Case 24 Questions 1-10

Question 1

Which of the following describe the normal curvature of the vertebral column

1. Kyphosis in the lumbar vertebrae and lordosis in the thoracic vertebrae
2. Kyphosis in the cervical vertebrae and lordosis in the thoracic vertebrae
3. Kyphosis in the thoracic vertebrae and kyphosis in the lumbar vertebrae
4. Kyphosis in the thoracic vertebrae and lordosis in the lumbar vertebrae
5. Lordosis in the thoracic vertebrae and lordosis in the lumbar vertebrae

The correct answer is option d, Kyphosis in the thoracic vertebrae and lordosis in the lumbar vertebrae

Normal curvature of the spine includes a small degree of kyphosis in the thoracic segment and lordosis in the lumbar segment of the vertebral column

Question 2

Which of the following statements are true about the ankle joint

1. The calcaneus bone articulates with the distal end of the tibia
2. Plantarflexion is primarily produced by the muscles in the posterior compartment of the leg
3. The arterial supply of the ankle joint is derived from branches of the profunda femoris artery
4. The common peroneal nerve is commonly injured in proximal tibial fractures, causing foot drop
5. The lateral ligaments resist over-eversion of the ankle joint

The correct answer is option b, Plantarflexion is primarily produced by the muscles in the posterior compartment of the leg

The talus bone articulates with the tibia and fibula. The arterial supply consists of the anterior tibial, posterior tibial, and fibular arteries which are branches of the popliteal artery, a continuation of the femoral artery. The common peroneal nerve wraps around the head of the fibula and would be implicated in proximal fibular fractures. The lateral ligaments resist over-inversion while the medial ligament resists over eversion of the ankle joint.

Question 3

Which of the following statements are false

1. The popliteal fossa contains the popliteal vein, popliteal artery, tibial nerve, and common fibular nerve
2. The semitendinosus, semimembranosus, and biceps femori originate from the ischial tuberosity and perform flexion of the knee joint
3. The gluteus medius and gluteus minimus are the major adductors of the hip
4. The rectus femoris muscle performs an antagonistic action to the semitendinosus muscle on the knee joint
5. The femoral artery is a continuation of the external iliac artery and continues on to become the popliteal artery

The correct answer is option c, The gluteus medius and gluteus minimus are the major adductors of the hip

The gluteus medius and gluteus minimus, along with the tensor fascia latae are the main abductor muscles of the hip. The hip adductors are adductor longus, adductor magnus, adductor brevis, obturator externus and gracilis instead.

Question 4

Local anaesthetics induce analgesia in a patient by

1. Reversibly blocking the voltage gated sodium channels, thus inhibiting transmission of normal action potentials
2. Irreversibly blocking the voltage gated sodium channels, thus inhibiting transmission of normal action potentials
3. Reversibly blocking the voltage gated potassium channels, thus inhibiting transmission of normal action potentials
4. Irreversibly blocking the voltage gated potassium channels, thus inhibiting transmission of normal action potentials
5. Decreases GABA-mediated inhibition in the CNS, this inhibiting transmission of normal action potential

The correct answer is option a, Reversibly blocking the voltage gated sodium channels, thus inhibiting transmission of normal action potentials

The MOA of local anaesthetics involve a reversible inhibition of voltage gates sodium channels, thus preventing normal AP firing. There has been some evidence to show that it may also have an effect on increasing GABA mediated inhibitory effects in the CNS to induce analgesia

Question 5

Which of the following is least likely to be associated with an increase in intracranial pressure

1. Encephalitis
2. Subarachnoid haemorrhage
3. Hydrocephalus
4. Migraine with aura
5. Haemorrhagic stroke

The correct answer is option d, Migraine with aura

All other options can cause an increase in intracranial pressure. While there is prevalence of increased ICP in migraine patients, there is no evidence suggesting that migraines primarily can cause an increase in ICP

Question 6

Which of the following is true in relation to the erector spinae muscles

1. They belong to the extrinsic muscles of the back and performs lateral flexion of the vertebral colum
2. They belong to the intrinsic muscles of the back and performs elevation of the scapulaThey belong to the intrinsic muscles of the back and performs lateral flexion of the vertebral column
3. They belong to the intrinsic muscles of the back and performs elevation of the scapulaThey belong to the intrinsic muscles of the back and performs lateral flexion of the vertebral column
4. They belong to the extrinsic muscles of the back and performs rotation of the vertebral column
5. They belong to the intrinsic muscles of the back and performs rotation of the vertebral column

The correct answer is option c, They belong to the intrinsic muscles of the back and performs lateral flexion of the vertebral column

The erector spinae group (consisitng of the iliocostalis, longissimus, and spinalis) belong to the deep/intrinsic muscles of the back. They primarily perform lateral flexion of the spine when acting unilaterally, and extension of the spine and head when acting bilaterally.

Question 7

Which of the following is not a branch of the external carotid artery?

1. Superior thyroid artery
2. Facial artery
3. Posterior auricular artery
4. Middle cerebral artery
5. Maxillary artery

The correct answer is option d, Middle cerebral artery

The MCA which supplies portions of the frontal, temporal, and parietal lobes of the brain is a branch of the internal carotid artery. The other options are branches of the external carotid artery and can be remembered via the mnemonic “some anatomists like freaking our poor medical students”

Question 8

Patient presents with unilateral facial paralysis. HPC : patient is unable to perform any facial expressions on the left side of her face but is able to raise both her eyebrows. This is an example of :

1. Lower motor neuron lesion of the facial nerve causing ipsilateral facial paralysis
2. Lower motor neuron lesion of the trigeminal nerve causing ipsilateral facial paralysis
3. Upper motor neuron lesion of the trigeminal nerve causing contralateral facial paralysis
4. Upper motor neuron lesion of the facial nerve causing contralateral facial paralysis
5. Upper motor neuron lesion of the facial nerve causing ipsilateral facial paralysis

The correct answer is option d, Upper motor neuron lesion of the facial nerve causing contralateral facial paralysis

This is a case of a forehead sparing facial paralysis. This is typically caused by an UMN lesion of the facial nerve which will result in contralateral facial paralysis. The Hx suggests that patient can raise both eyebrows, which indicates that ipsilateral innervation to the forehead is intact (remember the forehead is innervated by both ipsilateral AND contralateral facial nerve supply while the rest of the face is only innervated by contralateral facial nerve supply). In a LMN lesion scenario, it would be a one-sided facial paralysis that includes the forehead I.e. patient will NOT be able to raise eyebrow on the affected side

Question 9

Which of the following statements are correct?

1. The cribriform plate is a part of the ethmoid bone and supports the olfactory bulb
2. The mastoid air cells are air filled cavities in the mastoid process of the sphenoid bone in the cranium
3. The medulla oblangata passes through the foramen of the sphenoid bone and continues on to become the spinal cord
4. The nasopalatine and nasociliary nerves are terminal branches of the trigeminal nerve which travels through the foramen magnum of the occipital bone
5. The sphenoid, occipital, and parietal bones are some of the bones that form the base of the skull

The correct answer is option a, The cribriform plate is a part of the ethmoid bone and supports the olfactory bulb

Option a is the only true statement

Option b isnt correct as the mastoid process is a part of the temporal bone.

Option c isnt correct as the medulla/spinal cord passes through foramen magnum which is part ofoccipital bone

Option d isnt correct as the trigeminal nerve passes through foramen in the sphenoid bone.

Option e isnt correct as the parietal bone is not a part of the skull base, skull base consists of frontal, ethmoid, sphenoid, temporal, occipital bones

Question 10

Which of the following describe are of anastomosis for these 5 arteries : anterior ethmoidal artery, posterior ethmoidal artery, sphenopalatine artery, greater palatine artery, superior labial artery

1. Solar plexus
2. Lumbosacral plexus
3. Circle of willis
4. Kiesselbachs plexus
5. Cervical plexus

The correct answer is option d, Kiesselbachs plexus

Kiesselbachs plexus also known as Littles area is the area of anastomosis in the anterior part of the nose and is the most common site for epistaxis (nosebleeds)