from the ventral divisions of L2, L3, and L4 nerve roots, with L3 being the main contributor. It descends vertically in the posterior part of the psoas major muscle and emerges from its medial border at the lateral margin of the sacrum. After crossing the sacroiliac joint, it enters the lesser pelvis and descends on the obturator internus muscle to enter the obturator groove. The nerve lies lateral to the internal iliac vessels and ureter in the lesser pelvis and is joined by the obturator vessels lateral to the ovary or ductus deferens.

      The obturator nerve supplies the muscles of the medial compartment of the thigh, including the external obturator, adductor longus, adductor brevis, adductor magnus (except for the lower part supplied by the sciatic nerve), and gracilis. The cutaneous branch, which is often absent, supplies the skin and fascia of the distal two-thirds of the medial aspect of the thigh when present.

      The obturator canal connects the pelvis and thigh and contains the obturator artery, vein, and nerve, which divides into anterior and posterior branches. Understanding the anatomy of the obturator nerve is important in diagnosing and treating conditions that affect the medial thigh and pelvic region.

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      • Neurological System
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  • Question 20 - A 75-year-old woman presents with profuse rectal bleeding leading to hemodynamic instability. Upper...

    Incorrect

    • A 75-year-old woman presents with profuse rectal bleeding leading to hemodynamic instability. Upper GI endoscopy shows no abnormalities, but a mesenteric angiogram reveals a contrast blush in the sigmoid colon region. The radiologist opts for vessel embolization. What is the spinal level at which the vessel exits the aorta?

      Your Answer: T10

      Correct Answer: L3

      Explanation:

      The left colon and sigmoid are supplied by the inferior mesenteric artery, which departs from the aorta at the level of L3. The marginal artery serves as the link between the inferior mesenteric artery and the middle colic artery.

      Anatomical Planes and Levels in the Human Body

      The human body can be divided into different planes and levels to aid in anatomical study and medical procedures. One such plane is the transpyloric plane, which runs horizontally through the body of L1 and intersects with various organs such as the pylorus of the stomach, left kidney hilum, and duodenojejunal flexure. Another way to identify planes is by using common level landmarks, such as the inferior mesenteric artery at L3 or the formation of the IVC at L5.

      In addition to planes and levels, there are also diaphragm apertures located at specific levels in the body. These include the vena cava at T8, the esophagus at T10, and the aortic hiatus at T12. By understanding these planes, levels, and apertures, medical professionals can better navigate the human body during procedures and accurately diagnose and treat various conditions.

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      • Neurological System
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  • Question 21 - Samantha is a 65-year-old alcoholic who has come to her doctor with worries...

    Correct

    • Samantha is a 65-year-old alcoholic who has come to her doctor with worries about the feeling in her legs. She is experiencing decreased light-touch sensation and proprioception in both legs. Her blood work reveals a deficiency in vitamin B12.

      What signs are most probable for you to observe in Samantha?

      Your Answer: Positive Babinski sign

      Explanation:

      The presence of a positive Babinski sign may indicate subacute degeneration of the spinal cord, which is typically caused by a deficiency in vitamin B12. This condition primarily affects the dorsal columns of the spinal cord, which are responsible for fine-touch, proprioception, and vibration sensation. In addition to the Babinski sign, patients may also experience spastic paresis. However, hypotonia is not typically observed, as this is a characteristic of lower motor neuron lesions. It is also important to note that temperature sensation is not affected by subacute degeneration of the spinal cord, as this function is mediated by the spinothalamic tract.

      Subacute Combined Degeneration of Spinal Cord

      Subacute combined degeneration of spinal cord is a condition that occurs due to a deficiency of vitamin B12. The dorsal columns and lateral corticospinal tracts are affected, leading to the loss of joint position and vibration sense. The first symptoms are usually distal paraesthesia, followed by the development of upper motor neuron signs in the legs, such as extensor plantars, brisk knee reflexes, and absent ankle jerks. If left untreated, stiffness and weakness may persist.

      This condition is a serious concern and requires prompt medical attention. It is important to maintain a healthy diet that includes sufficient amounts of vitamin B12 to prevent the development of subacute combined degeneration of spinal cord.

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      • Neurological System
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  • Question 22 - A 58-year-old male presents to the GP with back pain. He tells you...

    Incorrect

    • A 58-year-old male presents to the GP with back pain. He tells you the pain started three weeks ago after helping a friend move where he was lifting lots of heavy boxes. He says the pain radiates down the lateral aspect of his right thigh and often feels a tingling sensation in this area. On clinical examination you find reduced sensation below the right knee but the knee reflex is intact. You suspect he may have damaged his sciatic nerve.

      Which other feature are you most likely to find?

      Your Answer: Positive trendelenburg sign

      Correct Answer: Absent plantar reflex

      Explanation:

      When a patient experiences a loss of ankle and plantar reflexes but retains their knee jerk reflex, it may indicate a sciatic nerve lesion. The sciatic nerve is responsible for innervating the hamstring and adductor muscles and is supplied by L4-5 and S1-3. Other symptoms of sciatic nerve damage include paralysis of knee flexion and sensory loss below the knee.

      If a patient presents with a Trendelenburg sign, it may indicate an injury to the superior gluteal nerve. This nerve is responsible for thigh abduction by gluteus medius, and damage to it can cause weakness and a compensatory tilt of the body to the weakened gluteal side.

      Tinel’s sign is a feature of carpel tunnel syndrome and occurs when the median nerve is tapped at the wrist, causing tingling or electric-like sensations over the distribution of the median nerve.

      Damage to the obturator nerve can result in sensory loss at the medial thigh. This nerve is typically damaged in an anterior hip dislocation.

      Understanding Sciatic Nerve Lesion

      The sciatic nerve is a major nerve that is supplied by the L4-5, S1-3 vertebrae and divides into the tibial and common peroneal nerves. It is responsible for supplying the hamstring and adductor muscles. When the sciatic nerve is damaged, it can result in a range of symptoms that affect both motor and sensory functions.

      Motor symptoms of sciatic nerve lesion include paralysis of knee flexion and all movements below the knee. Sensory symptoms include loss of sensation below the knee. Reflexes may also be affected, with ankle and plantar reflexes lost while the knee jerk reflex remains intact.

      There are several causes of sciatic nerve lesion, including fractures of the neck of the femur, posterior hip dislocation, and trauma.

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      • Neurological System
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  • Question 23 - A 60-year-old man visits an after-hours medical facility in the late evening with...

    Correct

    • A 60-year-old man visits an after-hours medical facility in the late evening with a complaint of a severe headache that is focused around his left eye. He mentions experiencing haloes in his vision and difficulty seeing clearly. The patient has a medical history of hypertension and diabetes. During the examination, the sclera appears red, and the cornea is hazy with a dilated pupil.

      What condition is the most probable diagnosis?

      Your Answer: Acute closed-angle glaucoma

      Explanation:

      The patient’s symptoms are consistent with acute closed-angle glaucoma, which is an urgent ophthalmological emergency. They are experiencing a headache with unilateral eye pain, reduced vision, visual haloes, a red and congested eye with a cloudy cornea, and a dilated, unresponsive pupil. These symptoms may be triggered by darkness or dilating eye drops. Treatment should involve laying the patient flat to relieve angle pressure, administering pilocarpine eye drops to constrict the pupil, acetazolamide orally to reduce aqueous humour production, and providing analgesia. Referral to secondary care is necessary.

      It is important to differentiate this condition from other potential causes of the patient’s symptoms. Central retinal vein occlusion, for example, would cause sudden painless loss of vision and severe retinal haemorrhages on fundoscopy. Migraines typically involve a visual or somatosensory aura followed by a unilateral throbbing headache, nausea, vomiting, and photophobia. Subarachnoid haemorrhages present with a sudden, severe headache, rather than a gradually worsening one accompanied by eye signs. Temporal arteritis may cause pain when chewing, difficulty brushing hair, and thickened temporal arteries visible on examination. However, the presence of a dilated, fixed pupil with conjunctival injection should steer the clinician away from a diagnosis of migraine.

      Acute angle closure glaucoma (AACG) is a type of glaucoma where there is a rise in intraocular pressure (IOP) due to a blockage in the outflow of aqueous humor. This condition is more likely to occur in individuals with hypermetropia, pupillary dilation, and lens growth associated with aging. Symptoms of AACG include severe pain, decreased visual acuity, a hard and red eye, haloes around lights, and a semi-dilated non-reacting pupil. AACG is an emergency and requires urgent referral to an ophthalmologist. The initial medical treatment involves a combination of eye drops, such as a direct parasympathomimetic, a beta-blocker, and an alpha-2 agonist, as well as intravenous acetazolamide to reduce aqueous secretions. Definitive management involves laser peripheral iridotomy, which creates a tiny hole in the peripheral iris to allow aqueous humor to flow to the angle.

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      • Neurological System
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  • Question 24 - Where is the area postrema located in the brain? A 16-year-old girl was...

    Incorrect

    • Where is the area postrema located in the brain? A 16-year-old girl was prescribed erythromycin for her severe acne, but after three days, she had to stop taking it due to severe nausea that made her unable to function.

      Your Answer: Antrum of the stomach

      Correct Answer: Floor of the 4th ventricle

      Explanation:

      The vomiting process is initiated by the chemoreceptor trigger zone, which receives signals from various sources such as the gastrointestinal tract, hormones, and drugs. This zone is located in the area postrema, which is situated on the floor of the 4th ventricle in the medulla. It is noteworthy that the area postrema is located outside the blood-brain barrier. The nucleus of tractus solitarius, which is also located in the medulla, contains autonomic centres that play a role in the vomiting reflex. This nucleus receives signals from the chemoreceptor trigger zone. The vomiting centres in the brain receive inputs from different areas, including the gastrointestinal tract and the vestibular system of the inner ear.

      Vomiting is the involuntary act of expelling the contents of the stomach and sometimes the intestines. This is caused by a reverse peristalsis and abdominal contraction. The vomiting center is located in the medulla oblongata and is activated by receptors in various parts of the body. These include the labyrinthine receptors in the ear, which can cause motion sickness, the over distention receptors in the duodenum and stomach, the trigger zone in the central nervous system, which can be affected by drugs such as opiates, and the touch receptors in the throat. Overall, vomiting is a reflex action that is triggered by various stimuli and is controlled by the vomiting center in the brainstem.

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      • Neurological System
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  • Question 25 - A 35 years old female presents to the emergency department with a mid-shaft...

    Incorrect

    • A 35 years old female presents to the emergency department with a mid-shaft humerus fracture. During the examination, the physician observes that she has lost the ability to extend her wrist, forearm, and fingers. Based on this, the doctor diagnoses a radial nerve injury.

      What other structure is most susceptible to damage in this scenario?

      Your Answer: Radial artery

      Correct Answer: Profunda brachii artery

      Explanation:

      The deep brachial artery, also known as the profunda brachii artery, arises from the brachial artery just below the teres major muscle. It runs closely alongside the radial nerve in the radial groove and provides blood supply to structures in the posterior aspect of the forearm. The brachial artery divides into the radial and ulnar arteries at the cubital fossa. It is important to note that the profunda femoris vein and great saphenous vein are located in the leg, not the arm.

      Anatomy of the Brachial Artery

      The brachial artery is a continuation of the axillary artery and runs from the lower border of teres major to the cubital fossa where it divides into the radial and ulnar arteries. It is located in the upper arm and has various relations with surrounding structures. Posteriorly, it is related to the long head of triceps with the radial nerve and profunda vessels in between. Anteriorly, it is overlapped by the medial border of biceps. The median nerve crosses the artery in the middle of the arm. In the cubital fossa, the brachial artery is separated from the median cubital vein by the bicipital aponeurosis. The basilic vein is in contact with the most proximal aspect of the cubital fossa and lies medially. Understanding the anatomy of the brachial artery is important for medical professionals when performing procedures such as blood pressure measurement or arterial line placement.

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      • Neurological System
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  • Question 26 - A 55-year-old woman is recuperating after a challenging mastectomy and axillary lymph node...

    Correct

    • A 55-year-old woman is recuperating after a challenging mastectomy and axillary lymph node dissection for breast cancer. She reports experiencing shoulder discomfort, and upon examination, her scapula is visibly winged. Which of the following is the most probable root cause of the loss of innervation?

      Your Answer: Serratus anterior

      Explanation:

      Winging of the scapula is usually caused by long thoracic nerve injury, which may occur during axillary dissection. Rhomboid damage is a rare cause.

      The Long Thoracic Nerve and its Role in Scapular Winging

      The long thoracic nerve is derived from the ventral rami of C5, C6, and C7, which are located close to their emergence from intervertebral foramina. It runs downward and passes either anterior or posterior to the middle scalene muscle before reaching the upper tip of the serratus anterior muscle. From there, it descends on the outer surface of this muscle, giving branches into it.

      One of the most common symptoms of long thoracic nerve injury is scapular winging, which occurs when the serratus anterior muscle is weakened or paralyzed. This can happen due to a variety of reasons, including trauma, surgery, or nerve damage. In addition to long thoracic nerve injury, scapular winging can also be caused by spinal accessory nerve injury (which denervates the trapezius) or a dorsal scapular nerve injury.

      Overall, the long thoracic nerve plays an important role in the function of the serratus anterior muscle and the stability of the scapula. Understanding its anatomy and function can help healthcare professionals diagnose and treat conditions that affect the nerve and its associated muscles.

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      • Neurological System
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  • Question 27 - A 60-year-old man visits his doctor complaining of headaches. He reports experiencing scalp...

    Incorrect

    • A 60-year-old man visits his doctor complaining of headaches. He reports experiencing scalp pain every morning while combing his hair and feeling fatigued while chewing his food. Upon conducting blood tests, the doctor discovers an elevated ESR. What condition is most likely causing these symptoms?

      Your Answer: Idiopathic intracranial hypertension (IIH)

      Correct Answer: Giant cell arteritis

      Explanation:

      Different Types of Headaches and Their Characteristics

      Giant cell arteritis is a condition that affects older patients and is characterized by a headache and scalp tenderness, along with jaw claudication. The superficial temporal artery is often affected, and if left untreated, it can lead to visual loss. High doses of steroids are required for treatment, and the dose is gradually reduced based on the patient’s symptoms and the ESR.

      Idiopathic intracranial hypertension (IIH) is a neurological disorder that causes increased intracranial pressure without a mass legion. Symptoms include a headache, which is often worse in the morning, and visual disturbances. A CT head is used to diagnose the condition, and it is treated with repeated lumbar punctures.

      Migraine is a recurrent headache that follows a transient prodromal phase. The headache can be accompanied by photophobia and vomiting and can be triggered by various factors such as chocolate and cheese.

      Subarachnoid hemorrhage (SAH) is characterized by the worst headache that patients have ever experienced, along with confusion and vomiting. Early recognition and referral to neurosurgery is essential.

      Tension headache is a feeling of pressure or tightness around the head, without any associated features.

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      • Neurological System
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  • Question 28 - A 78-year-old woman with a history of neurosarcoidosis treated with steroids visits her...

    Correct

    • A 78-year-old woman with a history of neurosarcoidosis treated with steroids visits her GP complaining of intense facial pain. The pain lasts only a few seconds but is unbearable and worsens with exposure to cold air and touch.

      Upon examination, there are no focal neurological signs. However, a few minutes after the examination, she experiences severe pain on her right cheek, which she describes as always being over her right zygoma.

      Through which opening in the skull does the affected cranial nerve pass?

      Your Answer: Foramen rotundum

      Explanation:

      The correct answer is Foramen rotundum, as the maxillary nerve passes through this foramen to exit the skull. This nerve is responsible for the sensory innervation of the upper teeth, gums, and palate. The patient’s trigeminal neuralgia is caused by irritation of the right-sided maxillary nerve.

      Cribriform plate is not the correct answer, as this area of the skull is where the olfactory nerve passes through to enable the sense of smell.

      Foramen ovale is also not the correct answer, as this foramen is where the mandibular nerve exits the skull to provide sensation to the lower face.

      Jugular foramen is not the correct answer, as this foramen is where the accessory nerve passes through to innervate the sternocleidomastoid and trapezius muscles.

      Cranial nerves are a set of 12 nerves that emerge from the brain and control various functions of the head and neck. Each nerve has a specific function, such as smell, sight, eye movement, facial sensation, and tongue movement. Some nerves are sensory, some are motor, and some are both. A useful mnemonic to remember the order of the nerves is Some Say Marry Money But My Brother Says Big Brains Matter Most, with S representing sensory, M representing motor, and B representing both.

      In addition to their specific functions, cranial nerves also play a role in various reflexes. These reflexes involve an afferent limb, which carries sensory information to the brain, and an efferent limb, which carries motor information from the brain to the muscles. Examples of cranial nerve reflexes include the corneal reflex, jaw jerk, gag reflex, carotid sinus reflex, pupillary light reflex, and lacrimation reflex. Understanding the functions and reflexes of the cranial nerves is important in diagnosing and treating neurological disorders.

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  • Question 29 - Which option is false regarding the trigeminal nerve? ...

    Correct

    • Which option is false regarding the trigeminal nerve?

      Your Answer: The posterior scalp is supplied by the trigeminal nerve

      Explanation:

      The blood supply to the posterior scalp is provided by the C2-C3 nerves.

      The trigeminal nerve is the main sensory nerve of the head and also innervates the muscles of mastication. It has sensory distribution to the scalp, face, oral cavity, nose and sinuses, and dura mater, and motor distribution to the muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani, and tensor palati. The nerve originates at the pons and has three branches: ophthalmic, maxillary, and mandibular. The ophthalmic and maxillary branches are sensory only, while the mandibular branch is both sensory and motor. The nerve innervates various muscles, including the masseter, temporalis, and pterygoids.

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      • Neurological System
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  • Question 30 - A 67-year-old man comes to the clinic with persistent speech difficulties. He is...

    Correct

    • A 67-year-old man comes to the clinic with persistent speech difficulties. He is concerned that he might have suffered a stroke. Which scoring system should be used to assess if he has had a stroke?

      Your Answer: ROSIER score

      Explanation:

      Stroke Assessment and Investigations

      Whilst diagnosing a stroke may be straightforward in some cases, it can be challenging in others due to vague symptoms. The FAST screening tool, which stands for Face/Arms/Speech/Time, is a well-known tool used by the general public to identify stroke symptoms. However, medical professionals use a validated tool called the ROSIER score, recommended by the Royal College of Physicians. The ROSIER score assesses loss of consciousness or syncope, seizure activity, and new, acute onset of asymmetric facial, arm, or leg weakness, speech disturbance, or visual field defect. A score of more than zero indicates a likely stroke.

      When investigating suspected stroke, a non-contrast CT head scan is the first line radiological investigation. The key question is whether the stroke is ischaemic or haemorrhagic, as this determines the appropriate treatment. Ischaemic strokes may show areas of low density in the grey and white matter of the territory, which may take time to develop. On the other hand, haemorrhagic strokes typically show areas of hyperdense material (blood) surrounded by low density (oedema). It is crucial to determine the type of stroke promptly, given the increasing role of thrombolysis and thrombectomy in acute stroke management. In rare cases, a third pathology such as a tumour may also be detected.

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      • Neurological System
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