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Question 1
Incorrect
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A 42-year-old man presented to the emergency room after an incident of slipping and falling onto his back and left hip. Upon physical examination, it was noted that he has pain on hip adduction, but normal hip flexion. Which of the following muscles was most likely injured in this case?
Your Answer: Iliacus
Correct Answer: Pectineus
Explanation:The hip adductors are a group of five muscles located in the medial compartment of the thigh. These muscles are the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus.The hip flexors consist of 5 key muscles that contribute to hip flexion: iliacus, psoas, pectineus, rectus femoris, and sartorius.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 2
Correct
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A 27-year-old man has been diagnosed with testicular cancer and has spread to the regional lymph nodes. The lymph from the testes will drain to which of the following nodes?
Your Answer: Para-aortic lymph nodes
Explanation:Testes are retroperitoneal organs and its lymphatic drainage is to the lumbar and para-aortic nodes along the lumbar vertebrae.The scrotum is the one which drains into the nearby superficial inguinal nodes.The glans penis and clitoris drains into the deep inguinal lymph nodes.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 3
Correct
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Which of the following is NOT a typical side effect of opioid analgesics:
Your Answer: Diarrhoea
Explanation:All opioids have the potential to cause:Gastrointestinal effects – Nausea, vomiting, constipation, difficulty with micturition (urinary retention), biliary spasmCentral nervous system effects – Sedation, euphoria, respiratory depression, miosisCardiovascular effects – Peripheral vasodilation, postural hypotensionDependence and tolerance
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 4
Incorrect
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Elevation of the eyeball is primarily produced by which of the following muscles:
Your Answer: Superior rectus and superior oblique
Correct Answer: Superior rectus and inferior oblique
Explanation:Elevation of the eyeball is produced by the superior rectus and the inferior oblique muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 5
Incorrect
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Which of the following clinical features is most suggestive of a lesion of the temporal lobe:
Your Answer: Hemispatial neglect
Correct Answer: Receptive dysphasia
Explanation:Damage to the Wernicke’s speech area in the temporal lobe can result in a receptive dysphasia. Hemispatial neglect is most likely to occur in a lesion of the parietal lobe. Homonymous hemianopia is most likely to occur in a lesion of the occipital lobe. Expressive dysphasia is most likely to occur in a lesion of the Broca speech area in the frontal lobe. Conjugate eye deviation towards the side of the lesion is most likely to occur in a lesion of the frontal lobe.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 6
Incorrect
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Which of the following is NOT a side effect of phenytoin:
Your Answer: Ataxia
Correct Answer: Ototoxicity
Explanation:Adverse effects of phenytoin include:Nausea and vomitingDrowsiness, lethargy, and loss of concentrationHeadache, dizziness, tremor, nystagmus and ataxiaGum enlargement or overgrowthCoarsening of facial features, acne and hirsutismSkin rashesBlood disorders
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 7
Correct
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A 30-year-old rugby player suffers from an anterior cruciate ligament tear while pivoting to attempt to run around another player. An MRI was performed and showed that his injury caused two other structures in the knee joint to be injured. Which of the following structures is most likely also injured?
Your Answer: Medial meniscus
Explanation:The O’Donoghue unhappy triad or terrible triad often occurs in contact and non-contact sports, such as basketball, football, or rugby, when there is a lateral force applied to the knee while the foot is fixated on the ground. This produces an abduction-external rotation mechanism of injury.The O’Donoghue unhappy triad comprises three types of soft tissue injury that frequently tend to occur simultaneously in knee injuries. O’Donoghue described the injuries as: anterior cruciate ligament tear, medial collateral ligament injury, and medial meniscal tear (lateral compartment bone bruise).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 8
Correct
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Question 9
Incorrect
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A patent has weakness of humeral flexion and extension. A CT scan reveals that he has suffered damage to the nerve that innervates pectoralis major.Pectoralis major receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer: Lateral pectoral nerve and long thoracic nerve
Correct Answer: Lateral and medial pectoral nerves
Explanation:Pectoralis major is a thick, fan-shaped muscle situated in the chest. It makes up the bulk of the chest musculature in the male and lies underneath the breast in the female. It overlies the thinner pectoralis minor muscle.Superficial muscles of the chest and arm showing pectoralis major (from Gray’s Anatomy)Pectoralis major has two heads; the clavicular head and the sternocostal head. The clavicular head originates from the anterior border and medial half of the clavicle. The sternocostal head originates from the anterior surface of the sternum, the superior six costal cartilages and the aponeurosis of the external oblique muscle. It inserts into the lateral lip of the bicipital groove of the humerus.Pectoralis major receives dual innervation from the medial pectoral nerve and the lateral pectoral nerve.Its main actions are as follows:Flexes humerus (clavicular head)Extends humerus (sternocostal head)Adducts and medially rotates the humerusDraws scapula anteriorly and inferiorly
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 10
Incorrect
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Which of the following is a contraindication to the use of opioid analgesics:
Your Answer: Acute angle-closure glaucoma
Correct Answer: Raised intracranial pressure
Explanation:Opioids should be avoided in people who have: A risk of paralytic ileus (opioids reduce gastric motility)Acute respiratory depressionAn acute exacerbation of asthma (opioids can aggravate bronchoconstriction as a result of histamine release)Conditions associated with increased intracranial pressure including head injury (opioids can interfere with pupillary response making neurological assessment difficult and may cause retention of carbon dioxide aggravating the increased intracranial pressure)
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 11
Incorrect
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A man suffered from a back injury due to a fall from a ladder. Significant bruising was found to be overlying his latissimus dorsi muscle.Which of the following statements regarding the latissimus dorsi muscle is considered correct?
Your Answer: It is the most superficial back muscle
Correct Answer: It raises the body towards the arm during climbing
Explanation:The latissimus dorsi muscle is a broad, flat muscle that occupies the majority of the lower posterior thorax. The muscle’s primary function is of the upper extremity but is also considered to be a respiratory accessory muscle.Latissimus dorsi is a climbing muscle. With the arms fixed above the head, it can raise the trunk upwards, together with the help of pectoralis major. Functionally, the latissimus dorsi muscle belongs to the muscles of the scapular motion. This muscle is able to pull the inferior angle of the scapula in various directions, producing movements on the shoulder joint (internal rotation, adduction and extension of the arm). It is innervated by the thoracodorsal nerve (C6 – C8) from the posterior cord of the brachial plexus, which enters the muscle on its deep surface.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 12
Correct
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Which of the following is NOT a typical cerebellar sign:
Your Answer: Hypertonia
Explanation:Hypotonia means decreased muscle tone. It can be a condition on its own, called benign congenital hypotonia, or it can be indicative of another problem where there is progressive loss of muscle tone, such as muscular dystrophy or cerebral palsy. It is usually detected during infancy. Hypotonia is characteristic of cerebellar dysfunction.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 13
Correct
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Which of the following is NOT a typical feature of lithium toxicity:
Your Answer: Miosis
Explanation:Features of toxicity include:Increasing gastrointestinal disturbances (vomiting, diarrhoea, anorexia)Visual disturbancesPolyuria and incontinenceMuscle weakness and tremorTinnitusCNS disturbances (dizziness, confusion and drowsiness increasing to lack of coordination, restlessness, stupor)Abnormal reflexes and myoclonusHypernatraemiaWith severe overdosage (serum-lithium concentration > 2 mmol/L) seizures, cardiac arrhythmias (including sinoatrial block, bradycardia and first-degree heart block), blood pressure changes, electrolyte imbalance, circulatory failure, renal failure, coma and sudden death may occur.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 14
Incorrect
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A patient suffers a stab wound to the neck. The entry point of the blade is situated within the anterior triangle of the neck.Which of the following muscles is most likely to be involved? Select ONE answer only.
Your Answer: Sternocleidomastoid
Correct Answer: Sternothyroid
Explanation:The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:Muscles: thyrohyoid, sternothyroid, sternohyoid musclesOrgans: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid glandArteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteriesVeins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veinsNerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerveThe posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.Contents:Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodesNerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 15
Incorrect
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Which of the following tracts must be affected if a patient presents with decreased pain and temperature sensation in both lower extremities?
Your Answer:
Correct Answer: The lateral spinothalamic tract
Explanation:The main function of the spinothalamic tract is to carry pain and temperature via the lateral part of the pathway and crude touch via the anterior part. The spinothalamic tract pathway is an imperative sensory pathway in human survival because it enables one to move away from noxious stimuli by carrying pain and temperature information from the skin to the thalamus where it is processed and transmitted to the primary sensory cortex. The primary sensory cortex communicates with the primary motor cortex, which lies close to it, to generate rapid movement in response to potentially harmful stimuli. Furthermore, the spinothalamic tract has a role in responding to pruritogens, causing us to itch. Interestingly, itching suppresses the spinothalamic tract neuron response to the histamine effect.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 16
Incorrect
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The following statements are not true of the extensor carpi radialis brevis muscle, except?
Your Answer:
Correct Answer: It receives its blood supply from the radial artery
Explanation:Extensor carpi radialis brevis is a fusiform muscle found in the lateral part of the posterior forearm. Together with anconaeus, brachioradialis, extensor carpi radialis longus, extensor digitorum, extensor digiti minimi and extensor carpi ulnaris, it belongs to the superficial forearm extensor group. Extensor carpi radialis brevis originates from the lateral epicondyle of humerus via the common extensor tendon. This is a common origin that it shares with the extensor digitorum, extensor digiti minimi and extensor carpi ulnaris muscles. Some fibres also originate from the lateral intermuscular septum, a thick aponeurosis that covers the muscle itself, and from the radial collateral ligament.The muscle courses inferiorly, giving off a long tendon in the middle of the forearm which descends towards the dorsal hand. The tendon passes through a groove on the posterior surface of radius, deep to the extensor retinaculum. After traversing the extensor retinaculum space, the tendon inserts into the posterior aspect of the base of the third metacarpal bone.Extensor carpi radialis brevis is innervated directly by the radial nerve (C5- C8), or sometimes from its deep branch/posterior interosseous nerve. The radial nerve stems from the posterior cord of the brachial plexus.The muscle is vascularized by the radial recurrent artery, radial artery and deep brachial artery (via its radial collateral branch).Extensor carpi radialis brevis works together with extensor carpi ulnaris and extensor carpi radialis longus to extend the hand at the wrist joint. This action is vital in a sequence of muscle contractions needed for clenching a fist or making a grip. When performing these functions, wrist extension blocks the flexor muscles from on acting upon the hand. Instead, flexors act only on the digits, thereby flexing them and producing an effective hand grip, such as that seen in a tennis backhand. When the extensor carpi radialis brevis muscle contracts together with extensor carpi radialis longus and flexor carpi radialis, it contributes to producing hand abduction (radial deviation).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 17
Incorrect
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Given a patient with dislocation of the patella, which muscle is the most important to address during rehabilitation to prevent recurrent dislocation?
Your Answer:
Correct Answer: Vastus medialis
Explanation:Patellar dislocation is a disabling musculoskeletal disorder which predominantly affects younger people who are engaged in multidirectional physically active pursuits. Conservative (non-operative) treatment is the treatment of choice for FTPD (first time patellar dislocation). Quadriceps strengthening exercises are considered one of the principal management aims for people following FTPD. A United Kingdom (UK) survey of physiotherapy practice has shown that quadriceps strengthening and specific-vastus medialis obliquus (VMO) or distal vastus medialis (VM) muscle strengthening or recruitment exercises were two of the most frequently used interventions for this population. Specific VM exercises are favoured in some quarters based on the assumption that the VM has an important role in preventing excessive lateral patellar translation.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 18
Incorrect
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A 36-year-old man presented to the emergency room after an incident of slipping and falling onto his back and left hip. Upon physical examination, it was noted that he has pain on hip extension, but normal hip abduction. Which of the following muscles was most likely injured in this case?
Your Answer:
Correct Answer: Gluteus maximus
Explanation:The primary hip extensors are the gluteus maximus and the hamstrings such as the long head of the biceps femoris, the semitendinosus, and the semimembranosus. The extensor head of the adductor magnus is also considered a primary hip extensor.The hip abductor muscle group is located on the lateral thigh. The primary hip abductor muscles include the gluteus medius, gluteus minimus, and tensor fasciae latae.The secondary hip abductors include the piriformis, sartorius, and superior fibres of the gluteus maximus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 19
Incorrect
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A patient presents to ED complaining of pins and needles over the lateral three and a half digits. You suspect carpal tunnel syndrome. Which of the following clinical features would you most expect to see on examination:
Your Answer:
Correct Answer: Inability to touch the pad of the little finger with the thumb
Explanation:Compression of the median nerve in the carpal tunnel will result in weakness and atrophy of the thenar muscles – resulting in weakness of opposition, abduction and flexion of the thumb at the metacarpophalangeal joint and anaesthesia or paraesthesia over the distribution of the palmar digital branch of the median nerve (skin over the palmar surface and fingertips of the lateral three and a half digits). The adductor pollicis muscle is innervated by the ulnar nerve, and abduction of the fingers is produced by the interossei, also innervated by the ulnar nerve. Flexion of the interphalangeal joint of the thumb is produced by the flexor pollicis longus, and flexion of the distal interphalangeal joint of the index finger is produced by the flexor digitorum profundus. Median nerve injury at the wrist will not affect the long flexors of the forearm as these are innervated by the anterior interosseous nerve which arises in the proximal forearm.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 20
Incorrect
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A man presents to the emergency department with a hand laceration that has damaged the opponens digiti minimi muscle.All of the following statements regarding the opponens digiti minimi muscle is considered correct, except:
Your Answer:
Correct Answer: It is innervated by the superficial branch of the ulnar nerve
Explanation:Opponens digiti minimi (ODM) is an intrinsic muscle of the hand. It’s a triangular muscle that extends between the hamate bone (carpal bone) and the 5th metacarpal bone. It forms the hypothenar muscle group together with the abductor digiti minimi and flexor digiti minimi brevis, based on the medial side of the palm (hypothenar eminence). These muscles act together in moving the little finger. The opponens digiti minimi is responsible for flexion, lateral rotation and opposition of the little finger.Its origin is the hook of hamate and flexor retinaculum. It inserts into the medial border of 5th metacarpal bone. It is innervated by the deep branch of the ulnar nerve, which stems from the brachial plexus (C8, T1 spinal nerves).Its blood supply is by the deep palmar branch of ulnar artery and deep palmar arch, which is the terminal branch of the radial artery.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 21
Incorrect
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A 22 year old male has been stabbed and is brought to the ED with a stab wound to his upper limb. On examination, the patient is unable to flex the distal interphalangeal joints of the ring and little finger. However, the proximal interphalangeal joint is intact. The most likely affected nerve is which of the following, and at which level is this occurring?
Your Answer:
Correct Answer: Ulnar nerve at elbow
Explanation:The medial half of the flexor digitorum profundus is innervated by the ulnar nerve. Paralysis of this muscle results in loss of flexion at the distal interphalangeal joint of the ring and little finger. Flexion at the proximal interphalangeal joint is preserved as this is a function of the flexor digitorum superficialis which is innervated by the median nerve. The ulnar nerve is not correct as ulnar nerve injury at the wrist would not affect the long flexors, and the injury must have been more proximal.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 22
Incorrect
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A patient presents with a laceration on his hand and wrist that has cut the nerve that innervates opponens pollicis.The opponens pollicis muscle is innervated by which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: The recurrent branch of the median nerve
Explanation:Opponens pollicis is a small, triangular muscle that forms part of the thenar eminence. It originates from the flexor retinaculum and the tubercle of trapezium bone and inserts into the whole length of the first metacarpal bone on its radial side.Opponens pollicis is innervated by the recurrent branch of the median nerve and receives its blood supply from the superficial palmar arch.The main action of opponens pollicis is to flex the first metacarpal bone at the carpometacarpal joint, which opposes the thumb towards the centre of the palm. It also medially rotates the first metacarpal bone at the carpometacarpal joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 23
Incorrect
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A 76-year-old man presents with complaints of double vision. Upon physical examination, it was observed that he exhibits left-sided hemiplegia and left-sided loss of joint position sense, vibratory sense and discriminatory touch. In addition, he has the inability to abduct his right eye and is holding his head towards the right side. A CT scan was ordered and showed that he has suffered a right-sided stroke. Branches of which of the following arteries are most likely implicated in the case?
Your Answer:
Correct Answer: Basilar artery
Explanation:Inferior medial pontine syndrome, also known as Foville syndrome, is one of the brainstem stroke syndromes which occurs when there is infarction of the medial inferior aspect of the pons due to occlusion of the paramedian branches of the basilar artery.It is characterized by ipsilateral sixth nerve palsy, facial palsy, contralateral hemiparesis, contralateral loss of proprioception and vibration, ipsilateral ataxia, ipsilateral facial weakness, and lateral gaze paralysis and diplopia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 24
Incorrect
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Which of the following nerves supplies the abductor pollicis brevis?
Your Answer:
Correct Answer: The recurrent branch of the median nerve
Explanation:Abductor pollicis brevis is innervated by the recurrent (thenar) branch of median nerve (root value C8 and T1).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 25
Incorrect
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At rest, the left dome of the diaphragm normally reaches as high as which of the following:
Your Answer:
Correct Answer: Fifth intercostal space
Explanation:At rest the right dome of the diaphragm lies slightly higher than the left; this is thought to be due to the position of the liver. In normal expiration, the normal upper limits of the superior margins are the fifth rib for the right dome, the fifth intercostal space for the left dome and the xiphoid process for the central tendon.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 26
Incorrect
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Which of the following is true about the extensor carpi radialis longus?
Your Answer:
Correct Answer: It assists with abduction of the hand at the wrist
Explanation:The majority of extensor carpi radialis longus originates from the lateral supracondylar ridge of humerus (distal third) and anterior aspect of the lateral intermuscular septum of the arm. A small portion of its fibres originate from the common extensor tendon attached to the lateral epicondyle of humerus. The fibres unite into a muscle belly which extends approximately to the middle of the forearm. The muscle belly is then replaced by a flat tendon that travels distally along the lateral surface of the radius, together with the tendon of extensor carpi radialis brevis. Both tendons course towards the radial styloid process, deep to the tendons of abductor pollicis longus and extensor pollicis brevis muscles. Proximal to the wrist, the tendons of extensor carpi radialis longus and brevis pass behind the radial styloid process within a common synovial sheath and continue along the radial groove deep to the extensor retinaculum of the wrist. At this level, the tendon of extensor carpi radialis longus is crossed by the tendon of extensor pollicis longus, after which it inserts on the posterior aspect of the base of the second metacarpal bone. Some tendon slips can insert into the first and third metacarpal bones.Extensor carpi radialis longus receives innervation from the radial nerve, with contributions mainly from spinal nerves C5-C8. The radial nerve is a branch of the brachial plexus.Extensor carpi radialis longus receives blood supply mainly from the radial artery. It directly supplies the distal part of the muscle, while the rest of the muscle receives blood from one of its radial recurrent branches. The brachial artery also supplies a small portion of the muscle via the radial collateral artery.Extensor carpi radialis longus primarily acts on the wrist joint to produce two major actions: (1) wrist extension by working synergistically with extensor carpi radialis brevis and extensor carpi ulnaris, and (2) hand abduction (radial deviation), with the help of flexor carpi radialis.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 27
Incorrect
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Which of the following best describes the mechanism of action of aspirin:
Your Answer:
Correct Answer: Cyclo-oxygenase (COX) inhibitor
Explanation:Aspirin is a non-steroidal anti-inflammatory drug (NSAID). Aspirin irreversibly inhibits cyclooxygenase (COX) enzymes and the resulting inhibition of prostaglandin synthesis results in analgesic, antipyretic and to a lesser extent anti-inflammatory actions.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 28
Incorrect
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Which of the following is most likely to cause a bitemporal hemianopia:
Your Answer:
Correct Answer: Pituitary adenoma
Explanation:A bitemporal hemianopia is most likely due to compression at the optic chiasm. This may be caused by pituitary tumour, craniopharyngioma, meningioma, optic glioma or aneurysm of the internal carotid artery. A posterior cerebral stroke will most likely result in a contralateral homonymous hemianopia with macular sparing.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 29
Incorrect
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Which of the following is NOT a typical feature of a lesion to the vestibulocochlear nerve:
Your Answer:
Correct Answer: Hyperacusis
Explanation:Hyperacusis is increased acuity of hearing with hypersensitivity to low tones resulting from paralysis of the stapedius muscle, innervated by the facial nerve. General sensation to the face and to the anterior two-thirds of the tongue is carried by the divisions of the trigeminal nerve (although taste to the anterior two-thirds of the tongue is supplied by the facial nerve). Eye movements are mediated by the oculomotor, trochlear and abducens nerve. Ptosis results from paralysis of the levator palpebrae superioris, innervated by the oculomotor nerve, or the superior tarsal muscle, innervated by the sympathetic chain.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 30
Incorrect
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A 39-year-old guy comes to the emergency room with a persistent nasal bleed. You suspect the bleeding is coming from Little's area based on your examination. Which of the blood vessels listed below is most likely to be involved:
Your Answer:
Correct Answer: Sphenopalatine and superior labial arteries
Explanation:The Kiesselbach plexus is a vascular network formed by five arteries that supply oxygenated blood to the nasal septum, which refers to the wall separating the right and left sides of the nose. The five arteries that form the Kiesselbach plexus: the sphenopalatine artery, which branches from the maxillary artery originating behind the jawbone; the anterior ethmoidal artery, which branches from the ophthalmic artery behind the eye; the posterior ethmoidal artery, which also branches from the ophthalmic artery; the septal branch of the superior labial artery, which is a branch of the facial artery supplying blood to all of the superficial features of the face; and finally, the greater palatine artery, which is a terminal branch of the maxillary artery.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 31
Incorrect
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When there is the presence of distended and engorged veins in the umbilical area, which of the following portosystemic anastomoses has most likely occurred?
Your Answer:
Correct Answer: Para-umbilical veins and inferior epigastric vein
Explanation:Caput medusae is a condition that consists of collateral veins radiating from the umbilicus and results from recanalization of the umbilical vein.Under normal conditions, the portal venous blood traverses the liver and drains into the inferior vena cava of the systemic venous circulation by way of the hepatic veins. This is the direct route. However, other, smaller communications exist between the portal and systemic systems, and they become important when the direct route becomes blocked. These communications are as follows:At the lower third of the oesophagus, the oesophageal branches of the left gastric vein (portal tributary) anastomose with the oesophageal veins draining the middle third of the oesophagus into the azygos veins (systemic tributary).Halfway down the anal canal, the superior rectal veins (portal tributary) draining the upper half of the anal canal anastomosis with the middle and inferior rectal veins (systemic tributaries), which are tributaries of the internal iliac and internal pudendal veins, respectively.The paraumbilical veins connect the left branch of the portal vein with the superficial veins of the anterior abdominal wall (systemic tributaries). The paraumbilical veins travel in the falciform ligament and accompany the ligamentum teres.The veins of the ascending colon, descending colon, duodenum, pancreas, and liver (portal tributary) anastomose with the renal, lumbar, and phrenic veins (systemic tributaries).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 32
Incorrect
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The most important nerve for plantar flexion of the foot at the ankle joint is:
Your Answer:
Correct Answer: Tibial nerve
Explanation:Muscles of the posterior compartment of the leg, innervated by the tibial nerve, perform plantar flexion of the foot at the ankle joint. The fibularis longus (innervated by the superficial fibular nerve) assists in plantar flexion but is not the most important.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 33
Incorrect
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Compression of this nerve can cause weakness in the left leg while walking and thigh adduction weakness at the hip joint.
Your Answer:
Correct Answer: Obturator nerve
Explanation:The obturator nerve is a sensory and motor nerve that emerges from the lumbar plexus and innervates the thigh. This nerve supplies motor innervation to the medial compartment of the thigh, making it necessary for thigh adduction.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 34
Incorrect
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You assess a patient that has suffered a nerve injury that has paralysed her left latissimus dorsi muscle.Latissimus dorsi receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: Thoracodorsal nerve
Explanation:Latissimus dorsi originates from the lower part of the back, where it covers a wide area. It lies underneath the inferior fibres of trapezius superiorly, and trapezius is the most superficial back muscle.Superficial muscles of the back showing latissimus dorsi (from Gray’s Anatomy)Latissimus dorsi has a broad origin, arising from the spinous processes of T6-T12, the thoracolumbar fascia, the iliac crest and the inferior 3 or 4 ribs. The fibres converge into a tendon that inserts into the intertubercular groove of the humerus.Latissimus dorsi is innervated by the thoracodorsal nerve.Latissimus dorsi acts to extend, adduct and medially rotate the humerus. It, therefore, raises the body towards the arm during climbing.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 35
Incorrect
-
A 34-year-old man presents with loss of vision in his left eye due to an episode of optic neuritis. Upon history taking, it was noted that he has a history of multiple sclerosis. Which of the following anatomical points in the visual pathway has the lesion occurred?
Your Answer:
Correct Answer: Optic nerve
Explanation:A lesion in the optic nerve causes ipsilateral monocular visual loss.Optic neuritis is an inflammatory demyelination of the optic nerve that is highly associated with multiple sclerosis. The two most common symptoms of optic neuritis are vision loss and eye pain.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 36
Incorrect
-
Which of the following cervical nerves is likely to be affected if your patient is complaining of elbow extension weakness and loss of sensation in her middle finger? She also has pain and tenderness in her cervical region, which is caused by a herniated disc, all after a whiplash-type injury in a car accident.
Your Answer:
Correct Answer: C7
Explanation:A C7 spinal nerve controls elbow extension and some finger extension. Damage to this nerve can result in a burning pain in the shoulder blade or back of the arms. The ability to extend shoulders, arms, and fingers may also be affected. Dexterity may also be compromised in the hands or fingers.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 37
Incorrect
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Question 38
Incorrect
-
A 70-year-old woman presents with right-sided loss of pain and temperature sense on the body as well as left-sided loss of pain and temperature sense on the face. She also has complaints of vertigo, nausea, and tinnitus. Further examination of her cranial nerves suggest the presence of Horner's Syndrome. An MRI and CT scan was ordered and results showed that she is suffering from a left-sided stroke. Branches of which of the following arteries are most likely implicated in the case?
Your Answer:
Correct Answer: Posterior inferior cerebellar artery
Explanation:Wallenberg syndrome is also known as lateral medullary syndrome and posterior inferior cerebellar artery syndrome. It is the most common posterior circulation ischemic stroke syndrome. The primary pathology of Wallenberg syndrome is occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches.It is characterized by vertigo with nystagmus, nausea and vomiting, and sometimes hiccups, dysphonia, dysarthria, and dysphagia often present with ipsilateral loss of gag reflex, ipsilateral ataxia with a tendency to fall to the ipsilateral side, pain and numbness with impaired facial sensation on the face, impaired taste sensation, and impaired pain and temperature sensation in the arms and legs.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 39
Incorrect
-
You are reviewing a patient complaining of loss of vision. Previous images shows a lesion at the optic chiasm. What type of visual field defect are you most likely to see in a lesion at the optic chiasm:
Your Answer:
Correct Answer: Bitemporal hemianopia
Explanation:A lesion at the optic chiasm will result in a bitemporal hemianopia.A lesion of the optic nerve will result in ipsilateral monocular visual loss.A lesion of the optic tract will result in a contralateral homonymous hemianopia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 40
Incorrect
-
Which of the following statements is true about percutaneous needle aspiration?
Your Answer:
Correct Answer: The needle should be inserted just above the upper border of the chosen rib
Explanation:Pleural aspiration describes a procedure whereby pleural fluid or air may be aspirated via a system inserted temporarily into the pleural space. This may be for diagnostic purposes (usually removing 20–50 ml fluid) or therapeutic to relieve symptoms. In the literature it is varyingly called thoracocentesis, thoracentesis or pleural aspiration.In determining the correct patient position and site of insertion, it is important for the operator to be aware of the normal anatomy of the thorax and the pathology of the patient. Patient position is dependent on the operator preference and the site of the pathology. In the case of a posterior lying locule, this may be specific to the image-guided spot where fluid is most likely to be obtained. In most circumstances, however, the site of insertion of the needle is either in the triangle of safety or the second intercostal space in the midclavicular line. The patient may therefore either sit upright leaning forward with arms elevated but resting on a table or bed, thereby exposing the axilla, or lying on a bed in a position. The needle is inserted in the space just above the chosen rib to avoid damaging the neurovascular bundle. It is common practice to insert the needle more posteriorly for a pleural aspiration, but it should be noted that the neurovascular bundle may not be covered by the lower flange of the rib in this position and a more lateral or anterior site of insertion is considered safer.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 41
Incorrect
-
Regarding the lung roots, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Generally the pulmonary arteries lie superior to the pulmonary veins in the lung root.
Explanation:Each lung root contains a pulmonary artery, two pulmonary veins, a main bronchus, bronchial vessels, nerves and lymphatics. Generally the pulmonary artery is superior in the lung root, the pulmonary veins are inferior and the bronchi are somewhat posterior in position. The vagus nerves pass posterior to the lung roots while the phrenic nerves pass anterior to them.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 42
Incorrect
-
A 68-year-old man with BPH presents to the emergency department in significant pain secondary to urinary retention. What is the location of the neuronal cell bodies that are responsible for urinary bladder discomfort sensation?
Your Answer:
Correct Answer: Dorsal root ganglia of spinal cord levels S2, S3 and S4
Explanation:The activation of stretch receptors with visceral afferents relayed through the pelvic nerve plexus and into the pelvic splanchnic nerves causes bladder pain. The sensory fibres of spinal nerves S2 – S4 enter the dorsal root ganglia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 43
Incorrect
-
A 27-year-old man presents with a laceration of his forearm that severed the nerve that innervates flexor carpi radialis.Which of the following nerves has been damaged in this case? Select ONE answer only.
Your Answer:
Correct Answer: The median nerve
Explanation:Flexor carpi radialis is innervated by the median nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 44
Incorrect
-
Which of the following clinical features is NOT typical of a facial nerve palsy:
Your Answer:
Correct Answer: Inability to raise the eyelid
Explanation:Facial nerve palsy can result in inability to close the eye due to paralysis of the orbicularis oculi muscle. Elevation of the eyelid in eye opening is a function of the levator palpebrae superioris muscle and the superior tarsal muscle, innervated by the oculomotor nerve and the sympathetic chain respectively.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 45
Incorrect
-
Which cervical interspace is most likely injured if a patient presents with difficulty of shoulder abduction and elbow flexion, pain in the right shoulder and lateral arm, and decreased sensation over the deltoid and lateral arm?
Your Answer:
Correct Answer: C4-C5
Explanation:In the setting of cervical radiculopathy, because the nerve root of a spinal nerve is compressed or otherwise impaired, the pain and symptomatology can spread far from the neck and radiates to arm, neck, chest, upper back and/or shoulders. Often muscle weakness and impaired deep tendon reflexes are noted along the course of the spinal nerve.Cervical radiculopathy is almost always unilateral, although, in rare cases, both nerves at a given level may be impacted. Those rare presentations can confound physical diagnosis and require acceleration to advanced imaging especially in cases of trauma. If there is nerve impingement, the affected side will be reduced relative to the unaffected side. Reduction in strength of muscles innervated by the affected nerve is also significant physical finding.For a C4-C5 injury, the following symptoms may present:Weakness in the deltoid muscle (front and side of the shoulder) and upper armShoulder painNumbness along the outside of the upper arm
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 46
Incorrect
-
Aside from the inability to extend the leg above the knee, which of the following clinical symptoms should you anticipate seeing in a patient who had a pelvic and right leg injury as well as femoral nerve damage?
Your Answer:
Correct Answer: Loss of sensation over the anterior thigh
Explanation:The femoral nerve runs down the front of the leg from the pelvis. It gives the front of the thigh and a portion of the lower leg sensation. Extension of the leg at the knee joint, flexion of the thigh at the hip are produced by muscles that is primarily innervated by the femoral nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 47
Incorrect
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You are taking care of a 55-year-old male patient who is a weightlifter. He is suspected of having a direct inguinal hernia. Where would this hernia appear?
Your Answer:
Correct Answer: Medial to the inferior epigastric artery
Explanation:A direct inguinal hernia is a form of groin hernia that occurs when abdominal viscera protrude through a weakness in the posterior wall of the inguinal canal, notably through Hesselbach’s triangle, medial to the inferior epigastric veins.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 48
Incorrect
-
Which of the following clinical features would you least expect to see in a lesion of the frontal lobe:
Your Answer:
Correct Answer: Contralateral homonymous hemianopia with macular sparing
Explanation:Contralateral homonymous hemianopia with macular sparing results from damage to the primary visual cortex of the occipital lobe. Incontinence may occur due to damage of the cortical micturition centre in the prefrontal cortex. Primitive reflexes and inability to problem solve may occur due to damage to the prefrontal cortex. Motor weakness of the contralateral limb with UMN signs may occur due to damage of the primary motor cortex.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 49
Incorrect
-
Which of the following clinical features is most suggestive of a lesion of the frontal lobe:
Your Answer:
Correct Answer: Conjugate eye deviation towards the side of the lesion
Explanation:Conjugate eye deviation towards the side of the lesion is seen in damage to the frontal eye field of the frontal lobe. Homonymous hemianopia is typically a result of damage to the occipital lobe (or of the optic radiation passing through the parietal and temporal lobes). Auditory agnosia may been seen in a lesion of the temporal lobe. Hemispatial neglect may be seen in a lesion of the parietal lobe. Receptive dysphasia is seen in damage to Wernicke’s area, in the temporal lobe.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 50
Incorrect
-
Which of the following is where the rectovesical fascia is located:
Your Answer:
Correct Answer: Between the fundus of the bladder and the ampulla of the rectum
Explanation:In a triangular area between the vasa deferentia, the bladder and rectum are separated only by rectovesical fascia, commonly known as Denonvillier’s fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 51
Incorrect
-
You note that the prostate of a 60-year-old patient is enlarged during the examination. You suspect BPH. Anatomically, the prostate has four main lobes. Which of the lobes is affected by benign prostatic hypertrophy?
Your Answer:
Correct Answer: Median lobe
Explanation:Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is characterized by an enlarged prostate gland. The prostate is divided into four major lobes. The median lobe is the most commonly affected by benign prostatic enlargement, resulting in urethral obstruction and urine symptoms.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 52
Incorrect
-
At which vertebral level does the spinal cord normally end in adults?
Your Answer:
Correct Answer: L1/L2
Explanation:The spinal cord starts at the foramen magnum, where it is continuous with the medulla oblongata, which is the most caudal portion of the brainstem.It then extends inferiorly through the vertebral canal. In adults, it usually ends at the level of the first or second lumbar vertebra.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 53
Incorrect
-
The following structures all lie anteriorly to the oesophagus EXCEPT for the:
Your Answer:
Correct Answer: Thoracic duct
Explanation:Posterior to the oesophagus, the thoracic duct is on the right side inferiorly but crosses to the left more superiorly (at T5).
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 54
Incorrect
-
A 60-year-old man with trauma to his cervical spine suffers from damage to the ansa cervicalis, resulting to paresis of his infrahyoid muscles.All of the following are considered infrahyoid muscles, except:
Your Answer:
Correct Answer: Mylohyoid
Explanation:Infrahyoid muscles are also known as “strap muscles” which connect the hyoid, sternum, clavicle and scapula. They are located below the hyoid bone on the anterolateral surface of the thyroid gland and are involved in movements of the hyoid bone and thyroid cartilage during vocalization, swallowing and mastication. They are composed of four paired muscles, organized into two layers.Superficial layer consists of the sternohyoid and omohyoidDeep layer consists of the sternothyroid and thyrohyoid.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 55
Incorrect
-
Following a road traffic collision, a patient sustains damage to the long thoracic nerve. Which of the following clinical findings would you most expect to see on examination:
Your Answer:
Correct Answer: Winged scapula deformity
Explanation:Damage to the long thoracic nerve results in weakness/paralysis of the serratus anterior muscle. Loss of function of this muscle causes the medial border, and particularly the inferior angle, of the scapula to elevate away from the thoracic wall, resulting in the characteristic ‘winging’ of the scapula. This deformity becomes more pronounced if the patient presses the upper limb against a wall. Furthermore, normal elevation of the arm is no longer possible.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 56
Incorrect
-
A 44 year old woman sustains an injury to the median nerve at the elbow after falling awkwardly. Which of the following clinical features are you LEAST likely to see on examination:
Your Answer:
Correct Answer: Loss of flexion of the medial two digits
Explanation:Flexion of the index and middle fingers at the IPJs is lost due to paralysis of the flexor digitorum superficialis and the lateral half of the flexor digitorum profundus. Flexion of the MCPJs of the index and middle fingers are lost due to paralysis of the lateral two lumbrical muscles. Flexion of the ring and little fingers are preserved as these are supported by the medial half of the flexor digitorum profundus and the medial two lumbrical muscles, innervated by the ulnar nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 57
Incorrect
-
A patient suffers a stab wound to the neck. The entry point of the blade is situated within the posterior triangle of the neck.Which of the following muscles is most likely to be involved? Select ONE answer only.
Your Answer:
Correct Answer: Anterior scalene
Explanation:The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:Muscles: thyrohyoid, sternothyroid, sternohyoid musclesOrgans: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid glandArteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteriesVeins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veinsNerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerveThe posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.Contents:Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodesNerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexusOf the muscles listed in the options, only the anterior scalene is situated within the posterior triangle of the neck.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 58
Incorrect
-
CSF is reabsorbed from subarachnoid space via which of the following structures:
Your Answer:
Correct Answer: Arachnoid granulations
Explanation:From the subarachnoid cisterns in the subarachnoid space, CSF is reabsorbed via arachnoid granulations which protrude into the dura mater, into the dural venous sinuses and from here back into the circulation.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 59
Incorrect
-
A man presents to the emergency department with an injury that has damaged the opponens pollicis muscle.Which of the following statements regarding the opponens pollicis muscle is considered correct?
Your Answer:
Correct Answer: It flexes the first metacarpal bone at the carpometacarpal joint
Explanation:Opponens pollicis is a muscle of thenar eminence, it is triangular in shape and lies deep to flexor pollicis brevis and abductor pollicis brevis. It originates from the flexor retinaculum, tubercles of scaphoid and trapezium, abductor pollicis longus tendon.Its insertion is in the radial side of the base of proximal phalanx of thumb. It is supplied by the median nerve (C8, T1). It receives blood supply from superficial arch.It flexes the metacarpal bone medially across the palm, also rotating it medially, causing opposition, the palmar aspect of the terminal segment of thumb contacts the flexor aspects of any other digit.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 60
Incorrect
-
Fracture of the medial epicondyle would result to the following, except
Your Answer:
Correct Answer: Weakness of abduction of the thumb
Explanation:Thumb abduction is mediated by the abductor pollicis longus and brevis, which are innervated by the radial and median nerves, respectively.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 61
Incorrect
-
A 65-year-old man complains of severe vertigo, nausea, and tinnitus. Upon presenting himself to the emergency room, it was observed that he is exhibiting ataxia, right-sided loss of pain and temperature sense on the face, and left-sided sensory loss to the body. An MRI and CT scan was ordered and the results showed that he is suffering from a right-sided stroke. Branches of which of the following arteries are most likely implicated in the case?
Your Answer:
Correct Answer: Basilar artery
Explanation:The lateral pontine syndrome occurs due to occlusion of perforating branches of the basilar and anterior inferior cerebellar (AICA) arteries. It is also known as Marie-Foix syndrome or Marie-Foix-Alajouanine syndrome. It is considered one of the brainstem stroke syndromes of the lateral aspect of the pons.It is characterized by ipsilateral limb ataxia, loss of pain and temperature sensation of the face, facial weakness, hearing loss, vertigo and nystagmus, hemiplegia/hemiparesis, and loss of pain and temperature sensation.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 62
Incorrect
-
A 45-year-old obese patient goes to the emergency department with a fever and significant right upper quadrant pain. The pain radiates to her right shoulder tip. Murphy's sign is positive and acute cholecystitis is diagnosed. The pain referred to the shoulder tip is caused by one of the following nerves:
Your Answer:
Correct Answer: Phrenic nerve
Explanation:Gallbladder inflammation can cause pain in the right upper quadrant and right shoulder, which is caused by irritation of the diaphragmatic peritoneum. Pain from areas supplied by the phrenic nerve is often referred to other somatic regions served by spinal nerves C3-C5.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 63
Incorrect
-
This anatomic part lies at the heart of the tooth.
Your Answer:
Correct Answer: The pulp cavity
Explanation:Within the central portion of the tooth lies the dental pulp. The pulp chamber provides mechanical support and functions as a barrier from external stimuli and the oral microbiome. The dental pulp is a unique tissue that is richly innervated and has an extensive microvascular network. Maintaining its vitality increases both the mechanical resistance of the tooth and the long-term survival. The junctional epithelium forms a band around the tooth at the base of the gingival sulcus, sealing off the periodontal tissues from the oral cavity.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 64
Incorrect
-
A 29-year-old man has been complaining about his recent headaches. Detailed history was taken and a neurological examination was performed.Which of the following cranial nerves is correctly paired with its lesion?
Your Answer:
Correct Answer: The oculomotor nerve: the eye appears to look ‘down and out’
Explanation:The following are the lesions of the cranial nerves:1. Olfactory nerve (I)Reduced taste and smell, but not to ammonia which stimulates the pain fibres carried in the trigeminal nerve2. Optic nerve (II)Manifested by visual field defects, pupillary abnormalities, optic neuritis, optic atrophy, papilledema3. Oculomotor nerve (III)A fixed, dilated pupil which doesn’t accommodate, ptosis, complete internal ophthalmoplegia (masked by ptosis), unopposed lateral rectus causes outward deviation of the eye. If the ocular sympathetic fibres are also affected behind the orbit, the pupil will be fixed but not dilated.4. Trochlear nerve (IV)Diplopia due to weakness of downward and inward eye movement. The most common cause of a pure vertical diplopia. The patient tends to compensate by tilting the head away from the affected side.5. Trigeminal nerve (V)Reduced sensation or dysesthesia over the affected area. Weakness of jaw clenching and side-to-side movement. If there is a lower motor neuron (LMN) lesion, the jaw deviates to the weak side when the mouth is opened. There may be fasciculation of temporalis and masseter.6. Abducens nerve (VI)Inability to look laterally. The eye is deviated medially because of unopposed action of the medial rectus muscle.7. Facial nerve (VII)Facial weakness. In an LMN lesion the forehead is paralysed – the final common pathway to the muscles is destroyed; whereas the upper facial muscles are partially spared in an upper motor neurone (UMN) lesion because of alternative pathways in the brainstem. There appear to be different pathways for voluntary and emotional movement. CVAs usually weaken voluntary movement, often sparing involuntary movements (e.g., spontaneous smiling). The much rarer selective loss of emotional movement is called mimic paralysis and is usually due to a frontal or thalamic lesion.8. Vestibulocochlear nerve (VIII)Unilateral sensorineural deafness, tinnitus. Slow-growing lesions seldom present with vestibular symptoms as compensation has time to occur.9. Glossopharyngeal nerve (IX)Unilateral lesions do not cause any deficit because of bilateral corticobulbar connections. Bilateral lesions result in pseudobulbar palsy. These nerves are closely interlinked.10. Vagus nerve (X)Palatal weakness can cause ‘nasal speech’ and nasal regurgitation of food. The palate moves asymmetrically when the patient says ‘ahh’. Recurrent nerve palsy results in hoarseness, loss of volume and ‘bovine cough’.11. Accessory nerve (XI)Weakness and wasting of sternocleidomastoid and trapezius muscles12.Hypoglossal nerve (XII)An LMN lesion produces wasting of the ipsilateral side of the tongue, with fasciculation; and on attempted protrusion the tongue deviates towards the affected side, but the tongue deviates away from the side of a central lesion.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 65
Incorrect
-
A 35 year old patient presents to ED having sustained an injury to his right hand whilst playing cricket. He is unable to fully straighten his right middle finger as the distal phalanx remains flexed. Which of the following structures within the digit was most likely injured:
Your Answer:
Correct Answer: Insertion of terminal extensor digitorum tendon
Explanation:Damage to the insertion of the terminal extensor digitorum tendon would result in loss of extension at the distal interphalangeal joint causing a fixed flexion deformity, called the Mallet deformity.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 66
Incorrect
-
A 70-year-old man has a resting tremor, rigidity, bradykinesia, and a shuffling gait. Parkinson's disease is caused by one of the following mechanisms:
Your Answer:
Correct Answer: Loss of dopaminergic neurons in the substantia nigra
Explanation:Parkinson’s disease (PD) is one of the most common neurologic disorders, affecting approximately 1% of individuals older than 60 years and causing progressive disability that can be slowed but not halted, by treatment. The 2 major neuropathologic findings in Parkinson’s disease are loss of pigmented dopaminergic neurons of the substantia nigra pars compacta and the presence of Lewy bodies and Lewy neurites. See the images below.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 67
Incorrect
-
Which of the following nerves supply the superficial head of the flexor pollicis brevis muscle?
Your Answer:
Correct Answer: The recurrent branch of the median nerve
Explanation:The two heads of the flexor pollicis brevis usually differ in their innervation. The superficial head of flexor pollicis muscle receives nervous supply from the recurrent branch of the median nerve, whereas the deep head receives innervation from the deep branch of the ulnar nerve, derived from spinal roots C8 and T1.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 68
Incorrect
-
Elevation of the mandible is produced primarily by which of the following muscles:
Your Answer:
Correct Answer: Temporalis, masseter and medial pterygoid
Explanation:Elevation of the mandible is generated by the temporalis, masseter and medial pterygoid muscles.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 69
Incorrect
-
Which coronary artery is mostly likely affected if an ECG shows a tombstone pattern in leads V2, V3 and V4?
Your Answer:
Correct Answer: Left anterior descending artery
Explanation:Tombstoning ST elevation myocardial infarction can be described as a STEMI characterized by tombstoning ST-segment elevation. This myocardial infarction is associated with extensive myocardial damage, reduced left ventricle function, serious hospital complications and poor prognosis. Tombstoning ECG pattern is a notion beyond morphological difference and is associated with more serious clinical results.Studies have shown that tombstoning is more commonly found in anterior than non-anterior STEMI, thus, higher rates of left anterior descending artery disease are observed in patients with tombstoning pattern.The following ECG leads determine the location and vessels involved in myocardial infarction:ECG Leads Location Vessel involvedV1-V2 Septal wall Left anterior descendingV3-V4 Anterior wall Left anterior descendingV5-V6 Lateral wall Left circumflex arteryII, III, aVF Inferior wall Right coronary artery (80%) or Left circumflex artery (20%)I, aVL High lateral wall Left circumflex arteryV1, V4R Right ventricle Right coronary arteryV7-V9 Posterior wall Right coronary artery
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 70
Incorrect
-
A patient suffers a stab wound to the neck. The entry point of the blade is situated within the anterior triangle of the neck.Which of the following muscles is most likely to be involved? Select ONE answer only.
Your Answer:
Correct Answer: Sternohyoid
Explanation:The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:Muscles: thyrohyoid, sternothyroid, sternohyoid musclesOrgans: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid glandArteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteriesVeins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veinsNerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerveThe posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.Contents:Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodesNerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 71
Incorrect
-
A 43-year-old woman presented to the emergency room after an incident of slipping and falling onto her back and left hip. Upon physical examination, it was noted that she has pain on hip abduction, but normal hip extension. Which of the following muscles was most likely injured in this case?
Your Answer:
Correct Answer: Gluteus medius
Explanation:The primary hip extensors are the gluteus maximus and the hamstrings such as the long head of the biceps femoris, the semitendinosus, and the semimembranosus. The extensor head of the adductor magnus is also considered a primary hip extensor.The hip abductor muscle group is located on the lateral thigh. The primary hip abductor muscles include the gluteus medius, gluteus minimus, and tensor fasciae latae.The secondary hip abductors include the piriformis, sartorius, and superior fibres of the gluteus maximus.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 72
Incorrect
-
Which of the following muscles is NOT involved in depression of the mandible:
Your Answer:
Correct Answer: Masseter
Explanation:Depression of the mandible is generated by the digastric, geniohyoid, mylohyoid and lateral pterygoid muscles on both side, assisted by gravity. The lateral pterygoid muscles are also involved as this movement also involves protraction of the mandible. The masseter muscle is a powerful elevator of the mandible.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 73
Incorrect
-
Which of the following nerves has been damaged when a patient presents with a foot drop?
Your Answer:
Correct Answer: Common peroneal nerve
Explanation:The common peroneal nerve often referred to as the common fibular nerve, is a major nerve that innervates the lower extremity. It is one of the two major branches off the sciatic nerve and receives fibres from the posterior divisions of L4 through S2 nerve roots. The common peroneal nerve separates from the sciatic nerve in the distal posterior thigh proximal to the popliteal fossa. After branching off of the sciatic nerve, it continues down the thigh, running posteroinferior to the biceps femoris muscle, and crosses laterally to the head of the lateral gastrocnemius muscle through the posterior intermuscular septum. The nerve then curves around the fibular neck before dividing into two branches, the superficial peroneal nerve (SPN) and the deep peroneal nerve (DPN). The common peroneal nerve does not have any motor innervation before dividing; however, it provides sensory innervation to the lateral leg via the lateral sural nerve.The superficial peroneal nerve innervates the lateral compartment of the leg, and the deep peroneal nerve innervates the anterior compartment of the leg and the dorsum of the foot. These two nerves are essential in the eversion of the foot and dorsiflexion of the foot, respectively. The superficial and deep peroneal nerves provide both motor and sensory innervation.The most common presentation with common peroneal nerve injury or palsy is acute foot drop, although symptoms may be progressive and can include sensory loss or pain. Weakness in foot eversion may occur if the superficial peroneal nerve component is involved.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 74
Incorrect
-
An 82 year old man has fever, left sided abdominal and back pain and presents to the emergency room. Imaging reveals a large perinephric abscess. Which of the following most likely describes the fluid location:
Your Answer:
Correct Answer: Between the renal capsule and the renal fascia
Explanation:The perinephric fat is immediately external to the renal capsule and completely surrounds the kidney. The renal fascia surrounds the perinephric fat and the paranephric fat is external to the renal fascia. The location of a perinephric abscess is in the perinephric fat between the renal capsule and the renal fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 75
Incorrect
-
In which of the following cases is intravenous phenytoin contraindicated?
Your Answer:
Correct Answer: Second degree heart block
Explanation:Phenytoin Contraindications include:HypersensitivitySinus bradycardiaSinoatrial blockSecond and third degree A-V blockAdams-Stokes syndromeConcurrent use with delavirdineHistory of prior acute hepatotoxicity attributable to phenytoin
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 76
Incorrect
-
Which of the following statements is false regarding the biceps brachii muscle?
Your Answer:
Correct Answer: It pronates the radioulnar joint in the forearm
Explanation:The biceps brachii muscle is one of the chief muscles of the arm. The origin at the scapula and the insertion into the radius of the biceps brachii means it can act on both the shoulder joint and the elbow joint, which is why this muscle participates in a few movements of the arm. It derives its name from its two heads which merge in one unique distal body, defining the unusual structure of the muscle.The biceps brachii muscle is supplied by the musculocutaneous nerve (C5-C6), a branch of the brachial plexus.Arterial supply to the biceps brachii muscle varies considerably, coming from up to eight vessels originating from the brachial artery in the middle third of the arm.In the shoulder joint both muscle heads partially enforce opposite movements. The long head pulls the arm away from the trunk (abduction) and turns it inwards (inward rotation) whereas the short head pulls the arm back towards the trunk (adduction). When both heads contract simultaneously it leads to an arm bend (flexion). In the elbow joint the muscle bends the forearm (flexion) and rotates it outwards (supination). The supination is most powerful in a flexed elbow. In addition to the movement functions, the biceps has the important task to support the humeral head within the shoulder joint. Its antagonist is the triceps brachii in the posterior compartment of the arm.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 77
Incorrect
-
Regarding the hard palate, which of the following statements is CORRECT:
Your Answer:
Correct Answer: Lymphatic vessels from the palate usually drain into deep cervical lymph nodes.
Explanation:Lymphatic vessels from the pharynx and palate drain into the deep cervical lymph nodes.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 78
Incorrect
-
A patient suffers an injury to his thigh that damages the nerve that innervates pectineus.Which of the following nerves has been damaged in this case? Select ONE answer only.
Your Answer:
Correct Answer: Femoral nerve
Explanation:Pectineus is innervated by the femoral nerve. It may also receive a branch from the obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 79
Incorrect
-
A 26-year old female comes to the Emergency Room with complaints of bloody stools. She reports that prior to the passage of bloody stools, she experienced a sharp pain during defecation. Medical history reveals that she has been experiencing constipation for the past 2 weeks. After completing her medical history and physical examination, the attending physician gives an initial diagnosis of an anal fissure.Which of the following nerves transmit painful sensation from the anus, resulting in the pain associated with anal fissure?
Your Answer:
Correct Answer: Inferior rectal nerve
Explanation:A fissure in ano is a tear in the anoderm distal to the dentate line. The pathophysiology of anal fissure is thought to be related to trauma from either the passage of hard stool or prolonged diarrhoea. A tear in the anoderm causes spasm of the internal anal sphincter, which results in pain, increased tearing, and decreased blood supply to the anoderm. The site of the anal fissure in the sensitive lower half of the anal canal, which is innervated by the inferior rectal nerve, results in reflex spasm of the external anal sphincter, aggravating the condition. Because of the intense pain, anal fissures may have to be examined under local anaesthesia.The inferior rectal nerve is a branch of the pudendal nerve. This nerve runs medially across the ischiorectal fossa and supplies the external anal sphincter, the mucous membrane of the lower half of the anal canal, and the perianal skin.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 80
Incorrect
-
The most common complication of paracetamol overdose is:
Your Answer:
Correct Answer: Hepatic failure
Explanation:The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 81
Incorrect
-
A patient presents complaining of visual loss. On examination you note a contralateral homonymous hemianopia. Where is the most likely site of the lesion:
Your Answer:
Correct Answer: Optic tract
Explanation:At the optic chiasm, fibres from the medial (nasal) half of each retina crossover, forming the right and left optic tracts.The left optic tract contains fibres from the left lateral (temporal) retina and the right medial retina.The right optic tract contains fibres from the right lateral retina and the left medial retina.Each optic tract travels to its corresponding cerebral hemisphere to reach its lateral geniculate nucleus (LGN) located in the thalamus where the fibres synapse.A lesion of the optic tract will cause a contralateral homonymous hemianopia.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 82
Incorrect
-
Most of the lymph from vessels that drain the breast is collected in which of the following lymph nodes?
Your Answer:
Correct Answer: Axillary nodes
Explanation:Lymph is the fluid that flows through the lymphatic system. Axillary lymph nodes are near the breasts. They are often the first location to which breast cancer spreads if it moves beyond the breast tissue. They receive approximately 75% of lymph drainage from the breast via lymphatic vessels, laterally and superiorly. The lymph usually first drains to the anterior axillary nodes, and from here, through the central axillary, apical, and supraclavicular nodes in sequence.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 83
Incorrect
-
A paediatric patient comes to the emergency room with complaints of right lower quadrant pain. The attending physician is considering appendicitis. Inside the operating room, the surgeon asks the medical student to locate the McBurney's point prior to the first incision.Which of the following is the surface anatomy of the McBurney's point?
Your Answer:
Correct Answer: One-third of the distance from the anterior superior iliac spine to the umbilicus
Explanation:Inflammation of the appendix is a significant public health problem with a lifetime incidence of 8.6% in men and 6.7% in women, with the highest incidence occurring in the second and third decade of life. While the rate of appendectomy in developed countries has decreased over the last several decades, it remains one of the most frequent emergent abdominal operations. Appendicitis can often result in anorexia, nausea, vomiting, and fever.McBurney’s point, which is found one-third of the distance between the anterior superior iliac spine and the umbilicus, is often the point of maximal tenderness in a patient with an anatomically normal appendix. A McBurney’s incision is chiefly used for cecostomy and appendectomy. It gives a limited exposure only, and should any doubt arise about the diagnosis, an infraumbilical right paramedian incision should be used instead.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 84
Incorrect
-
A patient presents with pain in the wrist and a tingling in the hand. On examination Tinel's test is positive and you diagnose carpal tunnel syndrome. Regarding the carpal tunnel, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: The tendons of the flexor digitorum profundus, flexor digitorum superficialis and flexor pollicis longus lie within a single synovial sheath.
Explanation:Free movement of the tendons in the carpal tunnel is facilitated by synovial sheaths, which surround the tendons. All of the tendons of the FDP and FDS are contained within a single synovial sheath with a separate sheath enclosing the tendon of the FPL.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 85
Incorrect
-
A 35 year old man presents with a deep laceration to the proximal part of the forearm. On further assessment, the patient is unable to flex the metacarpophalangeal joints and interphalangeal joints of the index, middle finger and the thumb. The ring and little fingers are intact but there is weakness at the proximal interphalangeal joint.There is also loss of sensation over the lateral palm and the palmar surface of the lateral three and a half fingers. Which of these nerve(s) has most likely been affected?
Your Answer:
Correct Answer: Median nerve
Explanation:A median nerve injury affecting the extrinsic and intrinsic muscles of the hand will present with:Loss of sensation to the lateral palm and the lateral three and a half fingers.Weakness of flexion at the metacarpophalangeal joints of the index and middle finger. This is because of paralysis of the lateral two lumbricals. Weakness of flexion of the proximal interphalangeal joints of all four fingers due to paralysis of the flexor digitorum superficialisWeakness of flexion at the distal interphalangeal joints of the index and middle finger following paralysis of the lateral half of the flexor digitorum profundus.Weakness of thumb flexion, abduction and opposition due to paralysis of the flexor pollicis longus and thenar muscles
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 86
Incorrect
-
A 70-year-old man presents with right-sided hemiplegia and loss of joint position sense, vibratory sense, and discriminatory touch. Upon further physical examination, it was observed that her tongue deviates to the left-hand side. An MRI and CT scan was ordered and results showed that he was suffering a left-sided stroke. Which of the following is considered the best diagnosis for the case presented above?
Your Answer:
Correct Answer: Medial medullary syndrome
Explanation:Medial medullary syndrome is a form of stroke that affects the medial medulla of the brain. It is caused by a lesion in the medial part of the medulla, which is due to an infraction of vertebral arteries and/or paramedian branches of the anterior spinal artery.It is characterized by contralateral paralysis of the upper and lower limb of the body, a contralateral decrease in proprioception, vibration, and/or fine touch sensation, paresthesias or less commonly dysesthesias in the contralateral trunk and lower limb, and loss of position and vibration sense with proprioceptive dysfunction. Ipsilateral deviation of the tongue due to ipsilateral hypoglossal nerve damage can also be seen.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 87
Incorrect
-
An injury to which nerve affects innervation to the adductor portion of the adductor magnus?
Your Answer:
Correct Answer: Posterior branch of the obturator nerve
Explanation:The nerves that supply the adductor magnus muscle have an embryologic origin from the anterior divisions of the lumbosacral plexus and include the obturator nerve, posterior division (L2-4), and the tibial portion of the sciatic nerve (L4). It is innervated by the posterior division of the obturator nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 88
Incorrect
-
A 21-year-old student presents to the minors area of your Emergency Department with a laceration on his external nose that occurred during sparring in a kickboxing class. The area is bleeding profusely and will require suturing. Pressure is being applied. The laceration extends through some of the nasal muscles.Motor innervation of the nasal muscles of facial expression is provided by which of the following ? Select ONE answer only.
Your Answer:
Correct Answer: Facial nerve
Explanation:The facial nerve (the labyrinthine segment) is the seventh cranial nerve, or simply CN VII. It emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue.Motor innervation of the nasal muscles of facial expression is provided by the facial nerve (CN VII).
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 89
Incorrect
-
In inserting a nasogastric tube, which area is least likely to be a site of resistance when the tube goes from the nose to the stomach?
Your Answer:
Correct Answer: In the posterior mediastinum where the oesophagus is crossed by the pulmonary trunk
Explanation:In the posterior mediastinum where the oesophagus is crossed by the pulmonary trunk offers the least resistance when nasogastric tube is inserted from the nose to the stomach.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 90
Incorrect
-
During quiet respiration, position of the right oblique fissure can be marked by a line drawn on the thoracic wall that:
Your Answer:
Correct Answer: Begins at the spinous process of T4, crosses the fifth intercostal space laterally and follows the contour of rib 6 anteriorly.
Explanation:During quiet respiration, the approximate position of the right oblique fissure can be marked by a line on the thoracic wall that begins at the spinous process of vertebra T4, crosses the fifth intercostal space laterally and then follows the contour of rib 6 anteriorly.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 91
Incorrect
-
In which part of the gastrointestinal tract is Meckel's diverticulum commonly located?
Your Answer:
Correct Answer: Ileum
Explanation:Meckel’s diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract, affecting approximately 2% of the general population. Meckel’s diverticulum are designated true diverticula because their walls contain all the layers found in normal small intestine. Their location varies among individual patients, but they are usually found in the ileum within 100 cm of the ileocecal valve.Approximately 60% of Meckel’s diverticulum contain heterotopic mucosa, of which over 60% consist of gastric mucosa. Pancreatic acini are the next most common; others include Brunner’s glands, pancreatic islets, colonic mucosa, endometriosis, and hepatobiliary tissues.A useful, although crude, mnemonic describing Meckel’s diverticulum is the “rule of twos”: 2% prevalence, 2:1 male predominance, location 2 feet proximal to the ileocecal valve in adults, and half of those who are symptomatic are under 2 years of age.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 92
Incorrect
-
A 29 year old woman is unable to invert her foot after sustaining an injury to her leg playing water-polo. Which of the following nerves are most likely damaged:
Your Answer:
Correct Answer: Tibial and deep fibular nerve
Explanation:Inversion of the foot is primarily produced by the tibialis anterior and the tibialis posterior muscles, innervated by the deep fibular nerve and the tibial nerve respectively.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 93
Incorrect
-
When inserting a Seldinger chest drain for management of pneumothorax, the 'safe triangle' should be identified. Which of the following forms the inferior border of the 'safe triangle'?
Your Answer:
Correct Answer: 5 th intercostal space
Explanation:Care and management of the thoracostomy tubes (chest tubes) are subject to the direction and practice pattern of the responsible physician. Therefore, it is difficult to make a “one size fits all” set of instructions about the specific management recommendations for all chest tubes. It is recommended to discuss specific expectations for management with the patient’s attending physician. Facility specific Clinical Practice Guidelines (CPGs) may provide further guidance for one’s practice.Placement of the appropriately sized chest tube is performed on the affected side. The typical landmark for placement is the 4th or 5th intercostal space (nipple line for males, inframammary fold for females) at the anterior axillary line. The space above the 5th intercostal space and below the base of the axilla that is bordered posteriorly by the trapezius and anteriorly by the pectoralis muscle has recently been described as the safe triangle. Tubes are positioned anteriorly for pneumothoraces and posteriorly for fluid processes.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 94
Incorrect
-
Which of the following body location is the appropriate site to apply pressure when performing a carotid sinus massage?
Your Answer:
Correct Answer: Thyroid cartilage
Explanation:The common carotid artery runs through the neck and divides into internal and external carotid arteries on both sides near the upper thyroid cartilage. In emergency situations, carotid sinus massage is also used to diagnose or treat paroxysmal supraventricular tachycardia. During the procedure, to maximize access to the carotid artery, the patient is put in a supine position with the neck extended (i.e. elevating the chin away from the chest). The carotid sinus is normally positioned inferior to the angle of the jaw, near the arterial impulse, at the level of the thyroid cartilage. For 5 to 10 seconds, pressure is administered to one carotid sinus. Although pulsatile pressure applied in a vigorous circular motion may be more effective, continuous pressure is preferred since it is more reproducible. If the predicted reaction is not obtained, the operation is repeated on the opposite side after a one- to two-minute wait.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 95
Incorrect
-
An 18-year-old patient was brought to the ER after falling off of his skateboard. He is unable to flex the distal interphalangeal joint of his index finger. You suspect that he suffers from a supracondylar fracture. Which of the following conditions would confirm supracondylar fracture?
Your Answer:
Correct Answer: Inability to oppose the thumb
Explanation:A supracondylar fracture is a fracture that occurs through the thin section of the distal humerus above the growth plate. A supracondylar fracture is most usually associated with median nerve injury. A medial nerve damage causes paralysis of the thenar muscles, as well as loss of thumb opposition.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 96
Incorrect
-
A 69-year-old man presents with a painful groin swelling on the right side. The suspected diagnosis is an inguinal hernia.Which of the following examination features make it more likely to be an indirect inguinal hernia?
Your Answer:
Correct Answer: It can be controlled by pressure over the deep inguinal ring
Explanation:The reduced indirect inguinal hernia can be controlled by pressure over the internal ring; a direct inguinal hernia cannot.An indirect inguinal hernia can be reduced superiorly then superolaterally, while a direct inguinal hernia can be reduced superiorly then posteriorly.An indirect inguinal hernia takes time to reach full size, but a direct inguinal hernia appears immediately upon standing.Indirect inguinal hernias are seen as elliptical swelling, while direct inguinal hernias appear as symmetric, circular swelling.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 97
Incorrect
-
A suicidal patient had lacerated his wrist, which resulted in an ulnar nerve injury. Which of the following will confirm the presence of an ulnar nerve injury?
Your Answer:
Correct Answer: Claw hand appearance
Explanation:An ulnar injury may result in abnormal sensations in the little finger and ring finger, usually on the palm side, weakness, and loss of coordination of the fingers. A claw like deformity of the hand and wrist is present. Pain, numbness, decreased sensation, tingling, or burning sensation in the areas controlled by the nerve are also possible.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 98
Incorrect
-
The 'pump handle' movement of the thoracic wall describes which of the following movements:
Your Answer:
Correct Answer: The anterior ends of the ribs moving upwards and forwards
Explanation:Because the anterior ends of the ribs are inferior to the posterior ends, when the ribs are elevated, the anterior end moves upwards and forwards, moving the sternum upwards and forwards in turn. This ‘pump handle’ upwards and forwards movement changes the anteroposterior (AP) dimension of the thorax.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 99
Incorrect
-
A 54 year old patient presents with vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis. Which of these blood vessels has most likely been occluded?
Your Answer:
Correct Answer: Posterior inferior cerebellar artery
Explanation:Posterior inferior cerebellar artery (PICA) occlusion is characterised by vertigo, ipsilateral hemiataxia, dysarthria, ptosis and miosis. PICA occlusion causes infarction of the posterior inferior cerebellum, inferior cerebellar vermis and lateral medulla.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 100
Incorrect
-
The lymph drainage of the anal canal above the pectinate line is initially to the:
Your Answer:
Correct Answer: Internal iliac nodes
Explanation:Above the pectinate line, the anal canal drains to the internal iliac lymph nodes which subsequently drain to the lumbar (para-aortic) nodes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 101
Incorrect
-
The sensation produced by touching the arm with a vibrating tuning fork during a neurological examination is mediated by which of the following spinal tracts:
Your Answer:
Correct Answer: Posterior column
Explanation:Fine-touch, proprioception and vibration sensation are mediated by the posterior column-medial lemniscus pathway.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 102
Incorrect
-
A 47-year old male comes to the out-patient department for a painful, right-sided groin mass. Medical history reveals a previous appendectomy 10 years prior. On physical examination, the mass can be reduced superiorly. Also, the mass extends to the scrotum. The initial diagnosis is a hernia.Among the types of hernia, which is the most likely diagnosis of the case above?
Your Answer:
Correct Answer: Indirect inguinal hernia
Explanation:Inguinal hernias can present with an array of different symptoms. Most patients present with a bulge in the groin area, or pain in the groin. Some will describe the pain or bulge that gets worse with physical activity or coughing. Symptoms may include a burning or pinching sensation in the groin. These sensations can radiate into the scrotum or down the leg. It is important to perform a thorough physical and history to rule out other causes of groin pain. At times an inguinal hernia can present with severe pain or obstructive symptoms caused by incarceration or strangulation of the hernia sac contents. A proper physical exam is essential in the diagnosis of an inguinal hernia. Physical examination is the best way to diagnose a hernia. The exam is best performed with the patient standing. Visual inspection of the inguinal area is conducted first to rule out obvious bulges or asymmetry in groin or scrotum. Next, the examiner palpates over the groin and scrotum to detect the presence of a hernia. The palpation of the inguinal canal is completed last. The examiner palpates through the scrotum and towards the external inguinal ring. The patient is then instructed to cough or perform a Valsalva manoeuvre. If a hernia is present, the examiner will be able to palpate a bulge that moves in and out as the patient increases intra abdominal pressure through coughing or Valsalva.Groin hernias are categorized into 2 main categories: inguinal and femoral.Inguinal hernias are further subdivided into direct and indirect. An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum, and can be reduced superiorly then superolaterally. A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.A femoral hernia is a protrusion into the femoral ring. The borders of the femoral ring are the femoral vein laterally, Cooper’s ligament posteriorly, the iliopubic tract/inguinal ligament anteriorly and lacunar ligament medially.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 103
Incorrect
-
Which of the following clinical features is most suggestive of a lesion of the occipital lobe:
Your Answer:
Correct Answer: Homonymous hemianopia
Explanation:Homonymous hemianopia is a visual field defect involving either the two right or the two left halves of the visual fields of both eyes. It is caused by lesions of the retrochiasmal visual pathways, ie, lesions of the optic tract, the lateral geniculate nucleus, the optic radiations, and the cerebral visual (occipital) cortex
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 104
Incorrect
-
After an accidental fall, a 75-year-old patient complains of neck pain and weakness in his upper limbs. Select the condition that most likely caused the neck pain and weakness of the upper limbs of the patient.
Your Answer:
Correct Answer: Central cord syndrome
Explanation:The cervical spinal cord is the section of the spinal cord that goes through the bones of the neck. It is injured incompletely in the central cord syndrome (CCS). This will result in arm weakness more than leg weakness.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 105
Incorrect
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You proceed to administer lorazepam intravenously to a 21-year-old patient with status epilepticus. Which of the following best describes lorazepam's action?
Your Answer:
Correct Answer: Potentiates effect of GABA
Explanation:Lorazepam is a type of benzodiazepine. Benzodiazepines are gamma-aminobutyric acid (GABA) receptor agonists with sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant characteristics that promote inhibitory synaptic transmission across the central nervous system.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 106
Incorrect
-
Needle thoracentesis in a patient with tension pneumothorax is performed at which anatomical landmark?
Your Answer:
Correct Answer: 4-5th intercostal space mid-axillary line
Explanation:Pleural aspiration describes a procedure whereby pleural fluid or air may be aspirated via a system inserted temporarily into the pleural space. This may be for diagnostic purposes (usually removing 20–50 ml fluid) or therapeutic to relieve symptoms. In the literature it is varyingly called thoracocentesis, thoracentesis or pleural aspiration.
Cadaver studies have shown improved success in reaching the thoracic cavity when the fourth or fifth intercostal space mid-axillary line is used instead of the second intercostal space mid-clavicular line in adult patients. ATLS now recommends this location for needle decompression in adult patients.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 107
Incorrect
-
Gallstones are commonly found lodged in which of the following parts of the gallbladder?
Your Answer:
Correct Answer: Neck
Explanation:There is a significant association between the presence of Hartmann’s pouch and gallbladder stones. It is the most common location for gallstones to become lodged and cause cholestasis.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 108
Incorrect
-
A 12-year old boy is taken to the emergency room after accidentally falling off the monkey bars. Witnesses of the accident reported that, when the patient fell, he hit his right hand on a bar and a loud thump was heard. On examination, the hand is oedematous, tender and erythematous. On ultrasound, a rupture of the flexor carpi ulnaris is noted.Which of the following statements is true regarding the flexor carpi ulnaris?
Your Answer:
Correct Answer: It acts to adduct the hand at the wrist joint
Explanation:Flexor carpi ulnaris is a fusiform muscle located in the anterior compartment of the forearm. It belongs to the superficial flexors of the forearm, along with pronator teres, palmaris longus, flexor digitorum superficialis and flexor carpi radialis. Flexor carpi ulnaris is the most medial of the superficial flexors.Innervation of the flexor carpi ulnaris muscle is from the brachial plexus via the ulnar nerve (C7-T1).Flexor carpi ulnaris receives its arterial blood supply via three different routes. Proximally, a branch of the posterior ulnar recurrent artery supplies the muscle as it passes between the humeral and ulnar heads. Branches of the ulnar artery supply the middle and distal parts of the muscle, with an accessory supply also present distally via the inferior ulnar collateral artery.Due to its position and direction in the forearm, flexor carpi ulnaris can move the hand sideways as well as flexing it. Contracting with flexor carpi radialis and palmaris longus, flexor carpi ulnaris produces flexion of the hand at the wrist joint. However, when it contracts alongside the extensor carpi ulnaris muscle in the posterior compartment, their counteracting forces produce adduction of the hand at the wrist, otherwise known as ulnar deviation or ulnar flexion
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 109
Incorrect
-
A patient is sent in by her GP with suspected ectopic pregnancy. Tubal ectopic pregnancies occur most commonly in which part of the uterine tube:
Your Answer:
Correct Answer: Ampulla
Explanation:Ectopic pregnancy most commonly occurs in the ampulla (70% of cases).
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 110
Incorrect
-
Oculomotor (CN III) palsy with sparing of the pupillary reflex is most likely caused by which of the following:
Your Answer:
Correct Answer: Diabetes mellitus
Explanation:Compressive causes of CN III palsy cause early pupillary dilatation because the parasympathetic fibres run peripherally in the nerve and are easily compressed. In diabetes mellitus the lesions are ischaemic rather than compressive and therefore typically affect the central fibres resulting in pupillary sparing.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 111
Incorrect
-
A 30 year old man stabbed in the upper arm presents to the Emergency Department and you perform a vascular examination. The brachial pulse can be best palpated at ?
Your Answer:
Correct Answer: In the antecubital fossa, medial to the tendon of the biceps brachii
Explanation:The brachial artery can be palpated in the antecubital fossa, medial to the tendon of the biceps brachii muscle.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 112
Incorrect
-
Which of the following is NOT a contraindication to treatment with aspirin at analgesic doses:
Your Answer:
Correct Answer: Myasthenia gravis
Explanation:Aspirin (at analgesic doses) is contraindicated in:People with a history of true hypersensitivity to aspirin or salicylates (symptoms of hypersensitivity to aspirin or salicylates include bronchospasm, urticaria, angioedema, and vasomotor rhinitis)People with active or previous peptic ulcerationPeople with haemophilia or another bleeding disorderChildren younger than 16 years of age (risk of Reye’s syndrome)People with severe cardiac failurePeople with severe hepatic impairmentPeople with severe renal impairmentN.B. Owing to an association with Reye’s syndrome, aspirin-containing preparations should not be given to children under 16 years, unless specifically indicated, e.g. for Kawasaki disease.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 113
Incorrect
-
Which of the following nerves innervates the gastrocnemius muscle?
Your Answer:
Correct Answer: Tibial nerve
Explanation:The gastrocnemius is innervated by the anterior rami of S1 and S2 spinal nerves, carried by the tibial nerve into the posterior compartment of the leg.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 114
Incorrect
-
Which of the following statement is correct with regards to the female urethra?
Your Answer:
Correct Answer: The urethra opens in the vestibule that lies between the labia minora.
Explanation:The urethra in women is short (about 4 cm long), and begins at the base of the bladder. Its course runs inferiorly through the urogenital diaphragm, then into the perineum. It then opens in the vestibule which lies between the labia minora. The inferior aspect of the urethra is bound to the anterior surface of the vagina. The urethral opening is anterior to the vaginal opening in the vestibule. As the urethra passes through the pelvic floor, it is surrounded by the external urethral sphincter.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 115
Incorrect
-
A 26-year-old athlete presents with buttock pain after tearing his gluteus maximus muscle.Which of the following is NOT an action of the gluteus maximus muscle? Select ONE answer only.
Your Answer:
Correct Answer: Hip abduction
Explanation:Gluteus maximus is the main extensor muscle of the hip and assists with lateral rotation of the thigh at the hip joint. It also acts as a hip adductor, steadies the thigh, and assists in raising the trunk from a flexed position.Gluteus maximus is innervated by the inferior gluteal nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 116
Incorrect
-
A 7-year old boy is referred to the Paediatrics Department due to slurred speech. Upon further examination, the attending physician noted the presence of dysdiadochokinesia, intention tremors, and nystagmus. An MRI is taken, which revealed a brain tumour.Which of the following options is the most probable diagnosis given the clinical features of the patient?
Your Answer:
Correct Answer: Astrocytoma of cerebellum
Explanation:Pilocytic astrocytoma (PCA), previously known as cystic cerebellar astrocytoma or juvenile pilocytic astrocytoma, was first described in 1931 by Harvey Cushing, based on a case series of cerebellar astrocytomas; though he never used these terms but rather described a spongioblastoma. They are low-grade, and usually well-circumscribed tumours, which tend to occur in young patients. By the World Health Organization (WHO) classification of central nervous system tumours, they are considered grade I gliomas and have a good prognosis.PCA most commonly occurs in the cerebellum but can also occur in the optic pathway, hypothalamus, and brainstem. They can also occur in the cerebral hemispheres, although this tends to be the case in young adults. Presentation and treatment vary for PCA in other locations. Glial cells include astrocytes, oligodendrocytes, ependymal cells, and microglia. Astrocytic tumours arise from astrocytes and are the most common tumour of glial origin. The WHO 2016 categorized these tumours as either diffuse gliomas or other astrocytic tumours. Diffuse gliomas include grade II and III diffuse astrocytomas, grade IV glioblastoma, and diffuse gliomas of childhood. The other astrocytic tumours group include PCA, pleomorphic xanthoastrocytoma, subependymal giant cell astrocytoma, and anaplastic pleomorphic xanthoastrocytoma.PCA can present with symptoms secondary to the posterior fossa mass effect. This may include obstructive hydrocephalus, with resultant headache, nausea and vomiting, and papilledema. If hydrocephalus occurs before the fusion of the cranial sutures (<18-months-of-age), then an increase in head circumference will likely occur. Lesions of the cerebellar hemisphere result in peripheral ataxia, dysmetria, intention tremor, nystagmus, and dysarthria. In contrast, lesions of the vermis cause a broad-based gait, truncal ataxia, and titubation. Posterior fossa lesions can also cause cranial nerve palsies. Diplopia may occur due to abducens palsy from the stretching of the nerve. They may also have blurred vision due to papilledema. Seizures are rare with posterior fossa lesions.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 117
Incorrect
-
Which of the following muscles acts as an extensor of the shoulder joint?
Your Answer:
Correct Answer: Teres major
Explanation:The glenohumeral joint possesses the capability of allowing an extreme range of motion in multiple planes.Flexion – Defined as bringing the upper limb anterior in the sagittal plane. The usual range of motion is 180 degrees. The main flexors of the shoulder are the anterior deltoid, coracobrachialis, and pectoralis major. Biceps brachii also weakly assists in this action.Extension—Defined as bringing the upper limb posterior in a sagittal plane. The normal range of motion is 45 to 60 degrees. The main extensors of the shoulder are the posterior deltoid, latissimus dorsi, and teres major.Internal rotation—Defined as rotation toward the midline along a vertical axis. The normal range of motion is 70 to 90 degrees. The internal rotation muscles are the subscapularis, pectoralis major, latissimus dorsi, teres major, and the anterior aspect of the deltoid.External rotation – Defined as rotation away from the midline along a vertical axis. The normal range of motion is 90 degrees. Primarily infraspinatus and teres minor are responsible for the motion.Adduction – Defined as bringing the upper limb towards the midline in the coronal plane. Pectoralis major, latissimus dorsi, and teres major are the muscles primarily responsible for shoulder adduction.Abduction – Defined as bringing the upper limb away from the midline in the coronal plane. The normal range of motion is 150 degrees. Due to the ability to differentiate several pathologies by the range of motion of the glenohumeral joint in this plane of motion, it is essential to understand how different muscles contribute to this action.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 118
Incorrect
-
What is the main mechanism of action of cyclizine:
Your Answer:
Correct Answer: Histamine-H1 antagonist
Explanation:Antihistamines e.g. cyclizine, are effective against nausea and vomiting caused by many different conditions, including motion sickness and vertigo. These agents act by inhibiting histamine pathways, and cholinergic pathways involved in transmission from the vestibular apparatus to the vomiting centre. There is no evidence that any one antihistamine is superior to another but their duration of action and incidence of adverse effects differ. Adverse effects include drowsiness and antimuscarinic effects such as blurred vision, dry mouth, urinary retention, constipation and confusion.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 119
Incorrect
-
Your consultant requests that you do a lumbar puncture on a patient who is suspected of having meningitis. This patient, a 15-year-old female, presented to the emergency department with a fever, headache, and neck stiffness. Where should you aspirate a sample of CSF?
Your Answer:
Correct Answer: Subarachnoid space
Explanation:A lumbar puncture, also known as a spinal tap, is a procedure that involves inserting a needle into the lower back’s lumbar region. A needle is inserted into the space between the arachnoid mater and the pia mater, also known as the subarachnoid space, to remove a sample of cerebrospinal fluid.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 120
Incorrect
-
A patient has suffered a nerve injury that has caused weakness of the pectoralis minor muscle.Pectoralis minor receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: Medial pectoral nerve
Explanation:Pectoralis minor is a thin, triangular muscle that is situated in the upper chest. It is thinner and smaller than pectoralis major. It is innervated by the medial pectoral nerve.The origin of pectoralis minor is the 3rdto the 5thribs, near the costal cartilages. It inserts into the medial border and superior surface of the coracoid process of the scapula.The main action of pectoralis minor is to draw the scapula inferiorly and anteriorly against the thoracic wall. This serves to stabilise the scapula.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 121
Incorrect
-
When the breast cancer of a 60-year old patient metastasizes and compresses the intervertebral foramina between the fourth and fifth cervical vertebrae, as well as the fourth and fifth thoracic vertebrae, this causes back pain. Which pair of nerves is most likely affected?
Your Answer:
Correct Answer: Fifth cervical and fourth thoracic nerves
Explanation:The fifth cervical nerve passes between the fourth and fifth cervical vertebrae, and the fourth thoracic nerve passes between the fourth and fifth thoracic vertebrae. Therefore, when the cancer metastasizes in this area, they are most likely affected.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 122
Incorrect
-
Which of the following statements accurately describes the flexor digitorum superficialis muscle?
Your Answer:
Correct Answer: It flexes the middle phalanges of the medial four fingers at the proximal interphalangeal joints
Explanation:Flexor digitorum superficialis is the largest muscle of the anterior compartment of the forearm. It belongs to the superficial flexors of the forearm, together with pronator teres, flexor carpi radialis, flexor carpi ulnaris and palmaris longus. Some sources alternatively classify this muscle as an independent middle/intermediate layer of the anterior forearm, found between the superficial and deep groups.Flexor digitorum superficialis is innervated by muscular branches of the median nerve, derived from roots C8 and T1 that arises from the medial and lateral cords of the brachial plexus. The skin that overlies the muscle is supplied by roots C6-8 and T1.The primary arterial blood supply to the flexor digitorum superficialis is derived from the ulnar artery and its anterior recurrent branch. In addition to branches of the ulnar artery, the anterior and lateral surfaces of the muscle are supplied by branches of the radial artery; and its posterior surface also receives branches from the median artery.The main function of flexor digitorum superficialis is flexion of the digits 2-5 at the proximal interphalangeal and metacarpophalangeal joints. Unlike the flexor digitorum profundus, flexor digitorum superficialis has independent muscle slips for all four digits. This allows it to flex the digits individually at their proximal interphalangeal joints. In addition, flexor digitorum superficialis aids the aids flexion of the wrist.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 123
Incorrect
-
A 30-year old male is taken to the emergency room after suffering a blunt trauma to the abdomen. He is complaining of severe abdominal pain, however all his other vital signs remain stable. A FAST scan is performed to assess for hemoperitoneum.If hemoperitoneum is present, it is most likely to be observed in which of the following areas?
Your Answer:
Correct Answer: Liver
Explanation:The Focused Assessment with Sonography in Trauma (FAST) is an ultrasound protocol developed to assess for hemoperitoneum and hemopericardium. Numerous studies have demonstrated sensitivities between 85% to 96% and specificities exceeding 98%.The FAST exam evaluates four regions for pathologic fluid: (1) the right upper quadrant, (2) the subxiphoid (or subcostal) view, (3) the left upper quadrant, and (4) the suprapubic region.The right upper quadrant (RUQ) visualizes the hepatorenal recess, also known as Morrison’s pouch, the right paracolic gutter, the hepato-diaphragmatic area, and the caudal edge of the left liver lobe. The probe is positioned in the sagittal orientation along the patient’s flank at the level of the 8 to 11 rib spaces. The hand is placed against the bed to ensure visualization of the retroperitoneal kidney. The RUQ view is the most likely to detect free fluid with an overall sensitivity of 66%. Recent retrospective evidence suggests the area along the caudal edge of the left lobe of the liver has the highest sensitivity, exceeding 93%.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 124
Incorrect
-
A 25-year-old guy who has had a knee-high plaster cast on his left leg for the past 5 weeks arrives at the emergency department complaining of numbness on the dorsum of his left foot and an inability to dorsiflex or evert his foot. You know that his symptoms are due to fibular nerve compression. Where is the fibular nerve located?
Your Answer:
Correct Answer: Neck of fibula
Explanation:Dorsiflexion and eversion of the foot are innervated by the deep fibular nerve and the superficial fibular nerve, respectively. The common fibular nerve runs obliquely downward along the lateral border of the popliteal fossa (medial to the biceps femoris) before branching at the neck of the fibula. Thus, it is prone to being affected during an impact injury or fracture to the bone or leg. Casts that are placed too high can also compress the fibular nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 125
Incorrect
-
A 25-year-old footballer develops pain and stiffness in his thigh. A diagnosis of iliopsoas syndrome is made.Iliacus is innervated by which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: Femoral nerve
Explanation:Iliacus is innervated by the femoral nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 126
Incorrect
-
A 55-year-old woman was complaining of headaches. On examination, the patient is found to have weakness on the left side of her body and her eyes are deviated towards the right hand side. These are signs of damage to which of the following areas?
Your Answer:
Correct Answer: Frontal lobe
Explanation:Some potential symptoms of frontal lobe damage can include loss of movement, either partial or complete, on the opposite side of the body. In the patient’s case, it is a result of motor cortex damage on the right side since her left side of the body is affected. The conjugate eye deviation symptom towards the side of the lesion is a result of damage to the frontal eye field.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 127
Incorrect
-
All of the following typically occurs as part of normal passive expiration except:
Your Answer:
Correct Answer: Contraction of the internal intercostal muscles
Explanation:Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) in addition to the elastic recoil of the lungs. In expiration, several movements occur. There are:1. depression of the sternal ends of the ribs (‘pump handle’ movement), 2. depression of the lateral shafts of the ribs (‘bucket handle’ movement) and 3. elevation of the diaphragm. These result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. There is then a decreased intrathoracic volume and increased intrathoracic pressure and air is forced out of the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 128
Incorrect
-
You are taking care of a 55-year-old male patient with a direct inguinal hernia. In explaining his hernia, which of the following layers was compromised and had resulted in his condition?
Your Answer:
Correct Answer: Transversalis fascia
Explanation:Direct inguinal hernias are most often caused by a weakness in the muscles of the abdominal wall that develops over time, or are due to straining or heavy lifting. A direct inguinal hernia protrudes through the Transversalis fascia.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 129
Incorrect
-
Which of the following statements about lithium treatment is FALSE:
Your Answer:
Correct Answer: Concomitant treatment with NSAIDs decreases serum-lithium concentration.
Explanation:Lithium levels are raised by NSAIDs because renal clearance is reduced. Lithium is a small ion (74 Daltons) with no protein or tissue binding and is therefore amenable to haemodialysis. Lithium is freely distributed throughout total body water with a volume of distribution between 0.6 to 0.9 L/kg, although the volume may be smaller in the elderly, who have less lean body mass and less total body water. Steady-state serum levels are typically reached within five days at the usual oral dose of 1200 to 1800 mg/day. The half-life for lithium is approximately 18 hours in adults and 36 hours in the elderly.Lithium is excreted almost entirely by the kidneys and is handled in a manner similar to sodium. Lithium is freely filtered but over 60 percent is then reabsorbed by the proximal tubules.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 130
Incorrect
-
A 45-year old man presented to the emergency room with complains of chest pain and breathlessness. Upon history taking and examination, it was discovered that he had a right-sided spontaneous pneumothorax and had a failed attempt at pleural aspiration. The pneumothorax is still considerable in size, but he remains breathless. A Seldinger chest drain was inserted but it started to drain frank blood shortly after. Which of the following complications is most likely to have occurred?
Your Answer:
Correct Answer: Intercostal artery laceration
Explanation:Injury to the intercostal artery (ICA) is an infrequent but potentially life-threatening complication of all pleural interventions. Traditional anatomy teaching describes the ICA as lying in the intercostal groove, protected by the flange of the rib. This is the rationale behind the recommendation to insert needles just above the superior border of the rib. Current recommendations for chest drain insertion suggest that drains should be inserted in the ‘safe triangle’ in order to avoid the heart and the mediastinum and be above the level of the diaphragm. The safe triangle is formed anteriorly by the lateral border of the pectoralis major, laterally by the lateral border of the latissimus dorsi, inferiorly by the line of the fifth intercostal space and superiorly by the base of the axilla. Imaging guidance also aids in the safety of the procedure.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 131
Incorrect
-
Regarding CSF (cerebrospinal fluid) production, approximately how much is produced per day?
Your Answer:
Correct Answer: 500 ml
Explanation:CSF fills the ventricular system, a series of interconnected spaces within the brain, and the subarachnoid space directly surrounding the brain. The intraventricular CSF reflects the composition of the brain’s extracellular space via free exchange across the ependyma, and the brain “floats” in the subarachnoid CSF to minimize the effect of external mechanical forces. The volume of CSF within the cerebral ventricles is approximately 30 mL, and that in the subarachnoid space is about 125 mL. Because about 0.35 mL of CSF is produced each minute, CSF is turned over more than three times daily. Approximately 500 mL of CSF is produced per day, at a rate of about 25 mL per hour.CSF is a filtrate of capillary blood formed largely by the choroid plexuses, which comprise pia mater, invaginating capillaries, and ependymal cells specialized for transport. The choroid plexuses are located in the lateral, third, and fourth ventricles. The lateral ventricles are situated within the two cerebral hemispheres. They each connect with the third ventricle through one of the interventricular foramina (of Monro). The third ventricle lies in the midline between the diencephalon on the two sides. The cerebral aqueduct (of Sylvius) traverses the midbrain and connects the third ventricle with the fourth ventricle. The fourth ventricle is a space defined by the pons and medulla below and the cerebellum above. The central canal of the spinal cord continues caudally from the fourth ventricle, although in adult humans the canal is not fully patent and continues to close with age.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 132
Incorrect
-
A 38-year-old taxi driver sustained blunt force trauma to his anterior chest from the steering wheel of his car after falling asleep while driving headlong into an oncoming HGV lorry. Bruising around his sternum was observed, which appears to be the central point of impact. Which of the following structures is most likely injured by the blunt force trauma?
Your Answer:
Correct Answer: Right ventricle
Explanation:In its typical anatomical orientation, the heart has 5 surfaces formed by different internal divisions of the heart:Anterior (or sternocostal) – Right ventriclePosterior (or base) – Left atriumInferior (or diaphragmatic) – Left and right ventriclesRight pulmonary – Right atriumLeft pulmonary – Left ventricle
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 133
Incorrect
-
A patient with diplopia is found to have eye deviation downwards and outwards. The likely nerves that are affected are:
Your Answer:
Correct Answer: Oculomotor nerve
Explanation:The results of an oculomotor (CN III) nerve palsy are a depressed and abducted (down and out) eye, ptosis, diplopia, and a fixed and dilated pupil.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 134
Incorrect
-
A 26-year-old man is involved in a motorcycle accident that results in an open fracture of his tibia and fibula. The nerve that innervates peroneus tertius is damaged as a consequence of his injuries.Peroneus tertius receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: Deep peroneal nerve
Explanation:Peroneus brevis is innervated by the superficial peroneal nerve.Peroneus longus is innervated by the superficial peroneal nerve.Peroneus tertius is innervated by the deep peroneal nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 135
Incorrect
-
You are giving a teaching session to a group of final year medical students regarding lower limb neurology. Which of the following clinical features would be expected in an obturator nerve palsy:
Your Answer:
Correct Answer: Weakness of hip adduction
Explanation:Damage to the obturator nerve results in weak adduction of the hip with lateral swinging of the limb during walking due to unopposed abduction.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 136
Incorrect
-
A 30-year-old man presents with piriformis syndrome pain, tingling, and numbness in her buttocks. He noted that the pain gets worse upon sitting down. He was seen by a physiotherapist and a diagnosis of piriformis syndrome was made.Which of the following nerves becomes irritated in piriformis syndrome?
Your Answer:
Correct Answer: Sciatic nerve
Explanation:Piriformis syndrome is a clinical condition of sciatic nerve entrapment at the level of the ischial tuberosity. While there are multiple factors potentially contributing to piriformis syndrome, the clinical presentation is fairly consistent, with patients often reporting pain in the gluteal/buttock region that may shoot, burn or ache down the back of the leg (i.e. sciatic-like pain). In addition, numbness in the buttocks and tingling sensations along the distribution of the sciatic nerve is not uncommon. The sciatic nerve runs just adjacent to the piriformis muscle, which functions as an external rotator of the hip. Hence, whenever the piriformis muscle is irritated or inflamed, it also affects the sciatic nerve, which then results in sciatica-like pain.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 137
Incorrect
-
The following statements are not true of the flexor digiti minimi brevis, except?
Your Answer:
Correct Answer: It is situated on the radial border of abductor digiti minimi
Explanation:Flexor digiti minimi brevis muscle is located on the ulnar side of the palm, lying on the radial border of the abductor digiti minimi. Together with the abductor digiti minimi and opponens digiti minimi muscles, it forms the hypothenar eminence. The muscle is situated inferior and lateral to adductor digiti minimi muscle and superior and medial to opponens digiti minimi muscle. The proximal parts of flexor digiti minimi brevis and abductor digiti minimi muscles form a gap through which deep branches of the ulnar artery and ulnar nerve pass.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 138
Incorrect
-
After what time period should intravenous phenytoin be used as second-line treatment of status epilepticus?
Your Answer:
Correct Answer: 25 minutes
Explanation:If seizures recur or fail to respond after initial treatment with benzodiazepines within 25 minutes of onset, phenytoin sodium, fosphenytoin sodium, or phenobarbital sodium should be used.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 139
Incorrect
-
You suspect that your patient with polycystic kidney disease has developed a berry aneurysm as a complication of his disease. The patient complains of a sudden, severe headache. You are guessing subarachnoid haemorrhage secondary to a ruptured berry aneurysm as the cause of his severe headaches. What is the most likely location of his aneurysm?
Your Answer:
Correct Answer: Anterior communicating artery
Explanation:One of the complications that polycystic kidney disease may cause is the development of a brain aneurysm. A berry aneurysm is the most common type of brain aneurysm. The Circle of Willis, where the major blood vessels meet at the base of the brain, is where it usually appears. The most common junctions of the Circle of Willis where an aneurysm may occur include the anterior communicating artery (35%), internal carotid artery (30%), the posterior communicating artery and the middle cerebral artery (22%), and finally, the posterior circulation sites, most commonly the basilar artery tip.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 140
Incorrect
-
The most important nerves for inversion of the foot are:
Your Answer:
Correct Answer: Tibial and deep fibular nerve
Explanation:Inversion of the foot is achieved by the tibialis anterior which is innervated by the deep fibular nerves, and the tibialis posterior muscles which is innervated by the tibial nerve respectively.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 141
Incorrect
-
The least likely feature expected to be seen in a lesion of the frontal lobe is which of the following?
Your Answer:
Correct Answer: Loss of two-point discrimination
Explanation:Lesions in different areas give rise to different symptoms. Lesions of the parietal lobe give rise to loss of two-point discrimination. Lesions to Broca’s area give rise to expressive dysphasia results from damage Lesions to the primary motor cortex give rise to contralateral weakness of the face and arm. Lesions to the prefrontal cortex give rise to personality change. Lesions to the frontal eye field give rise to conjugate eye deviation towards side of lesion.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 142
Incorrect
-
A 25-year-old man suffers from a shoulder injury that damaged the nerve that innervates the infraspinatus muscle.Which of the following nerves may most likely be affected?
Your Answer:
Correct Answer: The suprascapular nerve
Explanation:The suprascapular nerve (C5-C6) innervates the infraspinatus. It originates at the superior trunk of the brachial plexus. It runs laterally across the lateral cervical region to supply the infraspinatus and also the supraspinatus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 143
Incorrect
-
A patient was diagnosed with Erb's palsy as a result of a brachial plexus injury sustained in a car accident and, as a result, suffers from left arm paralysis. The following muscles are affected by the injury, except
Your Answer:
Correct Answer: Trapezius
Explanation:Damage to the C5 and C6 nerve roots causes Erb’s palsy. The spinal accessory nerve (CN XI) innervates the trapezius muscle, thus you would not expect this muscle to be impacted. The trapezius is a muscle that runs from the base of the neck across the shoulders and into the centre of the back.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 144
Incorrect
-
Which of the following occurs primarily to produce passive expiration:
Your Answer:
Correct Answer: Relaxation of diaphragm and external intercostal muscles
Explanation:Passive expiration is produced primarily by relaxation of the inspiratory muscles (diaphragm and external intercostal muscles) and the elastic recoil of the lungs. In expiration, depression of the sternal ends of the ribs (‘pump handle’ movement), depression of the lateral shafts of the ribs (‘bucket handle’ movement) and elevation of the diaphragm result in a reduction of the thorax in an anteroposterior, transverse and vertical direction respectively. This results in a decreased intrathoracic volume and increased intrathoracic pressure and thus air is forced out of the lungs.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 145
Incorrect
-
A tumour is discovered behind the pectinate line during an examination of a 72-year-old patient with rectal bleeding. Which of the following is the lymphatic drainage of the pectinate line?
Your Answer:
Correct Answer: Superficial inguinal nodes
Explanation:The pectinate line is known as the watershed line because it divides the anal canal into two sections. Below the pectinate line, lymphatic drainage drains to the superficial inguinal lymph nodes.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 146
Incorrect
-
You are examining the lower limbs of a 54 year old man who presented after falling from a ladder at home. During your neurological assessment you note a weakness of hip flexion. Which of the following nerves is the most important for flexion of the thigh at the hip joint:
Your Answer:
Correct Answer: Femoral nerve
Explanation:Flexion of the thigh at the hip joint is produced by the sartorius, psoas major, iliacus and pectineus muscles, assisted by the rectus femoris muscle, all innervated by the femoral nerve (except for the psoas major, innervated by the anterior rami of L1 – 3).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 147
Incorrect
-
A patient suffers an injury to the nerve that innervates piriformis.The piriformis muscle is innervated by which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: Nerve to piriformis
Explanation:Piriformis is innervated by the nerve to piriformis, which is a direct branch from the sacral plexus (S1 and S2).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 148
Incorrect
-
A 64-year-old lady attends the emergency department with a known brain tumour. Her left eye is directed outwards and downwards, she can't open it, and her pupil is fixed and dilated. The tumour is most likely compressing which of the following structures:
Your Answer:
Correct Answer: Oculomotor nerve
Explanation:The oculomotor nerve is the third cranial nerve. It is the main source of innervation to the extraocular muscles and also contains parasympathetic fibres which relay in the ciliary ganglion. Damage to the third cranial nerve may cause diplopia, pupil mydriasis, and/or upper eyelid ptosis. The clinical manifestations of third cranial nerve dysfunction reflect its constituent parts.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 149
Incorrect
-
Which of the following nerves is most important for eversion of the foot:
Your Answer:
Correct Answer: Superficial fibular nerve
Explanation:Eversion of the foot is primarily produced by the fibularis longus and fibularis brevis, both innervated by the superficial fibular nerve. The fibularis tertius, innervated by the deep fibular nerve, also assists in this action.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 150
Incorrect
-
A patient suffers a lower limb fracture that causes damage to the nerve that innervates peroneus brevis.Peroneus brevis receives its innervation from which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: Superficial peroneal nerve
Explanation:Peroneus brevis is innervated by the superficial peroneal nerve.Peroneus longus is innervated by the superficial peroneal nerve.Peroneus tertius is innervated by the deep peroneal nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 151
Incorrect
-
A 30-year-old man suffers from an open femoral shaft fracture after being involved in a road traffic accident. As a consequence of his injury, the nerve that was damaged innervates the popliteus muscle.In which of the following nerves is the popliteus muscle innervated by?
Your Answer:
Correct Answer: Tibial nerve
Explanation:The popliteus muscle is innervated by the tibial nerve (L4, 5 and S1).
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 152
Incorrect
-
Which of the following statements concerning the facial nerve is INCORRECT?
Your Answer:
Correct Answer: Forehead sparing in facial nerve palsy is indicative of a lower motor neuron lesion.
Explanation:In facial nerve palsy, LMN damage will involve the forehead and there will be an inability to close the eyes due to paralysis of the orbicularis oculi or raise the eyebrows due to paralysis of the occipitofrontalis muscle.UMN damage causes sparing of the forehead as the occipitofrontalis and orbicularis oculi muscles have bilateral cortical representation.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 153
Incorrect
-
A 45-year-old man had a painless superficial inguinal lymphadenopathy. It was later found to be malignant. Which of the following parts of the body is most likely the origin of this cancerous lymph node?
Your Answer:
Correct Answer: Anal canal
Explanation:A cancer of the anal canal below the pectinate line would spread to the superficial inguinal lymph nodes. Anal cancer often spreads through lymphatic drainage to the internal iliac lymph nodes in lesions above the pectinate line and to the superficial inguinal lymph nodes in lesions below the pectinate line.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 154
Incorrect
-
An 11-year-old boy was brought to the emergency room due to fever and pain in the ears. Upon physical examination, it was observed that the mastoid area is erythematous and there is a presence of a boggy, tender mass. A diagnosis of acute mastoiditis was made.Which of the following parts of the temporal bone is most likely involved?
Your Answer:
Correct Answer: Petrous part
Explanation:Mastoiditis is the inflammation of a portion of the temporal bone referred to as the mastoid air cells. The mastoid air cells are epithelium lined bone septations that are continuous with the middle ear cavity.The temporal bone is composed of four parts: the mastoid process, the petrous pyramid, the squamous, and tympanic portions. The mastoid process and the petrous pyramid are the portions of particular interest because of the prevalence of suppurations within these parts of the temporal bone.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 155
Incorrect
-
Which extraocular muscle is entrapped in a patient with a blowout fracture?
Your Answer:
Correct Answer: Inferior rectus
Explanation:A blowout fracture is an isolated fracture of the orbital walls without compromise of the orbital rims. The common mechanisms are falls, high-velocity ball-related sports, traffic accidents, and interpersonal violence.The frontal, ethmoidal, sphenoid, zygomatic, and lacrimal bones form the bony structures of the orbit. Medially, the maxillary and the lacrimal bone form the lacrimal fossa. Together with the lamina papyracea of the ethmoid bone, they form the medial wall. The sphenoid bone forms the posterior wall and houses the orbital canal. Lateral to the orbital canal lies the superior orbital fissure housing cranial nerves III, IV, V, and VI. The zygomatic bone forms the lateral wall. Superior and inferior borders are the frontal and maxillary bones. Located around the globe of the eye and attached to it are 6 extraocular muscles; the 4 rectus muscles and the superior and inferior oblique muscles. The fat and connective tissue around the globe help to reduce the pressure exerted by the extraocular muscles.The goal of treatment is to restore aesthetics and physiological function. The problem with orbital blowout fractures is that the volume of the orbit can be increased, resulting in enophthalmos and hypoglobus. In addition, the orbital tissue and inferior rectus muscle can become trapped by the bony fragments leading to diplopia, limitation of gaze, and tethering. Finally, the orbital injury can lead to retinal oedema, hyphema, and significant loss of vision.While some cases may be managed with conservative care, others may require some type of surgical intervention.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 156
Incorrect
-
Which of the following is a well recognised adverse effect of prochlorperazine:
Your Answer:
Correct Answer: Acute dystonic reaction
Explanation:Adverse actions include anticholinergic effects such as drowsiness, dry mouth, and blurred vision, extrapyramidal effects, and postural hypotension. Phenothiazines can all induce acute dystonic reactions such as facial and skeletal muscle spasms and oculogyric crises; children (especially girls, young women, and those under 10 kg) are particularly susceptible.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 157
Incorrect
-
A 77 year old lady presents to ED with her left leg shortened and externally rotated following slipping and falling on a wet bathroom floor. There is an intracapsular fracture of the neck of femur seen on imaging studies. She is at risk of avascular necrosis of the head of femur. This is caused by lack of blood supply from which of these arteries?
Your Answer:
Correct Answer: Medial circumflex artery
Explanation:The primary blood supply to the head of the femur is from branches of the medial femoral circumflex artery. The superior and inferior gluteal arteries supply the hip joint but not the head of femur.The lateral circumflex artery anastomoses with the medial femoral circumflex artery and assists in supplying the head of femur. The obturator artery is an important source of blood supply in children up to about 8 years. It gives rise to the artery of the head of femur which runs in the ligamentum teres and is insufficient to supply the head of femur in adults.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 158
Incorrect
-
Which of the following movements does the iliacus muscle produce?
Your Answer:
Correct Answer: Flexion of the thigh at the hip joint
Explanation:The iliacus flexes the thigh at the hip joint when the trunk is stabilised. It flexes the trunk against gravity when the body is supine.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 159
Incorrect
-
A patient with a stab wound to the axilla arrives to the emergency department. You notice weakness in elbow flexion and forearm supination during your assessment. Which of these nerves has been affected:
Your Answer:
Correct Answer: Musculocutaneous nerve
Explanation:The musculocutaneous nerve is relatively protected in the axilla, hence injury to it is uncommon. A stab wound in the axilla is the most prevalent source of damage. Because of the activities of the pectoralis major and deltoid, the brachioradialis, and the supinator muscles, arm flexion and forearm flexion and supination are diminished but not completely lost. Over the lateral part of the forearm, there is a lack of sensation.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 160
Incorrect
-
Which of these drugs may reduce the efficacy of contraception?
Your Answer:
Correct Answer: Carbamazepine
Explanation:Antiepileptic medications such as carbamazepine (Tegretol), topiramate (Topamax), and phenytoin (Dilantin) are widely known for reducing the contraceptive effectiveness of OCPs.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 161
Incorrect
-
A 32 year old man is brought to ED having been thrown off his motorbike. Following initial resuscitation and ruling out life-threatening injuries, you establish the patient has weakness of hip flexion. Which of the following nerves has most likely been injured:
Your Answer:
Correct Answer: Femoral nerve
Explanation:Flexion of the hip is produced by the iliacus, the psoas major, the sartorius, rectus femoris and the pectineus muscles. The femoral nerve innervates the iliacus, pectineus, sartorius and quadriceps femoris muscles, and supplies skin on the anterior thigh, anteromedial knee and medial leg.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 162
Incorrect
-
A 25 year old man presents to the emergency room with abdominal pain, vomiting and constipation. A CT scan is done which is suggestive of Meckel's diverticulum. Where does the blood supply of the Meckel's diverticulum originate?
Your Answer:
Correct Answer: Superior mesenteric artery
Explanation:Meckel’s diverticulum has certain classic characteristics.1. It lies on the antimesenteric border of the middle-to-distal ileum2. It is approximately 2 feet proximal to the ileocaecal junction3. It appears as a blind-ended tubular outpouching of bowel4. It is about 2 inches long, 5. It occurs in about 2% of the population, 6. It may contain two types of ectopic tissue (gastric and pancreatic). 7. The diverticulum is supplied by the superior mesenteric artery.8. Proximal to the major duodenal papilla the duodenum is supplied by the gastroduodenal artery (branch of the coeliac trunk)9. Distal to the major duodenal papilla it is supplied by the inferior pancreaticoduodenal artery (branch of superior mesenteric artery).10. The arterial supply to the jejunoileum is from the superior mesenteric artery.
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This question is part of the following fields:
- Abdomen
- Anatomy
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Question 163
Incorrect
-
A patient suffers an injury to the nerve that innervates gluteus medius.The gluteus medius muscle is innervated by which of the following nerves? Select ONE answer only.
Your Answer:
Correct Answer: Superior gluteal nerve
Explanation:Gluteus minimus is innervated by the superior gluteal nerve.Gluteus medius is innervated by the superior gluteal nerve.Gluteus maximus is innervated by the inferior gluteal nerve.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 164
Incorrect
-
Which of the following statements is correct regarding paracetamol?
Your Answer:
Correct Answer: Liver damage peaks 3 to 4 days after paracetamol ingestion.
Explanation:The maximum daily dose of paracetamol in an adult is 4 grams. Doses greater than this can lead to hepatotoxicity and, less frequently, acute kidney injury. Early symptoms of paracetamol toxicity include nausea, vomiting, and abdominal pain, and usually settle within 24 hours. Symptoms of liver damage include right subcostal pain and tenderness, and this peaks 3 to 4 days after paracetamol ingestion. Other signs of hepatic toxicity include encephalopathy, bleeding, hypoglycaemia, and cerebral oedema.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 165
Incorrect
-
Which nerve innervates the brachioradialis muscle?
Your Answer:
Correct Answer: The radial nerve
Explanation:Brachioradialis is innervated by the radial nerve (from the root values C5-C6) that stems from the posterior cord of the brachial plexus.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 166
Incorrect
-
A patient suffered from a chest injury while working out in the gym. As a consequence of his injury, his pectoralis minor muscle was damaged.Which of the following statements regarding the pectoralis minor muscle is considered correct?
Your Answer:
Correct Answer: It stabilises the scapula
Explanation:The pectoralis minor, in comparison to the pectoralis major, is much thinner and triangular in shape and resides below the major. It originates from the margins of the third to fifth ribs adjacent to the costochondral junction. The fibres consequently pass upward and laterally to insert into the medial border and superior surface of the coracoid process. It is crucial in the stabilization of the scapula by pulling it downward and anteriorly against the thoracic wall.Arterial supply to the pectoralis minor also derives from the pectoral branch of the thoracoacromial trunk. Nerve supply of the pectoralis minor is a function of the lateral pectoral nerve and the medial pectoral nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 167
Incorrect
-
A 35-year-old man suffers an open fracture of his forearm. The nerve that innervates the pronator quadratus muscle is damaged as a consequence of this injury.Which of the following nerves has been damaged in this case? Select ONE answer only.
Your Answer:
Correct Answer: The anterior interosseous nerve
Explanation:Pronator quadratus is a small, square-shaped muscle that lies in the anterior compartment of the forearm. It arises from the distal fourth of the anterior surface of the ulna and inserts into the distal fourth of the anterior surface of the radius.Pronator quadratus is innervated by the anterior interosseous nerve. It receives its blood supply from the anterior interosseous artery, which is a branch of the common interosseous artery, which in turn is a branch of the ulnar artery.The main action of pronator quadratus is to assist pronator teres with pronation of the forearm. The deep fibres bind the radius and ulna together.The pronator quadratus muscle highlighted in blue (adapted from Gray’s Anatomy)
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 168
Incorrect
-
A fracture on which of the following structures is associated with a posterior elbow dislocation?
Your Answer:
Correct Answer: Radial head
Explanation:Fracture dislocations of the elbow appear extremely complex, and identification of the basic injury patterns can facilitate management. The simplest pattern of elbow fracture dislocation is posterior dislocation of the elbow with fracture of the radial head. Addition of a coronoid fracture, no matter how small, to elbow dislocation and radial head fracture is called the terrible triad of the elbow.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 169
Incorrect
-
A 22 year old professional athlete sustains an inversion injury to her left ankle during the 800m. Which of the following ligaments is most likely injured:
Your Answer:
Correct Answer: Anterior talofibular ligament
Explanation:Inversion injuries at the ankle in plantarflexion (such as when wearing high heels) are common, and typically result in damage to the lateral collateral ligament of the ankle, made up of the anterior talofibular, the calcaneofibular and the posterior talofibular ligaments. The anterior talofibular and the calcaneofibular ligaments are most commonly injured, and the posterior talofibular ligament rarely. The spring ligament supports the head of the talus, the deltoid ligament supports the medial aspect of the ankle joint, and the long and short plantar ligaments are involved in maintaining the lateral longitudinal arch of the foot.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 170
Incorrect
-
Through which of the following anatomical structures does an indirect inguinal hernia pass?
Your Answer:
Correct Answer: External oblique
Explanation:Inguinal hernias are subdivided into direct and indirect.An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum.A direct inguinal hernia is protrusion of abdominal contents through the transversalis fascia within Hesselbach’s triangle. The borders of Hesselbach’s triangle are the inferior epigastric vessels superolaterally, the rectus sheath medially, and inguinal ligament inferiorly.The deep (internal) inguinal ring is located above and halfway between the pubic tubercle and the anterior superior iliac spine. This serves as the entrance to the inguinal canal. The superficial (external) inguinal ring lies immediately above and medial to the pubic tubercle. This triangular opening is a defect in the external oblique aponeurosis, and forms the exit of the inguinal canal.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 171
Incorrect
-
A 4-year old boy is taken to the emergency room after a sudden onset of coughing and wheezing. Further investigation reveals that he was drawing quietly in his room, when suddenly, he became anxious and started coughing. The parents also noted that the eraser on top of the pencil was missing.A plain radiographic chest imaging is conducted, and confirmed foreign body aspiration.Which of the following areas in the tracheobronchial tree is the most probable location of the aspirated eraser?
Your Answer:
Correct Answer: Right main bronchus
Explanation:In foreign body aspiration, the foreign body is more likely to enter the right main bronchus because it is shorter, wider and more vertical than the left main bronchus. In a patient who is standing or sitting, the foreign body tends to become lodged in the posterobasal segment of the inferior lobe of the right lung.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 172
Incorrect
-
You are reviewing a patient following a fall from a horse. You suspect they may have an Erb's palsy as a result of a brachial plexus injury. Regarding Erb's palsy, which one of the following statements is CORRECT:
Your Answer:
Correct Answer: Erb's palsy may result in loss of sensation of the regimental badge area.
Explanation:Erb’s palsy is caused by damage to the C5 and C6 nerve roots and thus primarily involves the musculocutaneous, suprascapular and axillary nerves. It commonly result from an excessive increase in the angle between the neck and the shoulder e.g. a person thrown from a motorbike or horseback or during a difficult birth. There is loss or weakness of abduction, lateral rotation and flexion of the arm and flexion and supination of the forearm and loss of sensation on the lateral arm. A characteristic ‘Waiter’s tip’ deformity may be present where the limb hangs limply by the side, medially rotated by the unopposed action of pectoralis major with the forearm pronated due to paralysis of the biceps brachii.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 173
Incorrect
-
A 38-year-old woman presented to the emergency room after an incident of slipping and falling onto her back and left hip. Upon physical examination, it was noted that she has pain on hip flexion, but normal hip adduction. Which of the following muscles was most likely injured in this case?
Your Answer:
Correct Answer: Sartorius
Explanation:The hip adductors are a group of five muscles located in the medial compartment of the thigh. These muscles are the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus.The hip flexors consist of 5 key muscles that contribute to hip flexion: iliacus, psoas, pectineus, rectus femoris, and sartorius.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 174
Incorrect
-
Regarding paracetamol, which of the following statements is CORRECT:
Your Answer:
Correct Answer: It has anti-pyretic action.
Explanation:Paracetamol is a non-opioid analgesic, similar in efficacy to aspirin, with antipyretic properties but no anti-inflammatory properties. It is well absorbed orally and does not cause gastric irritation. Paracetamol is a suitable first-line choice for most people with mild-to-moderate pain, and for combination therapy.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 175
Incorrect
-
A patient suffers a stab wound to the neck. The entry point of the blade is situated within the posterior triangle of the neck.Which of the following muscles is LEAST likely to be involved? Select ONE answer only.
Your Answer:
Correct Answer: Sternohyoid
Explanation:The anterior triangle is the triangular area of the neck found anteriorly to the sternocleidomastoid muscle. It is formed by the anterior border of sternocleidomastoid laterally, the median line of the neck medially and by the inferior border of the mandible superiorly. The apex of the anterior triangle extends towards the manubrium sterni. The anterior triangle contains:Muscles: thyrohyoid, sternothyroid, sternohyoid musclesOrgans: thyroid gland, parathyroid glands, larynx, trachea, esophagus, submandibular gland, caudal part of the parotid glandArteries: superior and inferior thyroid, common carotid, external carotid, internal carotid artery (and sinus), facial, submental, lingual arteriesVeins: anterior jugular veins, internal jugular, common facial, lingual, superior thyroid, middle thyroid veins, facial vein, submental vein, lingual veinsNerves: vagus nerve (CN X), hypoglossal nerve (CN XII), part of sympathetic trunk, mylohyoid nerveThe posterior triangle is a triangular area found posteriorly to the sternocleidomastoid muscle. It has three borders; anterior, posterior and inferior borders. The anterior border is the posterior margin of the sternocleidomastoid muscle. The posterior border is the anterior margin of the trapezius muscle, while the inferior border is the middle one-third of the clavicle. The investing layer of deep cervical fascia and integument forms the roof of the space, while the floor is covered with the prevertebral fascia along with levator scapulae, splenius capitis and the scalene muscles. The inferior belly of omohyoid subdivides the posterior triangle into a small supraclavicular, and a large occipital, triangle.Contents:Vessels: the third part of the subclavian artery, suprascapular and transverse cervical branches of the thyrocervical trunk, external jugular vein, lymph nodesNerves: accessory nerve (CN XI), the trunks of the brachial plexus, fibers of the cervical plexus
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 176
Incorrect
-
Which of the following movements is controlled by the pectoralis major muscle?
Your Answer:
Correct Answer: Flexion, adduction and medial rotation of the humerus
Explanation:The pectoralis major is a muscle that runs across the top of the chest and connects to a ridge on the back of the humerus (the bone of the upper arm). Adduction, or lowering, of the arm (opposed to the deltoideus muscle) and rotation of the arm forward around the axis of the body are two of its main functions.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 177
Incorrect
-
Due to a traffic accident, a male patient was unable to flex his arm at the glenohumeral joint. Based on the patient’s current condition, which nerve is most likely damaged?
Your Answer:
Correct Answer: Axillary and suprascapular nerve
Explanation:A suprascapular nerve injury causes numbness in the shoulder, as well as weakness in abduction and external rotation. Damage to the axillary nerve can result in shoulder or arm muscle weakness, as well as difficulty lifting the arm. This is because the deltoid and supraspinatus muscles, which are innervated by the axillary and suprascapular nerves, are responsible for abduction of the arm at the shoulder joint.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 178
Incorrect
-
If a lesion is observed in Broca's area, which function is expected to become affected?
Your Answer:
Correct Answer: Formation of words
Explanation:The primary functions of the Broca area are both language production and comprehension. While the exact role in the production is still unclear, many believe that it directly impacts the motor movements to allow for speech. Although originally thought to only aid in speech production, lesions in the area can rarely be related to impairments in the comprehension of language. Different regions of the Broca area specialize in various aspects of comprehension. The anterior portion helps with semantics, or word meaning, while the posterior is associated with phonology, or how words sound. The Broca area is also necessary for language repetition, gesture production, sentence grammar and fluidity, and the interpretation of others’ actions.Broca’s aphasia is a non-fluent aphasia in which the output of spontaneous speech is markedly diminished and there is a loss of normal grammatical structure. Specifically, small linking words, conjunctions, such as and, or, and but, and the use of prepositions are lost. Patients may exhibit interjectional speech where there is a long latency, and the words that are expressed are produced as if under pressure. The ability to repeat phrases is also impaired in patients with Broca’s aphasia. Despite these impairments, the words that are produced are often intelligible and contextually correct. In pure Broca’s aphasia, comprehension is intact.
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This question is part of the following fields:
- Anatomy
- Central Nervous System
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Question 179
Incorrect
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A 29 year old man presents to ED followed an alleged assault whilst out drinking. He received blunt trauma to his right axilla. He is complaining of difficulty abducting his right arm above the level of his shoulder, and on inspection, the inferior angle of his right scapula protrudes more than that of his left scapula. Which of the following nerves has most likely been affected:
Your Answer:
Correct Answer: Long thoracic nerve
Explanation:Damage to the long thoracic nerve results in weakness/paralysis of the serratus anterior muscle causing difficulty abducting the upper limb above 90 degrees and giving a ‘winged ‘ scapula appearance where the medial border, particularly the inferior angle, of the scapula moves laterally and posteriorly away from the thoracic wall (this becomes more pronounced if the patient presses the upper limb against a wall).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 180
Incorrect
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Which of the following nerves provides sensory innervation to the anteromedial and anterosuperior aspects of the external ear?
Your Answer:
Correct Answer: Auriculotemporal nerve
Explanation:Sensory innervation to the external ear is supplied by both cranial and spinal nerves. Branches of the trigeminal, facial, and vagus nerves (CN V, VII, X) are the cranial nerve components, while the lesser occipital (C2, C3) and greater auricular (C2, C3) nerves are the spinal nerve components involved. The lateral surface of the tympanic membrane, the external auditory canal, and the external acoustic meatus are all innervated by nervus intermedius (a branch of CN VII), the auriculotemporal nerve (CN V3), and the auricular branch of the vagus nerve. The concha receives split innervation from nervus intermedius, the auricular branch of the vagus nerve, and the greater auricular (spinal) nerve. Beyond the concha, the anteromedial and anterosuperior parts of the pinna are innervated by the auriculotemporal nerve, and a portion of the lateral helix by the lesser occipital nerve. The greater auricular nerve provides innervation to the area of the pinna inferolateral to the lobule.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 181
Incorrect
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A 63-year-old man presents with severe abdominal pain and vomiting of blood. An endoscopy was performed and a peptic ulcer was found to have eroded into an artery nearby.Which of the following most likely describes the location of the ulcer?
Your Answer:
Correct Answer: The posterior duodenum
Explanation:The most common cause of upper gastrointestinal bleeding is peptic ulcer disease, particularly gastric and duodenal ulcers. Duodenal ulcers are most commonly associated with bleeding compared with gastric ulcers. Posterior duodenal ulcers are considered to be the most likely to cause severe bleeding because of its proximity to the branches of the gastroduodenal artery (GDA).
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 182
Incorrect
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A 53-year-old man arrives at the emergency department complaining of visual impairment in his right eye. On examination, you notice that neither his right nor left pupil constricts when you shine a light in his right eye. When you flash a light in his left eye, the pupils of both his left and right eyes constrict. Which of the following nerves is the most likely to be affected:
Your Answer:
Correct Answer: Optic nerve
Explanation:In full optic nerve palsy, the afferent pupillary light reflex is lost. Because the afferent optic nerve does not sense light flashed in the afflicted eye, the ipsilateral direct and contralateral consensual reflexes are gone. However, the contralateral direct and ipsilateral consensual reflexes are intact because the efferent oculomotor nerve is normal.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 183
Incorrect
-
All of the muscles of the tongue (other than the palatoglossus) are innervated by which of the following nerves:
Your Answer:
Correct Answer: Hypoglossal nerve
Explanation:All of the muscles of the tongue are innervated by the hypoglossal nerve, except for the palatoglossus, which is innervated by the vagus nerve.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 184
Incorrect
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A well recognised adverse effect of metoclopramide is which of the following?
Your Answer:
Correct Answer: Acute dystonic reaction
Explanation:Side effects of metoclopramide are commonly associated with extrapyramidal effects and hyperprolactinemia. Therefore its use must be limited to short-term use. Metoclopramide can induce acute dystonic reactions which involve facial and skeletal muscle spasms and oculogyric crises. These dystonic effects are more common in the young girls and young women, and in the very old. These symptoms usually occur shortly after starting treatment with this drug and subside within 24 hours of stopping it. Abortion of dystonic attacks can be carried out by injection of an antiparkinsonian drug like procyclidine.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 185
Incorrect
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A 55 year old man presents to ED complaining of leg weakness. Your colleague has examined the patient and suspects femoral nerve palsy. Which of the following clinical features would you LEAST expect to see on examination of this patient:
Your Answer:
Correct Answer: Weakness of hip extension
Explanation:Damage to the femoral nerve results in weakness of hip flexion and knee extension and loss of sensation over the anterior thigh and the anteromedial knee, medial leg and medial foot.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 186
Incorrect
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A 36-year-old man presented to the emergency room with a two-week history of shortness of breath, fevers, and malaise. A chest X-ray was ordered and the results confirmed the diagnosis of a right middle lobe pneumonia. Which of the following structures of the heart lies closest to the consolidation?
Your Answer:
Correct Answer: Right atrium
Explanation:In its typical anatomical orientation, the heart has 5 surfaces formed by different internal divisions of the heart:Anterior (or sternocostal) – Right ventriclePosterior (or base) – Left atriumInferior (or diaphragmatic) – Left and right ventriclesRight pulmonary – Right atriumLeft pulmonary – Left ventricleThe silhouette sign of Felson is with respect to the right middle lobe. The right heart border should have a distinct appearance due to the right atrium abutting aerated right middle lobe. The consolidation in the right middle lobe has resulted in loss of this silhouette.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 187
Incorrect
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A 28-year-old woman with history of blunt thoracic trauma develops hypotension chest pain, and breathlessness. A bedside echocardiogram was performed and revealed a large pericardial effusion. Due to this finding, a pericardiocentesis was to be performed.Which of the following statements is considered true regarding pericardiocentesis?
Your Answer:
Correct Answer: The needle should be aimed at the midpoint of the left clavicle
Explanation:Pericardiocentesis is a procedure done to remove fluid build-up in the sac around the heart known as the pericardium. The pericardium can be tapped from almost any reasonable location on the chest wall. However, for the usual blind pericardiocentesis, the subxiphoid approach is preferred. Ideally, 2-D echocardiography is used to guide needle insertion and the subsequent path of the needle/catheter.In the subxiphoid approach, the needle is inserted 1 cm inferior to the left xiphocostal angle with an angle of 30 degrees from the patient’s chest with a direction towards the left mid-clavicle. The fingers may sense a distinct give when the needle penetrates the parietal pericardium. Successful removal of fluid confirms the needle’s position.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 188
Incorrect
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An injury to the brachial plexus can cause Erb's palsy. The following is expected to happen to a patient suffering from this condition, except for which one:
Your Answer:
Correct Answer: Weakness of medial rotation of the arm
Explanation:Erb’s palsy can be caused by a traumatic force downward on the upper arm and shoulder that damages the upper root of the brachial plexus. The patient will lose shoulder abduction (deltoid, supraspinatus), shoulder external rotation (infraspinatus), and elbow flexion as a result of this condition (biceps, brachialis).
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 189
Incorrect
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Which of the following is a contraindication for aspirin?
Your Answer:
Correct Answer: Children under 16 years
Explanation:Aspirin contraindications include: hypersensitivity to NSAIDs; asthma, rhinitis, and nasal polyps; and usage in children or teens.There is little evidence of allergic cross-reactivity for salicylates. However, due to similarities in chemical structure and/or pharmacologic activities, the possibility of cross-sensitivity cannot be completely ruled out.
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This question is part of the following fields:
- Central Nervous System
- Pharmacology
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Question 190
Incorrect
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Which of the following muscles is most responsible for thigh extension at the hip joint?
Your Answer:
Correct Answer: Hamstrings and gluteus maximus
Explanation:For hip extension, the gluteus maximus and hamstring muscles work together. To compensate for gluteus maximus weakness, the hamstring frequently acts as the primary hip extensor.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 191
Incorrect
-
Which of the following would you NOT expect from a deep fibular nerve palsy:
Your Answer:
Correct Answer: Loss of sensation over heel
Explanation:Damage to the deep fibular nerve results in loss of dorsiflexion of the ankle, with resultant foot drop with high-stepping gait, loss of toe extension, weakness of foot inversion and loss of sensation over the webspace between the 1st and 2nd toes.
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This question is part of the following fields:
- Anatomy
- Lower Limb
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Question 192
Incorrect
-
The muscles of the soft palate (other than the tensor veli palatini) are innervated by which of the following nerves:
Your Answer:
Correct Answer: Vagus nerve
Explanation:All of the muscles of the soft palate are innervated by the vagus nerve (from the pharyngeal plexus), except for the tensor veli palatini, which is innervated by a branch of the mandibular nerve.
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This question is part of the following fields:
- Anatomy
- Head And Neck
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Question 193
Incorrect
-
In the emergency department, a 50-year-old female appears with a lack of sensation over the front two-thirds of her tongue. Taste and salivation are both present. The patient might have damage which of her nerves?
Your Answer:
Correct Answer: Lingual nerve
Explanation:The lingual nerve, a branch of the mandibular nerve, transmits sensation to the anterior two-thirds of the tongue. The chorda tympani, a branch of the facial nerve, transmits taste to the front two-thirds of the tongue as well as secretomotor innervation to the submandibular and sublingual glands. As a result, any damage to the lingual nerve can cause changes in salivary secretion on the affected side, as well as a loss of taste in the anterior two-thirds of the tongue and temporary or permanent sensory changes in the anterior two-thirds of the tongue and the floor of the mouth.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 194
Incorrect
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A 34-year-old man presented to the emergency room after being involved in a road traffic accident. Upon observation and examination, it was noted that he was hypotensive and has muffled heart sounds. It was suspected that he has pericardial effusion, so an emergency pericardiocentesis was to be performed.In performing pericardiocentesis for suspected pericardial effusion, which of the following anatomical sites are at risk of being punctured?
Your Answer:
Correct Answer: 1 cm below the left xiphocostal angle
Explanation:Pericardiocentesis is a procedure done to remove fluid build-up in the sac around the heart known as the pericardium. The pericardium can be tapped from almost any reasonable location on the chest wall. However, for the usual blind pericardiocentesis, the subxiphoid approach is preferred. Ideally, 2-D echocardiography is used to guide needle insertion and the subsequent path of the needle/catheter.In the subxiphoid approach, the needle is inserted 1 cm inferior to the left xiphocostal angle with an angle of 30 degrees from the patient’s chest with a direction towards the left mid-clavicle. The fingers may sense a distinct give when the needle penetrates the parietal pericardium. Successful removal of fluid confirms the needle’s position.
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This question is part of the following fields:
- Abdomen And Pelvis
- Anatomy
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Question 195
Incorrect
-
Which of the following is true regarding respiration?
Your Answer:
Correct Answer: The diaphragm is responsible for abdominal breathing
Explanation:The following are the mechanisms of breathing during inspiration and expiration, whether normal or forced.Normal inspiration is an active process, with the diaphragm as the main muscle. The diaphragm descends, ribs move upward and outward, and the lungs become wider and taller.In forced inspiration, which commonly occurs during exercise, the external intercostals and accessory muscles, such as the sternocleidomastoid, anterior serrati, scalenes, alae nasi, genioglossus and arytenoid are involved. The ribs move upward and outward, and the abdominal contents move downward.Normal expiration is a passive process, while in forced expiration, the internal intercostals and abdominal muscles, such as the rectus abdominis, internal and external obliques and transversus abdominis are involved. The ribs move downward and inward, and the abdominal contents move upward.
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This question is part of the following fields:
- Anatomy
- Thorax
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Question 196
Incorrect
-
Regarding the accessory nerve, which of the following statements is INCORRECT:
Your Answer:
Correct Answer: Accessory nerve palsy results in the inability to nod the head.
Explanation:Accessory nerve palsy results in inability to shrug the shoulders and to rotate the head to look at the opposite side to the lesion.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 197
Incorrect
-
A 35-year-old lady has suffered a serious brain injury. Her uvula has deviated to the right, according to inspection. Which of the following nerves is likely to be affected?
Your Answer:
Correct Answer: Left vagus nerve
Explanation:When the vagus nerve is damaged, the soft palate is paralyzed and the uvula is shifted away from the affected side. The vagus nerve innervates the uvulae muscle, which forms the uvula’s core. If only one side is innervated, contraction of the active muscle will draw the uvula towards it.
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This question is part of the following fields:
- Anatomy
- Cranial Nerve Lesions
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Question 198
Incorrect
-
You have been asked to give a tutorial on common upper limb neurology to a group of medical students. You use the example of a man falling from a balcony onto spiked fencing, sustaining a puncture wound to the axilla. This results in an injury to the musculocutaneous nerve. Which of the following clinical features would you LEAST expect to see in this patient:
Your Answer:
Correct Answer: Weakness of forearm pronation
Explanation:Flexion of the arm and flexion and supination of the forearm are weakened but not lost entirely due to the actions of the pectoralis major and deltoid, the brachioradialis and the supinator muscles respectively. There is loss of sensation over the lateral aspect of the forearm. Forearm pronation would not be affected as this is primarily produced by the pronator quadratus and pronator teres muscles, innervated by the median nerve.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 199
Incorrect
-
Which of the following is most likely affected in De Quervain's tenosynovitis?
Your Answer:
Correct Answer: Extensor pollicis brevis
Explanation:De Quervain tenosynovitis is named after the Swiss surgeon, Fritz de Quervain, who first described it in 1895. It is a condition which involves tendon entrapment affecting the first dorsal compartment of the wrist. With this condition thickening of the tendon sheaths around the abductor pollicis longus and extensor pollicis brevis develops where the tendons pass in through the fibro-osseous tunnel located along the radial styloid at the distal wrist. Pain is exacerbated by thumb movement and radial and ulnar deviation of the wrist.The estimated prevalence of de Quervain tenosynovitis is about 0.5% in men and 1.3% in women with peak prevalence among those in their forties and fifties. It may be seen more commonly in individuals with a history of medial or lateral epicondylitis. Bilateral involvement is often reported in new mothers or child care providers in whom spontaneous resolution typically occurs once lifting of the child is less frequent.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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Question 200
Incorrect
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During bedside rounds, an 82-year old female in the Medicine Ward complains of pain and tingling of all fingers of the right hand. The attending physician is considering carpal tunnel syndrome.Which of the following is expected to undergo atrophy in carpal tunnel syndrome?
Your Answer:
Correct Answer: The thenar eminence
Explanation:Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist’s carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia’s. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.The muscles innervated by the median nerve can be remembered using the mnemonic ‘LOAF’:L– lateral two lumbricalsO– Opponens pollicisA– Abductor pollicisF– Flexor pollicis brevisIn the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In more advanced disease, symptoms can be constant.Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement.
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This question is part of the following fields:
- Anatomy
- Upper Limb
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SESSION STATS - PERFORMANCE PER SPECIALTY
