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  • Question 1 - A 58-year-old male comes to the GP with a complaint of changed sensation...

    Correct

    • A 58-year-old male comes to the GP with a complaint of changed sensation in his legs. Upon examination, you observe brisk knee reflexes and a positive Babinski sign, but no ankle jerks. What is the most probable diagnosis?

      Your Answer: Subacute combined degeneration of the spinal cord

      Explanation:

      Subacute Combined Degeneration of Spinal Cord

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

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

    • This question is part of the following fields:

      • Neurological System
      22.3
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  • Question 2 - Which muscle is innervated by the superficial peroneal nerve? ...

    Correct

    • Which muscle is innervated by the superficial peroneal nerve?

      Your Answer: Peroneus brevis

      Explanation:

      Anatomy of the Superficial Peroneal Nerve

      The superficial peroneal nerve is responsible for supplying the lateral compartment of the leg, specifically the peroneus longus and peroneus brevis muscles which aid in eversion and plantar flexion. It also provides sensation over the dorsum of the foot, excluding the first web space which is innervated by the deep peroneal nerve.

      The nerve passes between the peroneus longus and peroneus brevis muscles along the proximal one-third of the fibula. Approximately 10-12 cm above the tip of the lateral malleolus, the nerve pierces the fascia. It then bifurcates into intermediate and medial dorsal cutaneous nerves about 6-7 cm distal to the fibula.

      Understanding the anatomy of the superficial peroneal nerve is important in diagnosing and treating conditions that affect the lateral compartment of the leg and dorsum of the foot. Injuries or compression of the nerve can result in weakness or numbness in the affected areas.

    • This question is part of the following fields:

      • Neurological System
      11.5
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  • Question 3 - Sophie is a 25-year-old female who has been experiencing trouble fitting into her...

    Correct

    • Sophie is a 25-year-old female who has been experiencing trouble fitting into her shoes and wearing her rings. She has a deep voice, stands at a height of 195cm, and her GP observes coarse facial features. Sophie mentions that she suspects her anterior pituitary gland may be producing an excess of hormones. Which hormone is likely being overproduced in Sophie's case?

      Your Answer: Growth hormone

      Explanation:

      The pituitary gland is a small gland located within the sella turcica in the sphenoid bone of the middle cranial fossa. It weighs approximately 0.5g and is covered by a dural fold. The gland is attached to the hypothalamus by the infundibulum and receives hormonal stimuli from the hypothalamus through the hypothalamo-pituitary portal system. The anterior pituitary, which develops from a depression in the wall of the pharynx known as Rathkes pouch, secretes hormones such as ACTH, TSH, FSH, LH, GH, and prolactin. GH and prolactin are secreted by acidophilic cells, while ACTH, TSH, FSH, and LH are secreted by basophilic cells. On the other hand, the posterior pituitary, which is derived from neuroectoderm, secretes ADH and oxytocin. Both hormones are produced in the hypothalamus before being transported by the hypothalamo-hypophyseal portal system.

    • This question is part of the following fields:

      • Neurological System
      52.1
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  • Question 4 - A 16-year-old male comes to the clinic after experiencing a seizure. During the...

    Correct

    • A 16-year-old male comes to the clinic after experiencing a seizure. During the history-taking, he reports that he first noticed shaking in his hand about an hour ago. The shaking continued for a few seconds before he lost consciousness and bit his tongue. He also experienced urinary incontinence. How would you describe this presentation?

      Your Answer: Partial seizure with secondary generalisation

      Explanation:

      Epilepsy is a neurological condition that causes recurrent seizures. In the UK, around 500,000 people have epilepsy, and two-thirds of them can control their seizures with antiepileptic medication. While epilepsy usually occurs in isolation, certain conditions like cerebral palsy, tuberous sclerosis, and mitochondrial diseases have an association with epilepsy. It’s important to note that seizures can also occur due to other reasons like infection, trauma, or metabolic disturbance.

      Seizures can be classified into focal seizures, which start in a specific area of the brain, and generalised seizures, which involve networks on both sides of the brain. Patients who have had generalised seizures may experience biting their tongue or incontinence of urine. Following a seizure, patients typically have a postictal phase where they feel drowsy and tired for around 15 minutes.

      Patients who have had their first seizure generally undergo an electroencephalogram (EEG) and neuroimaging (usually a MRI). Most neurologists start antiepileptics following a second epileptic seizure. Antiepileptics are one of the few drugs where it is recommended that we prescribe by brand, rather than generically, due to the risk of slightly different bioavailability resulting in a lowered seizure threshold.

      Patients who drive, take other medications, wish to get pregnant, or take contraception need to consider the possible interactions of the antiepileptic medication. Some commonly used antiepileptics include sodium valproate, carbamazepine, lamotrigine, and phenytoin. In case of a seizure that doesn’t terminate after 5-10 minutes, medication like benzodiazepines may be administered to terminate the seizure. If a patient continues to fit despite such measures, they are said to have status epilepticus, which is a medical emergency requiring hospital treatment.

    • This question is part of the following fields:

      • Neurological System
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  • Question 5 - A 68-year-old male comes to the emergency department with a sudden onset of...

    Correct

    • A 68-year-old male comes to the emergency department with a sudden onset of numbness in his right arm and leg. During the examination, you observe that he has left-sided facial numbness. There are no alterations in his speech or hearing, and he has no weakness in any of his limbs.

      What is the probable diagnosis?

      Your Answer: Lateral medullary syndrome

      Explanation:

      Understanding Lateral Medullary Syndrome

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

    • This question is part of the following fields:

      • Neurological System
      52.8
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  • Question 6 - A 27-year-old male with a history of paraplegia, due to C5 spinal cord...

    Incorrect

    • A 27-year-old male with a history of paraplegia, due to C5 spinal cord injury sustained 8 weeks prior, is currently admitted to an orthopaedic and spinal ward. One night, he wakes up in distress with a headache and diaphoresis above the level of his spinal cord injury. His blood pressure is currently 160/110 mmHg. It was recorded 2 hours ago as 110/70mmHg. His pulse rate is 50. The patient also has an indwelling catheter which was changed earlier today.

      The healthcare provider on-call suspects that autonomic dysreflexia might be the cause of the patient's symptoms.

      What is the most common life-threatening outcome associated with this condition?

      Your Answer: Pulmonary oedema

      Correct Answer: Haemorrhagic stroke

      Explanation:

      Autonomic dysreflexia is a condition that occurs in patients who have suffered a spinal cord injury at or above the T6 spinal level. It is caused by a reflex response triggered by various stimuli, such as faecal impaction or urinary retention, which sends signals through the thoracolumbar outflow. However, due to the spinal cord lesion, the usual parasympathetic response is prevented, leading to an unbalanced physiological response. This response is characterized by extreme hypertension, flushing, and sweating above the level of the cord lesion, as well as agitation. If left untreated, severe consequences such as haemorrhagic stroke can occur. The management of autonomic dysreflexia involves removing or controlling the stimulus and treating any life-threatening hypertension and/or bradycardia.

    • This question is part of the following fields:

      • Neurological System
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  • Question 7 - A 28-year-old man visits his GP with complaints of bilateral numbness in his...

    Correct

    • A 28-year-old man visits his GP with complaints of bilateral numbness in his hands and feet, along with a feeling of muscle weakness that has been progressively worsening for the past 15 months. The man admits to avoiding hospitals and his GP, and has not reported these symptoms to anyone else. Upon examination, reduced bicep reflexes are noted bilaterally. Nerve conduction studies reveal evidence of peripheral nerve demyelination. What is the most probable underlying diagnosis?

      Your Answer: Chronic inflammatory demyelinating polyneuropathy

      Explanation:

      Chronic inflammatory demyelinating polyneuropathy (CIDP) is a condition where the inflammation and infiltration of the endoneurium with inflammatory T cells are thought to be caused by antibodies. This results in the demyelination of peripheral nerves in a segmental manner.

      CIDP is characterized by generalized symptoms and chronicity, and nerve conduction tests can reveal demyelination of the nerves. Guillain Barré syndrome (GBS) is an incorrect answer as it is more acute and often triggered by prior infection, particularly Campylobacter gastrointestinal infection. Diabetic neuropathy is also an incorrect answer as it typically presents as a focal peripheral neuropathy with sensory impairment. Multiple sclerosis (MS) is another incorrect answer as it involves the central nervous system and can present with additional signs/symptoms such as visual impairment and muscle stiffness. MS is diagnosed using an MRI scan and checking for oligoclonal bands in the cerebrospinal fluid.

      Understanding Chronic Inflammatory Demyelinating Polyneuropathy

      Chronic inflammatory demyelinating polyneuropathy (CIDP) is a type of peripheral neuropathy that is caused by antibody-mediated inflammation resulting in segmental demyelination of peripheral nerves. This condition is more common in males than females and shares similar features with Guillain-Barre syndrome (GBS), with motor symptoms being predominant. However, CIDP has a more insidious onset, occurring over weeks to months, and is often considered the chronic version of GBS.

      One of the distinguishing features of CIDP is the high protein content found in the cerebrospinal fluid (CSF). Treatment for CIDP may involve the use of steroids and immunosuppressants, which is different from GBS.

    • This question is part of the following fields:

      • Neurological System
      34.4
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  • Question 8 - A 35-year-old man visits his doctor with complaints of blurry vision that has...

    Incorrect

    • A 35-year-old man visits his doctor with complaints of blurry vision that has been ongoing for the past two months. The blurriness initially started in his right eye but has now spread to his left eye as well. He denies experiencing any pain or discharge from his eyes but admits to occasionally seeing specks and flashes in his vision.

      During the physical examination, the doctor notices needle injection scars on the patient's forearm. After some reluctance, the patient admits to having a history of heroin use. Upon fundoscopy, the doctor observes white lesions surrounded by areas of hemorrhagic necrotic areas in the patient's retina.

      Which organism is most likely responsible for causing this patient's eye condition?

      Your Answer: Human immunodeficiency virus

      Correct Answer: Cytomegalovirus

      Explanation:

      Understanding Chorioretinitis and Its Causes

      Chorioretinitis is a medical condition that affects the retina and choroid, which are the two layers of tissue at the back of the eye. This condition is characterized by inflammation and damage to these tissues, which can lead to vision loss and other complications. There are several possible causes of chorioretinitis, including syphilis, cytomegalovirus, toxoplasmosis, sarcoidosis, and tuberculosis.

      Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. It can affect various parts of the body, including the eyes, and can lead to chorioretinitis if left untreated. Cytomegalovirus is a common virus that can cause chorioretinitis in people with weakened immune systems, such as those with HIV/AIDS. Toxoplasmosis is a parasitic infection that can be contracted from contaminated food or water, and can also cause chorioretinitis.

      Sarcoidosis is a condition that causes inflammation in various parts of the body, including the eyes. It can lead to chorioretinitis as well as other eye problems such as uveitis and optic neuritis. Tuberculosis is a bacterial infection that can affect the lungs and other parts of the body, including the eyes. It can cause chorioretinitis as well as other eye problems such as iritis and scleritis.

      In summary, chorioretinitis is a serious eye condition that can lead to vision loss and other complications. It can be caused by various infections and inflammatory conditions, including syphilis, cytomegalovirus, toxoplasmosis, sarcoidosis, and tuberculosis. Early diagnosis and treatment are essential for preventing further damage and preserving vision.

    • This question is part of the following fields:

      • Neurological System
      48.8
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  • Question 9 - A 65 year old man is scheduled for a lymph node biopsy on...

    Correct

    • A 65 year old man is scheduled for a lymph node biopsy on the posterolateral aspect of his right neck due to suspected lymphoma. Which nerve is most vulnerable in this procedure?

      Your Answer: Accessory

      Explanation:

      The accessory nerve is at risk of injury due to its superficial location and proximity to the platysma muscle. It may be divided during the initial stages of a procedure.

      The Accessory Nerve and Its Functions

      The accessory nerve is the eleventh cranial nerve that provides motor innervation to the sternocleidomastoid and trapezius muscles. It is important to examine the function of this nerve by checking for any loss of muscle bulk in the shoulders, asking the patient to shrug their shoulders against resistance, and turning their head against resistance.

      Iatrogenic injury, which is caused by medical treatment or procedures, is a common cause of isolated accessory nerve lesions. This is especially true for surgeries in the posterior cervical triangle, such as lymph node biopsy. It is important to be aware of the potential for injury to the accessory nerve during these procedures to prevent any long-term complications.

    • This question is part of the following fields:

      • Neurological System
      15
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  • Question 10 - A 15-year-old boy presents with diplopia and headache. Imaging reveals acute hydrocephalus and...

    Correct

    • A 15-year-old boy presents with diplopia and headache. Imaging reveals acute hydrocephalus and a space occupying lesion in the base of the 4th ventricle. What type of cell proliferation would be expected on biopsy?

      Your Answer: Ependymal cells

      Explanation:

      Childhood tumours of the central nervous system (CNS) frequently develop at the base of the 4th ventricle. Oligodendrocytes are accountable for creating the myelin sheath in the CNS. The formation of the blood-brain barrier is a crucial function of astrocytes. Schwann cells are responsible for creating the myelin sheath in the peripheral nervous system.

      The nervous system is composed of various types of cells, each with their own unique functions. Oligodendroglia cells are responsible for producing myelin in the central nervous system (CNS) and are affected in multiple sclerosis. Schwann cells, on the other hand, produce myelin in the peripheral nervous system (PNS) and are affected in Guillain-Barre syndrome. Astrocytes provide physical support, remove excess potassium ions, help form the blood-brain barrier, and aid in physical repair. Microglia are specialised CNS phagocytes, while ependymal cells provide the inner lining of the ventricles.

      In summary, the nervous system is made up of different types of cells, each with their own specific roles. Oligodendroglia and Schwann cells produce myelin in the CNS and PNS, respectively, and are affected in certain diseases. Astrocytes provide physical support and aid in repair, while microglia are specialised phagocytes in the CNS. Ependymal cells line the ventricles. Understanding the functions of these cells is crucial in understanding the complex workings of the nervous system.

    • This question is part of the following fields:

      • Neurological System
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  • Question 11 - You are a medical student on an endocrine ward. There is a 65-year-old...

    Correct

    • You are a medical student on an endocrine ward. There is a 65-year-old patient on the ward suffering from hypopituitarism. One of the junior doctors explains to you that the patient's pituitary gland was damaged when they received radiation therapy for a successfully treated brain tumour last year. He shows you a CT scan and demonstrates that only the anterior pituitary gland is damaged, with the posterior pituitary gland unaffected.

      Which of the following hormones is unlikely to be affected?

      Your Answer: antidiuretic hormone

      Explanation:

      The pituitary gland is a small gland located within the sella turcica in the sphenoid bone of the middle cranial fossa. It weighs approximately 0.5g and is covered by a dural fold. The gland is attached to the hypothalamus by the infundibulum and receives hormonal stimuli from the hypothalamus through the hypothalamo-pituitary portal system. The anterior pituitary, which develops from a depression in the wall of the pharynx known as Rathkes pouch, secretes hormones such as ACTH, TSH, FSH, LH, GH, and prolactin. GH and prolactin are secreted by acidophilic cells, while ACTH, TSH, FSH, and LH are secreted by basophilic cells. On the other hand, the posterior pituitary, which is derived from neuroectoderm, secretes ADH and oxytocin. Both hormones are produced in the hypothalamus before being transported by the hypothalamo-hypophyseal portal system.

    • This question is part of the following fields:

      • Neurological System
      58.8
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  • Question 12 - Which of the following fields is primarily focused on regulating body temperature? ...

    Incorrect

    • Which of the following fields is primarily focused on regulating body temperature?

      Your Answer: Brain stem

      Correct Answer: Hypothalamus

      Explanation:

      The main function of the hypothalamus is to regulate body temperature. It can communicate with the cerebral cortex to prompt changes in behavior that aid in the regulation of body temperature.

      Thermoregulation and the Role of the Hypothalamus

      Thermoregulation is the process by which the body maintains its core temperature within a narrow range. The hypothalamus is the primary center for thermoregulation, receiving input from both peripheral and central thermoreceptors. Central thermoreceptors play a crucial role in maintaining core temperature, while peripheral vasodilation and vasoconstriction are autonomic responses that regulate heat loss.

      The hypothalamus can initiate involuntary motor responses, such as shivering, to raise body temperature. It can also stimulate the sympathetic nervous system to produce peripheral vasoconstriction and release adrenaline from the adrenal medulla. Behavioral responses also play a role in heat loss regulation. The thermoneutral zone, which is the range of temperatures where heat loss can be maintained, is between 25 to 30 degrees Celsius, but the absolute value depends on atmospheric humidity.

      In cases of sepsis, cytokines are released, which can reset the thermoregulatory center, resulting in fever. Understanding the role of the hypothalamus in thermoregulation is essential in maintaining a healthy body temperature and preventing complications associated with temperature dysregulation.

    • This question is part of the following fields:

      • Neurological System
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  • Question 13 - A 65-year-old man visits his GP complaining of vision changes, including deteriorating visual...

    Incorrect

    • A 65-year-old man visits his GP complaining of vision changes, including deteriorating visual acuity, colour perception, and distorted images. After conducting tests, the diagnosis of dry age-related macular degeneration (Dry-AMD) is confirmed. What retinal sign is typical of Dry-AMD?

      Your Answer: 'Cherry-red' spot

      Correct Answer: Drusen

      Explanation:

      Drusen, which are yellow deposits on the retina visible during fundoscopy, can indicate the severity of dry-AMD based on their distribution and quantity. Wet-AMD is more commonly associated with retinal hemorrhages and neovascularization. While painless vision loss can be caused by papilledema, this condition is typically linked to disorders that directly impact the optic disc.

      Age-related macular degeneration (ARMD) is a common cause of blindness in the UK, characterized by degeneration of the central retina (macula) and the formation of drusen. The risk of ARMD increases with age, smoking, family history, and conditions associated with an increased risk of ischaemic cardiovascular disease. ARMD is classified into dry and wet forms, with the latter carrying the worst prognosis. Clinical features include subacute onset of visual loss, difficulties in dark adaptation, and visual hallucinations. Signs include distortion of line perception, the presence of drusen, and well-demarcated red patches in wet ARMD. Investigations include slit-lamp microscopy, colour fundus photography, fluorescein angiography, indocyanine green angiography, and ocular coherence tomography. Treatment options include a combination of zinc with anti-oxidant vitamins for dry ARMD and anti-VEGF agents for wet ARMD. Laser photocoagulation is also an option, but anti-VEGF therapies are usually preferred.

    • This question is part of the following fields:

      • Neurological System
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  • Question 14 - A 27-year-old patient, Sarah, suffered severe left-sided craniofacial trauma in a car accident....

    Incorrect

    • A 27-year-old patient, Sarah, suffered severe left-sided craniofacial trauma in a car accident. Following a period in the ICU, Sarah has been discharged to the ward and requires rehabilitation therapy due to suspected cranial nerve damage. Sarah experiences numbness on the left side of her face and struggles with chewing. However, she can still smile and reports no alteration in her sense of taste. The left eye lacks the corneal reflex, while the right eye has it. What other symptom is likely present in Sarah?

      Your Answer: Tongue deviation to the right

      Correct Answer: Jaw deviation to the left

      Explanation:

      Tom’s jaw deviation towards the left is consistent with trigeminal nerve damage from his accident. The trigeminal nerve controls facial sensation and the muscles of mastication. His ability to smile and report no change in taste suggests that his facial nerve is intact, and he is not experiencing upper motor neuron lesion. Jaw deviation to the right, tongue deviation to the left or right, and inability to wrinkle the forehead are not consistent with trigeminal nerve palsy.

      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 15 - A 47-year-old woman is being evaluated on the ward 24 hours after a...

    Incorrect

    • A 47-year-old woman is being evaluated on the ward 24 hours after a thyroidectomy. Although she has been feeling fine, she has noticed a hoarseness in her voice. Which nerve may have been affected during the operation?

      Your Answer: Glossopharyngeal nerve

      Correct Answer: Right recurrent laryngeal nerve

      Explanation:

      During neck surgery, the right recurrent laryngeal nerve is at a higher risk of injury compared to the left due to its diagonal path across the neck originating under the subclavian. Both the recurrent and superior laryngeal nerves play a crucial role in the sensory and motor function of the vocal cords. The superior laryngeal nerve is less likely to be damaged during thyroid surgery in the lower neck as it descends from above the vocal cords. The glossopharyngeal nerve is also not commonly affected by this mechanism, but if injured, it can cause difficulty swallowing, changes in taste, and altered sensation in the back of the mouth. Hypoglossal nerve injury is rare and does not align with this mechanism, but if it occurs, it can lead to atrophy of the tongue muscles on the same side.

      The Recurrent Laryngeal Nerve: Anatomy and Function

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

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

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

    • This question is part of the following fields:

      • Neurological System
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  • Question 16 - A 70-year-old male on the geriatric ward has been awakened by a headache....

    Incorrect

    • A 70-year-old male on the geriatric ward has been awakened by a headache. Later in the morning, he began to vomit. He has a history of prostate cancer, a stroke 3 years ago, and high blood pressure. During the examination, papilloedema was observed on fundoscopy.

      What is the strongest association with this ophthalmic finding?

      Your Answer: Increase optic cup to disc ratio

      Correct Answer: Bilateral optic disc swelling

      Explanation:

      Papilloedema is almost always present in both eyes.

      Understanding Papilloedema

      Papilloedema is a condition characterized by swelling of the optic disc due to increased pressure within the skull. This condition typically affects both eyes. During a fundoscopy, several signs may be observed, including venous engorgement, loss of venous pulsation, blurring of the optic disc margin, elevation of the optic disc, loss of the optic cup, and Paton’s lines.

      There are several potential causes of papilloedema, including space-occupying lesions such as tumors or vascular abnormalities, malignant hypertension, idiopathic intracranial hypertension, hydrocephalus, and hypercapnia. In rare cases, papilloedema may be caused by hypoparathyroidism and hypocalcaemia or vitamin A toxicity.

      It is important to diagnose and treat papilloedema promptly, as it can lead to permanent vision loss if left untreated. Treatment typically involves addressing the underlying cause of the increased intracranial pressure, such as surgery to remove a tumor or medication to manage hypertension.

    • This question is part of the following fields:

      • Neurological System
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  • Question 17 - A 29-year-old female is being followed up in the epilepsy clinic after switching...

    Incorrect

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

      Your Answer: Binds to potassium channels to promote potassium efflux

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

      Explanation:

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

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

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

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

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

    • This question is part of the following fields:

      • Neurological System
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  • Question 18 - A 67-year-old male presents 7 months after being diagnosed with Parkinson's disease. During...

    Incorrect

    • A 67-year-old male presents 7 months after being diagnosed with Parkinson's disease. During the examination, the patient exhibits rigidity, a Parkinsonian gait, bradykinesia, and a resting tremor on one side of the body. Additionally, the patient displays hypomimia. Currently, the patient is taking levodopa and benserazide, and the neurologist has prescribed pramipexole to keep the levodopa dose low. What is a potential side effect of pramipexole that the patient should be warned about?

      Your Answer: Weight-gain

      Correct Answer: Compulsive gambling

      Explanation:

      Dopamine agonists, which are commonly used in the treatment of Parkinson’s disease, carry a risk of causing impulse control or obsessive disorders, such as excessive gambling or hypersexuality. Patients should be informed of this potential side-effect before starting the medication, as it can have devastating financial consequences for both the patient and their family. Blurred vision is a side-effect of antimuscarinic medications, while peripheral neuropathy is a possible side-effect of several medications, including some antibiotics, cytotoxic drugs, amiodarone, and phenytoin. Weight gain is a common side-effect of certain medications, such as steroids.

      Understanding the Mechanism of Action of Parkinson’s Drugs

      Parkinson’s disease is a complex condition that requires specialized management. The first-line treatment for motor symptoms that affect a patient’s quality of life is levodopa, while dopamine agonists, levodopa, or monoamine oxidase B (MAO-B) inhibitors are recommended for those whose motor symptoms do not affect their quality of life. However, all drugs used to treat Parkinson’s can cause a wide variety of side effects, and it is important to be aware of these when making treatment decisions.

      Levodopa is nearly always combined with a decarboxylase inhibitor to prevent the peripheral metabolism of levodopa to dopamine outside of the brain and reduce side effects. Dopamine receptor agonists, such as bromocriptine, ropinirole, cabergoline, and apomorphine, are more likely than levodopa to cause hallucinations in older patients. MAO-B inhibitors, such as selegiline, inhibit the breakdown of dopamine secreted by the dopaminergic neurons. Amantadine’s mechanism is not fully understood, but it probably increases dopamine release and inhibits its uptake at dopaminergic synapses. COMT inhibitors, such as entacapone and tolcapone, are used in conjunction with levodopa in patients with established PD. Antimuscarinics, such as procyclidine, benzotropine, and trihexyphenidyl (benzhexol), block cholinergic receptors and are now used more to treat drug-induced parkinsonism rather than idiopathic Parkinson’s disease.

      It is important to note that all drugs used to treat Parkinson’s can cause adverse effects, and clinicians must be aware of these when making treatment decisions. Patients should also be warned about the potential for dopamine receptor agonists to cause impulse control disorders and excessive daytime somnolence. Understanding the mechanism of action of Parkinson’s drugs is crucial in managing the condition effectively.

    • This question is part of the following fields:

      • Neurological System
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  • Question 19 - A 57-year-old woman is admitted to the orthogeriatric ward for further investigations into...

    Incorrect

    • A 57-year-old woman is admitted to the orthogeriatric ward for further investigations into the underlying cause of her recurrent falls. During a neurological examination, it is found that she has normal power, tone, reflexes, and coordination in both upper and lower limbs bilaterally, but there is a loss of sensation over the medial aspect of her left leg. Based on this information, which nerve is most likely to have been affected?

      Your Answer: Lateral femoral cutaneous

      Correct Answer: Saphenous nerve

      Explanation:

      The femoral nerve is a nerve that originates from the spinal roots L2, L3, and L4. It provides innervation to several muscles in the thigh, including the pectineus, sartorius, quadriceps femoris, and vastus lateralis, medialis, and intermedius. Additionally, it branches off into the medial cutaneous nerve of the thigh, saphenous nerve, and intermediate cutaneous nerve of the thigh. The femoral nerve passes through the psoas major muscle and exits the pelvis by going under the inguinal ligament. It then enters the femoral triangle, which is located lateral to the femoral artery and vein.

      To remember the femoral nerve’s supply, a helpful mnemonic is don’t MISVQ scan for PE. This stands for the medial cutaneous nerve of the thigh, intermediate cutaneous nerve of the thigh, saphenous nerve, vastus, quadriceps femoris, and sartorius, with the addition of the pectineus muscle. Overall, the femoral nerve plays an important role in the motor and sensory functions of the thigh.

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      • Neurological System
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  • Question 20 - A 43-year-old female comes to the ENT clinic with a history of constant...

    Correct

    • A 43-year-old female comes to the ENT clinic with a history of constant vertigo and right-sided deafness for the past year. She has no significant medical history. Upon conducting an audiogram, it is discovered that her right ear has reduced hearing to both bone and air conduction. During a cranial nerve exam, an absent corneal reflex is observed on the right side, and she has poor balance. Otoscopy of both ears is normal. What is the probable underlying pathology responsible for this patient's symptoms and signs?

      Your Answer: Vestibular schwannoma (acoustic neuroma)

      Explanation:

      If a patient presents with loss of the corneal reflex, the likely diagnosis is vestibular schwannoma (acoustic neuroma). This is a noncancerous tumor that affects the vestibular portion of the 8th cranial nerve, leading to sensorineural deafness, tinnitus, and vertigo. As the tumor grows, it can also press on other cranial nerves. Loss of the corneal reflex is a classic sign of early trigeminal (cranial nerve 5) involvement, which is unlikely in any of the other listed conditions.

      Meniere’s disease is not the correct answer. This is a disorder of the middle ear that causes episodic vertigo, sensorineural hearing loss, and a sensation of aural fullness or pressure.

      Otosclerosis is also incorrect. This is an inherited condition that causes conductive deafness and tinnitus, typically presenting in patients aged 20-40 years.

      Vestibular mononeuritis is not the correct answer either. This condition is caused by inflammation of the vestibular nerve following a recent viral infection and presents with vertigo, but hearing is not affected.

      Vestibular schwannomas, also known as acoustic neuromas, make up about 5% of intracranial tumors and 90% of cerebellopontine angle tumors. These tumors typically present with a combination of vertigo, hearing loss, tinnitus, and an absent corneal reflex. The specific symptoms can be predicted based on which cranial nerves are affected. For example, cranial nerve VIII involvement can cause vertigo, unilateral sensorineural hearing loss, and unilateral tinnitus. Bilateral vestibular schwannomas are associated with neurofibromatosis type 2.

      If a vestibular schwannoma is suspected, it is important to refer the patient to an ear, nose, and throat specialist urgently. However, it is worth noting that these tumors are often benign and slow-growing, so observation may be appropriate initially. The diagnosis is typically confirmed with an MRI of the cerebellopontine angle, and audiometry is also important as most patients will have some degree of hearing loss. Treatment options include surgery, radiotherapy, or continued observation.

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      • Neurological System
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  • Question 21 - An 80-year-old man arrives at the emergency department with intense shooting pain on...

    Incorrect

    • An 80-year-old man arrives at the emergency department with intense shooting pain on one side of his face that is aggravated by chewing. Which of the following accurately identifies the location where the maxillary (V2) and mandibular nerves (V3) exit the skull?

      Your Answer: V2 - superior orbital fissure, V3 - foramen ovale

      Correct Answer: V2 - foramen rotundum, V3 - foramen ovale

      Explanation:

      Trigeminal nerve branches exit the skull with Standing Room Only:
      V1 – Superior orbital fissure
      V2 – Foramen rotundum
      V3 – Foramen ovale

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

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      • Neurological System
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  • Question 22 - You are evaluating an 80-year-old woman in the emergency department who complains of...

    Incorrect

    • You are evaluating an 80-year-old woman in the emergency department who complains of a gradual decline in her vision over the past year. She reports having good eyesight in her younger years but now experiences hazy vision with halos around lights at night. During ophthalmoscope examination, you observe a dimming of the red reflex in both eyes, making it difficult to visualize the retina. Upon further examination with a slit lamp, you notice a uniform brunescent opacification of the crystalline lens.

      What type of lens pathology is present in this patient?

      Your Answer: Posterior subcapsular cataract

      Correct Answer: Nuclear sclerotic cataract

      Explanation:

      Cataract is a condition that occurs with age and affects the lens of the eye. The most prevalent type of age-related cataract is known as nuclear cataract.

      Nuclear sclerotic cataracts are characterized by the hardening and clouding of the center of the lens, which can lead to a decrease in the eye’s ability to focus. The quality of the lens can change as it matures, initially causing haziness and white or gray discoloration. As the cataract progresses, it can become brunescent and even liquefy in severe cases.

      While congenital cataracts are most commonly diagnosed in childhood, posterior subcapsular cataracts are more frequently seen in patients who have undergone cataract surgery or have conditions such as diabetes or have been on prolonged courses of steroids. These cataracts occur on the back surface of the lens.

      Cortical cataracts are less common and are characterized by spoke-like opacities radiating from the center of the lens.

      Understanding Cataracts

      A cataract is a common eye condition that occurs when the lens of the eye becomes cloudy, making it difficult for light to reach the retina and causing reduced or blurred vision. Cataracts are more common in women and increase in incidence with age, affecting 30% of individuals aged 65 and over. The most common cause of cataracts is the normal ageing process, but other possible causes include smoking, alcohol consumption, trauma, diabetes mellitus, long-term corticosteroids, radiation exposure, myotonic dystrophy, and metabolic disorders such as hypocalcaemia.

      Patients with cataracts typically experience a gradual onset of reduced vision, faded colour vision, glare, and halos around lights. Signs of cataracts include a defect in the red reflex, which is the reddish-orange reflection seen through an ophthalmoscope when a light is shone on the retina. Diagnosis is made through ophthalmoscopy and slit-lamp examination, which reveal a visible cataract.

      In the early stages, age-related cataracts can be managed conservatively with stronger glasses or contact lenses and brighter lighting. However, surgery is the only effective treatment for cataracts, involving the removal of the cloudy lens and replacement with an artificial one. Referral for surgery should be based on the presence of visual impairment, impact on quality of life, patient choice, and the risks and benefits of surgery. Complications following surgery may include posterior capsule opacification, retinal detachment, posterior capsule rupture, and endophthalmitis. Despite these risks, cataract surgery has a high success rate, with 85-90% of patients achieving corrected vision of 6/12 or better on a Snellen chart postoperatively.

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      • Neurological System
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  • Question 23 - At what level does the inferior vena cava exit the abdominal cavity? ...

    Incorrect

    • At what level does the inferior vena cava exit the abdominal cavity?

      Your Answer:

      Correct Answer: T8

      Explanation:

      Anatomical Planes and Levels in the Human Body

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

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

    • This question is part of the following fields:

      • Neurological System
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  • Question 24 - A motorcyclist in his mid-twenties has been in a road traffic accident resulting...

    Incorrect

    • A motorcyclist in his mid-twenties has been in a road traffic accident resulting in severe injuries to his right shoulder. Upon examination, his shoulder is adducted and medially rotated, while his elbow is fully extended and his forearm is pronated. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: C5, C6 root lesion

      Explanation:

      The individual is experiencing Erb’s palsy due to a lesion in the C5 and C6 roots. This condition is often linked to birth injuries that occur when a baby experiences shoulder dystocia. Symptoms include the waiter’s tip position, inability to raise the shoulder (due to paralysis of the deltoid and supraspinatus muscles), inability to externally rotate the shoulder (due to paralysis of the infraspinatus muscle), inability to flex the elbow (due to paralysis of the biceps, brachialis, and brachioradialis muscles), and inability to supinate the forearm (due to paralysis of the biceps muscle).

      Understanding the Brachial Plexus and Cutaneous Sensation of the Upper Limb

      The brachial plexus is a network of nerves that originates from the anterior rami of C5 to T1. It is divided into five sections: roots, trunks, divisions, cords, and branches. To remember these sections, a common mnemonic used is Real Teenagers Drink Cold Beer.

      The roots of the brachial plexus are located in the posterior triangle and pass between the scalenus anterior and medius muscles. The trunks are located posterior to the middle third of the clavicle, with the upper and middle trunks related superiorly to the subclavian artery. The lower trunk passes over the first rib posterior to the subclavian artery. The divisions of the brachial plexus are located at the apex of the axilla, while the cords are related to the axillary artery.

      The branches of the brachial plexus provide cutaneous sensation to the upper limb. This includes the radial nerve, which provides sensation to the posterior arm, forearm, and hand; the median nerve, which provides sensation to the palmar aspect of the thumb, index, middle, and half of the ring finger; and the ulnar nerve, which provides sensation to the palmar and dorsal aspects of the fifth finger and half of the ring finger.

      Understanding the brachial plexus and its branches is important in diagnosing and treating conditions that affect the upper limb, such as nerve injuries and neuropathies. It also helps in understanding the cutaneous sensation of the upper limb and how it relates to the different nerves of the brachial plexus.

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  • Question 25 - A 75-year-old man comes to the GP complaining of double vision that has...

    Incorrect

    • A 75-year-old man comes to the GP complaining of double vision that has been present for 3 days. He has a medical history of diabetes mellitus. During the examination, it was observed that his right eye was completely drooping and in a 'down and out' position. Additionally, his right pupil was slightly larger than his left pupil.

      Based on these findings, which cranial nerve is most likely to be affected in this patient?

      Your Answer:

      Correct Answer: Oculomotor nerve

      Explanation:

      When the third cranial nerve is affected, it can result in ptosis (drooping of the upper eyelid) and an down and out eye appearance. This is because the oculomotor nerve controls several muscles that are responsible for eye movements. The levator palpebrae superioris muscle, which lifts the upper eyelid, becomes paralyzed, causing ptosis. The pupillary sphincter muscle, which constricts the pupil, also becomes paralyzed, resulting in dilation of the affected pupil. The paralysis of the medial rectus, superior rectus, inferior rectus, and inferior oblique muscles causes the eye to move downward and outward due to the unopposed action of the other muscles controlling eye movements (the lateral rectus and superior oblique muscles, controlled by the sixth and fourth cranial nerves, respectively).

      If the optic nerve is damaged, it can lead to vision problems as it is responsible for transmitting visual information from the retina to the brain. A trochlear nerve palsy can cause double vision that is worse when looking downward. Damage to the ophthalmic nerve, which is the first branch of the trigeminal nerve, can cause neuralgia (nerve pain) and an absent corneal reflex. An abducens nerve palsy can cause a horizontal gaze palsy that is more pronounced when looking at objects in the distance.

      Understanding Third Nerve Palsy: Causes and Features

      Third nerve palsy is a neurological condition that affects the third cranial nerve, which controls the movement of the eye and eyelid. The condition is characterized by the eye being deviated ‘down and out’, ptosis, and a dilated pupil. In some cases, it may be referred to as a ‘surgical’ third nerve palsy due to the dilation of the pupil.

      There are several possible causes of third nerve palsy, including diabetes mellitus, vasculitis (such as temporal arteritis or SLE), uncal herniation through tentorium if raised ICP, posterior communicating artery aneurysm, and cavernous sinus thrombosis. In some cases, it may also be a false localizing sign. Weber’s syndrome, which is characterized by an ipsilateral third nerve palsy with contralateral hemiplegia, is caused by midbrain strokes. Other possible causes include amyloid and multiple sclerosis.

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  • Question 26 - A 29-year-old Caucasian female presented to her primary care physician complaining of left...

    Incorrect

    • A 29-year-old Caucasian female presented to her primary care physician complaining of left eye pain that has been bothering her for the past week. She also reported experiencing tingling sensations in her upper limbs and two episodes of weakness in her right arm that lasted for a few days before resolving. She noted that the weakness and tingling were exacerbated after taking a hot bath. What is the origin of the cells primarily impacted in this woman's condition?

      Your Answer:

      Correct Answer: Neural tube neuroepithelia

      Explanation:

      Multiple sclerosis is a neurodegenerative disorder caused by the loss of oligodendrocytes, which produce myelin in the central nervous system. These cells are derived from the neural tube neuroepithelial cells, not from mesenchymal cells, which develop into other tissue cells such as bone marrow, adipose tissue, and muscle cells. The neural crest cells give rise to the neurons of the peripheral nervous system and myelin-producing Schwann cells, while the mesoderm only gives rise to microglia during nervous system development. The notochord plays a role in inducing the overlying ectoderm to develop into the neuroectoderm and neural plate, and gives rise to the nucleus pulposus of the intervertebral disc. Ultimately, the oligodendrocytes are embryological derivatives of the neural tube neuroepithelia, which develop from the ectoderm overlying the notochord.

      Embryonic Development of the Nervous System

      The nervous system develops from the embryonic neural tube, which gives rise to the brain and spinal cord. The neural tube is divided into five regions, each of which gives rise to specific structures in the nervous system. The telencephalon gives rise to the cerebral cortex, lateral ventricles, and basal ganglia. The diencephalon gives rise to the thalamus, hypothalamus, optic nerves, and third ventricle. The mesencephalon gives rise to the midbrain and cerebral aqueduct. The metencephalon gives rise to the pons, cerebellum, and superior part of the fourth ventricle. The myelencephalon gives rise to the medulla and inferior part of the fourth ventricle.

      The neural tube is also divided into two plates: the alar plate and the basal plate. The alar plate gives rise to sensory neurons, while the basal plate gives rise to motor neurons. This division of the neural tube into different regions and plates is crucial for the proper development and function of the nervous system. Understanding the embryonic development of the nervous system is important for understanding the origins of neurological disorders and for developing new treatments for these disorders.

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      • Neurological System
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  • Question 27 - A 24-year-old dancer undergoes a thyroidectomy due to concerns about the appearance of...

    Incorrect

    • A 24-year-old dancer undergoes a thyroidectomy due to concerns about the appearance of her goitre. Following the surgery, she is informed that there was a laceration of the superior laryngeal nerve, which may affect her ability to produce higher pitches in her voice. She is referred for speech therapy.

      What counseling should be provided to this patient?

      Your Answer:

      Correct Answer: Nerve lacerations have a poor recovery, even with surgical nerve repair

      Explanation:

      The recovery of nerve lacerations is challenging due to the intricate nature of the neuronal system. However, there is a possibility of a better recovery if the injury is small, does not cause nerve stretching, requires a short nerve graft, and the patient is young and medically fit. It is worth noting that repaired nerves can regain sensory function similar to their pre-injury level.

      Nerve injuries can be classified into three types: neuropraxia, axonotmesis, and neurotmesis. Neuropraxia occurs when the nerve is intact but its electrical conduction is affected. However, full recovery is possible, and autonomic function is preserved. Wallerian degeneration, which is the degeneration of axons distal to the site of injury, does not occur. Axonotmesis, on the other hand, happens when the axon is damaged, but the myelin sheath is preserved, and the connective tissue framework is not affected. Wallerian degeneration occurs in this type of injury. Lastly, neurotmesis is the most severe type of nerve injury, where there is a disruption of the axon, myelin sheath, and surrounding connective tissue. Wallerian degeneration also occurs in this type of injury.

      Wallerian degeneration typically begins 24-36 hours following the injury. Axons are excitable before degeneration occurs, and the myelin sheath degenerates and is phagocytosed by tissue macrophages. Neuronal repair may only occur physiologically where nerves are in direct contact. However, nerve regeneration may be hampered when a large defect is present, and it may not occur at all or result in the formation of a neuroma. If nerve regrowth occurs, it typically happens at a rate of 1mm per day.

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      • Neurological System
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  • Question 28 - A 10-year-old boy is rushed to the emergency department following a seizure. According...

    Incorrect

    • A 10-year-old boy is rushed to the emergency department following a seizure. According to his mother, the twitching started in his right hand while he was having breakfast, then spread to his arm and face, and eventually affected his entire body. The seizure lasted for a few minutes, and afterward, he felt groggy and had no recollection of what happened.

      Which part of the boy's brain was impacted by the seizure?

      Your Answer:

      Correct Answer: Frontal lobe

      Explanation:

      The correct location for a seizure with progressive clonic movements travelling from a distal site (fingers) proximally, known as a Jacksonian march, is the frontal lobe. Seizures in the occipital lobe present with visual disturbances, while seizures in the parietal lobe result in sensory changes and seizures in the temporal lobe present with hallucinations and automatisms. Absence seizures are associated with the thalamus and are characterized by brief losses of consciousness without postictal fatigue or grogginess.

      Localising Features of Focal Seizures in Epilepsy

      Focal seizures in epilepsy can be localised based on the specific location of the brain where they occur. Temporal lobe seizures are common and may occur with or without impairment of consciousness or awareness. Most patients experience an aura, which is typically a rising epigastric sensation, along with psychic or experiential phenomena such as déjà vu or jamais vu. Less commonly, hallucinations may occur, such as auditory, gustatory, or olfactory hallucinations. These seizures typically last around one minute and are often accompanied by automatisms, such as lip smacking, grabbing, or plucking.

      On the other hand, frontal lobe seizures are characterised by motor symptoms such as head or leg movements, posturing, postictal weakness, and Jacksonian march. Parietal lobe seizures, on the other hand, are sensory in nature and may cause paraesthesia. Finally, occipital lobe seizures may cause visual symptoms such as floaters or flashes. By identifying the specific location and type of seizure, doctors can better diagnose and treat epilepsy in patients.

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      • Neurological System
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  • Question 29 - A 50-year-old man comes to your clinic complaining of progressive dysarthria, dysphagia, facial...

    Incorrect

    • A 50-year-old man comes to your clinic complaining of progressive dysarthria, dysphagia, facial and tongue weakness, and emotional lability. During the examination, you observe an exaggerated jaw jerk reflex. Which cranial nerve is responsible for this efferent pathway of the reflex?

      Your Answer:

      Correct Answer: Mandibular division of the trigeminal nerve

      Explanation:

      The efferent limb of the jaw jerk reflex is controlled by the mandibular division of the trigeminal nerve (CN V3). This nerve supplies sensation to the lower face and buccal membranes of the mouth, as well as providing secretory-motor function to the parotid gland. In conditions with pathology above the spinal cord, such as pseudobulbar palsy, the jaw jerk reflex can become hyperreflexic as an upper motor sign. The ophthalmic division of the trigeminal nerve (CN V1) and the maxillary division of the trigeminal nerve (CN V2) are not responsible for the efferent limb of the jaw jerk reflex, as they provide sensory function to other areas of the face.

      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 30 - A 26-year-old female was admitted to the Emergency Department after a motorcycle accident....

    Incorrect

    • A 26-year-old female was admitted to the Emergency Department after a motorcycle accident. She reported experiencing intense pain in her left shoulder and a loss of strength in elbow flexion. The physician in the Emergency Department suspects that damage to the lateral cord of the brachial plexus may be responsible for the weakness.

      What are the end branches of this cord?

      Your Answer:

      Correct Answer: The musculocutaneous nerve and the lateral root of the median nerve

      Explanation:

      The two end branches of the lateral cord of the brachial plexus are the lateral root of the median nerve and the musculocutaneous nerve. If the musculocutaneous nerve is damaged, it can result in weakened elbow flexion. The posterior cord has two end branches, the axillary nerve and radial nerve. The lateral pectoral nerve is a branch of the lateral cord but not an end branch. The medial cord has two end branches, the medial root of the median nerve and the ulnar nerve.

      Brachial Plexus Cords and their Origins

      The brachial plexus cords are categorized based on their position in relation to the axillary artery. These cords pass over the first rib near the lung’s dome and under the clavicle, just behind the subclavian artery. The lateral cord is formed by the anterior divisions of the upper and middle trunks and gives rise to the lateral pectoral nerve, which originates from C5, C6, and C7. The medial cord is formed by the anterior division of the lower trunk and gives rise to the medial pectoral nerve, the medial brachial cutaneous nerve, and the medial antebrachial cutaneous nerve, which originate from C8, T1, and C8, T1, respectively. The posterior cord is formed by the posterior divisions of the three trunks (C5-T1) and gives rise to the upper and lower subscapular nerves, the thoracodorsal nerve to the latissimus dorsi (also known as the middle subscapular nerve), and the axillary and radial nerves.

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      • Neurological System
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