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Head, Neck and Nervous System Block > HNNS Important Questions > Flashcards

HNNS Important Questions Flashcards

1
Q

[PP]
A junior doctor was asked to collect a sample of cerebrospinal fluid from a 30-year-old patient for analysis. Where should he insert the spinal needle?
A. Epidural space at L3/L4 interspinous level
B. Intervertebral foramen between L3 and L4
C. Subarachnoid space at L3/L4 interspinous level
D. Suburban space at L3/L4 interspinous level

A

C

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2
Q

[PP]
The middle cerebral artery (MCA) is a major source of blood supply to the brain. Which of the following would MOST LIKELY occur following an acute MCA occlusion?
A. Cortical blindness
B. Double vision
C. Speech disorder
D. Unsteady gait

A

C

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3
Q

[PP]
A 45-year-old male came to the clinic due to oculomotor nerve palsy. After examination, the clinician concluded that his symptoms were caused by compression. The aneurysm of which artery MOST LIKELY compressed the root of the oculomotor nerve?
A. Anterior inferior cerebellar artery
B. Basilar artery
C. Posterior inferior cerebellar artery
D. Superior cerebellar artery

A

D

Superior cerebellar artery arises near the end of the basilar artery, passing laterally around the brainstem
Its course is immediately inferior to the oculomotor nerve

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4
Q

[PP]
Occlusion of the internal carotid artery will diminish blood supply to the brain regions supplied by it. Which of the following structures is MOST LIKELY to be affected?
A. Calcarine gyrus
B. Cerebellar hemisphere
C. Inferior frontal gyrus
D. Pons

A

C

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5
Q

[Old PP]
Which of the following cranial nerves does not have nucleus in brainstem?
A. Abducent nerve
B. Optic nerve
C. Trochlear nerve
D. Vagus nerve
E. Vestibulocochlear nerve

A

B

Optic nerve nucleus: in retinal ganglion cells

11244
Telencephalon: CN I
Diencephalon (thalamus): CN II
Mesencephalon (midbrain): CN III, IV
Metencephalon (pons): CN V, VI, VII, VIII
Myelencephalon (medulla): CN IX, X, XI, XII

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6
Q

[Old PP]
Which cranial nerve is not part of PNS?
A. Ophthalmic nerve
B. Optic nerve
C. Trochlear nerve
D. Abducent nerve
E. Oculomotor nerve

A

B

Optic nerve is an outgrowing of diencephalon

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7
Q

[Old PP]
Following cranial nerves branch from pons except:
A. Trochlear nerve
B. Abducent nerve
C. Facial nerve
D. Vagus nerve
E. Hypoglossal nerve

A

A, D, E

A: midbrain
D, E: medulla oblongata

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8
Q

[Old PP]
Which cranial nerves does is responsible for gustatory sensation of anterior two third of tongue?

A

Facial nerve (VII)

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9
Q

[Old PP]
Which cranial nerve is responsible for motor function of masticatory muscles?

A

Trigeminal nerve (V)

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10
Q

[Old PP]
Which cranial nerve is responsible for up rolling of eyeball (i.e. contraction of superior rectus muscle)?

A

Oculomotor nerve (III)

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11
Q

[Old PP]
Which cranial nerve is responsible for autonomic supply to major salivary gland?

A

Glossopharyngeal nerve (IX)

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12
Q

[Old PP]
Which cranial nerve is responsible for supply to cardiac plexus?

A

Vagus nerve (X)

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13
Q

[Old PP]
Which cranial nerve is responsible for motor function of muscles of tongue?

A

Hypoglossal nerve (XII)

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14
Q

[Old PP]
Which of the following cranial nerves is purely sensory?
A. Olfactory nerve
B. Abducens nerve
C. Glossopharyngeal nerve
D. Hypoglossal nerve
E. Trigeminal nerve

A

A

B, D: purely motor
C, E: mixed

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15
Q

[Old PP]
Nuclei of cranial nerves mostly lie in brainstem. Which of the following nerves have its nucleus lying in midbrain?
A. Hypoglossal nerve
B. Oculomotor nerve
C. Optic nerve
D. Trigeminal nerve
E. Vagus nerve

A

B

A, E: medulla oblongata
C: diencephalon (thalamus)
D: pons

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16
Q

[Old PP]
Infarction to medial part of pontomedullary junction and patient presented with diplopia. Which nerve is most likely affected?

A

Abducens nerve (VI)

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17
Q

[Old PP]
A guy is severely injured in a car accident. X-ray shows that condyle of mandible of right side is broken. Surgery on TMJ but later found with abnormal facial expression on right side, suspected damaged right side facial nerve during operation. Which is/are functional component(s) of facial nerve?

A

Brachial motor, visceral motor, special sensory, general sensory

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18
Q

[Old PP]
Which of the following about ANS is incorrect?
A. Parasympathetic innervations arise from cervical and sacral nerve roots
B. Sympathetic trunk extends from C1 to T12
C. Vagus nerve branches out from brainstem and supplies many thoracic and abdominal organs
D. Parasympathetic ganglions are closer to target organs than sympathetic ganglions
E. Acetylcholine is the primary neurotransmitter at parasympathetic ganglion

A

A, B

Parasympathetic innervations: from brainstem & S2-S4
Sympathetic trunk: C1-S3

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19
Q

[Old PP]
Pain is detected by nociceptors. Which of the following is a cutaneous nociceptor?
A. Free nerve endings
B. Meissner corpuscle
C. Merkel’s disc
D. Pacinian corpuscle
E. Ruffini corpuscle

A

A

Free nerve ending: touch, injurious forces
Meissner corpuscle: dynamic deformation (e.g. skin motion, slippery objects)
Merkel’s disc: indentation depth (pressure receptor) e.g. texture
Pacinian corpuscle: vibration
Ruffini endings: stretch receptor

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20
Q

[Old PP]
Which of the following is receptor for noxious stimuli?
A. Free nerve ending
B. Meissner’s corpuscle
C. Merkel’s disc
D. Pacinian corpuscle
E. Ruffini endings

A

A

21
Q

[Old PP]
Skin has specific structures for sensation of touch, pain and temperature. In which of the following layers are Meissner’s corpuscles located?
A. Epidermal-dermal junction
B. Epidermis
C. Hypodermic
D. Papillary layer of dermis
E. Reticular layer of dermis

A

D

22
Q

[Old PP]
Which has the best 2-point discrimination?
A. Back of neck
B. Palm
C. Forehead
D. Sole
E. Finger tip

A

E

Tip of tongue > tip of index finger > lips > side of tongue > palm of hand > forehead > back of hand > dorsum of foot > neck > back

23
Q

[Old PP]
Which of the following lowers threshold for two-point discrimination?
A. Lateral inhibition from afferent fibres
B. Higher convergence to xxx from afferent fibres
C. Local anaesthetic
D. Larger receptive field
E. Low innervation density

A

A

24
Q

[Old PP]
Which type of receptors has fastest rate of adaptation?
A. Merkel’s disc
B. Meissner corpuscle
C. Nociceptor
D. Pacinian corpuscle
E. Ruffini corpuscle

A

D

25
Q

[Old PP]
Panician corpuscle and Ruffini corpuscle detect different stimuli. Skin receptor for vibration, stretch respectively. How do they differentiate from each other? What is the mechanism behind that allows them to detect different stimuli?
A. Rate of adaptation
B. Velocity in action potential conduction
C. Size of receptive field
D. Type of receptor
E. Localisation in skin

A

A

B: determined by nerve fibre
C: affect resolution of spatial discrimination
D: both are mechanoreceptor
E: Pacinian = more superficial, but no effect

26
Q

[Old PP]
A 2-month-old baby boy is presented with high fever and hyperirritability. Meningitis is suspected. What is most likely causative pathogen?
A. Streptococcus agalactiae
B. Haemophilus influenzae
C. Streptococcus pneumoniae
D. Staphylococcus aureus
E. Neisseria meningitidis

A

A

0-8 weeks:
- E. coli (K1) / other Enterobacteriaceae (Citrobacter, Salmonella)
- S. agalactiae (GBS)
- Listeria monocytogens

3 months - 18 years:
- With vaccination: H. influenzae serotype b, S. pneumoniae
- Without vaccination: N. meningitidis

Head trauma / neurosurgery:
- S. aureus / epidermidis, aerobic GNB

27
Q

[Old PP]
From CSF result below, what is the most likely diagnosis?

Appearance: slightly turbid
Glucose: lowered
Protein: elevated
Cells: Mononuclear cells predominant

A. Bacterial meningitis
B. Viral meningitis
C. Viral encephalitis
D. Tuberculous meningitis
E. Thberculous encephalitis

A

D

TB meningitis;
Low glucose, high protein, lymphocytic pleocytosis: predominantly lymphocytes / mononuclear cells predominant A

28
Q

[Old PP]
Meningitis in immunocompromised patients is mostly caused by
A. Naegleria fowleri
B. Angiostrongylus cantonensis
C. Cryptococcus neoformans
D. Herpes simplex virus I
E. Pneumocystis carinii

A

C

Cryptococcal meningitis:
- underlying immunodeficiency esp. HIV

Naegleria fowleri: contaminated fresh water / swimming pool
Angiostrongylus cantonensis: raw mollusks (eosinophilia)

29
Q

[Old PP]
A 56-year-old male with meningitis caused by Cryptococcus neoformans. What is the MOST LIKELY underlying disease of patient?
A. Head injury with fracture of skull
B. Infection with human immunodeficiency virus
C. Presence of ventriculoperitoneal shunt
D. Prolonged neutropenia as a result of cancer chemotherapy
E. Uncontrolled diabetes mellitus

A

B

30
Q

[Old PP]
What cerebrospinal fluid (CSF) finding is UNLIKELY to be seen in a patient with tuberculous meningitis?
A. Acid-fast bacilli on Ziehl-Neelsen staining
B. High protein
C. Low sugar
D. Lymphocytic pleocytosis
E. Mollaret cell

A

E

ZN smear: 15%
LJ culture: <50%
CSF for TB PCR: similar to culture
Sputum LJ culture: <40%
CXR: TB foci <30%

S/S & CSF findings fluctuate from day to day

Mollaret’s meningitis (recurrent benign lymphocytic meningitis): HSV-2

31
Q

[Old PP]
Bacterial meningitis. What is NOT seen?
A. Increased white cell count
B. Increased CSF glucose
C. Increased CSF opening pressure
D. Increased CSF protein
E. Increased neutrophil

A

B

CSF: increased protein, reduced glucose (<50% of blood), increased WBC, neutrophil (>80%)

32
Q

[Old PP]
A 7-year-old boy presents with fever, neck stiffness and headache. Lumbar puncture is done and it is neutrophil dominant. Which of the following organisms is MOST LIKELY to have caused the disease?
A. GBS
B. Meningococcus
C. Cryptococcus
D. Mycobacterium tuberculosis
E. Virus

A

B

33
Q

[PP]
Which brain area is regulated by the neurotransmitter serotonin?
A. Hypoglossal nucleus
B. Locus coeruleus
C. Raphe nucleus
D. Substantia nigra
E. Vestibular nucleus

A

C

34
Q

[PP]
Which nucleus of the brain is mediated by the neurotransmitter serotonin?
A. Basal nucleus of Meynert
B. Locus coerulus
C. Raphe nucleus
D. Vestibular nucleus

A

C

A: Acetylcholine
B. Norepinephrine

35
Q

[PP]
A 50-year-old man is diagnosed with Parkinson disease. The patient has undergone positron emission tomography scan examination for dopaminergic neurons. Which brain region shows loss of dopaminergic neurons?
A. Medial longitudinal fasciculus
B. Periaqueductal gray
C. Substantia nigra
D. Superior colliculus

A

C

Most populated region with dopaminergic neurons
= substantia nigra

36
Q

[PP]
The cerebral peduncle is a region of the midbrain. Which of the following structures passes through the cerebral peduncle?
A. Corticospinal tract
B. Medial lemniscus
C. Medial longitudinal fasciculus
D. Spinothalamic tract

A

A

37
Q

[Old PP]
Where is vomiting centre located in central nervous system?
A. Cerebral cortex
B. Cerebellum
C. Medulla
D. Brainstem
E. Midbrain

A

C

38
Q

[Old PP]
Where is vestibular nucleus located?
A. Basal ganglia
B. Medulla oblongata
C. Midbrain
D. Pons
E. Spinal cord

A

D

39
Q

[Old PP]
Brainstem contains many important nuclei and fibre tracts. Which structure in the following mediated pain signal of toothache?
A. Caudate nucleus
B. Corticospinal tract
C. Nucleus gracilis
D. Rubrospinal tract
E. Trigeminal nucleus

A

E

40
Q

[Old PP]
Where is red nucleus located?
A. Pons
B. Basal ganglia
C. Midbrain
D. Medulla
E. Pyramid

A

C

41
Q

[Old PP]
Superior colliculus is responsible for visual reflex. It is located in which brain region?
A. Basal ganglia
B. Medulla oblongata
C. Midbrain
D. Pons
E. Thalamus

A

C

42
Q

[Old PP]
Reticular formation location?
A. Caudate nucleus
B. Cerebellum
C. Cerebral cortex
D. Hypothalamus
E. Pons

A

E

ARAS -> thalamus, hypothalamus, cortex
DRAS -> cerebellum, sensory nerves

43
Q

[Old PP]
Neural tissue is formed from
A. Endoderm
B. Mesoderm
C. Ectoderm
D. Neuroderm
E. Germ layer

A

C

Both epidermis & neural tissue from ectoderm

44
Q

[Old PP]
Which of the following is not a brainstem function?
A. Maintain posture
B. Maintain consciousness
C. Plan and execute precise movement
D. Synapse upper neuron to lower neuron
E. None of the above

A

C

Mainly by primary motor cortex

45
Q

[Old PP]
Which of the following is correct regarding micurition?
A. Contain voluntary and involuntary components
B. Micurition centre is in brainstem
C. There is urge in micurition when over 400mL urine in bladder
D. Parasympathetic signal travels from pudendal nerve

A

B

Pontine micturition centre

46
Q

[PP]
After tonsillectomy, a boy experienced absence of tactile and taste sensation in the posterior 1/3 of the tongue. Which nerve was inadvertently severed during tonsillectomy?

A

Glossopharyngeal nerve

CN IX:
Inferior (petrosal) ganglion (special sensory)
-> solitary nucleus (rostral part)
-> taste buds in posterior 1/3 of tongue
-> taste

Damage
=> (Ipsilateral) loss of taste in posterior 1/3 of tongue

47
Q

[PP]
The pterygopalatine ganglion plays a major function in the nasal cavity and surrounding regions. What is the MOST COMMON sign manifested if maxillary tumours spread to the medial wall and invade this ganglion?
A. Double vision
B. Dryness of the nasal walls
C. Excessive secretion of tears
D. Hyposecretion of tears

A

C

Pterygopalatine ganglion: predominantly parasympathetic

Invasion => parasympathetic > sympathetic response (vasodilation & increased glandular secretions)

Excessive tear secretion through greater petrosal nerve (CN VII)

X A: extraocular muscles are supplied by CNIII, IV, VI

48
Q

[PP]
A 30-year-old female was diagnosed with skull base meningioma compressing at CNVI. Which muscle movement does the patient have difficulties with on the right side?
A. Directing the pupil laterally
B. Elevating the upper eyelid
C. Forcibly closing the eyelids
D. Pupillary constriction

A

A

Head, Neck and Nervous System Block (4 decks)

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