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1. Mandible Injuries
(a) The angle of the mandible is the most common area to be fractured.
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Frontal lobe
(b) Auditory=Superior temporal lobe
Heschl's gyrus
(c) Olfactory=fontal lobe
(c) Strangulation may cause the formation of petechiae below the level of injury.
Strangulation may cause the formation of petechiae above the level of injury.
(d) Major vessel injury may simulate an acute stroke.
(e) Vascular injury is most common with blunt trauma.
Vascular injury is most common with penetrating trauma.
11. The 2nd Cranial Nerve:
(a) Normal visual acuity is present when the line on the snellen chart marked 6
can be read from 6 metres away.
Normal visual acuity is present when the line on the snellen chart marked 6 can be
read from 6 metres away.
(b) Migraine is a cause of sudden blindness in both eyes
Migraine is a cause of sudden blindness in one eye.
(c) The fibres from the optic chiasm concerned with vision travel in the optic tract
to the medial geniculate body.
The fibres from the optic chiasm concerned with vision travel in the optic tract to
the lateral geniculate body.
(d) Fibres from the optic radiation pass through the anterior part of the internal
capsule and finish in the visual cortex in the occipital lobe.
Fibres from the optic radiation pass through the posterior part of the internal
capsule and finish in the visual cortex in the occipital lobe.
(e) Fibres serving the lower quadrants course through the parietal lobe while fibres
serving the upper quadrants traverse the temporal lobe.
Fibres serving the lower quadrants course through the parietal lobe while fibres
serving the upper quadrants traverse the temporal lobe.
12. Joints
(a) Patellofemoral dislocation is the commonest large joint dislocation.
Glenohumeral dislocation is the commonest large joint dislocation.
(b) Glenohumeral dislocation is the second commonest large joint dislocation
Patellofemoral dislocation is the second commonest large joint dislocation.
(c) Elbow dislocations are the third largest large joint dislocation in the body.
Elbow dislocations are the third largest large joint dislocation in the body.
(d) The majority of elbow dislocations are posterior.
The majority of elbow dislocations are posterior.
(e) The most common mechanism of injury during elbow dislocation is direct
trauma to the olecranon when a person falls on a flexed elbow.
The most common mechanism of injury for an elbow dislocation is fall on an
outstretched hand ( FOOSH )
13. Aortic Dissection
(a) The vast majority of patients have physical signs suggestive of dissection.
The presence of pulse deficits or focal neurological deficits increases the likelihood
of an acute thoracic aortic dissection in the appropriate clinical setting.
Conversely, a completely normal chest radiograph result or the absence of pain of
sudden onset lowers the likelihood. Overall, however, the clinical examination is
insufficiently sensitive to rule out aortic dissection given the high morbidity of
missed diagnosis.Klompass M. Does this patient have an acute thoracic
dissection? JAMA 2002; 287: 2262?72.
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(c) The second of cambells lines runs along the inferior orbital margins
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(b) Breath sounds should be checked for at the anterior chest wall bilaterally.
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(c) Breath sounds are normally louder on the right side of the chest wall.
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The diaphragm moves down on inspiration to increase the vertical diameter of the
thorax. Increasing intra abdominal pressure will aid in micturition, parturition and
defecation. By taking a deep breath and holding it you can fix the diaphragm to
raise intra abdominal pressure to such an extent that it prevents vertebral column
flexion. By raising intraabdominal pressure and lowering intrathoracic pressure the
venous return to the right side of the heart is encouraged.
24. The Femoral Triangle:
(a) The femoral vein is medial to the femoral nerve.
The femoral vein is medial to the femoral nerve.
(b) The femoral canal is on the lateral side of the femoral artery in the femoral
triangle.
The femoral canal is on the medial side of the femoral artery in the femoral
triangle.
(c) The femoral artery is a continuation of the external iliac artery and lies midway
between the anterior superior iliac spine and the pubic tubercle.
The femoral artery is a continuation of the external iliac artery and lies midway
between the anterior superior iliac spine and the pubic symphysis.
(d) In the femoral triangle the femoral vein is on the lateral aspect of the femoral
artery.
In the femoral triangle the femoral artery is related laterally to the femoral nerve
and medially to the femoral vein and femoral canal.
(e) The femoral nerve is medial to the femoral artery in the femoral canal.
The femoral nerve is lateral to the femoral artery in the femoral canal.
25. Glenohumeral dislocation
(a) Anterior dislocations usually occur with excessive external rotation with the
arm in abduction.
(b) Recurrent anterior shoulder dislocation becomes increasingly frequent with
age.
Recurrent anterior dislocation is indirectly related to age. 80% of those below 20
years and 10% of those over 40 years.
(c) About 10% of people with anterior dislocations will also have compression
fractures of the upper aspect of the humeral head.
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And medical therapy may be considered for old stable dissections ( >2 weeks ),
and isolated arch dissections.
27. Central Venous Access:
(a) The internal jugular vein ( IJV ) runs antero-laterally in the carotid sheath,
parallel to the carotid artery and deep to the sternocleidomastoid muscle.
The internal jugular vein runs antero-laterally in the carotid sheath, parallel to the
carotid artery and deep to the sternocleidomastoid muscle.
(b) The needle to cannulate the IJV is inserted 0.5cm medial to the carotid artery.
The needle to cannulate the IJV is inserted 0.5cm lateral to the carotid artery.
(c) The needle is inserted 1 cm above the mid clavicular point to cannulate the
subclavian vein
The needle is inserted 1 cm below the mid clavicular point to cannulate the
subclavian vein
(d) The femoral vein is cannulated lateral to the femoral artery.
The femoral vein is cannulated 1 cm medial to the femoral artery.
(e) The right side of the neck should be used where possible to decrease the risk
of thoracic duct damage.
The right side of the neck should be used where possible to decrease the risk of
thoracic duct damage.
28. The Thorax:
(a) The inferior angle of the scapula is at T9
The inferior angle of the scapula is at T7
(b) The IVC goes through the diaphragm at T6
The IVC goes through the diaphragm at T8 ( along with the right phrenic nerve )
(c) The start of the arch of the aorta is at T2/T3
The start of the arch of the aorta is at T4/T5
(d) The sternum runs from T2 to T4
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Slight swelling develops immediately but settles to a large extent within a few
hours.Bruising occurs with a true or severe sprain. It would require major damage
to produce joint instability. Cold compresses may help reduce the swelling.
30. The following are true:
(a) Hip extension is performed by the femoral nerve.
Infeior gluteal performs hip extension.
(b) The femoral nerve is composed of L1 and L2 nerve roots.
The femoral nerve is composed of L2,L3 and L4.
(c) The inferior gluteal nerve is composed of L5,S1,S2 nerve roots.
The inferior gluteal nerve is composed of L5,S1,S2 nerve roots.
(d) Hip extension is performed by the gluteus maximus muscle.
Inferior gluteal nerve, L5,S1,S2 nerve roots.
(e) Hip abduction is performed by gluteus medius and minimus.
Superior gluteal nerve.
31. With regard to neck trauma the following are true:
(a) Penetrating injuries to the neck zone 1 extends from the clavicle to the cricoid
cartilage.
Zone 1 extends from the clavicles to the cricoid cartilage
(b) Penetrating injuries to the neck zone 2 extends from the cricoid cartilage to the
hyoid bone.
With regard to penetrating injuries to the neck zone 2 extends from the cricoid
cartilage to the angle of the mandible.
(c) Penetrating injuries to the neck zone 3 extends from the hyoid bone to the
base of the skull.
With regard to penetrating injuries to the neck zone 3 extends from the angle of
the mandible to the skull base.
(d) Breach of the platysma is an indication for emergency surgical exploration.
Breach of the platysma , evidence of vascular injury ,evidence of surgical
emphysema and haemodynamic instability due to major bleeding from a neck
wound are indications for emergency surgical exploration.
32. Myocardial Contusion
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Manage as usual.
33. Tendon Reflexes
(a) The biceps are innervated by the radial nerve
Musculocutaneous, C5-6
(b) The biceps reflex main nerve roots are C5-6
Extension/Quadriceps/L3-4
34. The scaphoid bone
(a) The scaphoid only articulates with the radius, lunate, capitate, and trapezoid.
The scaphoid articulates with the radius, lunate, capitate, trapezoid, and
trapezium
(b) A small portion of the surface is covered by hyaline cartilage
Nearly the entire surface is covered by hyaline cartilage
(c) Vessels enter away from the sites of ligamentous attachment.
Vessels may enter only at the sites of ligamentous attachment
(d) The ulnar artery provides the blood supply to the scaphoid bone.
The dorsal and volar branches of the radial artery provide the blood supply to the
scaphoid
(e) The scaphoid lies at the ulnar border of the proximal carpal row
The scaphoid lies at the radial border of the proximal carpal row
The scaphoid lies at the radial border of the proximal carpal row, but its elongated
shape and position allow bridging between the 2 carpal rows because it acts as a
stabilizing rod. The scaphoid articulates with the radius, lunate, capitate,
trapezoid, and trapezium. As a result, nearly the entire surface is covered by
hyaline cartilage. Vessels may enter only at the sites of ligamentous attachment:
the flexor retinaculum at the tubercle, the volar ligaments along the palmar
surface, and the dorsal radiocarpal and radial collateral ligaments along the dorsal
ridge. The dorsal and volar branches of the radial artery provide the blood supply
to the scaphoid. The primary blood supply comes from the dorsal branch of the
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The vagi pierce the diaphragm at T10 along with the oesophagus
(d) The aortic opening in the diaphragm is anterior to the median arcuate ligament
and transmits the azygous and hemiazygous veins
The aortic opening in the diaphragm is posterior to the median arcuate ligament
and transmits the azygous and hemiazygous veins
(e) The aortic opening transmits the thoracic duct.
The aortic opening transmits the thoracic duct.
42. Carotid Sinus Syndrome may be caused by
(a) Trauma
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Non displaced medial 1/3rd fractures are treated conservatively while displaced
require orthopaedic referral. www.aafp.org/afp/20041115/1947.html
45. Haemorrhagic shock
(a) Class I patients usually do not have any mental anxiety
Class I-slight anxiety, Class II-more anxiety, Class III- anxious and sometimes
confused, class IV, confused and lethargic
46. Appreciation of the gross anatomy of the testis:
(a) The ductus deferens ascends on the medial side of the epididymis.
The ductus deferens ascends on the medial side of the epididymis.
(b) The epididymis is on the posterior aspect of the testes and is 6 m in length.
The epididymis is on the posterior aspect of the testes and is 6 m in length.
(c) The head of the epididymis lies on the lower pole of the testis where it is joined
by the efferent ducts.
The head of the epididymis lies on the upper pole of the testis where it is joined by
the efferent ducts.
(d) A hydrocele occurs when there is watery fluid between the parietal and visceral
layers of the tunica albuginea.
A hydrocele occurs when there is watery fluid between the parietal and visceral
layers of the tunica vaginalis ( a serous sac of peritoneal origin )
(e) The testicular artery is a direct branch of the abdominal aorta which arises just
below the renal arteries and descends in the spermatic cord to the posterior
aspect of the testes.
The testicular artery is a direct branch of the abdominal aorta which arises just
below the renal arteries and descends in the spermatic cord to the posterior
aspect of the testes.
47. Traumatic Brain Injury
(a) The majority of cases of epidural haematoma have a loss of consciousness
followed by a lucid interval followed by neurological decline.
A minority, approximately 20%, of cases have this classical description.
(b) 80% of cases of epidural haematoma have a skull fracture that lacerates
meningeal arteries.
80% of cases of epidural haematoma have a skull fracture that lacerates
meningeal arteries.
(c) A fixed and dilated pupil because of a epidural haematoma is an early sign.
A fixed and dilated pupil because of a epidural haematoma is a late sign.
(d) Contralateral hemiparesis in epidural haematoma is an early sign.
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(b) Solid organs such as liver resist cavitation more than softer tissues such as
lung
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(b) The posterior half of the ear is supplied by branch of the trigeminal nerve.
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(c) The posterior part of the ear is supplied by 2 nerve branches derived from the
cervical plexus.
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(d) The vagus nerve has no role in the inervation of the ear.
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The anterior half of the ear is supplied by the auriculotemporal nerve which is a
branch of the mandibular portion of the trigeminal nerve.The posterior part of the
ear is supplied by 2 nerve branches derived from the cervical plexus.The vagus
nerve supplies the external auditory canal.The position for an ear block is where
the ear lobe attaches to the head.
54. Elbow Dislocation
(a) On lateral X Ray the radius and the ulna are most commonly displaced
posteriorly.
On lateral X Ray the radius and the ulna are most commonly displaced posteriorly.
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(a) Orthopantomogram view can be used to assess the frontal bones False
?OPG is used to assess the mandible
(b) Submentovertical projection is used to assess the zygomatic arch True
?
(c) Occiptomental views are used to assess the maxilla True
?Occiptomental views are used to assess the maxilla, orbital floors and zygomatic arches
(d) Occipitomental views are used to assess the orbital floors True
?Occiptomental views are used to assess the maxilla, orbital floors and zygomatic arches
(e) Occipitomental views are used to assess the zygomatic arches True
?Occiptomental views are used to assess the maxilla, orbital floors and zygomatic arches
2. Surface Anatomy:
(a) The brachial artery divides into the radial and ulnar arteries just below the line of the elbow joint. True
?The brachial artery divides into the radial and ulnar arteries just below the line of the elbow joint.
(b) The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius.
True
?The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius.
The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius.
(c) The radial artery can be palpated on the lateral side of the trapezium in the anatomical snuff box. False
?The radial artery can be palpated on the lateral side of the scaphoid in the anatomical snuff box.
(d) In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. True
?In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis.
(e) The pulsations of the ulnar artery are recognised lateral to the pisiform bone. True
?The pulsations of the ulnar artery are recognised lateral to the pisiform bone
(a) Radial head fractures are the most common fractures of the elbow True
?Radial head fractures are the most common fractures of the elbow
(b) The radial head articulates with the trochlea False
?The radial head articulates with the capitellum.
(c) The radial head serves as a stabiliser against forces away from the midline. True
?The radial head serves as a stabiliser against valgus stress.
(d) Radial head fractures are usually the result of a fall on an outstretched hand causing the radial head to
be driven into the trochlea. False
?Radial head fractures are usually the result of a fall on an outstretched hand causing the radial head to be
driven into the capitellum.
(e) Are associated with medial epicondyle avulsion fractures. True
?This is secondary to valgus stress.
5. Anatomical Considerations of the thoracic vertebrae:
(a) Pelvic fractures in children are rare and clinically apparent, making the routine screening pelvic X Ray
obsolete. True
?
(b) Hypertonic saline is beneficial in hypotensive patients with head injury. False
?
(c) Steroids are beneficial in patients with head injury and GCS <15 False
?http://www.thelancet.com/journals/lancet/article/PIIS0140673604171882/abstract.
(d) Patients intubated without the need for anaesthetic drugs had a survival rate of about 2% False
?
(e) A post traumatic head injury seizure is an indication to request a CT brain scan immediately according
to the NICE guidelines. True
?http://www.nice.org.uk/nicemedia/pdf/CG56QuickRedGuide.pdf
One New Zealand study of 347 children who had a pelvic X Ray found only 1 fracture and this fracture was
clinically apparent. The authors recommend not X Raying. In the CRASH trial steroids in patients with head
injury showed more harm than good.
http://www.thelancet.com/journals/lancet/article/PIIS0140673604171882/abstract
(a) The median nerve supplies the interossei of the hand False
?Ulnar
(b) The radial nerve supplies the abductor pollicis brevis False
?The radial nerve does not supply any of the intrinsic muscles of the hand
(c) The ulnar nerve supplies sensation to the one and a half ulnar digits True
?
(d) The extensor muscles of the forearm are supplied by the radial nerve True
?
(e) The biceps muscle is supplied by the musculocutaneous nerve True
?
(a) An S1 root lesion will produce weakness of plantar flexion of the ankle and toes. True
?An S1 root lesion will produce weakness of plantar flexion of the ankle and toes.
(b) An S1 root lesion will cause loss of the knee jerk reflex. False
?An S1 root lesion will cause loss of the ankle jerk reflex.
(c) An L4 root lesion will cause sensory loss at the anteromedial shin. True
?An L4 root lesion will cause sensory loss at the anteromedial shin.
(d) An L5 root lesion will cause sensory loss over the sole of the foot. False
?An L5 root lesion will cause sensory loss over the dorsum of the foot and anterolateral shin while an S1
root lesion will cause sensory loss over the sole of the foot.
16. The Ear
(a) The right heart border is formed by the outer border of the right ventricle. False
?The right heart border is formed by the outer border of the right atrium.
(b) The left heart border is formed by the outer border of the left ventricle. True
?The left heart border is formed by the outer boder of the left ventricle.
(c) The left margin of the right ventricle lies about a thumbs breath in from the left heart border. True
?The left margin of the right ventricle lies about a thumbs breath in from the left heart border and on the
surface of the heart this is marked by the left anterior descending artery.
(d) Valve calcification is best seen on the AP view. False
?Valve calcification is best seen on the lateral view as on the AP view valve calcification cannot be
visualised over the spine.
(e) A large pulmonary artery will cause hilar enlargement. True
?A large pulmonary artery will cause hilar enlargement as will lymphadenopathy.
19. The facial nerve
(a) The nerve emerges on the anterior surface of the brain between the pons and the medulla and it enters
the internal acoustic meatus with the vestibulocochlear nerve. True
?The nerve emerges on the anterior surface of the brain between the pons and the medulla and it enters
the internal acoustic meatus with the vestibulocochlear nerve.
(b) The greater petrosal nerve arises from the nerve at the geniculate ganglion. True
?The greater petrosal nerve contains taste fibers from the palate. It also contains preganglionic
parasympathetic fibres that synapse in the pterygopalatine ganglion. The postganglionic fibers are
secretomotor to the lacrimal gland and the glands of the nose and palate.
(c) Passes through the posterior fossa. True
?
(d) On reaching the medial wall of the middle ear the nerve swells to form the sensory geniculate ganglion.
True
?
(e) Emerges from the temporal bone through the stylo-mastoid foramen. True
?
The facial nerve arises in the medulla and emerges between the pons and medulla. It then passes through
the posterior fossa and runs through the middle ear before emerging from the stylo-mastoid foramen and
running through the parotid.
20. The Forearm:
(a) The radial artery can be palpated on the medial side of the scaphoid in the anatomical snuff box. False
?The radial artery can be palpated on the lateral side of the scaphoid in the anatomical snuff box.
(b) The pulsations of the ulnar artery are recognised lateral to the lunate bone. False
?The pulsations of the ulnar artery are recognised lateral to the pisiform bone
(c) The radial artery lies in a groove between the flexor digitorum profundus and the anterior border of the
radius. False
?The radial artery lies in a groove between the flexor carpi radialis and the anterior border of the radius.
(d) In the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. True
(a) The frontal part of the scalp is innervated by branches of the opthalmic part of the trigeminal nerve.
True
(b) The frontal part of the scalp is innervated by the supraorbital and supratrochlear nerves. True
(c) The posterior part of the scalp is innervated by branches of the first division of the trigeminal nerve
False
(d) The posterior part of the scalp is innervated by branches of the cervical plexus. True
(e) The cervical plexus plays a role in innervation of the posterior and lateral scalp. True
The frontal part of the scalp is innervated by the supraorbital and supratrochlear nerves which are branches
of the first division of the trigeminal nerve.The posterior part of the scalp is innervated by branches of the
cervical plexus, more specifically the greater and lesser occipital nerves. The cervical plexus innervates the
lateral scalp through the lesser occipital nerve.
22. Muscles of the hand
(a) Flexor pollicis brevis flexes the MCP joint of the thumb. True
(b) Flexor pollicis brevis is innervated by median nerve True
This is usually the case however may also be innervated by the deep branch of the ulnar nerve
(c) Flexor pollicis longus flexes proximal phalanx of thumb False
Flexor pollicis longus flexes distal phalanx of thumb
(d) Extensor pollicis longus extends the IP and MCP joints of the thumb True
?
(e) Extensor pollicis brevis forms anterior border of the anatomical snuff box. True
Extensor pollicis brevis forms anterior border of the anatomical snuff box and the posterior border of the
snuffbox is the tendon of the extensor pollicis longus.
23. Penetrating injuries of the diaphragm
(a) The arching domes of the diaphragm highest point is the level of the 6th rib False
(b) If a penetrating injury is just below the level of the nipples one should not be suspicious of a penetrating
injury to the diaphragm False
The arching domes of the diaphragm can reach the level of the 5th rib.If a penetrating injury is just below
the level of the nipples one should be suspicious of a penetrating injury to the diaphragm
24. Occlusion of the anterior cerebral artery causes
(a) The median nerve enters the hand through the carpal tunnel, deep to the flexor retinaculum, between
the tendons of the flexor digitorum superficialis and the flexor carpi radialis. True
?The median nerve enters the hand through the carpal tunnel, deep to the flexor retinaculum, between the
tendons of the flexor digitorum superficialis and the flexor carpi radialis.
(b) To anaesthetise the median nerve local anaesthetic is injected between the tendon's of the flexpr carpi
radialis and palmaris longus. True
?To anaesthetise the median nerve local anaesthetic is injected between the tendon's of the flexpr carpi
radialis and palmaris longus.
(c) At the wrist the ulnar nerve is blocked by injecting local anaesthetic between the palmaris longus and
the flexor carpi ulnaris False
?At the wrist the ulnar nerve is blocked by injecting local anaesthetic between the ulnar artery and the
flexor carpi ulnaris.
(d) The ulnar nerve supplies cutaneuos sensation to the volar surface of the middle finger. False
?The ulnar nerve supplies cutaneuos sensation to the volar surface of the little finger and the medial half of
the ring finger.
(e) About 5 ml's of 2% lignocaine is required to anaesthetise the ulnar nerve. False
?
30. Left common carotid artery
(a) Lies postero-laterally to the left vagus nerve in the neck. False
The left common carotid artery lies antero-medial to the left vagus nerve in the neck
(b) Lies anteriorly to the prevertebral fascia in the neck. True
The left common carotid artery lies anteriorly to the prevertebral fascia in the neck.
(c) Gives off the left inferior thyroid artery. False
The left thyroid artery is a branch of the left thyrocervical trunk of subclavian
(d) Is a direct branch from the aortic arch. True
The left common carotid artery is a direct branch from the aortic arch.
31. Haemorrhagic Shock
(a) The femoral nerve originates from the lumbar plexus from L2, L3 and L4. True
?The femoral nerve originates from the lumbar plexus from L2, L3 and L4.
(b) The obturator nerve originates from L1 and L2 and supplies the adductor muscles of the thigh. False
?The obturator nerve originates from L2, L3 and L4 and supplies the adductor muscles of the thigh.
(c) The femoral nerve supplies the skin on the posterior aspect of the leg and foot. False
?The femoral nerve supplies the skin on the medial side of the leg and foot.
(d) The iliohypogastric nerve supplies the cremaster muscle. False
?The genitofemoral nerve supplies the cremaster muscle.
(e) The femoral nerve supplies the skin on the medial surface of the thigh only. False
?The femoral nerve supplies the skin on the anterior surface of the thigh.The obturator nerve innervates the
adductors of the thigh and the skin on the medial surface of the thigh.
33. Lower vertebral levels:
The skin drains to the axillary lymph nodes.The intercostal spaces drain forwards to the internal thoracic
nodes and backwards to the posterior intercostal nodes and the para aortic nodes.
36. Characteristic features of repetitive strain injury:
(a) Lateral flexion of the body is restricted by the thoracic section of the vertebral column. True
?Lateral flexion of the body is restricted by the thoracic section of the vertebral column because of the ribs.
(b) Rotation ( twisting of the body ) of the body is least extensive in the lumbar region. True
?Rotation of the body is least extensive in the lumbar region.
(c) Flexion and extension of the vertebral column is extensive in the cervical and thoracic regions but
limited by the lumbar region. False
?Flexion and extension of the vertebral column is extensive in the cervical and lumbar regions but limited
by the thoracic region.
(d) The cervical vertebrae normally have a posterior convexity while the thoracic region has a posterior
concavity. False
?The cervical vertebrae normally have a posterior concavity while the thoracic region has a posterior
convexity.
(e) There is normally 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, and 5 sacral
vertebrae, and 4 coccygeal vertebrae. True
?There is normally 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, and 5 sacral vertebrae,
and 4 coccygeal vertebrae.
39. The thorcic spine:
(a) Has an increased amount of flexibility afforded by it's articulation with the rib cage. False
?The rib cage makes the thoracic spine more inflexible and more rigid.
(b) The thorcic spine is the most commonly injured part of the spine. False
?The thoracic spine is among the least frequently injured parts of the spine.
(c) The spinal canal is wider than that found in the cervical spine. False
?The spinal canal is narrower in the thoracic spine than that found in the cervical or lumbar spine.
(d) When spinal cord injury does occur they are mostly neurologically complete. True
?Because of the high ratio of spinal cord to spinal canal in the thoracic spine when spinal cord injury does
occur it is usually complete.
(e) The thoracolumbar junction (T11-L2) is considered a transitional zone between the fixed thoracic and
mobile lumbar regions True
?The thoracolumbar junction (T11-L2) is considered a transitional zone between the fixed thoracic and
mobile lumbar regions
40. The following muscles and nerve root supply are correctly paired:
(a) Extracapsular fractures are more likely to compromise blood supply to the femoral head than
intracapsular fractures. False
?
(b) Isolated femoral head fractures are most commonly associated with hip dislocations. True
?
(c) Non displaced neck fractures are treated with pin fixation. True
?
(d) Displaced fractures are treated with open reduction or prosthesis placement. True
?
(e) Overall mortality for intertrochanteric hip fractures is 50% False
?Overall mortality for intertrochanteric hip fractures is 10 to 30%.
Hip fracture incidence doubles for each decade after 50. Hip fracture incidence is 3 to 4 times higher in
women than in men. The affected leg in a hip fracture is classically shortened and externally rotated.
Intracapsular hip fractures involve the femoral head and femoral neck. Extracapsular hip fractures may be
intertrochanteric or subtrochanteric. Intracapsular fractures are more likely to compromise blood supply to
the femoral head than extracapsular fractures. Isolated femoral head fractures are most commonly
associated with hip dislocations. Non displaced neck fractures are treated with pin fixation. Displaced
fractures are treated with open reduction or prosthesis placement. Intertrochanteric fractures are classed as
stable or unstable. stable fractures are those which the medial cortices of the femoral neck and the femoral
fragment abut. Overall mortality for intertrochanteric hip fractures is 10 to 30%.
42. Classification of shock
(a) Class I shock is when blood loss is <10% of blood volume False
?
(b) Class II shock is when blood loss is <20% of blood volume False
?
(c) Class III shock is when 20-40% of blood volume is lost False
?
(d) Class IV shock is when >40% blood volume is lost True
?
(e) Class V shock is when >50% of blood volume is lost False
?
Class I = <15%, Class II = <30%, Class III = <40%, Class IV = >40%
(a) GCS < 13 when first assessed in ED CT brain should be requested immediately according to the NICE
guidelines after head injury. True
?GCS < 13 when first assessed in ED CT brain should be requested immediately
(b) If GCS < 15 when assessed 2 hours after presentation in ED CT brain should be requested. True
?If GCS < 15 when assessed 2 hours after presentation in ED CT brain should be requested.
(c) A suspected skull fracture is not an indication to request a CT Brain scan. False
?A suspected skull fracture is an indication to request a CT Brain scan.
(d) 'Panda' eyes are not an indication to request a CT Brain scan False
?'Panda' eyes is an indication to request a CT brain scan as this is evidence of a fracture at the skull base.
(e) A collection of blood in the middle ear space is not an indication to request a CT Brain scan. False
?Haemotympanum is an indication to request a CT Brain scan as this is evidence of a fracture at the skull
base.
44. Openings in the diaphragm
(a) The aortic opening lies anterior to the body of T10 False
The aortic opening lies anterior to the body of T12.The aortic opening transmits the aorta,the thoracic duct
and the azygous vein
(b) The aortic opening transmits the aorta,the thoracic duct, the azygous vein, and the vagus nerve. False
The aortic opening transmits the aorta,the thoracic duct and the azygous vein. The oesophageal opening
transmits the vagi.
(c) The esophageal opening is at the level of T12 False
The esophageal opening is at the level of T10.
(d) The esophageal opening transmits the phrenic nerve False
The esophageal opening transmits the vagi at T10. The right phrenic nerve penetrates the diaphragm with
the IVC while the left phrenic nerve penetrates on it's own.
(e) The caval opening transmits the inferior vena cava at the level of T8 True
The caval opening transmits the inferior vena cava at the level of T8.
The aortic opening lies anterior to the body of T12.The aortic opening transmits the aorta,the thoracic duct
and the azygous vein.The esophageal opening transmits the vagus nerve
45. With regard to the nervous system
(a) The sternal angle lies at the level of the second intercostal space. False
The sternal angle lies at the level of the second costal cartilage.
(b) The sternal angle lies at the level of the intervertebral disc between the 5th and 6th thoracic vertebrae
False
The sternal angle lies at the level of the intervertebral disc between the 4th and 5th thoracic vertebrae.
(c) The sternal angle lies at the level of the junction of the ascending aorta and the aortic arch but not at the
junction between the descending aorta and the aortic arch. False
The sternal angle lies at the level of the junction of the ascending aorta and the aortic arch ( and also the
junction between the aortic arch and the descending aorta )
(d) The sternal angle lies at the level of the junction between the superior and inferior mediastinum. True
The sternal angle lies at the level of the junction between the superior and inferior mediastinum.
(e) The sternal angle lies at the level of the bifurcation of the trachea. True
The sternal angle lies at the level of the bifurcation of the trachea.
The sternal angle lies at the level of the second costal cartilage.As well as the above it lies at the junction of
the superior and inferior mediastinum.
47. Abnormal JVP:
Cervical Spondylosis -When severe most commonly effects C5/C6 as this is where bending the neck is
greatest. Most episodes settle without treatment.Disc protrusion may narrow the vertebral arteries and
cause vertebrobasilar insufficiency.Manipulation is contraindicated in myelopathy.
49. The following are causes of spinal cord compression:
(a) The urethra and bladder lie close to the pubic symphysis are damaged by a majority of traumatic
injuries to this area. False
?The urethra and bladder lie close to the pubic symphysis and are sometimes damaged by trauma to this
area (In 1/5 th of cases)
(b) For the pubic bones to separate by over 2.5 cm one or both of the ligaments have to be torn. True
?For the pubic bones to separate by over 2.5 cm one or both of the ligaments have to be torn.
(c) It is only possible to obtain the correct diagnosis in 50% of cases from AP views of the pelvis alone.
False
?In 94% of cases a correct diagnosis can be made from only AP views of the pelvis
(d) The pelvic brim is often disrupted in only one place False
?The pelvic brim cannot be disrupted in only one place
(e) Lateral compression fracture causes a disruption of the ala of the sacrum and a horizontal fracture of
the ipsilateral pubic symphysis True
?And momentary medial displacement of the hemipelvis
52. The following joints are often subluxed/dislocated in ehlers-danlos syndrome:
(a) A bitemporal hemianopia may be caused by a pituitary tumor or a sella meningioma. True
?A bitemporal hemianopia may be caused by a pituitary tumor or a sella meningioma
(b) A homonymous hemianopia is caused by a lesion of the optic tract to the occipital cortex. True
?A homonymous hemianopia is caused by a lesion of the optic tract to the occipital cortex.
(c) An incomplete lesion of the optic tract is associated with a central scotomata. False
?An incomplete lesion of the optic tract is associated with macular ( central ) vision sparing
(d) An upper quadrant homonymous hemianopia is associated with a parietal lobe lesion. False
?A lower quadrant homonymous hemianopia is associated with a parietal lobe lesion.
(e) A lower quadrant homonymous hemianopia is associated with a temporal lobe lesion. False
?An upper quadrant homonymous hemianopia is associated with a temporal lobe lesion.
56. Thoracic vertebrae:
(a) The top of the arch of the aorta is at the level of T3/4 True
?The top of the arch of the aorta is at the level of T3/4
(b) The manubrium sterni encompasses levels T3 and T4 True
?The manubrium sterni encompasses levels T3 and T4
(c) The azygous vein enters the SVC at T6 False
?The azygous vein enters the SVC at T4
(d) The angle of louis is at the level of T4/5 True
?The angle of louis is at the level of T4/5
(e) The bifurcation of the trachea is at the level of T4/T5 True
?The bifurcation of the trachea is at the level of T4/T5
(a) Diffuse bleeding most often occurs from the subdermal plexus and superficial veins True
? Diffuse bleeding most often occurs from the subdermal plexus and superficial veins
(b) Povidone-iodine based skin disinfectant suppress bacterial growth on intact skin. True
?
(c) Povidone-iodine based skin disinfectant should be used in the wound itslf to suppress bacterial growth.
False
?Povidone-iodine based skin disinfectant should not be used in the wound itself as it may impair host
defences and promote bacteria growth.
(d) Chlorhexidine based skin disinfectant should be used in the wound itslf to suppress bacterial growth.
False
?Chlorhexidine based skin disinfectant should not be used in the wound itself as it may impair host
defences and promote bacteria growth.
(e) In well perfused tissues (e.g., scalp) wounds closed without prior hair removal heal with an increase in
infection. False
?In well perfused tissues (e.g., scalp) wounds closed without prior hair removal heal with no apparent
increase in infection
58. The circle of willis is supplied by
(a) The hand position of function for splinting includes the MCP joint being at 50 to 90 degrees flexion.
True
?
(b) Midpalmer space infection occurs from spread of a flexor tenosynovitis or from a penetrating wound to
the palm causing infection in the radial or ulnar bursa of the hand. True
?
(c) Paronychia is an infection of the lateral nail fold. True
?
(d) Flexor tenosynovitis is suggested by tenderness over the flexor tendon sheath. True
?
(e) Closed fist injury ( human bite wound above the MCP joint resulting from punching an individual ) be be
explored, irrigated and allowed to heal by secondary intention. True
?
61. Eye Trauma:
(a) Hyperextension at the MCP joint of the little and ring fingers accompanied by flexion of the
interphalangeal joints. True
?This is claw-like hand pattern.Hyperextension at the MCP joint of the little and ring fingers accompanied
by flexion of the interphalangeal joints.
(b) Clawing of the hand is more pronounced with a more proximal lesion. False
?Clawing of the hand is more pronounced with a lesion at the wrist as a lesion at or above the elbow
causes loss of flexor digitorum profundus and less flexion at the IP joints.
(a) The lumbar plexus is formed by the anterior rami of the upper four lumbar nerves. True
?The lumbar plexus is formed by the anterior rami of the upper four lumbar nerves.
(b) It is situated within the psoas muscle True
?It is situated within the psoas muscle
(c) The femoral nerve originates from the lumbar plexus from L1 and L2. False
?The femoral nerve originates from the lumbar plexus from L2, L3 and L4
(a) The ulnar nerve is largely made up from C6 and C7 fibres. False
?The ulnar nerve is largely made up from C8 and T1 fibres.
(b) The axillary nerve is given off by the posterior cord. True
?The axillary nerve is given off by the posterior cord.
(c) The musculocutaneous nerve is made up from C5 , C6 , and C7 True
?The musculocutaneous nerve is made up from C5 , C6 , and C7
(d) The medial cord and the lateral cord form the median nerve True
?The medial cord and the lateral cord form the median nerve
(e) The dorsal scapular nerve ( C5 ) supplies the serratus anterior muscle. False
?The dorsal scapular nerve ( C5 ) supplies the rhomboid muscles. Serratus Anterior is supplied by the long
thoracic nerve.
68. The following are true in relation to common root compression syndromes produced by lumbar disc
prolapse:
(a) An L5 root lesion will cause pain from the buttock to the lateral aspect of the leg and on the dorsum of
the foot. True
?An L5 root lesion will cause pain from the buttock to the lateral aspect of the leg and on the dorsum of the
foot.
(b) An L4 root lesion will cause pain from the lateral aspect of the thigh to the medial side of the calf. True
?An L4 root lesion will cause pain from the lateral aspect of the thigh to the medial side of the calf.
(c) An S1 root lesion will cause sensory loss on the sole of the foot and the posterior calf. True
?An S1 root lesion will cause sensory loss on the sole of the foot and the posterior calf.
(d) An L5 root lesion will cause sensory loss on the dorsum of the foot and anterolateral aspect of the leg.
True
?An L5 root lesion will cause sensory loss on the dorsum of the foot and anterolateral aspect of the leg.