review

Question 1

The parotid gland
a) Is separated from the submandicular gland by the stylomandibular ligament
b) Is related anteriorly to the lateral pterygoid
c) Has the ECA running superficial to the facial nerve within its substance
d) Receive secretomotor fibres from the facial nerve

Answer 1

A. the “only thing separating the parotid gland from the submandibular gland is the stylomandibular ligament”, which is a thin condensation of the parotid gland’s fascial sheath. This is clinically significant because it makes it difficult to determine the source of swelling in this area.

Question 2

The medial pterygoid muscle:
a) Is not attached to the lateral pterygoid plate of the sphenoid bone
b) Attached to the maxillary tuberosity
c) Innervated by the buccal nerve

Answer 2

B. The maxillary tuberosity gives origin to a few fibres of the medial pterygoid muscle.

Question 3

Which of the following is false regarding the TMJ?
a) Lateral ligament is taut when the jaw is elevated
b) Is a condyloid joint
c) Has tendon of the medial pterygoid muscle attached to the fibrocartilaginous disc
d) Has the chorda tympani nerve as a posterior relation

Answer 3

Option C: False. It is the tendon of the lateral pterygoid muscle that attaches to the fibrocartilaginous disc, not the medial pterygoid.

Question 4

The ophthalmic artery:
a) arises from the internal carotid soon after if pierces the dura and enters the subarachnoid space
b) enters the orbit through the superior orbital fissure
c) Passes from medial to lateral over the optic nerve as these structures pass anteriorly through the orbit
d) Terminates by dividing into supraorbital and infratrochlear branches

Answer 4

A
Option A: True! After coursing through the cavernous sinus, the ICA pierces through the dural wall of the sinus to enter the subarachnoid space. It then gives off its first branch - the ophthalmic artery, which runs with the optic nerve and ophthalmic vein into the orbit.
Option B: False, the ophthalmic artery enters the SOF via the Optic Canal.
Option C: False. Referring to the diagram (of the right eye), the ophthalmic artery passes beneath the optic nerve from lateral to medial.
Option D: False, it terminates by dividing into supraorbital and supratrochlear branches.

Question 5

In the lacrimal apparatus:
a) The lacrimal gland is innervated by the zygomaticotemporal nerve
b) The gland is superficial to the orbicularis oculi muscle
c) Removal of tears is entirely by evaporation from the exposed surface of the eyeball
d) The nasolacrimal duct descends between the maxillary bone and the middle concha

Answer 5

A

Question 6

11. Destruction of which cranial nerve would result in the inability to masticate food?
    a. V
    b. VI
    c. VII
    d. IX

Answer 6

A. Muscles of mastication are innervated by CN V3. These include the masseter, temporalis, as well as the medial and lateral pterygoid muscles.

Question 7

14. Bundles of axons or nerve fibers are known as tracts, except in the PNS, where they are known as:
    a. ganglia
    b. interneurons
    c. nuclei
    d. nerves
    e. postsynaptic neurons

Answer 7

D.

A: Ganglia are aggregations of cell bodies in the PNS.
B: Interneurons are singular nerves connecting sensory neurons to motor neurons, mostly found in the grey column of the spinal cord.
C: Nuclei are aggregations of cell bodies in the CNS.
E: ‘Postsynaptic neurons’ is a very broad term. Anyway, neurons are single cells, and bundles of axons or nerve fibres are not going to be found in single cells.

Question 8

16. The part of the brain responsible for the regulation of body temperature and hunger is the:
    a. superior colliculus
    b. parietal lobe
    c. epithalamus
    d. medulla oblongata
    e. hypothalamus

Answer 8

Option E: Factual. According to Prof Ng Yee Kong’s slides, the hypothalamus is also responsible for endocrine control (via releasing/inhibitory hormones), neurosecretion (eg oxytocin/ADH), thermoregulation, regulation of food and water intake, sexual behavior, reproduction, acting as head ganglion of the ANS, a biological clock and part of the limbic system.

Question 9

18. Which of the following statements about the spinal cord is true?
    a. it extends from the foramen magnum to the level of S1
    b. it is located in the central canal
    c. both ascending and descending fiber tracts are present
    d. it consists of a central area of white matter, surrounded by gray matter
    e. two of the above

Answer 9

C

Option A: It extends from foramen magnum to L1/L2 and not S1.
Option B: It is located in the vertebral canal, which is formed from the vertebral foramen of the vertebrae. It is CSF that is located in the central canal.
Option C: Factual.
Option D: The spinal cord is made up of gray matter surrounded by white matter.

Question 10

The cell bodies of postganglionic autonomic fibers are located in:
A. the lateral horn of the spinal cord (1st)
B. the effector organ
C. the ventral horn of the spinal cord
D. the medulla oblongata
E. ganglia

Answer 10

E. The cell bodies of postganglionic autonomic fibres are located in various ganglia, and are always outside the CNS

Question 11

The cell bodies of preganglionic parasympathetic neurons are located in the:
A. cervical and thoracic spinal cord
B. brain and lumbar spinal cord
C. thoracic and lumbar spinal cord
D. brain and sacral spinal cord

Answer 11

D.
Option D: Factual. That’s why the parasympathetic system is said to have “craniosacral outflow”.

Question 12

The hormone melatonin is produced by the:
A. pituitary gland
B. hypothalamus
C. epithalamus
D. medulla oblongata
E. none of the preceding

Answer 12

Option C: Melatonin is produced by the pineal gland of the epithalamus.

Question 13

The _____ separates the two cerebellar hemispheres.
A)falx cerebelli
B)falx cerebri
C)tentorium cerebelli
D)arachnoid meninx

Answer 13

Option A: Factual and derivable from the name! It is a sickle-shaped (falx = sickle) fold of dura mater that separate the cerebellar hemispheres (cerebelli refers to cerebellum).

Question 14

At what level do the majority of nerve fibers cross from the right to the left?
A)T1-T12
B)medulla
C)pons
D)cervical region of spinal cord

Answer 14

Option B: The medulla is the site of decussation of all DCML fibres and nearly all corticospinal fibres.

Question 15

Initially, the developing forebrain is called the _____.
A)prosencephalon
B)diencephalon
C)telencephalon
D)rhombencephalon

Answer 15

Option A: Factual. Brief embryology: the brain is divided into 3 primary portions during early development: the prosencephalon (forebrain), mesencephalon (midbrain) and rhombencephalon (hindbrain). Eventually, this develops into a 5-ventricle stage when the forebrain separates into the telencephalon (cerebrum) and diencephalon (hypothalamus, thalamus, epithalamus), and the hindbrain separates into the metencephalon (pons and cerebellum) and myelencephalon (medulla). The mesencephalon remains as the midbrain.

Question 16

The cerebral hemispheres are connected by a large white fiber pathway called the _____.
A)fornix
B)insula
C)circular sulcus
D)corpus callosum

Answer 16

Option D: Factual. In fact, the corpus callosum is the largest type of commissural fibre (fibres that connect the two hemispheres of the brain).

Question 17

Broca’s area is usually in the _____ area of the _____.
A)left; prefrontal cortex
B)right; temporal lobe
C)left; frontal lobe
D)right; occipital lobe

Answer 17

Option C: Factual. In particular, it is noteworthy that Broca’s is only located unilaterally (usually in the left hemisphere). This phenomenon where certain neural functions are more dominant on or even exclusively located on one hemisphere is known as “lateralization”. For Broca’s, a correlation to handedness is also exhibited (eg. right handed people have Broca’s on their left hemispheres, and vice versa for left handed people)

Question 18

Pyramidal cells are located in the _____ region.
A)cerebellar
B)cerebral cortex
C)corpus callosum
D)basal ganglia

Answer 18

Option B: A pyramidal cell is a type of neuron that is found in forebrain structures like the cerebral cortex, hippocampus and amygdala. It is named as such due to its pyramidal (triangular)-shaped cell body.

Question 19

The interventricular foramen connects the _____.
A)two lateral ventricles
B)lateral to fourth ventricle
C)lateral to third ventricle
D)third to fourth ventricle

Answer 19

C.
The interventricular foramina (of Monro) connect the lateral ventricles to the third ventricles. Do not confuse this with the medial foramen (of Magendie) or the lateral foramina (of Luschka) which connect the fourth ventricle to the subarachnoid space.

Question 20

The third ventricle is located around and near the _____.
A)hippocampus
B)thalamus
C)cerebellum
D)midbrain

Answer 20

Option B: The third ventricle is located in the diencephalon, and the thalamus is part of the diencephalon. (Meanwhile, the lateral ventricles are in the telencephalon (i.e. cerebrum), and 4th ventricle is in the metencephalon (i.e. between pons and cerebellum).

Question 21

On the average, nearly _____ ml of CSF are produced daily.
A)100
B)500
C)140
D)1,000

Answer 21

b

Question 22

The infundibulum is a narrow part of the _____.
A)hypothalamus
B)pituitary
C)pineal gland
D)thalamus

Answer 22

B

Question 23

Sensory impulses are screened and relayed to higher centers by the _____ region.
A)thalamus
B)hypothalamus
C)mammillary body
D)limbic system

Answer 23

Option A: The thalamus acts as a “relaying centre” which receives sensory, motor and cognitive information, integrates it, and then “sends” it on to reach the sensory and motor cortices. (Btw it also regulates consciousness and sleep)

Question 24

The area that coordinates visual reflexes is the _____.
A)cerebellum
B)superior colliculus
C)inferior colliculus
D)cerebral peduncles

Answer 24

B

Option B: Factual (in particular, it is involved in the accommodation-convergence reflex). (But a good trick question! Note that inferior colliculus is involved in the auditory pathway, while superior colliculus is involved in the visual pathway.)
Option D (if you’re interested): the cerebral peduncles are a part of the midbrain that link the remainder of the brainstem to the thalamus (and from there, the cerebrum). They assist in refining motor movements, learning of new motor skills, and converting proprioceptive
information into balance and posture maintenance

Question 25

The _____ has the main centers for breathing reflexes.
A)pons
B)medulla
C)cerebrum
D)hypothalamus

Answer 25

Option B: Factual, the medulla is the location of the “vital centres” responsible for
vital functions like breathing

Question 26

Which of the following is not a medullary vital center?
A)blood pressure
B)cardiac
C)vasomotor
D)respiratory

Answer 26

A
Option A: There is no such thing as a “blood pressure centre”. Rather, blood pressure is regulated by the “vasomotor centre”.
Options B-D: The medulla is indeed to have these 3 vital centres: cardiac (regulates heart rate via ANS fibres to the sinuatrial node), respiratory centre (regulates rate and depth of ventilation) and vasomotor centre (modulates ANS to regulate blood pressure, e.g. by changing blood vessel diameter). An injury to the medulla is thus most likely fatal.

Question 27

The longest autonomic nerve is the _____.
A)phrenic
B)spinal accessory
C)vagus
D)thoracic

Answer 27

C

Question 28

Sympathetic nerves arise from _____ and _____ regions.
A)cervical; lumbar
B)cranial; sacral
C)cranial; thoracic
D)thoracic; lumbar

Answer 28

Option D: That’s why the sympathetic system is said to have “thoracolumbar outflow”.

Question 29

Norepinephrine is released from _____ nerves.
A)all autonomic
B)parasympathetic
C)the vagus
D)sympathetic

Answer 29

Option D: Norepinephrine is a neurotransmitter of nearly all post-ganglionic sympathetic nerves (Except those of sweat glands)

Question 30

When a person thinks and solves problems, which area of the cerebrum is involved?
A)frontal lobe
B)parietal lobe
C)occipital lobe
D)temporal lobe (1st)

Answer 30

Option A: Factual

Question 31

The connection between the third and fourth ventricle is called the _____.
A)interventricular foramen
B)cerebral aqueduct
C)foramen of Monro
D)hypothalamus

Answer 31

B

Question 32

The centers that control vital visceral activities are located within the _______ area of the brain.
A)hypothalamus
B)cerebral cortex
C)pons
D)medulla oblongata

Answer 32

D
The correct answer to the question about which area of the brain controls vital visceral activities is D) medulla oblongata. Here’s why:

1. Autonomic Functions: The medulla oblongata is responsible for regulating several critical autonomic functions, including heart rate, blood pressure, and respiration. It contains vital centers such as the cardiovascular center and the respiratory center, which are essential for maintaining homeostasis in the body[1][2][4].
2. Connection to the Spinal Cord: The medulla serves as a conduit between the brain and the spinal cord, allowing for the integration of autonomic functions with higher brain activity. This connection is crucial for reflex actions that involve visceral organs[3][4].
3. Reflex Centers: In addition to regulating basic physiological functions, the medulla also houses reflex centers for actions such as vomiting, coughing, sneezing, and swallowing. These reflexes are vital for protecting the body and maintaining internal stability[2][5].

In contrast, while the hypothalamus also plays a significant role in regulating visceral activities by influencing autonomic functions and hormone release, the direct control of basic life-sustaining functions like respiration and cardiovascular regulation primarily resides in the medulla oblongata. Therefore, option D is indeed correct.

Question 33

Which brain area acts to regulate body temperature?
A)thalamus
B)cerebrum
C)hypothalamus
D)cerebellum

Answer 33

C

Question 34

Which brain area acts to screen all incoming sensory data except for smell?
A)cerebral cortex
B)medulla
C)cerebellum
D)thalamus

Answer 34

Option D: an interesting fact! The thalamus does indeed screen all sensory info except for smell; olfaction is processed by the limbic system instead (which may explain smell is most strongly linked to strong emotions and/or memories)

Question 35

The image focused on the blind spot lies in which area of the visual axis?
a. In the visual axis
b. Medial to the visual axis
c. Superior to the visual axis
d. Inferior to the visual axis
e. Lateral to the visual visual axis

Answer 35

Option B: Factual. Note that “blind spot” refers to the position of the optic disk at which there are no photoreceptors. Lateral to the blind spot is the fovea centralis, which contains a high concentration of cones and where visual acuity is thus very high. Since the “visual axis” is defined as a straight line passing from the object through the pupil to reach the centre of the fovea (which thus gives the best colour vision), the blind spot thus ends up medial to the visual axis.

Question 36

Profuse bleeding from the scalp is from which of the following?
a. Epidermis from the skin
b. Occipitofrontalis aponeurosis
c. Subcutaneous tissue
d. Loose areolar tissue
e. Pericardium

Answer 36

Option C: The dense subcutaneous tissue layer is actually the site of the superficial blood vessels of the scalp. Profuse bleeding is thus most likely to originate from a lesion in this layer.

Question 37

The accommodation of the eye involves the following except:
a. Ciliary ganglion
b. Medial rectus muscle
c. Ciliary muscle
d. Oculomotor nerve
e. Lateral rectus

Answer 37

Option E: Lateral rectus abducts the eye – an action that is irrelevant to accommodation. (When focusing on an object that’s moving nearer, you are obviously more likely to adduct rather than abduct your eyes!)

Question 38

Anterior cranial fossa fracture is least likely to cause
a. Bleeding into orbit
b. Bleeding from nose
c. Loss of smell
d. Leaking of cerebrospinal fluid from nose
e. Loss of vision

Answer 38

E

E: Loss of vision is unlikely because the optic nerve is well protected by orbital fat within the orbit, and it travels through the optic canal which is in the middle cranial fossa.
A & B: If the floor of the anterior cranial fossa is fractured, there will be a large communication between the anterior cranial fossa and the orbit, or between the anterior cranial fossa and the nasal cavity. This could mean that blood or CSF from the anterior cranial fossa (as a result of torn meninges associated with the fracture) could leak into the orbit and nasal cavity.
C: The fracture can involve the cribriform plate where the olfactory nerve runs through, and this can result in anosmia – the loss of smell.
D: The bone fragments can tear through the meningeal coverings, resulting in the leaking of CSF from the nose. This is known as CSF rhinorrhea, and this is dangerous because it means that there is a communication from the external environment to the brain and extreme precautions must be made to prevent infection.

Question 39

Occlusion of the left middle cerebral artery may lead to the following except:
A) Contralateral hemiparesis of the face
B) Contralateral hemisensory deficit of the arm
C) Contralateral hemiplegia of the leg
D) Dressing apraxia
E) Expressive (Broca’s) aphasia

Answer 39

Option C: According to the Motor Homunculus, the lower limb is located on the medial surface of the pre-central gyrus, which is supplied by the ACA. An occlusion of the MCA will thus not cause this.
Options A, B: The superior division of the MCA supplies motor and sensory function to areas of pre and post-central gyri that correspond to the face and arms.
D: Dressing apraxia (D) is an inability to put on clothes. Apraxia is usually due to a lesion of the frontal and parietal lobes of the dominant (usually left) hemisphere of the brain, which is supplied by the inf division of the MCA.
E: Expressive (Broca’s) aphasia is caused by a lesion of the Broca’s area, which is in the posterior part of the frontal lobe on the dominant hemisphere of the brain. It is supplied by the sup division of the MCA. Expressive aphasia may therefore occur following occlusion of the left middle cerebral artery.

Question 40

Lesion of the cerebellum may lead to the following except:
A) Altered walking gait
B) Ipsilateral uncoordinated movements of the hand
C) Contralateral hemiparesis
D) Dysmetria
E) Dysdiadochokinesia

Answer 40

Option C: Contralateral hemiparesis (one-sided weakness) is a symptom of a lesion to the pre-central gyrus instead. Lesion of the cerebellum will not cause contralateral hemiparesis because the cerebellum is not responsible for initiating movements.

Question 41

These can be surgically accessed in the posterior triangle of the neck except
A) Apex of lung
B) Brachial Plexus
C) Vagus Nerve
D) Phrenic Nerve
E) Subclavian Artery

Answer 41

Option C: The vagus nerve isn’t considered to be located in the posterior triangle of the neck.

Question 42

An injury to CN 7 in the facial canal will not cause changes to:
a. Hearing
b. Lacrimation
c. Taste sensation to the anterior ⅔ of the tongue
d. Parotid gland secretion
e. Ability to smile

Answer 42

D
CN7 functions
Somatic sensory:
- Small area around your pinna (external ear)

Somatic motor:
- Muscles of facial expression
- Stapedius (prevents too much sound from being transmitted by stapes)
- In CN7 lesion, hyperacusis
- Posterior belly of digastric
- Stylohyoid

Special sensory:
- Taste at anterior ⅔ of tongue (via chorda tympani) minus the circumvallate papillae

Visceral sensory
- Nil

Visceral motor
- ALL MUCOUS GLANDS OF THE HEAD AND NECK MINUS PAROTID (CN IX)

Question 43

The following muscles all arise specifically from pharyngeal arches EXCEPT FOR:
a. Extrinsic muscles of the Tongue
b. Stylopharyngeus
c. Mylohyoid
d. Platysma
e. Levator palatine

Answer 43

A

Question 44

Which of the following structures are not involved in our bodies’ ability to regulate the sounds we hear?
a. Nerve to Stapedius
b. Semicircular canals
c. Round window
d. Oval window
e. Motor nucleus of V

Answer 44

B

Question 45

Which of the following arteries DO NOT supply the Maxillary sinus?
a. Posterior Superior alveolar arteries
b. Posterior Lateral nasal arteries
c. Facial artery
d. Infraorbital arteries

Answer 45

C

Question 46

Which of the following is true about the swallowing reflex?
a. Swallowing cannot be somatically initiated
b. The swallowing center is in cerebrum
c. The mylohyoid helps to elevate the tongue, pushing the food bolus towards the oropharynx
d. The levator veli palatini and tensor veli palatini relax to push the soft palate downwards, directing food into the oropharynx
e. The epiglottis is closed by the posterior cricoarytenoid muscles

Answer 46

C.
Mylohyoid is an interesting muscle; it elevates the hyoid and tongue, but if the hyoid is held in place (as is the case with the other strap muscles contracting), it actually pulls down the mandible instead. The function of interest here is the tongue elevation, which pushes food to the roof of the mouth and subsequently posteriorly into the oropharynx to be swallowed.

Epiglottis is closed by aryepiglottis and other intrinsic larynx muscles, but definitely not the posterior cricoarytenoid, which abducts the vocal folds.

Question 47

The recurrent laryngeal nerve supplies all of the following structures EXCEPT:
a. Aryepiglottis
b. Posterior cricoarytenoids
c. Lateral cricoarytenoid
d. Interarytenoids
e. Cricothyroid

Answer 47

E.
Cricothyroid is supplied by the external laryngeal nerve of the superior laryngeal nerve of the vagus nerve. It is important in strengthening and tensing the vocal folds.

Question 48

Pituitary tumour is least likely to affect?
a. Occulomotor nerve
b. Abducens nerve
c. Olfactory nerve
d. Ophthalmic nerve
e. Maxillary nerve

Answer 48

C. Consider the structures that pass through the cavernous sinus; notably CN 3, 4, 6, 5.1 and 5.2. + the ophthalmic vessels

This is an enclosed space that can be compressed in a pituitary growth. Simple as that. Olfactory nerve exits through the cribriform plate of the ethmoid bone.

This is your sign to revise the various endocrine tumours that can exist and their clinical consequences (e.g. growth-hormone secreting pituitary tumour = acromegaly in adults) which came out for 20/21 M1 pros MEQ and 21/22 M2 pros MEQ AND 21/22 MBBS…

Question 49

Patient unable to elevate his right shoulder and rotate his neck to the left. Which nerve is affected?
a. Left Spinal accessory nerve
b. Long thoracic nerve
c. Left Dorsal scapular nerve
d. Right spinal accessory nerve
e. Right dorsal scapular nerve

Answer 49

D
Right trapezius raises right shoulder
I always struggled with remembering which muscles turn ur body left or right (like SCM or abdo obliques)
Right SCM turns head to the left. Imagine the pivot of the right SCM being the right side of the sternum; contraction of the right SCM pulls the superior end of the SCM anteriorly, which therefore turns the head to the left.

Question 50

Injury of nerve in parotid gland does not affect which muscle
a. Zygomaticus major
b. Orbicularis occuli
c. Levator Palpebrae Superioris
d. Occipitofrontalis
e. Platysma

Answer 50

C
Nerve that passes through the parotid gland is classically the facial nerve, not to be confused with the parasympathetic innervation of the parotid gland; CN IX.
Anyway, Levator palpebrae superioris is innervated by CN III. To note, the other eyelid openers include the superior tarsal muscle that has sympathetic innervation.

Question 51

Patient presents with left shoulder pain and numbness, and weakened left brachioradialis and biceps reflexes. Where is the lesion?
A. Muscle
B. Radialnerve
C. Cerebrum
D. Cervicalcord
E. C5 root

Answer 51

E

Question 52

The World Health Organisation International Classification Functioning, Disability and Health (ICF):
a) Emphasizes the relationship between health and functioning with environment and personal factors
b) Replaces the Diagnostic and Statistical Manual 4th edition
c) Complements the International Classification of Impairment, Disabilities and Handicaps
d) Replaces the International Classification of Diseases and Related Health Problem (ICD 10)
e) Provides the coding system for common medical diagnostics

Answer 52

A

Question 53

The Dorsal Root Ganglion
A. has oligodendrocytes
B. has motor neurons
C. has pseudounipolar neurons
D. has post-ganglionic sympathetic neurons
E. has both afferent and efferent neurons

Answer 53

C

Question 54

Which branch of the external carotid artery anastomoses with a branch of the internal carotid artery?
A. Superior Thyroid
B. Lingual
C. Posterior Auricular
D. Occipital
E. Facial

Answer 54

E. The facial artery, a branch of the external carotid artery, has anastomotic connections with branches of the internal carotid artery. Specifically, it can form anastomoses with the superior labial artery, which is a branch of the facial artery, and the angular artery, which can connect with branches of the internal carotid artery such as the ophthalmic artery. This connection helps to provide collateral circulation to the face.

Question 55

the following are derivaives of the pharyngeal pouches except
A. external acoustic meatus
B. thymus
C. palatine tonsil
D. parathyroid gland
E. eustachian tube

Answer 55

A

Question 56

The middle nasal meatus can give access to the following spaces except
A. Frontal sinus
B. Sphenoid Sinus
C. Hiatus Semilunaris
D. Middle Ethnoidal Sinus
E. Maxillary Sinus

Answer 56

B
he middle nasal meatus is an important passage within the nasal cavity that provides drainage for several paranasal sinuses, including:
A. Frontal sinus: Drains into the middle meatus via the nasofrontal duct.
C. Hiatus Semilunaris: This is a groove in the lateral wall of the middle meatus that serves as a drainage pathway for the anterior ethmoidal air cells and maxillary sinus.
D. Middle Ethmoidal Sinus: Opens into the middle meatus through the ethmoidal bulla.
E. Maxillary Sinus: Drains into the middle meatus at the hiatus semilunaris.
However, the sphenoid sinus does not drain into the middle nasal meatus; instead, it drains into the sphenoethmoidal recess, which is located above the superior nasal concha. Therefore, option B is the correct choice as it is not accessible via the middle nasal meatus.

Question 57

Which area is most prone to (?) spontaneous bleeding in the nose
A. anterior of the nasal septum
B. nasal vestibule
C. middle meatus
D. inferior concha
E. roof of anterior cranial fossa

Answer 57

A
The anterior nasal septum, specifically an area known as Kiesselbach’s plexus, is highly vascularized and contains numerous small blood vessels that are susceptible to rupture. This region is commonly affected by various factors such as dry air, trauma, or irritation, leading to frequent nosebleeds (epistaxis) from this site. Most nosebleeds originate from this area due to its fragility and exposure to environmental conditions

Question 58

What does not contribute to movement of the eye following an object upwards?
A. Oculomotor Nerve
B. Levator Palpabrae Superioris
C. Superior Rectus
D. Trochlear Nerve
E. Inferior Oblique

Answer 58

D

Question 59

Which is not a result of anterior cranial fossa fracture
A. bleeding the eyes
B. bleeding from the ear
C. bleeding from the nose
D. CSF leakage from nose
E. loss of smell

Answer 59

B. bleeding from the ear is more commonly associated with fractures of the middle cranial fossa or posterior cranial fossa, where structures such as the temporal bone and the ear canal are involved. Therefore, it is not a typical result of an anterior cranial fossa fracture.

Question 60

Which nerve is most likely to be affected first if there is an aneurysm of the internal carotid artery in the cavernous sinus
A. Opthalimic
B. Maxillary
C. Oculomotor
D. Abducens
E. Trochlear

Answer 60

D. Aneurysms involving the cavernous segment of the internal carotid artery can exert pressure on adjacent cranial nerves due to their location. Among the cranial nerves that traverse the cavernous sinus, the abducens nerve (CN VI) is particularly vulnerable because of its position. It runs along the lateral wall of the cavernous sinus and is often affected first by any mass effect from an aneurysm or other lesions in this area.

Question 61

What is the most common cause of dementia?
Vascular
Lewy body
Frontotemporal
Parkinson’s disease
Alzheimer’s

Answer 61

E

Question 62

Which symptom is not present in myasthenia gravis?
A. Ptosis
B. Dysphagia
C. Hypophonia
D. Proximal muscle weakness
E. Bradycardia

Answer 62

E
MG (type II hypersensitivity) affects the neuromuscular junctions, leading to skeletal muscle weakness. Patients initially complain of painless weakness, ±starting with the eyes, progressing to fatigue.

Question 63

Myasthenia gravis can precipitate the development of which neoplasm?
A. Lymphoma
B. Thymoma
C. Parathyroid adenoma
D. Schwannoma
E. Pigmented villonodular synovitis

Answer 63

B. 10-15% of MG patients develop a thymoma, requiring a thymectomy.

Question 64

Patient has positive Froment’s test. Which nerve is affected?
A. Median nerve
B. Radial nerve
C. Ulnar nerve
D. C8-T1 nerve root lesion
E. Axillary nerve

Answer 64

C. A positive Froment’s test indicates an issue with the ulnar nerve. This test evaluates the function of the adductor pollicis muscle, which is responsible for adducting the thumb and is innervated by the ulnar nerve.

Question 65

Patient presents with a positive Romberg test. He does not have any vision or hearing problems. Where is the lesion likely to be?
A. Spinocerebellar
B. Spinothalamic
C. Frontal lobe
D. Dorsal column medial lemniscus
E. Occipital lobe

Answer 65

D. Loss of proprioception.

Question 66

Answer 66

A
Option A: Wernicke’s area. Option B: Broca’s area.

Question 67

0M suffered a head injury 7 months ago, and made a full recovery except for minor memory impairment. He suddenly has a witnessed LOC with arm & leg twitching. He is disoriented for 2 hours post-event, and gradually returns to baseline. There was no incontinence or tongue biting,
and PE was normal. What is the most likely diagnosis?
Syncope
Drop attack
Cardiac arrhythmia
Generalised seizure
Focal aware seizure

Answer 67

D. Drop attacks are tonic/atonic seizures. Focal aware seizures do not have LOC.

Question 68

How does age-related macular degeneration (AMD) present?
A. Bitemporal hemianopia
B. Binasal hemianopia
C. Loss of central vision
D. Diplopia and presbyopia
E. Dulling of colour vision

Answer 68

C

Question 69

Name a non-motor symptom of parkinsonism:
A. Pill-rolling tremor at rest
B. Lead pipe rigidity
C. Festinant gait
D. Hypomimia
E. Dysautonomia

Answer 69

E

Question 70

A 10M comes in to see the GP with a week history of reduced hearing & worsening otalgia. Weber’s test lateralises to the right ear, & Rinne’s test is negative in the right ear. What type of hearing loss is this?
A. Left sided conductive hearing loss
B. Left sided sensorineural hearing loss
C. Right sided sensorineural hearing loss
D. Right sided conductive hearing loss
E. Bilateral sensorineural hearing loss, worse on the left

Answer 70

D

Question 71

Which of the following is least recognised as a cause of vertigo?
A. Gentamicin
B. Meniere’s disease
C. Acoustic neuroma
D. BPPV
E. Diabetic neuropathy

Answer 71

E. Peripheral neuropathy, primarily sensory loss.

Question 72

Which of the following would cause a communicating hydrocephalus?
A. Subarachnoid haemorrhage
B. Arnold-Chiari malformation
C. Extradural haematoma
D. Glioblastoma multiforme
E. Intracranial epidermoid cyst

Answer 72

A. There would still be full communication between the ventricles & subarachnoid space. Examples of non- communicating causes would be space-occupying lesions causing obstruction.

Question 73

Which statement on anti-psychotics is true?
A. Typical antipsychotics block D2 receptors more than 5-HT2 receptors
B. Haloperidol has lower efficacy than chlorpromazine
C. Olanzapine is an example of a typical antipsychotic
D. Atypical antipsychotics have more extrapyramidal side effects than typical antipsychotics
E. Tardive dyskinesia is associated with fever & muscle rigidity

Answer 73

A. Typical (1st gen) antipsychotics include haloperidol & chlorpromazine. Since they block D2 receptors more, they have more EPSEs.

Question 74

A 46 year old man presenting with leakage of cerebrospinal fluid through the nose is most likely to have an injury to the
A. Olfactory mucosa
B. Pterion
C. Nasal bone
D. Cribriform plate
E. Frontal bone

Answer 74

D
This condition is known as cerebrospinal fluid rhinorrhea. Fracture to the cribiform plate is likely to cause this condition because the cribiform plate forms part of the base of the skull and lies posteriorly and superiorly to the nasal cavity. Hence, CSF can leak out of the fracture into the nasal cavity. Note that this is a medical emergency because bacteria can enter from the nasal to cranial cavity and result in infection + meningitis.

Question 75

The glossopharyngeal nerve provides sensory innervation to all of the following except:
A. Carotid sinus
B. Palatine tonsil
C. Tongue
D. Larynx
E. Pharynx

Answer 75

D
Glossopharyngeal nerve (IX) supplies the following structures:
General sensory: Inner surface of tympanic membrane and middle ear, palatine tonsil, oropharynx, posterior ⅓ of tongue including circumvallate papillae
Special sensory: Taste from posterior ⅔ of tongue
Visceral sensory: Carotid body (chemoreceptor) and sinus (baroreceptor)

Question 76

Which features of the posterior 1/3 of the tongue is FALSE?
A. Epithelium is derived from 1st pharyngeal arch
B. Lymphatic drainage is to deep cervical nodes
C. Forms part of the valleculae
D. Forms part of oropharynx
E. Mucosa is rich in lymphoid tissue

Answer 76

A
Posterior ⅓ of the tongue develops from the third pharyngeal arch. A way to remember is by remembering the sensory nervous supply of the various pharyngeal arches:
arch 1: CN V (trigeminal)
arch 2: CN VII (facial)
arch 3: CN IX (glossopharyngeal)
arch 4: CN X (superior laryngeal branch of the vagus)
arch 6: CN X (recurrent laryngeal branch of the vagus)
For example: anterior ⅔ of the tongue is supplied by sensory branches from trigeminal nerve (lingual nerve), and hence develops from first pharyngeal arch.

Question 77

During the surgical removal of a diseased thyroid, all of the following may be noted regarding the recurrent laryngeal nerve EXCEPT
A. It hooks around the subclavian artery on the right side
B. It crosses anterior to the scalenus anterior
C. It is related to the vagus nerve
D. It is related to the hypoglossal nerve
E. It may be lesioned when the inferior thyroid artery is cut close to the gland.

Answer 77

D

Question 78

Which of the following abt the TMJ is false?
A. Digastric facilitates depression of the mandible
B. Contraction of the masseter opposes depression of the mandible
C. The lateral pterygoid assists in the depression of the mandible.
D. The lateral temporomandibular ligament stabilizes the TMJ.
E. The articular disc does not move during movement of the TMJ.

Answer 78

E. Contraction of the lateral pterygoid acts to pull the articular disc and condyle forward within the glenoid fossa.

Question 79

A patient suffered from demyelination of the spinal cord and presented with a loss of fine touch. Which of the ascending pathways was affected?
A. Spinotectal tract
B. Lateral spinothalamic tract
C. Spinocerebellar tract
D. Ventral spinothalamic tract
E. Dorsal columns

Answer 79

E
More important tracts to know:
Spinothalamic (anterolateral) tract: Anterior: crude touch and pressure. Lateral: pain and temperature
Spinocerebellar tract: Unconscious proprioception
Dorsal column medial lemniscus: Fine touch, vibration, pressure, conscious proprioception

Question 80

Which of the following statements regarding the scalp is false?
A. Skin has abundant sebaceous glands
B. Bleeding deep to the aponeurosis can spread to face
C. Frontalis muscle attaches to underlying bones of the skull
D. The deepest layer is the periosteum (pericranium)
E. Sensory supply of the scalp is partially by the ophthalmic nerve

Answer 80

C
It only attaches to the overlying skin and other muscles in the face.

Question 81

When a 33 year old woman with pituitary gland tumour and increase in Intra-cranial pressure, she may have the following signs and symptoms except:
A. headache
B. Papilledema
C. Seizures
D. Homonymous hemiaponia
E. vomiting

Answer 81

D

A. Headache
a. Besides this paper giving me a headache, headaches are usually symptomatic of elevated intra-cranial pressure
B. Papilledema
a. What on earth is this? Break the word down into papilla (most probs eye) and edema (swelling due to loads of fluid). Combine these two and you’ll end up with optic disk swelling and this is normally attributed to intracranial hypertension.
C. Seizures
a. If there’s too much pressure within the cranial cavity, it’ll probably impede the brain normal function leading to seizures.
D. Homonymous hemianopia
a. Sneaky as usual, trying to test our pattern recognition again. The bingo term for partial loss of visual field associated with pituitary tumour compression of optic chiasm is BITEMPORAL hemianopia.
E. Vomiting
a. Google says yes. And apparently it is associated with projectile vomiting.

Question 82

The internal carotid artery supplies the following structures except
A. pituitary gland
B. eye
C. scalp
D. inner ear
E. thalamus

Answer 82

D
Inner ear is supply by the labyrinthine artery which is a branch of the basilar artery formed from the vertebral arteries.

Question 83

Which statement regarding the vertebral artery is false?
A. It arises from the subclavian artery
B. It continues as the basilar artery
C. It passes through the transverse foramina of all cervical vertebrae
D. It is closely related to the thoracic duct on the left side
E. It enters the cranial cavity via the foramen magnum

Answer 83

C. : In most individuals, the vertebral arteries ascend up from C6 (and not C7) through their transverse foramina then the foramen magnum into the skull. Hence, it does not pass through the transverse foramina of all the cervical vertebrae. Take note however that the vertebral veins do pass through the transverse foramina of all 7 cervical vertebrae and drain into the brachiocephalic veins.

Question 84

The following structures are found deep to the prevertebral fascia in the neck EXCEPT
A. Scalenus medius muslce
B. Subclavian artery
C. Subclavian vein
D. brachial plexus
E. cervical plexus

Answer 84

C
Basically everything in the posterior neck wall will be deep to the prevertebral fascia. Subclavian vein is anterior to scalenus anterior muscle, hence is superficial to the prevertebral fascia.

Question 85

The following nerves convey general sensation from the nasal cavity except
A. Olfactory Nerve
B. Anterior Ethmoidal Nerve
C. Nasopalatine Nerve
D. Greater Palatine Nerve
E. Infraorbital Nerve

Answer 85

A.
The Olfactory Nerve (CN I) is responsible for the sense of smell (olfaction) and does not convey general sensory information such as touch, pain, or temperature from the nasal cavity.
The other options listed are involved in providing general sensation:
Anterior Ethmoidal Nerve: A branch of the nasociliary nerve (from V1), it provides sensation to the anterosuperior aspect of the nasal cavity.
Nasopalatine Nerve: Supplies sensation to the nasal septum and is a branch of the maxillary nerve (V2).
Greater Palatine Nerve: Also a branch of V2, it supplies sensation to the hard palate and parts of the nasal cavity.
Infraorbital Nerve: A branch of V2, it provides sensation to the lower eyelid, cheek, and upper lip, including parts of the nasal area.

Question 86

Which muscle is not innervated by the superior cervical nerves
A. Sternohyoid
B. Sternothyroid
C. Thyrohyoid
D. Omohyoid
E. Cricothyroid

Answer 86

E
A,B,C & D: Strap muscles innervated by ansa cervicalis (C1-C3)
E: Cricothyroid is innervated by external laryngeal nerve (branch of superior laryngeal nerve of vagus nerve). Function of cricothyroid is to tense the vocal cords to create higher pitches

Question 87

50. Following an injury to the facial nerve at the stylomastoid foramen, all muscles will be paralysed except?

a. Buccinator
b. Orbicularis oculi
c. Zygomaticus major
d. Frontalis
e. Stapedius

Answer 87

E
One of these options is not like the others. The stapedius (E) is the only muscle here that is not a muscle of facial expression, and the branch is given off within the facial canal, before the facial nerve exits the stylomastoid foramen.

Question 88

51. Which branch of the mandibular nerve provides secretomotor fibers to the parotid gland?

a. Masseteric nerve
b. Inferior alveolar nerve
c. Lingual nerve
d. Auriculotemporal nerve
e. Buccal nerve

Answer 88

D
I like to think about the trigeminal nerve and its branches as a tree, while the parasympathetic nerves are like snakes that climb the branches of the tree to supply the glands there. The secretomotor fibres to the parotid gland in the lesser petrosal nerve synapse at the otic ganglion and are carried by the auriculotemporal nerve (D) to the parotid gland. The lingual nerve (C) carries the secretomotor fibres of the chorda tympani to the submandibular ganglion, where they synapse and proceed to supply the submandibular and sublingual glands. The zygomatic branch of the maxillary nerve carries the postsynaptic secretomotor fibres to the lacrimal gland from the pterygopalatine ganglion through the lacrimal nerve.

Question 89

52. Ptosis (drooping eyelid) commonly results from

a. Subdural hemorrhage in the anterior cranial fossa
b. Facial palsy
c. Hyperthyroidism
d. Damage to the abducens nerve
e. Compression of the cervical sympathetic chain

Answer 89

E
The eyelid is opened by the levator palpebrae superioris muscle, which is supplied by the oculomotor nerve (CN III), as well as the superior tarsal muscles, which are supplied by the sympathetic nervous system. The oculomotor nerve runs from the midbrain into the orbit via the superior orbital fissure. It does not pass through, and thus will not be compressed by a subdural hemorrhage in the anterior cranial fossa (A). The facial nerve (CN VII) (B) controls the orbicularis oculi muscle, which closes the eyes. Hyperthyroidism (C) may result in retraction of the eyelids, regardless of whether or not it is due to Graves’ disease. The abducens nerve (CN VI) (D) controls the lateral rectus muscle only. The cervical sympathetic chain supplies sympathetic innervation to the head, including the superior tarsal muscles, and therefore compression would compromise the superior tarsal muscle resulting in ptosis.

Question 90

57. The ophthalmic artery supplies all the following structures except:

a. Eyeball
b. Nasal cavity
c. Pituitary gland
d. Scalp
e. Dura mater

Answer 90

C
The ophthalmic artery supplies the eyeball (A) through the central retinal artery as well as the ciliary arteries. It supplies the nasal cavity (B) via the ethmoidal arteries. The pituitary gland (C) is supplies by the superior and inferior hypophyseal arteries, which are branches of the internal carotid artery. The ophthalmic artery supplies the scalp (D) through the supratrochlear and supraorbital arteries. The optic nerve is surrounded by the meninges of the central nervous system, and the dura mater (E) surrounding the optic nerve is supplied by the ophthalmic artery.

Question 91

The mandibular division of the trigeminal nerve innervates all except
a. temporal
b. external ear
c. nose
d. cheek
e. Teeth of lower jaw

Answer 91

C
While it is fairly tricky to describe the boundaries of the regions innervated (which you can simply google /refer to your textbooks), there is a trick to roughly determining these boundaries. (DISCLAIMER: this was what Prof Maria told me, and I reiterate that these are not the exact boundaries) Imagine a horizontal line connecting the superior most part of the auricle to the lateral canthus of the eye. Bisect this horizontal line with a vertical one to determine the portion of the lateral face supplied by V2 and V3. Extend this line down to a point one to two centimeters superior to the plane of the labial angle, then bring the line forward to meet the labial angle. This again divides the areas supplied by V2 and V3. Draw a line just anterior to the nostrils (inferior aspect of nose) and extend this line, along the nose and face, to the lateral canthus of the eye. This divides the regions supplied by V1 and V2. Above the horizontal line that you first drew, the regions are harder to estimate using this method (and are also less likely to be tested). With this method, you can see how V3 supplies the temple, external ear, teeth of the lower jaw and cheek (and if you’ve studied the braches of V3, you’ll find that there are specific sensory branches to these regions: the auriclotemporal, buccal and inferior alveolar nerves.)

Question 92

The following are related to the submandibular duct EXCEPT
a. lingual nerve
b. inferior alveolar nerve
c. sublingual gland
d. hyoglossus
e. Genioglossus

Answer 92

B
The submandibular duct connects the submandibular gland to the sublingual caruncle, which is just lateral to the frenulum of the tongue. As such, it crosses many structures inferior to the tongue. However, the inferior alveolar nerve enters the mandibular foramen superior to the submandibular gland, and is not related to the duct. (Note that the submandibular gland is bounded superiorly by the stylomandibular ligament, and therefore would not reach the mandibular foramen)

Question 93

Which of the following structures is not related to the SCM?
a. accessory nerve
b. greater auricular nerve
c. thyrohyoid muscle
d. external jugular vein
e. parotid gland

Answer 93

C

a. The spinal accessory nerve innervates the SCM (along with the trapezius)
b. The 4 cutaneous branches of the cervical plexus (including the great / greater auricular nerve) curve around the posterior border of the SCM at the junction between the upper- and middle-thirds of the muscle. This site is clinically significant as it can be used in applying anesthesia.
c. The thyrohyoid muscle is a strap muscle
d. The external jugular vein lies superficial to the SCM
e. The parotid gland is bounded posteriorly by the SCM

Question 94

Which is false of the thyroid gland?
a. related to the sternothyroid
b. produces calcitonin
c. covered by pretracheal fascia
d. supplied by inferior thyroid artery which is a branch of external carotid artery
e. parathyroid gland embedded posteriorly

Answer 94

D

Subclavian artery gives a branch known as the thyrocervical trunk, which further gives another branch: the inferior thyroid artery. The external carotid artery also supplies the thyroid gland, but this is through the superior thyroid artery.

Question 95

The lateral part of the parietal lobe is supplied by the
a. middle cerebral artery
b. anterior cerebral artery
c. posterior cerebral artery
d. middle meningeal artery
e. posterior meningeal artery

Answer 95

A. The middle cerebral artery splits into superior and inferior branches, which exit from the lateral fissure to supply the lateral aspect of the brain. The superior branches supply superiorly to the lateral sulcus, particularly the lateral aspects of the frontal and parietal lobes, while the inferior branches supply inferiorly to the lateral sulcus, particularly the lateral aspect of the temporal lobe.

Question 96

The cervical plexus supplies the following except the:
A. Erector spinae
B. Infra hyoid muscles
C. Skin behind ear
D. Diaphragm
E. Pericardium

Answer 96

A. (supplied by posterior rami of spinal nerves)

Question 97

Which structure is found within the parotid gland?
a) Otic ganglion
b) Stylohyoid muscle
c) Facial nerve
d) Internal carotid artery
e) External jugular vein

Answer 97

C
(superficial to deep relations: CN VII, retromandibular vein, external carotid art)

Question 98

Damage to the sympathetic chain in the neck may result in the following EXCEPT
a) dryness of the face
b) drooping of the eyelid
c) flushing of the face
d) decreased secretion of tears
e) constriction of the pupil

Answer 98

D
(parasympathetics from CN VII)

Question 99

Which of the following us the most important for full depression of the mandible?
A) backward movement of the head of the mandible
B) activation of hypoglossal nerve
C) contraction of lateral pterygoid muscle
D) gravity
E) tension in temporomandibular ligament

Answer 99

C
Contraction of lateral pterygoid muscle: This muscle plays a crucial role in depressing and protruding the mandible. Its contraction is essential for opening the jaw fully, making it a significant factor in mandibular depression.

Question 100

The image focused on the blind spot lies in which area of the visual axis?
a. In the visual axis
b. Medial to the visual axis
c. Superior to the visual axis
d. Inferior to the visual axis
e. Lateral to the visual axis

Answer 100

B

Question 101

A 50 year old man presents with R sided ataxia, hemiparesis, double vision. Where is the most likely offending lesion?

A) Brainstem
B) Cerebral hemispheres
C) Spinal cord
D) Cerebellum
E) Peripheral nerves

Answer 101

A
Ataxia points towards cerebellar tract involvement, meaning that the lesion cannot be within the cerebrum. Cerebellar lesions present with pure ataxia, hence the presence of hemiparesis and double vision help to localise the lesion within the brainstem.

Question 102

A 70yo men presents with conditions pointing to Alzheimer’s disease. Which of the following morphological features are part of Alzheimer’s except:

a) cortical atrophy particularly at frontal temporal and parietal
b) pallor of substantia nigra
c) neurofibrillary tangles
d) neuritic plaques
e) cerebral amyloid angiopathy

Answer 102

B

Question 103

All of the following muscles are involved in dorsiflexion (extension) of the foot
EXCEPT
A. tibialis anterior
B. extensor digitorum longus
C. fibularis (peroneus) tertius
D. extensor hallucis longus
E. extensor digitorum brevis

Answer 103

E. Extensor Digitorum Brevis: Primarily extends the toes but does not participate in dorsiflexion