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  • Question 1 - A 78-year-old man is receiving community physiotherapy after a prolonged period of immobility...

    Correct

    • A 78-year-old man is receiving community physiotherapy after a prolonged period of immobility caused by depression. He is experiencing difficulty with hip abduction. Which muscle is primarily responsible for this movement?

      Your Answer: Gluteus medius

      Explanation:

      The correct muscle for hip abduction is the gluteus medius, which has anterior and posterior parts. The anterior part contributes to hip flexion and internal rotation, while the posterior part contributes to hip extension and external rotation. When both parts work together, they abduct the hip. The gluteus maximus primarily functions for hip extension and external rotation, while the hamstrings coordinate flexion and extension of the hip and knee joints but do not contribute to abduction. The iliopsoas primarily functions for hip extension.

      Anatomy of the Hip Joint

      The hip joint is formed by the articulation of the head of the femur with the acetabulum of the pelvis. Both of these structures are covered by articular hyaline cartilage. The acetabulum is formed at the junction of the ilium, pubis, and ischium, and is separated by the triradiate cartilage, which is a Y-shaped growth plate. The femoral head is held in place by the acetabular labrum. The normal angle between the femoral head and shaft is 130 degrees.

      There are several ligaments that support the hip joint. The transverse ligament connects the anterior and posterior ends of the articular cartilage, while the head of femur ligament (ligamentum teres) connects the acetabular notch to the fovea. In children, this ligament contains the arterial supply to the head of the femur. There are also extracapsular ligaments, including the iliofemoral ligament, which runs from the anterior iliac spine to the trochanteric line, the pubofemoral ligament, which connects the acetabulum to the lesser trochanter, and the ischiofemoral ligament, which provides posterior support from the ischium to the greater trochanter.

      The blood supply to the hip joint comes from the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head of the femur.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      6.4
      Seconds
  • Question 2 - Which one of the following is not part of the rectus sheath? ...

    Incorrect

    • Which one of the following is not part of the rectus sheath?

      Your Answer: Inferior epigastric vein

      Correct Answer: Internal iliac artery

      Explanation:

      The rectus sheath includes the inferior epigastric artery and the superior epigastric vein.

      Muscles and Layers of the Abdominal Wall

      The abdominal wall is composed of various muscles and layers that provide support and protection to the organs within the abdominal cavity. The two main muscles of the abdominal wall are the rectus abdominis and the quadratus lumborum. The rectus abdominis is located anteriorly, while the quadratus lumborum is located posteriorly.

      The remaining abdominal wall is made up of three muscular layers, each passing from the lateral aspect of the quadratus lumborum to the lateral margin of the rectus sheath. These layers are muscular posterolaterally and aponeurotic anteriorly. The external oblique muscle lies most superficially and originates from the 5th to 12th ribs, inserting into the anterior half of the outer aspect of the iliac crest, linea alba, and pubic tubercle. The internal oblique arises from the thoracolumbar fascia, the anterior 2/3 of the iliac crest, and the lateral 2/3 of the inguinal ligament, while the transversus abdominis is the innermost muscle, arising from the inner aspect of the costal cartilages of the lower 6 ribs, the anterior 2/3 of the iliac crest, and the lateral 1/3 of the inguinal ligament.

      During abdominal surgery, it is often necessary to divide either the muscles or their aponeuroses. It is desirable to divide the aponeurosis during a midline laparotomy, leaving the rectus sheath intact above the arcuate line and the muscles intact below it. Straying off the midline can lead to damage to the rectus muscles, particularly below the arcuate line where they may be in close proximity to each other. The nerve supply for these muscles is the anterior primary rami of T7-12.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      2.6
      Seconds
  • Question 3 - A 25-year-old man was in a car accident where two cars collided at...

    Incorrect

    • A 25-year-old man was in a car accident where two cars collided at around 60 miles per hour. After being stabilized, the doctor conducts a secondary survey and finds that the patient's right leg is adducted, flexed, and internally rotated. The diagnosis is a hip dislocation. What type of dislocation is probable and why?

      Your Answer: Anterior dislocation as the ischiofemoral ligament is strongest

      Correct Answer: Posterior dislocation as the iliofemoral ligament is strongest

      Explanation:

      The iliofemoral ligament is the strongest ligament stabilizing the hip joint, making posterior dislocations more common. The deep acetabulum of the hip provides stability and reduces the risk of anterior dislocation. The ischiofemoral ligament is the weakest of the three capsular ligaments and does not play a significant role in hip stability. Therefore, the iliofemoral ligament is the most important factor in preventing hip dislocation.

      Anatomy of the Hip Joint

      The hip joint is formed by the articulation of the head of the femur with the acetabulum of the pelvis. Both of these structures are covered by articular hyaline cartilage. The acetabulum is formed at the junction of the ilium, pubis, and ischium, and is separated by the triradiate cartilage, which is a Y-shaped growth plate. The femoral head is held in place by the acetabular labrum. The normal angle between the femoral head and shaft is 130 degrees.

      There are several ligaments that support the hip joint. The transverse ligament connects the anterior and posterior ends of the articular cartilage, while the head of femur ligament (ligamentum teres) connects the acetabular notch to the fovea. In children, this ligament contains the arterial supply to the head of the femur. There are also extracapsular ligaments, including the iliofemoral ligament, which runs from the anterior iliac spine to the trochanteric line, the pubofemoral ligament, which connects the acetabulum to the lesser trochanter, and the ischiofemoral ligament, which provides posterior support from the ischium to the greater trochanter.

      The blood supply to the hip joint comes from the medial circumflex femoral and lateral circumflex femoral arteries, which are branches of the profunda femoris. The inferior gluteal artery also contributes to the blood supply. These arteries form an anastomosis and travel up the femoral neck to supply the head of the femur.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      8.8
      Seconds
  • Question 4 - A 32-year-old man with a submandibular gland stone is undergoing excision of the...

    Incorrect

    • A 32-year-old man with a submandibular gland stone is undergoing excision of the submandibular gland. The incision is sited transversely approximately 4 cm below the mandible. After incising the skin, platysma and deep fascia which of the following structures is most likely to be encountered.

      Your Answer: Glossopharyngeal nerve

      Correct Answer: Facial vein

      Explanation:

      When accessing the submandibular gland, the facial vein and submandibular lymph nodes are the structures that are most easily visible. The gland is divided into a superficial and deep part by the mylohyoid muscle. The facial artery runs along the surface of the gland and can be seen in a groove. It then passes between the gland and the mandible before emerging on the face. During surgery, the facial vein is encountered first as the incision is made 4 cm below the mandible to prevent damage to the marginal mandibular nerve.

      Anatomy of the Submandibular Gland

      The submandibular gland is located beneath the mandible and is surrounded by the superficial platysma, deep fascia, and mandible. It is also in close proximity to various structures such as the submandibular lymph nodes, facial vein, marginal mandibular nerve, cervical branch of the facial nerve, deep facial artery, mylohyoid muscle, hyoglossus muscle, lingual nerve, submandibular ganglion, and hypoglossal nerve.

      The submandibular duct, also known as Wharton’s duct, is responsible for draining saliva from the gland. It opens laterally to the lingual frenulum on the anterior floor of the mouth and is approximately 5 cm in length. The lingual nerve wraps around the duct, and as it passes forward, it crosses medial to the nerve to lie above it before crossing back, lateral to it, to reach a position below the nerve.

      The submandibular gland receives sympathetic innervation from the superior cervical ganglion and parasympathetic innervation from the submandibular ganglion via the lingual nerve. Its arterial supply comes from a branch of the facial artery, which passes through the gland to groove its deep surface before emerging onto the face by passing between the gland and the mandible. The anterior facial vein provides venous drainage, and the gland’s lymphatic drainage goes to the deep cervical and jugular chains of nodes.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      19.1
      Seconds
  • Question 5 - Samantha, a 65-year-old female, visits a vascular clinic and complains of leg pain...

    Incorrect

    • Samantha, a 65-year-old female, visits a vascular clinic and complains of leg pain while walking, which subsides when she rests. However, she has recently experienced night pain in her leg that wakes her up. She has a medical history of hypertension, diabetes, and hypercholesterolemia, and her BMI is 29kg/m².

      The surgeon suspects peripheral vascular disease and conducts a peripheral vascular exam. During the exam, the surgeon finds it difficult to palpate the posterior tibial pulse.

      Where is the posterior tibial pulse located anatomically?

      Your Answer: Superior posteriorly to the lateral malleolus

      Correct Answer: Inferior posteriorly to the medial malleolus

      Explanation:

      The posterior tibial pulse is located inferiorly and posteriorly to the medial malleolus. It is not found superiorly or anteriorly to the medial malleolus, nor is it located posterior to the lateral malleolus. It is important to accurately locate the pulse for proper assessment and diagnosis.

      Anatomy of the Posterior Tibial Artery

      The posterior tibial artery is a major branch of the popliteal artery that terminates by dividing into the medial and lateral plantar arteries. It is accompanied by two veins throughout its length and its position corresponds to a line drawn from the lower angle of the popliteal fossa to a point midway between the medial malleolus and the most prominent part of the heel.

      The artery is located anteriorly to the tibialis posterior and flexor digitorum longus muscles, and posteriorly to the surface of the tibia and ankle joint. The posterior tibial nerve is located 2.5 cm distal to its origin. The proximal part of the artery is covered by the gastrocnemius and soleus muscles, while the distal part is covered by skin and fascia. The artery is also covered by the fascia overlying the deep muscular layer.

      Understanding the anatomy of the posterior tibial artery is important for medical professionals, as it plays a crucial role in the blood supply to the foot and ankle. Any damage or blockage to this artery can lead to serious complications, such as peripheral artery disease or even amputation.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      17
      Seconds
  • Question 6 - A 26-year-old woman comes to her GP complaining of low back pain. She...

    Correct

    • A 26-year-old woman comes to her GP complaining of low back pain. She is in good health otherwise. She reports several finger and wrist fractures during her childhood. Her father and sister have also experienced multiple fractures throughout their lives. On examination, she displays paralumbar tenderness and scoliosis. Her sclera is blue-grey. What type of collagen mutation is likely responsible for her condition?

      Your Answer: Type 1

      Explanation:

      Osteogenesis imperfecta is caused by an abnormality in type 1 collagen, which is the primary component of bone, skin, and tendons. The diagnosis is based on a combination of factors, including a history of fractures, scoliosis, family history, and physical examination findings. In contrast, mutations in type 2 collagen can lead to chondrodysplasias, while mutations in type 3 collagen may cause a type of Ehlers-Danlos syndrome. Additionally, mutations in type 4 collagen can result in Alport’s syndrome and Goodpasture’s syndrome, as this type of collagen forms the basal lamina.

      Understanding Osteogenesis Imperfecta

      Osteogenesis imperfecta, also known as brittle bone disease, is a group of disorders that affect collagen metabolism, leading to bone fragility and fractures. The most common type of osteogenesis imperfecta is type 1, which is inherited in an autosomal dominant manner and is caused by decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides.

      This condition typically presents in childhood, with individuals experiencing fractures following minor trauma. Other common features include blue sclera, deafness secondary to otosclerosis, and dental imperfections. Despite these symptoms, adjusted calcium, phosphate, parathyroid hormone, and ALP results are usually normal in individuals with osteogenesis imperfecta.

      Overall, understanding the symptoms and underlying causes of osteogenesis imperfecta is crucial for proper diagnosis and management of this condition.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      7.4
      Seconds
  • Question 7 - A 30-year-old male runner visits his doctor with a rough, hard, warty growth...

    Correct

    • A 30-year-old male runner visits his doctor with a rough, hard, warty growth on the sole of his foot. He has observed a tiny black spot in the center of the wart. The lesion has been there for 8 weeks.

      What is the probable cause of his condition?

      Your Answer: Human papillomavirus

      Explanation:

      The human papillomavirus is responsible for causing plantar warts, which are non-cancerous and typically resolve on their own. These warts are more common in individuals who frequent public showers, as the warm and damp environment is conducive to their growth. They are characterized by a rough and thickened surface, often with small black spots resulting from clotted blood vessels.

      Understanding Viral Warts: When to Seek Treatment

      Viral warts are a common skin condition caused by the human papillomavirus (HPV). While they are generally harmless, they can be painful and unsightly, leading some patients to seek treatment. However, in most cases, treatment is not necessary as warts will typically resolve on their own within a few months to two years. In fact, it can take up to 10 years for warts to disappear in adults.

      It is important to note that while viral warts are not a serious medical concern, they can be contagious and easily spread through skin-to-skin contact or contact with contaminated surfaces. Therefore, it is important to practice good hygiene and avoid sharing personal items such as towels or razors with others to prevent the spread of warts.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      9.5
      Seconds
  • Question 8 - An injury to the spinal accessory nerve will impact which movements? ...

    Correct

    • An injury to the spinal accessory nerve will impact which movements?

      Your Answer: Upward rotation of the scapula

      Explanation:

      The spinal accessory nerve controls the trapezius muscle, which retracts the scapula and upwardly rotates it through the combined action of its upper and lower fibers.

      The shoulder joint is a shallow synovial ball and socket joint that is inherently unstable but capable of a wide range of movement. Stability is provided by the muscles of the rotator cuff. The glenoid labrum is a fibrocartilaginous rim attached to the free edge of the glenoid cavity. The fibrous capsule attaches to the scapula, humerus, and tendons of various muscles. Movements of the shoulder joint are controlled by different muscles. The joint is closely related to important anatomical structures such as the brachial plexus, axillary artery and vein, and various nerves and vessels.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      9
      Seconds
  • Question 9 - A 30-year-old construction worker presents to the GP with a complaint of right...

    Correct

    • A 30-year-old construction worker presents to the GP with a complaint of right forearm pain that started 2 days ago. He reports that the pain began suddenly after lifting heavy equipment and has been progressively worsening. Upon examination, there is noticeable swelling in the forearm, and the pain intensifies with flexion of the elbow. The GP suspects a possible injury to the brachioradialis muscle.

      Which nerve could have been impacted by this injury?

      Your Answer: Radial nerve

      Explanation:

      The correct nerve that supplies innervation to the brachioradialis muscle is the radial nerve.

      Upper limb anatomy is a common topic in examinations, and it is important to know certain facts about the nerves and muscles involved. The musculocutaneous nerve is responsible for elbow flexion and supination, and typically only injured as part of a brachial plexus injury. The axillary nerve controls shoulder abduction and can be damaged in cases of humeral neck fracture or dislocation, resulting in a flattened deltoid. The radial nerve is responsible for extension in the forearm, wrist, fingers, and thumb, and can be damaged in cases of humeral midshaft fracture, resulting in wrist drop. The median nerve controls the LOAF muscles and can be damaged in cases of carpal tunnel syndrome or elbow injury. The ulnar nerve controls wrist flexion and can be damaged in cases of medial epicondyle fracture, resulting in a claw hand. The long thoracic nerve controls the serratus anterior and can be damaged during sports or as a complication of mastectomy, resulting in a winged scapula. The brachial plexus can also be damaged, resulting in Erb-Duchenne palsy or Klumpke injury, which can cause the arm to hang by the side and be internally rotated or associated with Horner’s syndrome, respectively.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      22.4
      Seconds
  • Question 10 - A 46-year-old woman arrives at the emergency department after falling while walking her...

    Correct

    • A 46-year-old woman arrives at the emergency department after falling while walking her dog. She explains that she stumbled on the pavement and landed on her left hand, with her hands taking the brunt of the fall.

      During the examination, the doctor notices tenderness over the anatomical snuffbox and telescoping of the left thumb. What other structure is in danger of being harmed, considering the probable diagnosis?

      Your Answer: Radial artery

      Explanation:

      The anatomical snuffbox contains the radial artery and is a common site for scaphoid fractures. The scaphoid bone forms the floor of the snuffbox and the radial artery provides its blood supply. Missing a scaphoid fracture can lead to avascular necrosis. Other structures such as the flexor pollicis longus tendon, median nerve, pisiform bone, and ulnar artery do not lie within the snuffbox.

      The Anatomical Snuffbox: A Triangle on the Wrist

      The anatomical snuffbox is a triangular depression located on the lateral aspect of the wrist. It is bordered by tendons of the extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus muscles, as well as the styloid process of the radius. The floor of the snuffbox is formed by the trapezium and scaphoid bones. The apex of the triangle is located distally, while the posterior border is formed by the tendon of the extensor pollicis longus. The radial artery runs through the snuffbox, making it an important landmark for medical professionals.

      In summary, the anatomical snuffbox is a small triangular area on the wrist that is bordered by tendons and bones. It is an important landmark for medical professionals due to the presence of the radial artery.

    • This question is part of the following fields:

      • Musculoskeletal System And Skin
      45.6
      Seconds

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Musculoskeletal System And Skin (6/10) 60%
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