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Question 1
Incorrect
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Which of the following nerves innervates the gastrocnemius muscle?
Your Answer: Deep peroneal nerve
Correct Answer: Tibial nerve
Explanation:The gastrocnemius is innervated by the anterior rami of S1 and S2 spinal nerves, carried by the tibial nerve into the posterior compartment of the leg.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 2
Incorrect
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A 25-year-old man suffers from a shoulder injury that damaged the nerve that innervates the infraspinatus muscle.Which of the following nerves may most likely be affected?
Your Answer: The lower subscapular nerve
Correct Answer: The suprascapular nerve
Explanation:The suprascapular nerve (C5-C6) innervates the infraspinatus. It originates at the superior trunk of the brachial plexus. It runs laterally across the lateral cervical region to supply the infraspinatus and also the supraspinatus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 3
Correct
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Which of the following is where the rectovesical fascia is located:
Your Answer: Between the fundus of the bladder and the ampulla of the rectum
Explanation:In a triangular area between the vasa deferentia, the bladder and rectum are separated only by rectovesical fascia, commonly known as Denonvillier’s fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 4
Incorrect
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Which of the following nerves supplies the abductor pollicis brevis?
Your Answer: The radial nerve
Correct Answer: The recurrent branch of the median nerve
Explanation:Abductor pollicis brevis is innervated by the recurrent (thenar) branch of median nerve (root value C8 and T1).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 5
Correct
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The sensation produced by touching the arm with a vibrating tuning fork during a neurological examination is mediated by which of the following spinal tracts:
Your Answer: Posterior column
Explanation:Fine-touch, proprioception and vibration sensation are mediated by the posterior column-medial lemniscus pathway.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 6
Incorrect
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Which of the following is most likely to cause a homonymous hemianopia:
Your Answer: Pituitary adenoma
Correct Answer: Posterior cerebral artery stroke
Explanation:A posterior cerebral stroke will most likely 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 7
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 8
Correct
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All of the following typically occurs as part of normal passive expiration except:
Your Answer: Contraction of the internal intercostal muscles
Explanation:Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) in addition to the elastic recoil of the lungs. In expiration, several movements occur. There are:1. depression of the sternal ends of the ribs (‘pump handle’ movement), 2. depression of the lateral shafts of the ribs (‘bucket handle’ movement) and 3. elevation of the diaphragm. These result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. There is then a decreased intrathoracic volume and increased intrathoracic pressure and air is forced out of the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 9
Correct
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Which of these is NOT a lithium side effect:
Your Answer: Peptic ulcer disease
Explanation:Adverse Effects of lithium IncludeLeucocytosis (most patients)Polyuria/polydipsia (30-50%)Dry mouth (20-50%)Hand tremor (45% initially, 10% after 1 year of treatment)Confusion (40%)Decreased memory (40%)Headache (40%)Muscle weakness (30% initially, 1% after 1 year of treatment)Electrocardiographic (ECG) changes (20-30%)Nausea, vomiting, diarrhoea (10-30% initially, 1-10% after 1-2 years of treatment)Hyperreflexia (15%)Muscle twitch (15%)Vertigo (15%)Extrapyramidal symptoms, goitre (5%)Hypothyroidism (1-4%)Acne (1%)Hair thinning (1%)
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 10
Incorrect
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Elevation of the eyeball is primarily produced by which of the following muscles:
Your Answer:
Correct Answer: Superior rectus and inferior oblique
Explanation:Elevation of the eyeball is produced by the superior rectus and the inferior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 11
Incorrect
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A 70-year old male is taken to the Emergency Room after suffering a traumatic fall while showering. Upon physical examination, the attending physician noted a hyperextended neck, 1/5 muscle strength in both upper extremities, 4/5 muscle strength in both lower extremities, and variable loss in sensation. The patient is placed in the wards for monitoring. For the next 24 hours, anuria is noted.Which of the following spinal cord injuries is the most likely diagnosis?
Your Answer:
Correct Answer: Central cord syndrome
Explanation:Central cord syndrome is the most common type of incomplete cord injury and almost always occurs due to a traumatic injury. It results in motor deficits that are worse in the upper extremities as compared to the lower extremities. It may also cause bladder dysfunction (retention) and variable sensory deficits below the level of injury.The majority of these patients will be older and present with symptoms after a fall with hyperextension of their neck. On examination, patients will have more significant strength impairments in the upper extremities (especially the hands) compared to the lower extremities. Patients often complain of sensory deficits below the level of injury, but this is variable. Pain and temperature sensations are typically affected, but the sensation of light touch can also be impaired. The most common sensory deficits are in a cape-like distribution across their upper back and down their posterior upper extremities. They will often have neck pain at the site of spinal cord impingement.Bladder dysfunction (most commonly urinary retention) and priapism can also be signs of upper motor neuron dysfunction. The sacral sensation is usually preserved, but the clinician should assess the rectal tone to evaluate the severity of the compression.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 12
Incorrect
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Which of the following body location is the appropriate site to apply pressure when performing a carotid sinus massage?
Your Answer:
Correct Answer: Thyroid cartilage
Explanation:The common carotid artery runs through the neck and divides into internal and external carotid arteries on both sides near the upper thyroid cartilage. In emergency situations, carotid sinus massage is also used to diagnose or treat paroxysmal supraventricular tachycardia. During the procedure, to maximize access to the carotid artery, the patient is put in a supine position with the neck extended (i.e. elevating the chin away from the chest). The carotid sinus is normally positioned inferior to the angle of the jaw, near the arterial impulse, at the level of the thyroid cartilage. For 5 to 10 seconds, pressure is administered to one carotid sinus. Although pulsatile pressure applied in a vigorous circular motion may be more effective, continuous pressure is preferred since it is more reproducible. If the predicted reaction is not obtained, the operation is repeated on the opposite side after a one- to two-minute wait.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 13
Incorrect
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Where on the body is the radial artery pulsation best palpated?
Your Answer:
Correct Answer: At the wrist just lateral to the flexor carpi radialis tendon
Explanation:The radial artery lies lateral to the large tendon of the flexor carpi radialis muscle and anterior to the pronator quadratus at the distal end of the radius. The flexor carpi radialis muscle is used as a landmark in locating the pulse.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 14
Incorrect
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In inserting a nasogastric tube, which area is least likely to be a site of resistance when the tube goes from the nose to the stomach?
Your Answer:
Correct Answer: In the posterior mediastinum where the oesophagus is crossed by the pulmonary trunk
Explanation:In the posterior mediastinum where the oesophagus is crossed by the pulmonary trunk offers the least resistance when nasogastric tube is inserted from the nose to the stomach.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 15
Incorrect
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A 35 year old man presents with a deep laceration to the proximal part of the forearm. On further assessment, the patient is unable to flex the metacarpophalangeal joints and interphalangeal joints of the index, middle finger and the thumb. The ring and little fingers are intact but there is weakness at the proximal interphalangeal joint.There is also loss of sensation over the lateral palm and the palmar surface of the lateral three and a half fingers. Which of these nerve(s) has most likely been affected?
Your Answer:
Correct Answer: Median nerve
Explanation:A median nerve injury affecting the extrinsic and intrinsic muscles of the hand will present with:Loss of sensation to the lateral palm and the lateral three and a half fingers.Weakness of flexion at the metacarpophalangeal joints of the index and middle finger. This is because of paralysis of the lateral two lumbricals. Weakness of flexion of the proximal interphalangeal joints of all four fingers due to paralysis of the flexor digitorum superficialisWeakness of flexion at the distal interphalangeal joints of the index and middle finger following paralysis of the lateral half of the flexor digitorum profundus.Weakness of thumb flexion, abduction and opposition due to paralysis of the flexor pollicis longus and thenar muscles
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 16
Incorrect
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A 43-year old male is taken to the Emergency Room for a lacerated wound on the abdomen, situated above the umbilicus. A short segment of the small bowel has herniated through the wound.Which of these anatomic structures is the most superficial structure injured in the case above?
Your Answer:
Correct Answer: Camper’s fascia
Explanation:The following structures are the layers of the anterior abdominal wall from the most superficial to the deepest layer:SkinFatty layer of the superficial fascia (Camper’s fascia)Membranous layer of the superficial fascia (Scarpa’s fascia)Aponeurosis of the external and internal oblique musclesRectus abdominis muscleAponeurosis of the internal oblique and transversus abdominisFascia transversalisExtraperitoneal fatParietal peritoneum
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 17
Incorrect
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Which of the following is NOT a typical side effect of opioid analgesics:
Your Answer:
Correct 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 18
Incorrect
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Regarding the lumbar plexus, which of the following is a direct muscular branch?
Your Answer:
Correct Answer: Nerve to quadratus lumborum
Explanation:The lumbar plexus gives rise to several branches which supply various muscles and regions of the posterior abdominal wall and lower limb. These branches include the Iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral and obturator nerves.In addition, the lumbar plexus gives off muscular branches from its roots, a branch to the lumbosacral trunk and occasionally an accessory obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 19
Incorrect
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In which of the following cases is intravenous phenytoin contraindicated?
Your Answer:
Correct Answer: Second degree heart block
Explanation:Phenytoin Contraindications include:HypersensitivitySinus bradycardiaSinoatrial blockSecond and third degree A-V blockAdams-Stokes syndromeConcurrent use with delavirdineHistory of prior acute hepatotoxicity attributable to phenytoin
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 20
Incorrect
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You suspect that your patient with polycystic kidney disease has developed a berry aneurysm as a complication of his disease. The patient complains of a sudden, severe headache. You are guessing subarachnoid haemorrhage secondary to a ruptured berry aneurysm as the cause of his severe headaches. What is the most likely location of his aneurysm?
Your Answer:
Correct Answer: Anterior communicating artery
Explanation:One of the complications that polycystic kidney disease may cause is the development of a brain aneurysm. A berry aneurysm is the most common type of brain aneurysm. The Circle of Willis, where the major blood vessels meet at the base of the brain, is where it usually appears. The most common junctions of the Circle of Willis where an aneurysm may occur include the anterior communicating artery (35%), internal carotid artery (30%), the posterior communicating artery and the middle cerebral artery (22%), and finally, the posterior circulation sites, most commonly the basilar artery tip.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 21
Incorrect
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A newborn baby girl is delivered vaginally to a 19-year old female, however with complications due to cephalopelvic disproportion. Upon examination by the attending paediatrician, there is a notable 'claw hand' deformity of the left, and sensory loss of the ulnar aspect of the left distal upper extremity.What is the most probable diagnosis of the case above?
Your Answer:
Correct Answer: Klumpke’s palsy
Explanation:Klumpke palsy, named after Augusta Dejerine-Klumpke, is a neuropathy involving the lower brachial plexus. In contrast, the more common Erb–Duchenne palsy involves the more cephalic portion of the brachial plexus C5 to C6. The brachial plexus is a bundle of individual nerves that exit between the anterior and middle scalene muscles in the anterior lateral and basal portion of the neck. Although the most common anatomical presentation of the brachial plexus is between the anterior and middle scalene, there are variations, with the most common being penetration of the anterior scalene. The main mechanism of injury to the lower brachial plexus is hyper-abduction traction, and depending on the intensity, it will lead to signs and symptoms consistent with a neurological insult.The most common aetiology resulting in Klumpke palsy is a hyper-abduction trauma to the arm that has enough intensity to traction the lower brachial plexus. Trauma during birth can cause brachial plexus injuries, but again hyper-abduction and traction forces to the upper extremity are usually present.The history presented by the patient usually depicts a long axis hyper-abduction traction injury with high amplitude and velocity. The typical patient presentation is a decrease of sensation along the medial aspect of the distal upper extremity along the C8 and T1 dermatome. The patient might also present myotome findings that can range from decreasing muscular strength to muscular atrophy and positional deformity. For example, if the neurological damage has led to muscular atrophy and tightening, the patient may present with a claw hand. This deformity presents a finger and wrist flexion. The patient may also describe the severe pain that starts at the neck and travels down the medial portion of the arm. One other sign of a lower brachial plexus injury is Horner syndrome; because of its approximation to the T1 nerve root, it may damage the cephalic sympathetic chain. If this happens, the patient will develop ipsilateral ptosis, anhidrosis, and miosis.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 22
Incorrect
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Contraction of the diaphragm results in which of the following effects:
Your Answer:
Correct Answer: Increased vertical dimension of the thorax
Explanation:Contraction of the diaphragm (as in inspiration) results in flattening (depression) of the diaphragm with an increase in vertical dimension of the thorax. This results in decreased intrathoracic pressure and increased intra-abdominal pressure.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 23
Incorrect
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Following a road traffic collision, a patient sustains damage to the long thoracic nerve. Which of the following clinical findings would you most expect to see on examination:
Your Answer:
Correct Answer: Winged scapula deformity
Explanation:Damage to the long thoracic nerve results in weakness/paralysis of the serratus anterior muscle. Loss of function of this muscle causes the medial border, and particularly the inferior angle, of the scapula to elevate away from the thoracic wall, resulting in the characteristic ‘winging’ of the scapula. This deformity becomes more pronounced if the patient presses the upper limb against a wall. Furthermore, normal elevation of the arm is no longer possible.
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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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In adults, the conus medullaris of the spinal cord lies at which of the following vertebral levels:
Your Answer:
Correct Answer: L1/L2
Explanation:At birth, the conus medullaris lies at L3. By the age of 21, it sits at L1/L2.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 25
Incorrect
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Which of the following cervical nerves is likely to be affected if your patient is complaining of elbow extension weakness and loss of sensation in her middle finger? She also has pain and tenderness in her cervical region, which is caused by a herniated disc, all after a whiplash-type injury in a car accident.
Your Answer:
Correct Answer: C7
Explanation:A C7 spinal nerve controls elbow extension and some finger extension. Damage to this nerve can result in a burning pain in the shoulder blade or back of the arms. The ability to extend shoulders, arms, and fingers may also be affected. Dexterity may also be compromised in the hands or fingers.
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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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A 24-year-old waiter cuts his hand on a dropped plate that smashed and damages the nerve that innervates opponens digiti minimi.The opponens digiti minimi muscle is innervated by which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: The deep branch of the ulnar nerve
Explanation:Opponens digiti minimi is a triangular-shaped muscle in the hand that forms part of the hypothenar eminence. It originates from the hook of the hamate bone and the flexor retinaculum and inserts into the medial border of the 5thmetacarpal.Opponens digiti minimi is innervated by the deep branch of the ulnar nerve and receives its blood supply from the ulnar artery.Opponens digiti minimi draws the fifth metacarpal bone anteriorly and rotates it, bringing the fifth digiti into opposition with the thumb.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 27
Incorrect
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What is the main mechanism of action of metoclopramide:
Your Answer:
Correct 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 28
Incorrect
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Your consultant requests that you do a lumbar puncture on a patient who is suspected of having meningitis. This patient, a 15-year-old female, presented to the emergency department with a fever, headache, and neck stiffness. Where should you aspirate a sample of CSF?
Your Answer:
Correct Answer: Subarachnoid space
Explanation:A lumbar puncture, also known as a spinal tap, is a procedure that involves inserting a needle into the lower back’s lumbar region. A needle is inserted into the space between the arachnoid mater and the pia mater, also known as the subarachnoid space, to remove a sample of cerebrospinal fluid.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 29
Incorrect
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Which of the following accurately describes the extensor pollicis brevis muscle?
Your Answer:
Correct Answer: It lies on the medial side of abductor pollicis longus
Explanation:Extensor pollicis brevis is a short and slender muscle located in the posterior compartment of the forearm, extending from the posterior surface of radius to the proximal phalanx of thumb. It is one of the deep extensors of the forearm, together with supinator, abductor pollicis longus, extensor pollicis longus and extensor indicis muscles.Extensor pollicis brevis is a deep extensor of the thumb that lies deep to extensor digitorum muscle. It sits directly medial to abductor pollicis longus and posterolateral to extensor pollicis longus muscle. Just above the wrist, extensor pollicis brevis obliquely crosses the tendons of extensor carpi radialis brevis and extensor carpi radialis longus muscles.Extensor pollicis brevis is innervated by posterior interosseous nerve which is a continuation of a deep branch of radial nerve (root value C7 and C8).Extensor pollicis brevis receives its blood supply by posterior interosseous artery and perforating branches from the anterior interosseous artery, which are the branches of common interosseous artery. The common interosseous artery arises immediately below the tuberosity of radius from the ulnar artery.Together with extensor pollicis longus, extensor pollicis brevis is in charge of extension of the thumb in the first metacarpophalangeal joint. It also extends the thumb in the carpometacarpal joint of the thumb. This movement is important in the anatomy of the grip, as it enables letting go of an object. As it crosses the wrist, extensor pollicis brevis also participates in the extension and abduction of this joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 30
Incorrect
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Which of the following statements is correct regarding paracetamol?
Your Answer:
Correct Answer: Liver damage peaks 3 to 4 days after paracetamol ingestion.
Explanation:The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 31
Incorrect
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A 25 year old man presents to the emergency room with abdominal pain, vomiting and constipation. A CT scan is done which is suggestive of Meckel's diverticulum. Where does the blood supply of the Meckel's diverticulum originate?
Your Answer:
Correct Answer: Superior mesenteric artery
Explanation:Meckel’s diverticulum has certain classic characteristics.1. It lies on the antimesenteric border of the middle-to-distal ileum2. It is approximately 2 feet proximal to the ileocaecal junction3. It appears as a blind-ended tubular outpouching of bowel4. It is about 2 inches long, 5. It occurs in about 2% of the population, 6. It may contain two types of ectopic tissue (gastric and pancreatic). 7. The diverticulum is supplied by the superior mesenteric artery.8. Proximal to the major duodenal papilla the duodenum is supplied by the gastroduodenal artery (branch of the coeliac trunk)9. Distal to the major duodenal papilla it is supplied by the inferior pancreaticoduodenal artery (branch of superior mesenteric artery).10. The arterial supply to the jejunoileum is from the superior mesenteric artery.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 32
Incorrect
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The common bile duct drains into the duodenum in which of the following regions:
Your Answer:
Correct Answer: Second part of the duodenum
Explanation:As the common bile duct descends, it passes posterior to the first part of the duodenum before joining with the pancreatic duct from the pancreas, forming the hepatopancreatic ampulla (ampulla of Vater) at the major duodenal papilla, located in the second part of the duodenum. Surrounding the ampulla is the sphincter of Oddi, a collection of smooth muscle which can open to allow bile and pancreatic fluid to empty into the duodenum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 33
Incorrect
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You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus. Which of the following best describes lorazepam's action?
Your Answer:
Correct Answer: Potentiates effect of GABA
Explanation:Lorazepam is a type of benzodiazepine. Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists with sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant characteristics that promote inhibitory synaptic transmission across the central nervous system.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 34
Incorrect
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A 32 year old man is brought to ED having been thrown off his motorbike. Following initial resuscitation and ruling out life-threatening injuries, you establish the patient has weakness of hip flexion. Which of the following nerves has most likely been injured:
Your Answer:
Correct Answer: Femoral nerve
Explanation:Flexion of the hip is produced by the iliacus, the psoas major, the sartorius, rectus femoris and the pectineus muscles. The femoral nerve innervates the iliacus, pectineus, sartorius and quadriceps femoris muscles, and supplies skin on the anterior thigh, anteromedial knee and medial leg.
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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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External haemorrhoids may cause anal pain. When explaining to your patient why it does so, which of the following nerves will you point out as being affected?
Your Answer:
Correct Answer: Pudendal nerve
Explanation:The pain associated with external haemorrhoids is carried by a branch of the pudendal nerve, specifically the somatic fibres (S2-S4). It innervates the external anal sphincter and most of the skin over the perineum.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 36
Incorrect
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A well recognised adverse effect of metoclopramide is which of the following?
Your Answer:
Correct Answer: Acute dystonic reaction
Explanation:Side effects of metoclopramide are commonly associated with extrapyramidal effects and hyperprolactinemia. Therefore its use must be limited to short-term use. Metoclopramide can induce acute dystonic reactions which involve facial and skeletal muscle spasms and oculogyric crises. These dystonic effects are more common in the young girls and young women, and in the very old. These symptoms usually occur shortly after starting treatment with this drug and subside within 24 hours of stopping it. Abortion of dystonic attacks can be carried out by injection of an antiparkinsonian drug like procyclidine.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 37
Incorrect
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A 18 year old student presents to ED with a headache, fever and photophobia. You suspect meningitis and agree to observe your junior performing a lumbar puncture. What is the highest safest vertebral level to perform lumbar puncture in adults:
Your Answer:
Correct Answer: L3/L4
Explanation:In adults, the spinal cord typically ends between L1/L2 whereas the subarachnoid space extends to approximately the lower border of vertebra S2. Lumbar puncture is performed in the intervertebral space L4/L5 or L3/L4.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 38
Incorrect
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Regarding the tongue, which of the following statements is CORRECT:
Your Answer:
Correct Answer: The lymphatic supply of the tongue drains to the jugulo-omohyoid node of the deep cervical chain.
Explanation:All lymphatics from the tongue ultimately drain into the deep cervical chain of nodes along the internal jugular vein, particularly the jugulo-omohyoid lymph node.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 39
Incorrect
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A patient presents with an adducted eye at rest which cannot abduct past the midline, which of the following cranial nerves is most likely to be affected:
Your Answer:
Correct Answer: Abducens nerve
Explanation:Abducens nerve palsies result in a convergent squint at rest (eye turned inwards) with inability to abduct the eye because of unopposed action of the rectus medialis. The patient complains of horizontal diplopia when looking towards the affected side. With complete paralysis, the eye cannot abduct past the midline.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 40
Incorrect
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A patient suffers a lower limb fracture that causes damage to the nerve that innervates peroneus brevis.Peroneus brevis receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: Superficial peroneal nerve
Explanation:Peroneus brevis is innervated by the superficial peroneal nerve.Peroneus longus is innervated by the superficial peroneal nerve.Peroneus tertius is innervated by the deep peroneal nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 41
Incorrect
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What type of visual field defect are you most likely to see in a lesion of the parietal optic radiation:
Your Answer:
Correct Answer: Contralateral homonymous inferior quadrantanopia
Explanation:A lesion of the parietal optic radiation will result in a contralateral homonymous inferior quadrantanopia.A lesion of the temporal optic radiation will result in a contralateral homonymous superior quadrantanopia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 42
Incorrect
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Which of the following is a contraindication to the use of opioid analgesics:
Your Answer:
Correct Answer: Raised intracranial pressure
Explanation:Opioids should be avoided in people who have: A risk of paralytic ileus (opioids reduce gastric motility)Acute respiratory depressionAn acute exacerbation of asthma (opioids can aggravate bronchoconstriction as a result of histamine release)Conditions associated with increased intracranial pressure including head injury (opioids can interfere with pupillary response making neurological assessment difficult and may cause retention of carbon dioxide aggravating the increased intracranial pressure)
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 43
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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Question 44
Incorrect
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When inserting a Seldinger chest drain for management of pneumothorax, the 'safe triangle' should be identified. Which of the following forms the inferior border of the 'safe triangle'?
Your Answer:
Correct Answer: 5 th intercostal space
Explanation:Care and management of the thoracostomy tubes (chest tubes) are subject to the direction and practice pattern of the responsible physician. Therefore, it is difficult to make a “one size fits all” set of instructions about the specific management recommendations for all chest tubes. It is recommended to discuss specific expectations for management with the patient’s attending physician. Facility specific Clinical Practice Guidelines (CPGs) may provide further guidance for one’s practice.Placement of the appropriately sized chest tube is performed on the affected side. The typical landmark for placement is the 4th or 5th intercostal space (nipple line for males, inframammary fold for females) at the anterior axillary line. The space above the 5th intercostal space and below the base of the axilla that is bordered posteriorly by the trapezius and anteriorly by the pectoralis muscle has recently been described as the safe triangle. Tubes are positioned anteriorly for pneumothoraces and posteriorly for fluid processes.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 45
Incorrect
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A 4-year old boy is taken to the emergency room after a sudden onset of coughing and wheezing. Further investigation reveals that he was drawing quietly in his room, when suddenly, he became anxious and started coughing. The parents also noted that the eraser on top of the pencil was missing.A plain radiographic chest imaging is conducted, and confirmed foreign body aspiration.Which of the following areas in the tracheobronchial tree is the most probable location of the aspirated eraser?
Your Answer:
Correct Answer: Right main bronchus
Explanation:In foreign body aspiration, the foreign body is more likely to enter the right main bronchus because it is shorter, wider and more vertical than the left main bronchus. In a patient who is standing or sitting, the foreign body tends to become lodged in the posterobasal segment of the inferior lobe of the right lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 46
Incorrect
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Regarding antiemetics, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Of the antiemetics, cyclizine is most commonly associated with acute dystonic reactions.
Explanation:Cyclizine acts by inhibiting histamine pathways and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. Metoclopramide is a dopamine-receptor antagonist which acts both peripherally in the GI tract and centrally within the chemoreceptor trigger zone. Prochlorperazine is a dopamine-D2 receptor antagonist and acts centrally by blocking the chemoreceptor trigger zone. Metoclopramide and prochlorperazine are both commonly associated with extrapyramidal effects, such as acute dystonic reaction. Cyclizine may rarely cause extrapyramidal effects.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 47
Incorrect
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Which of the following classes of drugs may predispose to lithium toxicity:
Your Answer:
Correct Answer: Thiazide diuretics
Explanation:Excretion of lithium may be reduced by thiazide diuretics, NSAIDs, and ACE inhibitors thus predisposing to lithium toxicity. Loop diuretics also cause lithium retention but are less likely to result in lithium toxicity.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 48
Incorrect
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A 33-year-old woman demonstrates right-sided superior homonymous quadrantanopia upon visual field testing. A diagnosis of a brain tumour has been established.Which of the following anatomical points in the visual pathway has the lesion occurred?
Your Answer:
Correct Answer: Lower optic radiation
Explanation:Homonymous quadrantanopia is not a disease; it is a clinical finding that points towards a lesion of the optic radiations coursing through the temporal lobe.Homonymous superior quadrantanopia is caused by damage to the contralateral inferior parts of the posterior visual pathway: the inferior optic radiation (temporal Meyer loop), or the inferior part of the occipital visual cortex below the calcarine fissure.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 49
Incorrect
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In a patient with an ongoing seizure, after what time period should treatment be commenced?
Your Answer:
Correct Answer: 5 minutes
Explanation:Immediate emergency care and treatment should be given to children, young people and adults who have prolonged or repeated convulsive seizures.Prolonged seizures last 5 minutes or more. Repeated seizures refer to 3 or more seizures in an hour.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 50
Incorrect
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Which of the following occurs primarily to produce passive expiration:
Your Answer:
Correct Answer: Relaxation of diaphragm and external intercostal muscles
Explanation:Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) and the elastic recoil of the lungs. In expiration, depression of the sternal ends of the ribs (‘pump handle’ movement), depression of the lateral shafts of the ribs (‘bucket handle’ movement) and elevation of the diaphragm result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in a decreased intrathoracic volume and increased intrathoracic pressure and thus air is forced out of the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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SESSION STATS - PERFORMANCE PER SPECIALTY
