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  • Question 1 - You are asked to clerk a 73-year-old-man who presented with a fall. He...

    Correct

    • You are asked to clerk a 73-year-old-man who presented with a fall. He was seen by the stroke team who requested a CT head. This excluded an intracranial haemorrhage and he was started on aspirin. When you enter the cubicle, you notice the patient has a right-sided facial droop.

      What type of speech disturbance does this patient have? You start taking a history but find it difficult to understand what he says. He is unable to get the words out easily and his speech is non-fluent as if hesitating before uttering the words.

      During the cranial nerve examination, he understood and followed your instructions well. However, he is unable to repeat words after you.

      Your Answer: Broca's dysphasia

      Explanation:

      This man experienced a stroke that affected Broca’s area, resulting in Broca’s dysphasia. This condition causes non-fluent speech, but normal comprehension, and impaired repetition. Despite knowing what they want to say, patients with Broca’s dysphasia struggle to articulate their words. They can understand instructions, but have difficulty repeating words. This is different from conductive dysphasia, which presents with fluent speech but an inability to repeat words. Dysarthria, on the other hand, is characterized by difficulty articulating words due to a lack of coordination in the muscles of speech. Global aphasia is the inability to understand, repeat, and produce speech, which was not the case for this patient as they were able to understand instructions.

      Types of Aphasia: Understanding the Different Forms of Language Impairment

      Aphasia is a language disorder that affects a person’s ability to communicate effectively. There are different types of aphasia, each with its own set of symptoms and underlying causes. Wernicke’s aphasia, also known as receptive aphasia, is caused by a lesion in the superior temporal gyrus. This area is responsible for forming speech before sending it to Broca’s area. People with Wernicke’s aphasia may speak fluently, but their sentences often make no sense, and they may use word substitutions and neologisms. Comprehension is impaired.

      Broca’s aphasia, also known as expressive aphasia, is caused by a lesion in the inferior frontal gyrus. This area is responsible for speech production. People with Broca’s aphasia may speak in a non-fluent, labored, and halting manner. Repetition is impaired, but comprehension is normal.

      Conduction aphasia is caused by a stroke affecting the arcuate fasciculus, the connection between Wernicke’s and Broca’s area. People with conduction aphasia may speak fluently, but their repetition is poor. They are aware of the errors they are making, but comprehension is normal.

      Global aphasia is caused by a large lesion affecting all three areas mentioned above, resulting in severe expressive and receptive aphasia. People with global aphasia may still be able to communicate using gestures. Understanding the different types of aphasia is important for proper diagnosis and treatment.

    • This question is part of the following fields:

      • Neurological System
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  • Question 2 - A 45-year-old woman presents with a lesion in the cerebellopontine angle. Which cranial...

    Incorrect

    • A 45-year-old woman presents with a lesion in the cerebellopontine angle. Which cranial nerve is expected to be affected initially?

      Your Answer: CN III

      Correct Answer: CN V

      Explanation:

      An acoustic neuroma is the most probable type of lesion to develop in the cerebellopontine angle. The trigeminal nerve is typically affected first, with a wide base of involvement. The initial symptoms may be subtle, such as the loss of the corneal reflex on the same side. Additionally, hearing loss on the same side is likely to occur. If left untreated, the lesion may progress and eventually impact multiple cranial nerve roots in the area.

      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
      83.9
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  • Question 3 - A 38-year-old male presents to a neurology clinic with complaints of recent falls...

    Incorrect

    • A 38-year-old male presents to a neurology clinic with complaints of recent falls and slurred speech. During examination, he exhibits horizontal nystagmus, difficulty with repetitive hand movements, and an intention tremor. What area of the brain is most likely affected by his lesion?

      Your Answer: Temporal Lobe

      Correct Answer: Cerebellum

      Explanation:

      Unconsciousness can be caused by lesions in the brainstem.

      Cerebellar syndrome is a condition that affects the cerebellum, a part of the brain responsible for coordinating movement and balance. When there is damage or injury to one side of the cerebellum, it can cause symptoms on the same side of the body. These symptoms can be remembered using the mnemonic DANISH, which stands for Dysdiadochokinesia, Dysmetria, Ataxia, Nystagmus, Intention tremour, Slurred staccato speech, and Hypotonia.

      There are several possible causes of cerebellar syndrome, including genetic conditions like Friedreich’s ataxia and ataxic telangiectasia, neoplastic growths like cerebellar haemangioma, strokes, alcohol use, multiple sclerosis, hypothyroidism, and certain medications or toxins like phenytoin or lead poisoning. In some cases, cerebellar syndrome may be a paraneoplastic condition, meaning it is a secondary effect of an underlying cancer like lung cancer. It is important to identify the underlying cause of cerebellar syndrome in order to provide appropriate treatment and management.

    • This question is part of the following fields:

      • Neurological System
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  • Question 4 - A 82-year-old man arrives at the emergency department complaining of bone and abdominal...

    Incorrect

    • A 82-year-old man arrives at the emergency department complaining of bone and abdominal pain. He appears confused, and his wife reports that he has been experiencing low mood lately. Upon conducting blood tests, it is discovered that he has elevated levels of calcium and parathyroid hormone. What is the probable cause of his hypercalcaemia?

      Your Answer: Decreased resorption in the kidneys

      Correct Answer: Increased activity of osteoclasts

      Explanation:

      Primary hyperparathyroidism is the likely diagnosis for this patient, which is typically caused by a single adenoma in the parathyroid gland. The hormone PTH plays a key role in increasing plasma calcium levels while decreasing phosphate levels. This is achieved through increased absorption of calcium in the bowel and kidneys, as well as increased bone resorption through the activity of osteoclasts.

      If osteoblast activity were increased, it would actually decrease plasma calcium levels. Conversely, decreased resorption in the kidneys would result in more calcium being lost in the urine, leading to lower plasma calcium levels. Lower levels of plasma calcium would also result from decreased activity of vitamin D.

      It’s important to note that PTH has no direct effect on calcitonin secretion, which is controlled by plasma calcium levels as well as the hormones gastrin and pentagastrin.

      Maintaining Calcium Balance in the Body

      Calcium ions are essential for various physiological processes in the body, and the largest store of calcium is found in the skeleton. The levels of calcium in the body are regulated by three hormones: parathyroid hormone (PTH), vitamin D, and calcitonin.

      PTH increases calcium levels and decreases phosphate levels by increasing bone resorption and activating osteoclasts. It also stimulates osteoblasts to produce a protein signaling molecule that activates osteoclasts, leading to bone resorption. PTH increases renal tubular reabsorption of calcium and the synthesis of 1,25(OH)2D (active form of vitamin D) in the kidney, which increases bowel absorption of calcium. Additionally, PTH decreases renal phosphate reabsorption.

      Vitamin D, specifically the active form 1,25-dihydroxycholecalciferol, increases plasma calcium and plasma phosphate levels. It increases renal tubular reabsorption and gut absorption of calcium, as well as osteoclastic activity. Vitamin D also increases renal phosphate reabsorption in the proximal tubule.

      Calcitonin, secreted by C cells of the thyroid, inhibits osteoclast activity and renal tubular absorption of calcium.

      Although growth hormone and thyroxine play a small role in calcium metabolism, the primary regulation of calcium levels in the body is through PTH, vitamin D, and calcitonin. Maintaining proper calcium balance is crucial for overall health and well-being.

    • This question is part of the following fields:

      • Neurological System
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  • Question 5 - Which of the cranial nerves listed below is least likely to carry parasympathetic...

    Correct

    • Which of the cranial nerves listed below is least likely to carry parasympathetic fibers?

      Your Answer: II

      Explanation:

      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
      129.3
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  • Question 6 - A 75-year-old female patient presents to the Emergency Department after experiencing a fall....

    Correct

    • A 75-year-old female patient presents to the Emergency Department after experiencing a fall. She has a medical history of hypertension and type 2 diabetes, and is a smoker with a BMI of 34 kg/m². Her family history includes high cholesterol in her father and older sister, who both passed away due to a heart attack.

      The patient denies any head trauma from the fall and has a regular pulse of 78 bpm. Upon conducting a full neurological examination, it is discovered that her left arm and left leg have a power of 3/5. Additionally, her smile is asymmetrical and droops on the left side.

      What is the most probable underlying cause of her symptoms?

      Your Answer: Emboli caused by atherosclerosis

      Explanation:

      Intracerebral haemorrhage is not the most probable cause of all strokes. Hence, it is crucial to conduct a CT head scan to eliminate the possibility of haemorrhagic stroke before initiating treatment.

      A transient ischaemic attack (TIA) is a brief period of neurological deficit caused by a vascular issue, lasting less than an hour. The original definition of a TIA was based on time, but it is now recognized that even short periods of ischaemia can result in pathological changes to the brain. Therefore, a new ’tissue-based’ definition is now used. The clinical features of a TIA are similar to those of a stroke, but the symptoms resolve within an hour. Possible features include unilateral weakness or sensory loss, aphasia or dysarthria, ataxia, vertigo, or loss of balance, visual problems, sudden transient loss of vision in one eye (amaurosis fugax), diplopia, and homonymous hemianopia.

      NICE recommends immediate antithrombotic therapy, giving aspirin 300 mg immediately unless the patient has a bleeding disorder or is taking an anticoagulant. If aspirin is contraindicated, management should be discussed urgently with the specialist team. Specialist review is necessary if the patient has had more than one TIA or has a suspected cardioembolic source or severe carotid stenosis. Urgent assessment within 24 hours by a specialist stroke physician is required if the patient has had a suspected TIA in the last 7 days. Referral for specialist assessment should be made as soon as possible within 7 days if the patient has had a suspected TIA more than a week previously. The person should be advised not to drive until they have been seen by a specialist.

      Neuroimaging should be done on the same day as specialist assessment if possible. MRI is preferred to determine the territory of ischaemia or to detect haemorrhage or alternative pathologies. Carotid imaging is necessary as atherosclerosis in the carotid artery may be a source of emboli in some patients. All patients should have an urgent carotid doppler unless they are not a candidate for carotid endarterectomy.

      Antithrombotic therapy is recommended, with clopidogrel being the first-line treatment. Aspirin + dipyridamole should be given to patients who cannot tolerate clopidogrel. Carotid artery endarterectomy should only be considered if the patient has suffered a stroke or TIA in the carotid territory and is not severely disabled. It should only be recommended if carotid stenosis is greater

    • This question is part of the following fields:

      • Neurological System
      72.3
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  • Question 7 - A 70-year-old male has been diagnosed with Alzheimer's disease, but there is no...

    Incorrect

    • A 70-year-old male has been diagnosed with Alzheimer's disease, but there is no family history of the disease.

      Which gene is the most probable to be affected in this individual?

      Your Answer: Amyloid precursor protein gene (APP)

      Correct Answer: APOE ε4 gene

      Explanation:

      The risk of sporadic Alzheimer’s disease is primarily determined by APOE polymorphic alleles, with the ε4 allele carrying the highest risk. Familial Alzheimer’s disease is linked to the APP, PSEN1, and PSEN2 genes, while familial Parkinson’s disease is associated with the PARK genes.

      Alzheimer’s disease is a type of dementia that gradually worsens over time and is caused by the degeneration of the brain. There are several risk factors associated with Alzheimer’s disease, including increasing age, family history, and certain genetic mutations. The disease is also more common in individuals of Caucasian ethnicity and those with Down’s syndrome.

      The pathological changes associated with Alzheimer’s disease include widespread cerebral atrophy, particularly in the cortex and hippocampus. Microscopically, there are cortical plaques caused by the deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein. The hyperphosphorylation of the tau protein has been linked to Alzheimer’s disease. Additionally, there is a deficit of acetylcholine due to damage to an ascending forebrain projection.

      Neurofibrillary tangles are a hallmark of Alzheimer’s disease and are partly made from a protein called tau. Tau is a protein that interacts with tubulin to stabilize microtubules and promote tubulin assembly into microtubules. In Alzheimer’s disease, tau proteins are excessively phosphorylated, impairing their function.

    • This question is part of the following fields:

      • Neurological System
      10.6
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  • Question 8 - After a carotid endarterectomy, a woman experiences weakness in her tongue. Which nerve...

    Correct

    • After a carotid endarterectomy, a woman experiences weakness in her tongue. Which nerve is most likely to have been damaged in this process?

      Your Answer: Hypoglossal

      Explanation:

      Carotid surgery poses a higher risk to the hypoglossal nerve, which is responsible for innervating the tongue.

      The internal carotid artery originates from the common carotid artery near the upper border of the thyroid cartilage and travels upwards to enter the skull through the carotid canal. It then passes through the cavernous sinus and divides into the anterior and middle cerebral arteries. In the neck, it is surrounded by various structures such as the longus capitis, pre-vertebral fascia, sympathetic chain, and superior laryngeal nerve. It is also closely related to the external carotid artery, the wall of the pharynx, the ascending pharyngeal artery, the internal jugular vein, the vagus nerve, the sternocleidomastoid muscle, the lingual and facial veins, and the hypoglossal nerve. Inside the cranial cavity, the internal carotid artery bends forwards in the cavernous sinus and is closely related to several nerves such as the oculomotor, trochlear, ophthalmic, and maxillary nerves. It terminates below the anterior perforated substance by dividing into the anterior and middle cerebral arteries and gives off several branches such as the ophthalmic artery, posterior communicating artery, anterior choroid artery, meningeal arteries, and hypophyseal arteries.

    • This question is part of the following fields:

      • Neurological System
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  • Question 9 - A 36-year-old woman visits her GP with a facial droop and is diagnosed...

    Incorrect

    • A 36-year-old woman visits her GP with a facial droop and is diagnosed with facial nerve palsy. The GP is aware that this nerve has motor, sensory, and autonomic functions and proceeds to assess her for any deficits in these areas. Which glands receive autonomic stimulation from this nerve?

      Your Answer: Submandibular and sublingual

      Correct Answer: Lacrimal, submandibular and sublingual

      Explanation:

      The internal acoustic meatus serves as the exit point for the facial nerve from the cranial cavity. It then proceeds through the stylomastoid foramen and enters the parotid gland. Within the gland, the nerve splits into multiple branches that provide motor function to the facial muscles, sensory function to the front two-thirds of the tongue, and autonomic stimulation to the lacrimal, submandibular, and sublingual glands.

      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
      126.6
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  • Question 10 - A 58-year-old man has arrived at the emergency department via ambulance following a...

    Incorrect

    • A 58-year-old man has arrived at the emergency department via ambulance following a sudden onset of symptoms during lunch with his daughter. He reports feeling extremely dizzy and nauseous, and has since lost hearing in his left ear and the ability to move the left side of his face. An urgent CT scan reveals a thrombus blocking an artery in his brain. Which artery is most likely affected by the thrombus?

      Your Answer: Middle cerebral artery

      Correct Answer: Anterior inferior cerebellar artery

      Explanation:

      The correct answer is the anterior inferior cerebellar artery, as sudden onset vertigo and vomiting, ipsilateral facial paralysis, and deafness are all symptoms of lesions in this area.

      The middle cerebral artery is an incorrect answer, as lesions in this area cause contralateral hemiparesis and sensory loss, contralateral homonymous hemianopia, and aphasia.

      The posterior cerebral artery is also an incorrect answer, as lesions in this area cause contralateral homonymous hemianopia with macular sparing and visual agnosia.

      Similarly, the posterior inferior cerebellar artery is an incorrect answer, as lesions in this area cause ipsilateral facial pain and temperature loss, contralateral limb/torso pain and temperature loss, ataxia, and nystagmus.

      Stroke can affect different parts of the brain depending on which artery is affected. If the anterior cerebral artery is affected, the person may experience weakness and loss of sensation on the opposite side of the body, with the lower extremities being more affected than the upper. If the middle cerebral artery is affected, the person may experience weakness and loss of sensation on the opposite side of the body, with the upper extremities being more affected than the lower. They may also experience vision loss and difficulty with language. If the posterior cerebral artery is affected, the person may experience vision loss and difficulty recognizing objects.

      Lacunar strokes are a type of stroke that are strongly associated with hypertension. They typically present with isolated weakness or loss of sensation on one side of the body, or weakness with difficulty coordinating movements. They often occur in the basal ganglia, thalamus, or internal capsule.

    • This question is part of the following fields:

      • Neurological System
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  • Question 11 - A 75-year-old woman complains of faecal incontinence and displays weakened anal sphincter muscles...

    Incorrect

    • A 75-year-old woman complains of faecal incontinence and displays weakened anal sphincter muscles upon examination. What are the primary nerve root values for the nerves that provide the external anal sphincter?

      Your Answer: S2,3

      Correct Answer: S2,3,4

      Explanation:

      To prevent fecal matter from reaching the floor, the external anal sphincter receives nerve supply from the pudendal nerve’s inferior rectal branch, which originates from S2, S3, and S4 root values.

      Anatomy of the Anal Sphincter

      The anal sphincter is composed of two muscles: the internal anal sphincter and the external anal sphincter. The internal anal sphincter is made up of smooth muscle and is continuous with the circular muscle of the rectum. It surrounds the upper two-thirds of the anal canal and is supplied by sympathetic nerves. On the other hand, the external anal sphincter is composed of striated muscle and surrounds the internal sphincter but extends more distally. It is supplied by the inferior rectal branch of the pudendal nerve (S2 and S3) and the perineal branch of the S4 nerve roots.

      In summary, the anal sphincter is a complex structure that plays a crucial role in maintaining continence. The internal and external anal sphincters work together to control the passage of feces and gas through the anus. Understanding the anatomy of the anal sphincter is important for diagnosing and treating conditions that affect bowel function.

    • This question is part of the following fields:

      • Neurological System
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  • Question 12 - At which of the following anatomical locations does the common peroneal nerve bifurcate...

    Incorrect

    • At which of the following anatomical locations does the common peroneal nerve bifurcate into the superficial and deep peroneal nerves?

      Your Answer: Within the substance of tibialis anterior muscle

      Correct Answer: At the lateral aspect of the neck of the fibula

      Explanation:

      The point where the common peroneal nerve is most susceptible to injury is at the neck of the fibula, where it divides into two branches.

      The common peroneal nerve originates from the dorsal divisions of the sacral plexus, specifically from L4, L5, S1, and S2. This nerve provides sensation to the skin and fascia of the anterolateral surface of the leg and dorsum of the foot, as well as innervating the muscles of the anterior and peroneal compartments of the leg, extensor digitorum brevis, and the knee, ankle, and foot joints. It is located laterally within the sciatic nerve and passes through the lateral and proximal part of the popliteal fossa, under the cover of biceps femoris and its tendon, to reach the posterior aspect of the fibular head. The common peroneal nerve divides into the deep and superficial peroneal nerves at the point where it winds around the lateral surface of the neck of the fibula in the body of peroneus longus, approximately 2 cm distal to the apex of the head of the fibula. It is palpable posterior to the head of the fibula. The nerve has several branches, including the nerve to the short head of biceps, articular branch (knee), lateral cutaneous nerve of the calf, and superficial and deep peroneal nerves at the neck of the fibula.

    • This question is part of the following fields:

      • Neurological System
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  • Question 13 - A 27-year-old male presents to the neurology clinic with worsening epilepsy despite being...

    Incorrect

    • A 27-year-old male presents to the neurology clinic with worsening epilepsy despite being on levetiracetam and sodium valproate. He has had 6 seizures in the past 2 weeks, with one requiring hospitalization. The neurology consultant suggests adding vigabatrin to his treatment regimen.

      What is the mechanism of action of vigabatrin?

      Your Answer: GABA receptor antagonist

      Correct Answer: Irreversible inhibitor of GABA transaminase

      Explanation:

      Vigabatrin works by irreversibly inhibiting GABA transaminase, while haloperidol acts as a dopamine (D2) receptor antagonist. Cabergoline, on the other hand, is a dopamine receptor agonist, while benzodiazepines function as GABA receptor agonists. Flumazenil has not been specified in terms of its mechanism of action.

      Vigabatrin and its potential impact on visual fields

      Vigabatrin is a medication used to treat epilepsy and other seizure disorders. However, it is important to note that approximately 40% of patients who take this medication may develop visual field defects, which can potentially be irreversible. Therefore, it is crucial for patients taking vigabatrin to have their visual fields checked every six months to monitor any changes or potential damage. This precautionary measure can help ensure that any visual field defects are caught early and appropriate action can be taken to prevent further damage. It is important for patients to discuss any concerns or questions about vigabatrin and its potential impact on their vision with their healthcare provider.

    • This question is part of the following fields:

      • Neurological System
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  • Question 14 - A 50-year-old male comes to the emergency department complaining of left sided vision...

    Correct

    • A 50-year-old male comes to the emergency department complaining of left sided vision loss, headache and scalp tenderness. During the examination, he has a fever of 38.5°C, jaw claudication and a relative afferent pupillary defect is observed. The medical team suspects giant cell arteritis and initiates high dose prednisone treatment.

      What structural abnormality is responsible for the relative afferent pupillary defect?

      Your Answer: Ischaemic optic neuropathy

      Explanation:

      A relative afferent pupillary defect is a sign that there may be an optic nerve lesion or a severe retinal disease. In cases of giant cell arteritis (GCA), an inflammatory process of the blood vessels in the head can lead to ischaemic optic neuropathy, which can cause a RAPD. However, blindness, corneal opacity, and photophobia alone are not enough to cause a RAPD. While optic neuritis can also result in a RAPD, this is not typically seen in GCA and may instead indicate a first presentation of multiple sclerosis.

      A relative afferent pupillary defect, also known as the Marcus-Gunn pupil, can be identified through the swinging light test. This condition is caused by a lesion that is located anterior to the optic chiasm, which can be found in the optic nerve or retina. When light is shone on the affected eye, it appears to dilate while the normal eye remains unchanged.

      The causes of a relative afferent pupillary defect can vary. For instance, it may be caused by a detachment of the retina or optic neuritis, which is often associated with multiple sclerosis. The pupillary light reflex pathway involves the afferent pathway, which starts from the retina and goes through the optic nerve, lateral geniculate body, and midbrain. The efferent pathway, on the other hand, starts from the Edinger-Westphal nucleus in the midbrain and goes through the oculomotor nerve.

    • This question is part of the following fields:

      • Neurological System
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  • Question 15 - A 65-year-old man comes to the clinic complaining of arm weakness. During the...

    Incorrect

    • A 65-year-old man comes to the clinic complaining of arm weakness. During the examination, it is observed that he has a weakness in elbow extension and has lost sensation on the dorsal aspect of his first digit. Where is the most probable location of the underlying defect?

      Your Answer: Musculocutaneous nerve

      Correct Answer: Radial nerve

      Explanation:

      Even if there are nerve lesions located proximally, complete loss of triceps muscle function may not occur as the axillary nerve can innervate the long head of the triceps muscle.

      The Radial Nerve: Anatomy, Innervation, and Patterns of Damage

      The radial nerve is a continuation of the posterior cord of the brachial plexus, with root values ranging from C5 to T1. It travels through the axilla, posterior to the axillary artery, and enters the arm between the brachial artery and the long head of triceps. From there, it spirals around the posterior surface of the humerus in the groove for the radial nerve before piercing the intermuscular septum and descending in front of the lateral epicondyle. At the lateral epicondyle, it divides into a superficial and deep terminal branch, with the deep branch crossing the supinator to become the posterior interosseous nerve.

      The radial nerve innervates several muscles, including triceps, anconeus, brachioradialis, and extensor carpi radialis. The posterior interosseous branch innervates supinator, extensor carpi ulnaris, extensor digitorum, and other muscles. Denervation of these muscles can lead to weakness or paralysis, with effects ranging from minor effects on shoulder stability to loss of elbow extension and weakening of supination of prone hand and elbow flexion in mid prone position.

      Damage to the radial nerve can result in wrist drop and sensory loss to a small area between the dorsal aspect of the 1st and 2nd metacarpals. Axillary damage can also cause paralysis of triceps. Understanding the anatomy, innervation, and patterns of damage of the radial nerve is important for diagnosing and treating conditions that affect this nerve.

    • This question is part of the following fields:

      • Neurological System
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  • Question 16 - A patient presents at the clinic after experiencing head trauma. The physician conducts...

    Correct

    • A patient presents at the clinic after experiencing head trauma. The physician conducts a neurological assessment to evaluate for nerve damage. During the examination, the doctor observes a lack of pupil constriction when shining a flashlight into the patient's eyes.

      Which cranial nerve is accountable for this parasympathetic reaction?

      Your Answer: Oculomotor

      Explanation:

      The cranial nerves that carry parasympathetic fibers are the vagus nerve (X), glossopharyngeal nerve (IX), facial nerve (VII), and oculomotor nerve (III). The oculomotor nerve is responsible for the parasympathetic response of pupil constriction through innervating the iris sphincter muscle. The abducens nerve (VI) does not provide a parasympathetic response and only innervates the lateral rectus muscle of the eye for abduction. The ophthalmic nerve is a branch of the trigeminal nerve and does not provide any autonomic innervation. The optic nerve is responsible for vision and does not provide any autonomic or parasympathetic innervation.

      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
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  • Question 17 - A 26-year-old male is in a motorcycle crash and experiences a head injury....

    Correct

    • A 26-year-old male is in a motorcycle crash and experiences a head injury. Upon admission to the emergency department, it is determined that neuro-imaging is necessary. A CT scan reveals a haemorrhage resulting from damage to the bridging veins connecting the cortex and cavernous sinuses.

      What classification of haemorrhage does this fall under?

      Your Answer: Subdural haemorrhage

      Explanation:

      Understanding Subdural Haemorrhage

      Subdural haemorrhage is a condition where blood accumulates beneath the dural layer of the meninges. This type of bleeding is not within the brain tissue and is referred to as an extra-axial or extrinsic lesion. Subdural haematomas can be classified into three types based on their age: acute, subacute, and chronic.

      Acute subdural haematomas are caused by high-impact trauma and are associated with other brain injuries. Symptoms and severity of presentation vary depending on the size of the compressive acute subdural haematoma and the associated injuries. CT imaging is the first-line investigation, and surgical options include monitoring of intracranial pressure and decompressive craniectomy.

      Chronic subdural haematomas, on the other hand, are collections of blood within the subdural space that have been present for weeks to months. They are caused by the rupture of small bridging veins within the subdural space, which leads to slow bleeding. Elderly and alcoholic patients are particularly at risk of subdural haematomas due to brain atrophy and fragile or taut bridging veins. Infants can also experience subdural haematomas due to fragile bridging veins rupturing in shaken baby syndrome.

      Chronic subdural haematomas typically present with a progressive history of confusion, reduced consciousness, or neurological deficit. CT imaging shows a crescentic shape, not restricted by suture lines, and compresses the brain. Unlike acute subdurals, chronic subdurals are hypodense compared to the substance of the brain. Treatment options depend on the size and severity of the haematoma, with conservative management or surgical decompression with burr holes being the main options.

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      • Neurological System
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  • Question 18 - Where does the spinal cord terminate in infants? ...

    Incorrect

    • Where does the spinal cord terminate in infants?

      Your Answer: L5

      Correct Answer: L3

      Explanation:

      During the third month of development, the spinal cord of the foetus extends throughout the entire vertebral canal. However, as the vertebral column continues to grow, it surpasses the growth rate of the spinal cord. As a result, at birth, the spinal cord is located at the level of L3, but by adulthood, it shifts up to L1-2.

      The spinal cord is a central structure located within the vertebral column that provides it with structural support. It extends rostrally to the medulla oblongata of the brain and tapers caudally at the L1-2 level, where it is anchored to the first coccygeal vertebrae by the filum terminale. The cord is characterised by cervico-lumbar enlargements that correspond to the brachial and lumbar plexuses. It is incompletely divided into two symmetrical halves by a dorsal median sulcus and ventral median fissure, with grey matter surrounding a central canal that is continuous with the ventricular system of the CNS. Afferent fibres entering through the dorsal roots usually terminate near their point of entry but may travel for varying distances in Lissauer’s tract. The key point to remember is that the anatomy of the cord will dictate the clinical presentation in cases of injury, which can be caused by trauma, neoplasia, inflammatory diseases, vascular issues, or infection.

      One important condition to remember is Brown-Sequard syndrome, which is caused by hemisection of the cord and produces ipsilateral loss of proprioception and upper motor neuron signs, as well as contralateral loss of pain and temperature sensation. Lesions below L1 tend to present with lower motor neuron signs. It is important to keep a clinical perspective in mind when revising CNS anatomy and to understand the ways in which the spinal cord can become injured, as this will help in diagnosing and treating patients with spinal cord injuries.

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      • Neurological System
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  • Question 19 - A 73-year-old man arrives at the emergency department with complaints of sudden onset...

    Incorrect

    • A 73-year-old man arrives at the emergency department with complaints of sudden onset weakness on the right side of his face and arm. He has a medical history of atrial fibrillation and admits to occasionally forgetting to take his anticoagulant medication. During a complete neurological examination, you assess the corneal reflex. What nerves are involved in the corneal reflex test?

      Your Answer: Oculomotor nerve and facial nerve.

      Correct Answer: Ophthalmic nerve and facial nerve

      Explanation:

      The corneal reflex involves the afferent limb of the nasociliary branch of the ophthalmic nerve and the efferent impulse of the facial nerve. The optic nerve carries visual information, the oculomotor nerve supplies motor innervation to extra-ocular muscles, the ophthalmic nerve carries sensation from the orbit, and the facial nerve innervates muscles of facial expression and carries taste and parasympathetic fibers.

      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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      • Neurological System
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  • Question 20 - A person experiences a haemorrhage in a specific area of their brain. As...

    Incorrect

    • A person experiences a haemorrhage in a specific area of their brain. As a result, they are no longer able to control their body temperature. Which region of the brain has been affected?

      Your Answer: Thalamus

      Correct Answer: Hypothalamus

      Explanation:

      The hypothalamus plays a crucial role in regulating body temperature. Specifically, the anterior portion of the hypothalamus helps to lower body temperature by activating the parasympathetic nervous system, while the posterior nucleus helps to raise body temperature by activating the sympathetic nervous system. In contrast, the thalamus serves as a relay center in the brain, the pituitary gland secretes hormones, the midbrain is the uppermost part of the brainstem, and the medulla is the lowermost part of the brainstem. Lesions to these areas would not have a significant impact on body temperature regulation.

      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.

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      • Neurological System
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