Section D Past Papers

Question 1

4 Causes of Anosmia?

Answer 1

1. Upper respiratory tract infection
2. Trauma (Fracture of Cribiform Plate)
3. Ageing
4. Neurodegenerative Diseases (Parkinsons)

Question 2

For a lesion to cause Bitemporal Hemianopia it would have to be located in _____.

Answer 2

Optic Chiasm

Question 3

Name 2 causes for Exopthalmos - abnormal protrusion of the eye from the orbit _____/ _____

Answer 3

Graves Disease/Orbital Tumours

Question 4

In the Corneal Reflex, the afferent is _____ and efferent is _____. If the result of performing this reflex is a lack of bilateral blinking, it would indicate a lesion in the _____ cranial nerve.

Answer 4

In the Corneal Reflex, the afferent is cranial nerve V (trigeminal nerve) and the efferent is* cranial nerve VII (facial nerve). If the result of performing this reflex is a lack of bilateral blinking, it would indicate a lesion in the *trigeminal nerve (cranial nerve V).

Question 5

Name 6 signs/symptoms that one could expect to find/observe in a cerebellar lesions. _____ / _____ / _____ / _____ / _____ / _____

Answer 5

DHNDAI

• Ataxia
• Intention tremor
• Dysmetria
• Nystagmus
• Dysdiadochokinesia
• Hypotonia

Question 6

Hypertonicity can be subdivided into _____ caused by a lesion in the _____ and _____ caused by a lesion in the _____. (Marks 2)

Answer 6

Hypertonicity can be subdivided into spasticity caused by a lesion in the upper motor neurons (UMN) and rigidity caused by a lesion in the basal ganglia.

Question 7

In Parkinson’s disease once might note hypertonicity which is described as _____ or _____

Answer 7

In Parkinson’s disease, one might note hypertonicity which is described as Cogwheel or lead-pipe rigidity

Question 8

The Pontine micturition centre (PMC) controls the balance that allows for the mechanical process of urination allowing the urethral sphincter to _____ and the detrusor to _____.

Answer 8

The Pontine micturition centre (PMC) controls the balance that allows for the mechanical process of urination allowing the urethral sphincter to relax and the detrusor to contract.

Question 9

The main difference between a i) tendonitis and a ii) tendinosis is that
i) Involves a process and
ii) Involves a process (Marks *2)

Answer 9

The main difference between a i) tendonitis and a ii) tendinosis is that
i) Involves a* Inflammatory* process and
ii) Involves a Degenerative process (Marks *2)

Question 10

Depuytren’s contracture is caused by a contracture of the palmar and digital ____________ affecting most commonly the or _____ digit. It is associated with the following 2 diseases _________ and ________ (Marks 2)

Answer 10

Dupuytren’s contracture is caused by a contracture of the palmar and digital fascia affecting most commonly the 4th (ring) or 5th (little) digit. It is associated with the following two diseases: diabetes and **alcoholism **

Question 11

Maigne’s Syndrome causes referred pain from the following spinal levels ________, which is mediated through the _________ nerves

Answer 11

Maigne’s Syndrome causes referred pain from the following spinal levels T12-L1, which is mediated through the **cluneal **nerves

Question 12

With the patient lying supine and the doctor taking a thumb web contact over the superior aspect of the patella and presses the patella inferiorly. The patient is instructed to contract the quadriceps. This test is called _____________ and causes pain if _____________ is present (Marks 2)

Answer 12

With the patient lying supine and the doctor taking a thumb web contact over the superior aspect of the patella and presses the patella inferiorly. The patient is instructed to contract the quadriceps. This test is called **Patella Grind Test **and causes pain if chondromalacia Patella if present (Marks 2)

Question 13

Reciprocal Clicking of the TMJ is heard most commonly upon _________ the mouth. This is caused because the _________ moves anteriorly and snaps beneath the

Answer 13

**Reciprocal clicking of the TMJ is heard most commonly upon opening the mouth. This is caused because the articular disc moves anteriorly and snaps beneath the condyle

Question 14

Lateral Epicondylitis is most commonly seen in the age groups _____ to _____. There are 4 types and the lesion of the most common type II is found at _____. The underlying pathology on an acute episode is _____ of the enthesis and consequent _____

Answer 14

Lateral Epicondylitis is most commonly seen in the age groups 30 to 50. There are 4 types, and the lesion of the most common type II is found at the origin of the extensor carpi radialis brevis (ECRB). The underlying pathology in an acute episode is microtearing of the enthesis and consequent inflammation.

Question 15

Please name the 4 separate stages of a disc herniation. (Marks 2)

i)_________ ii)_________ iii)_________ iv)________

Answer 15

The four separate stages of a disc herniation are:

i) Degeneration

ii) Prolapse

iii) Extrusion

iv) Sequestration

DONT PUT EGGS SIDESWAYS

Question 16

A 26 year old male complains of low back stiffness, noticed mostly in the mornings. You perform measurements on the lumbar spine in neutral and in forward flexion. What should the outcome of Schober’s Test be for you to consider the possibility of Ankylosing Spondylitis? ________

Answer 16

To consider the possibility of Ankylosing Spondylitis, the outcome of Schober’s Test should show an increase of less than 5 cm when measuring the distance between the marked points on the lumbar spine from neutral to forward flexion.

Question 17

A Subhyaloid haemorrhage – which usually lies between the posterior limiting layer of
the vitreous and the retina is a pathognomonic sign of an _____________

Answer 17

A subhyaloid haemorrhage, which usually lies between the posterior limiting layer of the vitreous and the retina, is a pathognomonic sign of an Intraocular hemorrhage.

Question 18

For sensory loss to occur in the face and ipsilateral body the lesion must lie in the
_. The lesion would have to be located on the side of the
symptomatology

Answer 18

For sensory loss to occur in the face and ipsilateral body, the lesion must lie in the brainstem. The lesion would have to be located on the contralateral side of the symptomatology.

Question 19

The posterior cervical facet capsule is innervated by_________

Answer 19

The posterior cervical facet capsule is innervated by the medial branches of the dorsal rami of the cervical spinal nerves

Question 20

Decreased hearing is noted in the left ear of your patient. The right reveals normal
hearing. In conductive deafness Weber’s test would in this situation lateralise to the
_____ ear

Answer 20

Decreased hearing is noted in the left ear of your patient. The right reveals normal
hearing. In conductive deafness, Weber’s test would lateralize to the left ear.

Question 21

Which cranial nerves are involved in the Light Reflex? a) _ and b) _____
A lesion in a) will lead to _________________________
A lesion in b) will lead to _________________________

Answer 21

The cranial nerves involved in the light reflex are:

a) Cranial Nerve II (Optic Nerve)
b) Cranial Nerve III (Oculomotor Nerve)

Lesion in CN II: The affected eye won’t react to light.
Lesion in CN III: The affected eye won’t get smaller in response to light.

Question 22

A sensory polyneuropathy affecting the slower small unmyelinated C fibres in the
periphery will lead to change in the patients perception of what sensory modality(ies)

Answer 22

Pain
Temperature
Crude touch

Question 23

When considering Cranial Nerve VII (Facial Nerve) what kind of lesion has occurred in
order to give the presentation A and B and on what side would the lesions lie? (Marks 2)
A) Type of lesion __________ Side of lesion __________
B) Type of lesion __________ Side of lesion __________

Answer 23

A) Type of lesion: Upper motor neuron lesion (UMN)
Side of lesion: Contralateral side to the facial weakness

B) Type of lesion: Lower motor neuron lesion (LMN)
Side of lesion: Ipsilateral side to the facial weakness

Question 24

In Neurosyphilis one may see a characteristic presentation affecting the eye called
pupil.
Name 4 characteristics for this eye presentation _ / _ / _ / _

Answer 24

In neurosyphilis, one may see a characteristic presentation affecting the eye called Argyll Robertson pupil.

Four characteristics of Argyll Robertson pupil are:

Pupil does not react to light (light-near dissociation)
Pupil constricts with accommodation
Pupils are usually small and irregular in shape
Pupils are usually bilateral

Question 25

Performing a Tinnell’s test just inferior to the medial malleoli would be done in order to
assess for?___________________

Answer 25

Performing a Tinel’s test just inferior to the medial malleolus would be done in order to assess for tarsal tunnel syndrome.

Question 26

Percussion of a muscle which produces an initial depression, which spreads out over
the muscle like a ripple effect, following which the depression rises up appearing like a small
mound and lasts for a few seconds is known as?
It can be seen in _ and other disorders.

Answer 26

Percussion of a muscle which produces an initial depression, which spreads out over the muscle like a ripple effect, followed by the depression rising up appearing like a small mound and lasting for a few seconds is known as “muscle belly myotonia”.

It can be seen in myotonic dystrophy and other myotonic disorders.

Question 27

Muscle Dysfunction presents in a variety of signs and symptoms such as:
i) _____________
ii) _____________
iii) _____________
iv) _____________
v) _____________
vi) _____________

Answer 27

i) Muscle weakness

ii) Muscle cramps

iii) Muscle stiffness or rigidity

iv) Fatigue

v) Muscle atrophy

vi) Twitching or fasciculations

Question 28

A sensory polyneuropathy affecting the slower small unmyelinated C fibres in the
periphery will lead to change in the patients perception of what sensory modality(ies)?
____________

Answer 28

A sensory polyneuropathy affecting the slower small unmyelinated C fibers in the periphery will lead to changes in the patient’s perception of the following sensory modalities:
Pain
Temperature
Crude touch

Question 29

A patient with Cervical Myelopathy may be looking down at their feet during gait, due to ________. This may most likely occur due to compression of _______

Answer 29

A patient with cervical myelopathy may be looking down at their feet during gait due to difficulty with proprioception and balance. This may most likely occur due to compression of the cervical spinal cord,

Question 30

Name two childhood hip conditions known to be - linked to / precursors for - femoral
acetabular impingement: _ and _
The Cam type occurs in M F and in the following age group _
The Pincher type is caused by an abnormality of the _

Answer 30

Two childhood hip conditions linked to or precursors for femoral acetabular impingement are:

Developmental Dysplasia of the Hip (DDH)
Legg-Calvé-Perthes Disease
The **Cam type **occurs in **Males more frequently **and in the following age group: late teens to early adulthood.

The Pincer type is caused by an abnormality of the acetabulum (specifically, an over-coverage or increased acetabular rim)

Question 31

Three characteristic signs and symptoms of Plantar Interdigital Neuroma (Morton’s Neuroma) are:
___________, ___________ and ___________

Answer 31

• Pain or burning sensation in the forefoot (often between the third and fourth toes)
• Numbness or tingling in the toes (usually affecting the same area as the pain)
• Pain relief when removing footwear or massaging the area (as pressure on the affected nerve exacerbates the symptoms)

Question 32

Synovial osteochondromatosis (SOC) (AKA synovial chondromatosis)
SOC of the Elbow is a benign condition characterized by __________ and __________.
The clinical presentation could be __________, __________, __________ or __________

Answer 32

Synovial osteochondromatosis (SOC) (also known as synovial chondromatosis) of the elbow is a benign condition characterized by synovial proliferation and cartilaginous nodule formation.

The clinical presentation could be:

Joint pain
Swelling or effusion
Restricted range of motion

Question 33

The Dorsal-scapular nerve is innervated by the following cervical root level(s) ______
and innervates the ______ muscle(s) (be specific)

Answer 33

The Dorsal-scapular nerve is innervated by the following cervical root level(s) C5
and innervates the
Rhomboid major
Rhomboid minor
Levator scapulae muscle(s) (be specific)

Question 34

The cervical posterior facet joint articular capsule is innervated by_________

Answer 34

The cervical posterior facet joint articular capsule is innervated by the medial branches of the dorsal rami of the cervical spinal nerves.

Question 35

Exertional Compartment syndrome can lead to foot drop due to compression of the
______________ nerve

Answer 35

Exertional compartment syndrome can lead to foot drop due to compression of the deep peroneal (deep fibular) nerve.

Question 36

Meralgia Parasthetica can be caused externally by direct trauma or overstretching
injury involving the Lateral Femoral Cutaneous nerve L2-3. Name 2 possible internal causes
for this condition: __________ and__________

Answer 36

Two possible internal causes for meralgia paresthetica are:
Pregnancy
Obesity

Question 37

Myotome & Reflex of C6, C7 L4 & S1

Answer 37

C6
M - Wrist Extension
R - Brachioradalis Reflex

C7
M - Elbow extension (triceps), wrist flexion (flexor carpi radialis and ulnaris)
R - Triceps reflex

L4 -
M - Ankle dorsiflexion (tibialis anterior)
R - Patellar (Knee-jerk) Reflex

S1:
M - Ankle Plantarflexion
R - Achillies (Ankle Jerk) Reflex

Question 38

Neck stiffness on passive neck flexion and / or thigh flexion upon the flexion of the
neck is called __________ sign and is caused by __________

Answer 38

Neck stiffness on passive neck flexion and/or thigh flexion upon the flexion of the neck is called Brudzinski’s sign and is caused by meningeal irritation, commonly seen in conditions such as meningitis.

Question 39

The underlying pathology of MS is an ______________________ disease, which
causes _________________ and variable axonal loss. The outcome/consequence in the
myelin sheet is ____________ which is also called / know as ____________

Answer 39

The underlying pathology of MS is an autoimmune disease, which causes demyelination and variable axonal loss. The outcome/consequence in the myelin sheath is damage or destruction which is also called sclerosis or plaques.

Question 40

Internuclear ophthalmoplegia is seen in MS and affects the ability of adduction of the
eye on attempted contralateral gaze. This is seen bilaterally. The lesion therefore lies in the
____________

Answer 40

Internuclear ophthalmoplegia seen in MS affects the ability of adduction of the eye on attempted contralateral gaze and is typically bilateral. The lesion therefore lies in the Medial longitudinal fasciculus (MLF).