MCEM Pathology MCQ 1. Cervical Spine Fractures (a) A hangmans fracture is a fracture through the odontoid peg. A hangmans fracture implies bilateral fractures through the pedicles of C2 due to hyperextension. (b) A hangmans fracture is almost alays associated ith spinal in!ury. "t is seldom associated ith spinal in!ury# since the anteroposterior diameter of the spinal canal is greatest at this level. (c) A !e$erson fracture is caused by a hyperextension in!ury. %his fracture is caused by a compressive donard force that is transmitted evenly through the occipital condyles to the superior articular surfaces of the lateral masses of C1# it is also called a burst fracture. (d) "n a !e$erson fracture the radiograph is characteri&ed by bilateral lateral displacement of the articular masses of C1. "n a !e$erson fracture the radiograph is characteri&ed by bilateral lateral displacement of the articular masses of C1. (e) %ype """ odontoid fracture occurs hen the fracture line extends into the body of the axis. %ype "'odontoid fracture is an avulsion of the tip of the dens. %ype ""'occur at the base of the dens. %ype """'the fracture line extends into the body of the axis 2. %he folloing factors shift the oxygen'haemoglobin dissociation curve to the right (a) ecrease in temperature A decrease in temperature shifts the curve to the left. (b) An increase in 2#*'+, An increase in 2#*'+, ill shift the oxygen'haemoglobin dissociation curve to the right. (c) An increase in pAn increase in p- ill shift the oxygen'haemoglobin dissociation curve to the left. (d) An increase in Carbon onoxide Carbon onoxide ill shift the curve to the left. (e) An increase in ethemoglobinemia
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ethemoglobinemia ill shift the curve to the left. An increase in -/ ions# temperature and 2#*'+, ill shift the curve to the right. A decrease in -/ ions# temperature and 2#*'+, ill shift the curve to the left along ith an increase in C0 and methemoglobinemia. *. Airay anagement (a) Suxamethonium (Succinylcholine) is a non'depolarising neuromuscular blocer. Suxamethonium (Succinylcholine) is a depolarising (non'competitive) neuromuscular blocer hich produces profound paralysis ithin *'34 seconds of an intravenous in!ection of 1.4'2 mg5g. (b) %he normal dose of suxamethonium (succinylcholine) is 1'2 mg5g. %he normal dose of suxamethonium (succinylcholine) is 1.4'2 mg5g. (c) Suxamethonium is associated ith bradycardia. Suxamethonium is associated ith bradycardia especially in children ho are particularly sensitive to the muscarinic e$ects of suxamethonium. (d) 6etamine is a bronchodilator
MCEM Pathology MCQ 6etamine is a bronchodilator. %he normal induction dose is 1'2mg5g# the onset of anaesthesia is 14'* seconds# the recovery time is 14'* minutes and it has minimal cardiovascular depression. (e) +ropofol is not associated ith cardiovascular depression.
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+ropofol is associated ith cardiovascular depression# pain on in!ection and involuntary movements on induction. 3. %he folloing anti'dotes and poisons are correctly paired (a) 7thylene ,lycol 7thanol5Fomepi&ole 7thanol and Fomepi&ole are anti'dotes for 7thylene ,lycol poinoning. (b) 8'8locers ,lucagon5Atropine ,lucagon and Atropine are anti'dotes for 8'8locers. (c) Cyanide Sodium 9itrite5Sodium %hiosulphate5icobalt 7detate Sodium 9itrite5Sodium %hiosulphate5icobalt 7detate are anti'dotes for Cyanide. (d) ethanol7thanol5Fomepi&ole 7thanol and Fomepi&ole are anti'dotes for methanol. (e) 0rganophosphatesFomepi&ole 0rganophosphatesAtropine5+ralidoxime 4. %etanus (a) %etanospasmin is produced by an aerobic spore forming gram negative bacillus. %etanospasmin is produced by an anaerobic spore forming gram positive bacillus. (b) Animal bite ounds are not considered tetanus prone. Animal bite ounds# puncture ounds# devitalised tissue# and heavily contaminated ounds are considered tetanus prone. (c) +regnancy is a contraindication for giving tetanus prophylaxis +regnancy is not a contraindication for giving tetanus prophylaxis. (d) %he usual dose of human anti'tetanus immunoglobulin (-A%") is 24'4 units ". %he usual dose of human anti'tetanus immunoglobulin (-A%") is 24'4 units ". (e) A burn is not a potential portal of entry for tetanus. Any ound# including a burn is a potential portal of entry for tetanus. :. ;euaemia < classi=cation> acute and chronic lymphoblastic leuaemia> acute and chronic myeloid leuaemia (a) Anaemia and thrombocytopenia are late developments in C;;. Anaemia and thrombocytopenia are late developments in C;;. (b) %here is a mean survival of 1 year in C,;. %here is a mean survival of 3 years in C,;. (c) "n A;; there is a up to ?4@ cure rate in children aged 2' years. "n A;; there is a up to ?4@ cure rate in children aged 2' years. (d) Secondary autoimmune haemolytic anaemia develops in 1@ of patients ith C;;. Secondary autoimmune haemolytic anaemia develops in 1@ of patients ith C;;. (e) "n C;; the leucocytosis is usually from the % helper lymphocytes. "n C;; the leucocytosis is usually from the 8 lymphocytes.
MCEM Pathology MCQ 7. 8asal metabolic rate
(a) "s increased by propofol. All sedatives decrease metabolic rate. (b) "s increased by 1.3@ for every 1 degree rise in temperature. 8B is increased by 13@ for every 1 degree rise in temperature. (c) Bemains una$ected by excercise.
(d) "s una$ected by age. 8B falls ith age. (e) "s increased ith pain.
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8B is increased ith pain and anxiety. . %he folloing factors suggest a central cause of vertigo(rather than a peripheral) (a) ;ess intense. Central causes of vertigo are less intense than peripheral causes. (b) %he onset is usually more sudden in central causes. %he onset is usually more sudden in peripheral causes hile the onset is more gradual in central causes. (c) A central cause is liely to be constant hereas a peripheral cause is liely to be intermittent. A central cause is liely to be constant hereas a peripheral cause is liely to be intermittent. (d) %here is more commonly associated nausea and diaphoresis ith peripheral causes. %here is more commonly associated nausea and diaphoresis ith central causes. (e) -earing loss more commonly occurs ith central causes of vertigo. -earing loss more commonly occurs ith peripheral causes of vertigo. . 7C, abnormalities... (a) 9on pathological D aves are usually more than one small sDuare in idth. 9on pathological D aves are usually less than one small sDuare in idth.0ne small sDuare is 3ms or .3s. (b) 9on pathological D aves are usually more than 2mm in depth. 9on pathological D aves are usually less than 2mm in depth. (c) %he % ave is usually inverted in E1. And EB( and in E2 in young people and also in E* in some blac people). (d) igoxin treatment may cause inverted % aves igoxin treatment may cause inverted % aves. (e) 8undle branch bloc may cause inverted % aves. 8undle branch bloc may cause inverted % aves. %he most common abnormality of the 7C, is % ave inversion. %his is seen in normality# ischaemia# ventricular hypertrophy# bundle branch bloc# and digoxin treatment. 10. %he folloing statements about hite blood cells are true
MCEM Pathology MCQ (a) ;eucopenia in severe pyogenic infection augurs a poor prognosis.
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(b) "nfants often respond to a bacterial infection ith a lymphocytosis.
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(c) onocytosis is a recognised feature of malaria and tuberculosis.
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(d) 7osinophilia is a characteristic =nding in brucellosis.
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(b) ysuria.
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(c) Grgency.
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(d) ;o 8ac +ain.
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(e) +elvic ,irdle myalgia.
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7osinophils# normally present in small numbers (less than 4@ of hite cells)# are recogni&ed by their vibrant orange granules and a characteristic bilobed nucleus . "ncreased numbers of eosinophils can be a clue to an underlying allergic state# parasitic infection# or other conditions. (e) yelocytes in the peripheral blood are pathognomonic of leuaemia. etamyelocytes# and rarely myelocytes# may be seen during infections# pregnancy# leuemoid reactions# and recovery from myelosuppression. 11. %he folloing are true ith regard to retinal vein occlusions
(a) Betinal vein occlusions associated ith high intraocular pressure. Betinal vein occlusions associated ith high intraocular pressure. (b) Characteristically present ith a storm of oaters in the eye.
(c) Fundal examination shos multiple ame haemorrhages. Fundal examination shos multiple ame haemorrhages. (d) +atients should have an 7SB measured to exclude temporal arteritis.
(e) emand referral to an opthalmologist
Are associated ith high intraocular pressure## hypertension and diseases that increase blood viscosity. Eisual loss occurs suddenly ith retinal vein occlusions. Floaters suggest retinal detachment or vitreous haemorrhage.Fundal examination shos multiple ame haemorrhages ith disc oedema.+atients should have an 7SB if they have retinal artery occlusion. 12. %he folloing are often found in acute prostatitis (a) ,roin pain.
%he typical signs and symptoms of acute prostatitis include spiing fever# chills# malaise# myalgia# dysuria# pelvic or perineal pain# and cloudy urine. Acute cystitis does not commonly occur in men# the vast ma!ority of loer G%"s are due to
MCEM Pathology MCQ prostatitis.A variety of antimicrobials may be used for treatment of acute prostatitis and treatment depends on the causative organism. 13. %he pressure...
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(d) 9A is cleaved by endonucleases.
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(e) Besults in an inammatory response.
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(a) rop along ma!or veins is similar to that along ma!or arteries. 8oth o$er little resistance to o. (b) rop across the hepatic portal bed is similar to that across the splenic vascular bed. %he drop is much larger across the splenic vascular bed it includes normal systemic arteriolar resistance. (c) "n the hepatic portal vein exceeds that in the inferior vena cava. 0therise blood ould not o through the portal bed. (d) rop across the vascular bed in the foot is less hen standing than hen lying don. Hhen standing the column of blood from heart increases arterial and venous pressure eDually. (e) "n venules in the foot is loer hen aling rather than standing. %he muscle pump in the leg reduces venous pressure. 14. Apoptosis
(a) "s only a pathological process. Apoptosis can be either a pathological or physiological process. (b) 0ccurs in groups of cells. Single cells are usually involved. (c) Besults in cell shrinage and fragmentation.
%here is no inammatory response. Apoptosis# or physiologic cell death# di$ers substantially from necrosis# or pathologic cell death. Gnlie necrosis# apoptosis is essential for morphogenesis during embryonic development #normal cell reneal # and elimination of immune e$ector cells that proliferate in response to microbial infection. %he morphological features of include cytoplasmic and nuclear condensation# fragmentation of nuclei into membrane enclosed Iapoptotic bodies#I and surface expression of opsonic receptors that allo neighboring parenchymal cells to rapidly phagocytose and digest the corpse . A ey feature of this physiologic death process is the preservation of plasma membrane integrity. Bapid digestion of the contained apoptotic corpse avoids the recruitment of inammatory cells hich typically cause signi=cant Icollateral damageI to surrounding normal tissues. 15. -aematuria
(a) 8ergers disease is a common cause. 8ergers disease is an uncommon cause of haematuria. A recent upper respiratory infection# raises the possibility of postinfectious glomerulonephritis or "gA nephropathy. (b) Easculitis is a possible cause.
(c) S;7 is a possible cause.
MCEM Pathology MCQ S;7 may cause glomerulonephritis. (d) +rostatis may cause haematuria. %he causes vary ith age ith the most common being inammation or infection of the prostate or bladder# stones# and# in older patients# a idney or urinary tract malignancy or benign prostatic hyperplasia (e) -enoch'Schonlein purpura may cause haematuria.
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Becent vigorous exercise or trauma may also cause haematuria. 1:. Atrial Flutter%reatment (a) +atients ith atrial utter do not reDuire anticoagulation. +atients ith atrial utter reDuire anticoagulation. (b) Gnstable patients reDuire transoesophageal echocardiogram prior to cardioversion. For unstable patients or those ith onset less than 3 hours prior to presentation# lo energy synchroni&ed cardioversion(24'4!) can convert more than @ of patients into sinus rhythm. (c) "f a patient has stable atrial utter of greater than 3 hours duration they alays reDuire at least * ees of anticoagulation prior to cardioversion. A %07 can be performed to outrule thrombus and a patient cardioverted almost immediately. (d) igoxin should not be used in patients ith impaired cardiac function. igoxin is positively inotropic. +atients ith left ventricular systolic dysfunction (;E7F J3 percent) ho continue to have 9K-A functional class ""# """ and "E symptoms despite optimal therapy (eg# AC7 inhibitor or AB8# beta blocer# and# if necessary for uid control# a diuretic) should be started on digoxin. (e) Amiodarone should not be used in patients ith impaired cardiac function. Amiodarone has very little negative inotropic e$ect. As such# the drug may be used safely in most patients ith prior diagnosis of heart failure. 1?. G%" (a) A positive SG sample has 1 to the poer of 4 colony forming units per milliliter of urine. A positive SG sample has 1 to the poer of 4 colony forming units per milliliter of urine. (b) 6lebsiella is the responsible pathogen in the ma!ority of G%"s. 7'Coli is the responsible pathogen in a ma!ority of G%"s. (c) Asymptomatic bacteriuria occurs in up to 1 percent of pregnant omen. Asymptomatic bacteriuria occurs in up to * percent of pregnant omen. (d) Asymptomatic bacteriuria occurs in up to 3@ of elderly nursing home residents. Asymptomatic bacteriuria occurs in up to 3@ of elderly nursing home residents. (e) "n healthy asymptomatic sexually active non'pregnant omen asymptomatic bacteriuria occurs in 14@. "n healthy asymptomatic sexually active non'pregnant omen asymptomatic bacteriuria occurs in 4@. 1. Hound -ealing (a) %he type of healing process depends on the extent of tissue damage.
(b) "n =rst intention healing the margins are unapposed.
MCEM Pathology MCQ "n =rst intention healing the margins are closely apposed. (c) "n =rst intention healing the ound is =nally covered by epidermal groth.
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(d) "n second intention healing the margins are apposed.
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(e) Scar formation is associated ith second intention healing.
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1. Eestibulocochlear nerve testing (a) 9ormally air conduction is geater than bone conduction. 9ormally air conduction is geater than bone conduction. (b) iddle ear infection is a common cause of conduction deafness. "n conduction deafness the air conduction component is reduced to a greater degree than the bone conduction deafness. (c) "n ebers test the noise is usually heard centrally. "n ebers test the noise is usually heard centrally. (d) "n ebers test the noise lateralises to the normal side in sensorineural deafness. "n ebers test the noise lateralises to the normal side in sensorineural deafness. (e) "n ebers test the noise lateralises to the deaf side in conduction deafness. "n ebers test the noise lateralises to the deaf side in conduction deafness. 2. +atellar Fractures (a) ay occur from forceful contraction of the Duadriceps tendon 0r from direct trauma. (b) %he most common fracture is avulsion type. %he most common fracture is transverse. 0ther fractures include comminuted and avulsion type. (c) %here is often a palpable defect in the patella. %here is often a palpable defect in the patella. (d) All patellar fractures reDuire operative intervention. 9on'displaced patellar fractures ith intact extensor mechanisms are treated ith nee immobilisation# ice# analgesics# elevation and casting. (e) Fractures of 2 mm displacement reDuire operative repair. Fractures of * mm displacement reDuire operative repair. 0r those associated ith disruption of the extensor mechanism or open fractures. 21. A virus (a) "s able to replicate independently of the host. A virus reDuires cellular machinery to replicate. (b) Consists of a nucleic acid core and protein coat. A virus consists of a nucleic acid core and protein coat. (c) "s alays enveloped by host membrane. 0nly some viruses are enveloped. (d) Causes tissue in!ury by direct cytopathic e$ects.
MCEM Pathology MCQ %issue in!ury can occur by direct cytopathic e$ects. (e) Can cause pathology through the incorporation of viral genes into the host 9A. Can cause pathology through the incorporation of viral genes into the host 9A.
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(b) ;ate seDuelae include amyloidosis.
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;ate seDuelae include amyloidosis(due to chronic inammation) and sinus formation. (c) A psoas abscess in a patient ith a normal 7SB excludes tuberculosis as a cause.
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(d) %he commonest site of the underlying infection is the mid thoracic spine.
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(e) Successful culture of infected pus taen from a psoas abscess is liely in more than per cent of cases.
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22. BansonLs severity criteria on admission for acute pancreatitis include (a) ,lucose J11. mmol5;. ,lucose M11. mmol5;. (b) ;- M*4 "G5;. 0thers include age M 44years# HCC M1:.# AS% M24 G5; and glucose M11.. (c) Amylase M24. Amylase is not one of Banson
the mortality rate rises signi=cantly ith four or more criteria. 2*. %he folloing are true ith regard to a psoas abscess (a) %he most liely cause is potts disease. %he most liey cause of a psoas abscess is potts disease due to tuberculosis of the lumbar spine. @ of primary psoas abscesses ( not secondary to %8 ) are associated ith Staphylococcus aureus# although 7scherichia coli# -aemophilus inuen&a and +roteus mirabilis have also been reported.
%he most liey cause of a psoas abscess is potts disease due to tuberculosis of the lumbar spine. ;ate seDuelae include amyloidosis and sinus formation. "n a cold abscess diagnostic culture is sometimes diNcult. 23. +ancreatitis (a) %he inammatory process can cause systemic e$ects because of the presence of cytoines# such as bradyinins and phospholipase A. %he inammatory process can cause systemic e$ects because of the presence of cytoines# such as bradyinins and phospholipase A. (b) Fat necrosis may cause hypercalcemia. Fat necrosis may cause hypocalcemia. (c) %he incidence of acute pancreatitis ranges beteen 14'2 per 1# population. %he incidence of acute pancreatitis ranges beteen 4 and per 1# population. (d) ild edematous pancreatitis occurs in about @ of presentations# and the
MCEM Pathology MCQ mortality rate is about @. ild edematous pancreatitis occurs in about @ of presentations# and the mortality rate is belo 1@. (e) 8ecause the pancreas is located in the retroperitoneal space ith a =brous capsule inammation can spread easily. 8ecause the pancreas is located in the retroperitoneal space ith no capsule# inammation can spread easily. 24. %he folloing statements are true (a) 9ormal intracranial pressure("C+) is approximately 1mm-g. "ntracranial pressure above 2 mm-g considered abnormal. (b) "C+ can remain normal despite a space occupying lesion "C+ can remain normal despite a space occupying lesion. (c) Cerebral perfusion pressure is independent of "C+.
(d) -ypotensive patients tend to have a lo "C+. -ypotensive patients tend to have a lo "C+. (e) Autoregulation refers to maintenance of constant cerebral blood o.
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Autoregulation refers to maintenance of constant cerebral blood o. 2:. AcDuired +latelet isorders (a) ;o platelets due to alcohol misuse is generally irreversible. Chronic alcohol misuse is a common cause of lo platelets and ill often resolve if the patient abstains from drining for a ee or so. (b) +latelet transfusion should be considered for counts of less than 2#5ul. +latelet transfusion should be considered for counts of less than 1#5ul. (c) -ypothermia does not a$ect platelets. -ypothermia can cause splenic seDuestration of platelets. (d) %he mumps virus can cause platelet destruction. %he mumps virus can cause platelet destruction# along ith other viruses such as measles# varicella and -"E. (e) +latelet production may be decreased by Eitamin 812 or folate de=ciency. +latelet production may be decreased by viral infections# drugs such as thia&ides and oestrogens# and Eitamin 812 or folate de=ciency as ell as marro in=ltration and aplastic anaemia. 2?. "nfective 7ndocarditis (a) %he most common organism overall is staph aureus. %he most common organism overall is staph aureus. (b) +rosthetic valve endocarditis represents a ma!ority of cases 9ative valve endocarditis represents :'?@ of "7# "EG associated "7 1'14@# and prosthetic valve endocarditis 14'*@. (c) %alc bombardment is thought to be responsible for endothelium in!ury in "EGs. 9ormal endothelium is resistant to infection but turbulent o# high pressure states# and talc bombardment may in!ury endothelium. (d) "EG associated "7 is normally caused by strep mirabilis. "EG associated "7 is normally caused by staph aureus in over 4@ of cases.
MCEM Pathology MCQ (e) +rosthetic valve endocarditis is de=ned as early if ithin the =rst months post surgery. +rosthetic valve endocarditis is de=ned as early if ithin : months of surgery. Staph epidermidis is associated ith early disease. 2. %he folloing are true (a) %he line of the nipples is in the %3 dermatome. %he line of the nipples is in the %3 dermatome. (b) %he umbilicus lies in the %1 dermatome. %he umbilicus lies in the %1 dermatome. (c) +eri'anal sensation is via the loer lumbar nerves. +eri'anal sensation is via the sacral nerves. (d) Shoulder abduction is via C4. %he deltoid muscle root is C4. (e) Hrist exors are supplied by C:.
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Hrist exors are supplied by C?. Hrist extensors are supplied by C:. simple ankle strain(with damage to a few fibres of a ligament only)
(a) Slight swelling True Slight swelling may develop almost immediately after injury. (b) Bruising False Bruising is associated with more severe injuries. (c) oint instability False !t would re"uire major damage to cause joint instability. (d) #iscomfort overthe ligament True #iscomfort over the ligament is often found with mild strains. (e) #ramatic pain relief with cold compresses. False
Slight swelling develops immediately but settles to a large e$tent within a few hours.Bruising occurs with a true or severe sprain. !t would re"uire major damage to produce joint instability. %old compresses may help reduce the swelling.
MCEM Pathology MCQ The following are true&
(a) 'ip e$tension is performed bythe femoral nerve. False !nfeior gluteal performs hip e$tension. (b) The femoral nerve is composed of* and + nerve roots. False The femoral nerve is composed of +,- and . (c) The inferior gluteal nerveis composed of /,S*,S+ nerve roots. True The inferior gluteal nerve is composed of /,S*,S+ nerve roots. (d) 'ip e$tension is performed bythe gluteus ma$imus muscle. True !nferior gluteal nerve, /,S*,S+ nerve roots. (e) 'ip abduction is performedby gluteus medius and minimus. True Superior gluteal nerve.
MCEM Pathology MCQ 0ith regard to neck trauma the following are true&
(a) 1enetrating injuries to the neck 2one* e$tends from the clavicle to the cricoid cartilage. True 3one * e$tends from the clavicles to the cricoid cartilage (b) 1enetrating injuries to the neck 2one+ e$tends from the cricoid cartilage to the hyoid bone. False 0ith regard to penetrating injuries to the neck 2one + e$tends from the cricoid cartilage to the angle of the mandible. (c) 1enetrating injuries to the neck 2one - e$tends from the hyoid bone to the base of the skull. False 0ith regard to penetrating injuries to the neck 2one - e$tends from the angle of the mandible to the skull base. (d) Breach of the platysma is an indication for emergency surgical e$ploration.True Breach of the platysma , evidence of vascular injury ,evidence of surgical emphysema and haemodynamic instability due to major bleeding from a neck wound are indications for emergency surgical e$ploration.
MCEM Pathology MCQ 4yocardial %ontusion
(a) !s usually caused byblunt trauma to the chest True 5specially with fractures to sternum or anterior ribs (b) 6n 5%7 may be represented by bundle branch block pattern True (c) 6n 5%7 may be represented bydysrhythmia8s True (d) 6n Trans Thoracic two dimensional echo may be represented by focal or regional wall motion abnormalities True (e) #ysrhythmias shouldbe managed conservatively False 4anage as usual.
MCEM Pathology MCQ Tendon 9efle$es
(a) The biceps are innervated by theradial nerve False 4usculocutaneous, %/:; (b) The biceps refle$ main nerve roots are%/:; True (c) The triceps is innervated by the radial nerve True (d) The supinator refle$ is innervated by the radialnerve True (e) The knee jerk tests knee fle$ion False 5$tension<=uadriceps<-:
MCEM Pathology MCQ The scaphoid bone
(a) The scaphoid only articulates with theradius, lunate, capitate, and trape2oid. False The scaphoid articulates with the radius, lunate, capitate, trape2oid, and trape2ium (b) > small portion of the surface is coveredby hyaline cartilage False ?early the entire surface is covered by hyaline cartilage (c) @essels enter away fromthe sites of ligamentous attachment. False @essels may enter only at the sites of ligamentous attachment (d) The ulnar artery provides the bloodsupply to the scaphoid bone. False The dorsal and volar branches of the radial artery provide the blood supply to the scaphoid (e) The scaphoid lies at the ulnarborder of the pro$imal carpal row False The scaphoid lies at the radial border of the pro$imal carpal row
The scaphoid lies at the radial border of the pro$imal carpal row, but its elongated shape and position allow bridging between the + carpal rows because it acts as a stabili2ing rod. The scaphoid articulates with the radius, lunate, capitate, trape2oid, and trape2ium. >s a result, nearly the entire surface is covered by hyaline cartilage. @essels may enter only at the sites of ligamentous attachment& the fle$or 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 radial artery, which divides into +: branches before entering the waist of the scaphoid along the dorsal ridge. The branches course volar and pro$imal within the bone, supplying A:C/D of the scaphoid. The volar scaphoid branch also enters the bone as several perforators in the region of the tubercleE these supply the distal +D:-D of the bone
MCEM Pathology MCQ 7astrointestinal Bleeding&
(a) >bout D of duodenal bleeds will re:bleed within +:C hours. False >bout *D of duodenal bleeds will re:bleed within + :C hours. (b) > 4allory weiss tear occurs in the distal oesophagus due to a tear in the mucosa usually from repeated vomiting, but may alsooccur secondary to snee2ing True > 4allory weiss tear occurs in the distal oesophagus due to a tear in the mucosa usually from repeated vomiting, but may also occur secondary to snee2ing (c) !n lower 7! bleeding, not from haemorrhoids, the most common aetiologies are adenomatous polyps. False !n lower 7! bleeding, not from haemorrhoids, the most common aetiologies are diverticular disease and angiodysplasia. (d) >ngiodysplasia is more commonin patients with aorticregurgitation. False >ngiodysplasia is more common in patients with aortic stenosis. (e) 1# causes about -Dof all upper 7! bleeds. False 1# causes about ;D of all upper 7! bleeds
MCEM Pathology MCQ 6ttawa >nkle 9ules&!ndication for G 9ay
(a) 1osterior edge of lateral malleolus bonetenderness. True 1osterior edge of lateral malleolus bone tenderness is an indication for G 9ay. (b) Tip of lateral malleolus bone tenderness. True Tip of lateral malleolus bone tenderness is an indication for G 9ay (c) 1osterior edge of medial malleolus bonetenderness. True 1osterior edge of medial malleolus bone tenderness is an indication for G 9ay. (d) Tip of medial malleolus bone tenderness. True Tip of medial malleolus bone tenderness is an indication for G 9ay. (e) Base of the /th metacarpal. False Base of the /th metatarsal tenderness is an indication for G 9ay. http&<
MCEM Pathology MCQ The following are true with regard to lower vertebral levels&
(a) The bifurcation of the aorta occurs at the vertebral level of True The bifurcation of the aorta occurs at the vertebral level of (b) The sacral dimples are at thevertebral levels of S+ True The sacral dimples are at the vertebral levels of S+ (c) The posterior superior iliac spine is at the vertebral level ofS* False The posterior superior iliac spine is at the vertebral level of S+ (d) The dural sac ends at the vertebral level of S* False The dural sac ends at the vertebral level of S+ (e) The rectum starts at the vertebral level of S- True The rectum starts at the vertebral level of S-
MCEM Pathology MCQ 5ye 5mergencies
(a) 'erpes Simple$ @irus can involve eyelids, conjunctiva and cornea. True 'S@ classically causes a dendritic epithelial defect. Treatment is with topical anti:virals. (b) 'erpes 3oster 6pthalmicus fre"uently involves aconcurrent iritis True 'erpes 3oster 6pthalmicus is shingles in the distribution of the trigeminal nerve, ocular involvement and fre"uently involves a concurrent iritis. (c) 'yphema is not associated with rebleeding. False 9ebleeding can occur about -:/ days following the initial injury. (d) 1eri:orbital cellulitis is associated with painful eye movements. False 6rbital cellulitis is but peri:orbital cellulitis is not.
MCEM Pathology MCQ The Spinal %ord&
(a) There are +I pairs of spinal nerves. False There are -* pairs of spinal nerves. (b) There are C pairs of cervical nerves. True There are C pairs of cervical nerves. (c) There are ** pairs of thoracic nerves. False There are *+ pairs of thoracic nerves. (d) There are pairs of sacral nerves. False There are / pairs of sacral nerves. (e) There are pairs of coccygeal nerves. False There is usually * pair of coccygeal nerves.
The spinal cord gives rise to -* pairs of spinal nerves& C cervical, *+ thoracic, / lumbar, / sacral, and * coccygeal
MCEM Pathology MCQ Tract #ysfunction
(a) %orticospinal tract injuryis characterised bycontralateral motor deficits False !psilateral.%orticospinal tract injury is characterised by ipsilateral motor deficits. (b) Spinothalamic tract injury ischaracterised by ipsilateral pain andtemperature sensation loss False %ontralateral.Spinothalamic tract injury is characterised by contralateral pain and temperature sensation loss. (c) 1osterior %olumn injury ischaracterised by ipsilateral proprioception lossTrue 1osterior %olumn injury is characterised by ipsilateral proprioception loss (d) %ervical Spine injurymay present with hypotension andbradycardia True This is neurogenic shock due to loss of sympathetic tone. (e) %ervical spine injuries may present with pain b aove but not below the clavicle True %ervical spine injuries may present with pain above but not below the clavicle
MCEM Pathology MCQ >natomical considerations&
(a) The srcin of the coeliac a$is isat TC False The srcin of the coeliac a$is is at T*+ (b) - is crossed by the transpyloric plane of addison ( half way between the suprasternal notch and the symphysis pubis.) False * is crossed by the transpyloric plane of addison ( half way between the suprasternal notch and the symphysis pubis.) (c) The vagi pierce the diaphragm atTC along with the oesophagus False The vagi pierce the diaphragm at T* along with the oesophagus (d) The aortic opening in the diaphragm is anterior to the median arcuate ligament and transmits the a2ygous and hemia2ygous veins False The aortic opening in the diaphragm is posterior to the median arcuate ligament and transmits the a2ygous and hemia2ygous veins (e) The aortic opening transmits the thoracic duct. True The aortic opening transmits the thoracic duct.
MCEM Pathology MCQ %arotid Sinus Syndrome may be caused by
(a) Trauma True (b) %arotid artery aneursym True (c) 1osterior %ommunicating>rtery >neursym True (d) ?asopharyngeal tumor spread True (e) 0egeners 7ranulomatosis True 6r any other cause of infection such as sinusitis or tuberculosis
MCEM Pathology MCQ The following is true with regard to rupture of the biceps tendon&
(a) !t most often affects +to year old men. False 9upture of the biceps most commonly affects to ; year olds. (b) 4ay cause a popping sound during someactivity. True 6r a sudden pain with a snapping sensation. (c) Shoulder aching may beworse at night. True 6r painful during repetitive or overhead movements (d) 4ay cause a visible mass between the shoulder and the elbow . True !f not visible may well be palpable. (e) The treatment of choice issurgical repair. False 6f debatable value, but may be helpful in young athletic types.
MCEM Pathology MCQ %lavicle fractures
(a) >ccount for * in + adult fractures True (b) >re usually caused by adirect blow to the clavicle False They are usually caused by a fall onto the lateral clavicle. (c) ?on displaced fractures are almost always seenon >1 views. False ?on displaced fractures may be difficult to see on >1 views and may need + degree ( 3anca ) views or / degree cephalic tilt. (d) ateral *<- rd of the clavicle are themost common site for fracture. False 4iddle *<- rd are the most common site for fracture and represents CD of fractured clavicles.( >llman classification ) (e) ?on displaced lateral *<-rd clavicular fractures should betreated conservatively. True #isplaced lateral *<-rd fractures usually re"uire operative intervention because they have a high rate of non:union.
?on displaced medial *<-rd fractures are treated conservatively while displaced re"uire orthopaedic referral. www.aafp.org
MCEM Pathology MCQ 'aemorrhagic shock
(a) %lass ! patients usually do nothave any mental an$iety False (b) %lass !! shock usually do nothave any mental an$iety False (c) %lass !!! patients usually havesome an$iety True (d) %lass !@ patients are usually alert andnot confused False (e) %lass !! patients are usually confused False
%lass !:slight an$iety, %lass !!:more an$iety, %lass !!!: an$ious and sometimes confused, class !@, confused and lethargic
MCEM Pathology MCQ >ppreciation of the gross anatomy of the testis&
(a) The ductus deferens ascends on the medialside of the epididymis. True The ductus deferens ascends on the medial side of the epididymis. (b) The epididymis is on the posterior aspect of the testes and is ; m in length. True The epididymis is on the posterior aspect of the testes and is ; 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. False The head of the epididymis lies on the upper pole of the testis where it is joined by the efferent ducts. (d) > hydrocele occurs when there is watery fluid between the parietal and visceral layers of the tunica albuginea. False > hydrocele occurs when there is watery fluid between the parietal and visceral layers of the tunica vaginalis ( a serous sac of peritoneal srcin ) (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 ofthe testes. True 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.
MCEM Pathology MCQ Traumatic Brain !njury
(a) The majority of cases of epidural haematoma have a loss of consciousness followed by a lucid interval followed by neurological decline. False > minority, appro$imately +D, of cases have this classical description. (b) CD of cases of epidural haematoma havea skull fracture that lacerates meningeal arteries.True CD of cases of epidural haematoma have a skull fracture that lacerates meningeal arteries. (c) > fi$ed and dilated pupil because of a epidural haematoma is an early sign.False > fi$ed and dilated pupil because of a epidural haematoma is a late sign. (d) %ontralateral hemiparesis in epiduralhaematoma is an early sign. False %ontralateral hemiparesis in epidural haematoma is a late sign. (e) > common mechanism for subdural haematoma is an acceleration: decelerati on injury. True > common mechanism for subdural haematoma is an acceleration: deceleration injury.
MCEM Pathology MCQ @ertebrae
(a) The vertebral arch is made up of two pedicles, two laminae, andseven processes True The vertebral arch is made up of two pedicles, two laminae, and seven processes (one spinous, two transverse, and four articular). (b) 5ach disk consists of aperipheral annulus fibrosus and acentral nucleus pulposus True 5ach disk consists of a peripheral annulus fibrosus and a central nucleus pulposus (c) The annulus fibrosus is composedof fibrocartilage True The annulus fibrosus is composed of fibrocartilage (d) The nucleus pulposus is made ofwater and cartilage fibers. True The nucleus pulposus is made of water and cartilage fibers. (e) 0ith increasing agethe proportion of fibrocartilage to fluid decreases. False 0ith increasing age the porportion of fibrocartilage to water increases.
MCEM Pathology MCQ Testes, 5pididymis and Spermatic %ord&
(a) The cremasteric fascia containing the cremasteric muscle is derived from the rectus abdominis muscle. False The cremasteric fascia containing the cremasteric muscle is derived from the internal obli"ue muscle (b) The e$ternal spermatic fascia is derived fromthe aponeurosis of the transversalis fascia. False The e$ternal spermatic fascia is derived from the aponeurosis of the e$ternal obli"ue muscle (c) The round ligament terminates in the fibrofatty tissue of the labium majus.True The round ligament terminates in the fibrofatty tissue of the labium majus. (d) The deep inguinal ring transmits the genital branchof the genitofemoral nerve. True The deep inguinal ring transmits the genital branch of the genitofemoral nerve. (e) The internal spermatic fascia is derived fromthe internal obli"ue. False The internal spermatic fascia is derived from the transversalis fascia
MCEM Pathology MCQ !ntracranial bleeding
(a) 5$tra dural haematoma is often due to bleeding from the anterior branch of the middle meningeal artery after a temporal bone fracture True The classical history of this haematoma is one of an intial loss of consciousness followed by a subse"uent lucid period follwed by neurological deterioration. (b) >n acute rise in intracranial pressure may manifest as a falling pulse rate.True %ushings response is characterised by bradycardia and hypertension. (c) >n acute rise in intracranial pressure may manifest as a rising bloodpressure. True %ushings response is characterised by bradycardia and hypertension. (d) >mnesia for events J*/min beforethe head injury is an indication for %T Brain Scan.False >mnesia for events J-min before the head injury is an indication for %T Brain Scan. (e) >n acute rise in intracranial pressure may manifest as a central respiratory depression.True >n acute rise in intracranial pressure may manifest as a central respiratory depression.
%ushings response occurs with bradycardia and hypertension
MCEM Pathology MCQ >bdominal structures corresponding to vertebral levels&
(a) The renal arteries srcinate at the vetebral level of*<+. True The renal arteries srcinate at the vetebral level of *<+. (b) The spinal cord ends inadults at the level of *<+. True The spinal cord ends in adults at the level of *<+. (c) The a2ygous and hemia2ygous veins are formed at vertebral level. False The a2ygous and hemia2ygous veins are formed at + vertebral level (d) The ligament of treit2 is at the level of the upperborder of the vertebra. False The ligament of treit2 is at the level of the upper border of the + vertebra . (e) The umbilicus is at the vertebral level of -<. True The umbilicus is at the vertebral level of -<.
MCEM Pathology MCQ 7unshot 0ounds&
(a) Temporary cavitation is caused by a sonic shock w ave in high velocity injuries. False (b) Solid organs such as liver resist cavitation more than softer tissues such as lung False (c) 'igh velocity injuries usually haveless bacterial contamination False (d) >bdominal gunshot wounds invariably re"uire laparotomy.True (e) %ranial gunshot wounds invariably re"uire ventilation. True
MCEM Pathology MCQ 0ith regard to innervation of the ear
(a) The anterior half of the ear is supplied by the auriculotemporal nerve which is a branch of the mandibular portion ofthe trigeminal nerve. True
(b) The posterior half of the earis supplied by branch ofthe trigeminal nerve. False
(c) The posterior part of the earis supplied by + nerve branches derived from the cervical ple$us.True
(d) The vagus nerve hasno role in the inervation of the ear. False (e) The vagus nerve supplies the e$ternal auditory canal.True
The anterior half of the ear is supplied by the auriculotemporal nerve which is a branch of the mandibular portion of the trigeminal nerve.The posterior part of the ear is supplied by + nerve branches derived from the cervical ple$us.The vagus nerve supplies the e$ternal auditory canal.The position for an ear block is where the ear lobe attaches to the head.
MCEM Pathology MCQ 5lbow #islocation
(a) 6n lateral G 9ay the radius andthe ulna are most commonly displaced posteriorly.True 6n lateral G 9ay the radius and the ulna are most commonly displaced posteriorly. (b) The most fre"uent neurological injury is to the mediannerve. False The most fre"uent neurological injury is to the ulnar nerve. (c) 6n clinical e$am the olecranonprocess is commonly notprominent. False 6n clinical e$am the olecranon process is commonly prominent. (d) 6n clinical e$am the elbow is commonly fle$ed at I degrees. False 6n clinical e$am the elbow is commonly fle$ed at / degrees and the olecranon is prominent. (e) @ascular complications occur in about *D of elbowdislocations. True The most common artery involved is the brachial artery.
MCEM Pathology MCQ Structure Function and 4echanics of the @ertebral %olumn&
(a) Fle$ion and e$tension of the vertebral column is e$tensive in the cervical and thoracic regions but limited by the lumbar region. False Fle$ion and e$tension of the vertebral column is e$tensive in the cervical and lumbar regions but limited by the thoracic region because of the rib cage. (b) The cervical vertebrae normally have a posterior conve$ity while the thoracic region has a posterior concavity. False The cervical vertebrae normally have a posterior concavity while the thoracic region has a posterior conve$ity. (c) There is normally A cervical vertebrae, *+ thoracic vertebrae, / lumbar vertebrae, and / sacral vertebrae, and coccygeal vertebrae. True There is normally A cervical vertebrae, *+ thoracic vertebrae, / lumbar vertebrae, and / sacral vertebrae, and coccygeal vertebrae. (d) 9otation ( twisting movement ) ofthe body is least e$tensive inthe cervical region. False 9otation of the body is least e$tensive in the lumbar region. (e) ateral fle$ion of thebody is restricted by the cervical section of thevertebral column False ateral fle$ion of the body is restricted by the thoracic section of the vertebral column
MCEM Pathology MCQ 4a$illofacial radiographs
(a) 6rthopantomogram view can beused to assess the frontal bones False 617 is used to assess the mandible (b) Submentovertical projection is usedto assess the 2ygomatic arch True (c) 6cciptomental views are usedto assess the ma$illa True 6cciptomental views are used to assess the ma$illa, orbital floors and 2ygomatic arches (d) 6ccipitomental views are usedto assess the orbital floors True 6cciptomental views are used to assess the ma$illa, orbital floors and 2ygomatic arches (e) 6ccipitomental views are usedto assess the 2ygomatic arches True 6cciptomental views are used to assess the ma$illa, orbital floors and 2ygomatic arches
MCEM Pathology MCQ Surface >natomy&
(a) The pharyn$ becomes the oesophagus at%; True The pharyn$ becomes the oesophagus at %; (b) %A is the first clearly palpablespinous process. True %A is the first clearly palpable spinous process. (c) The superior border of the scapula is at T- False The superior border of the scapula is at T+ (d) The suprasternal notch is at the level ofT+<- True The suprasternal notch is at the level of T+<(e) The end of the obli"ue fissure of the lung is at the spine ofT- True The end of the obli"ue fissure of the lung is at the spine of T-
MCEM Pathology MCQ Surface >natomy of the >nterior Forearm&
(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 fle$or carpi radialis and the anterior border of the radius. True The radial artery lies in a groove between the fle$or carpi radialis and the anterior border of the radius. The radial artery lies in a groove between the fle$or carpi radialis and the anterior border of the radius. (c) The radial artery can be palpated on the lateral sideof the trape2ium in theanatomical snuff bo$. False The radial artery can be palpated on the lateral side of the scaphoid in the anatomical snuff bo$. (d) !n the area of thewrist and hand the ulnar artery is covered by the a plmer aponeurosis. True !n the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. (e) The pulsations of the ulnarartery are recognised lateralto the pisiform bone. True The pulsations of the ulnar artery are recognised lateral to the pisiform bone
MCEM Pathology MCQ 9adial 'ead Fractures
(a) 9adial head fractures arethe most common fractures of theelbow True 9adial head fractures are the most common fractures of the elbow (b) The radial head articulates with the trochlea False The radial head articulates with the capitellum. (c) The radial head serves as a stabiliser against forces away fromthe midline. True The radial head serves as a stabiliser against valgus stress. (d) 9adial head fractures are usually the result of a fall on an outstretched hand causing the radial head to be driven into the trochlea. False 9adial head fractures are usually the result of a fall on an outstretched hand causing the radial head to be driven into the capitellum. (e) >re associated with medialepicondyle avulsion fractures. True This is secondary to valgus stress.
MCEM Pathology MCQ >natomical %onsiderations of the thoracic vertebrae&
(a) The start of the arch of the aorta is at T
MCEM Pathology MCQ the ulnar nerve is interrupted at the wrist the following muscles are not innervated.
(a) 1almaris brevis . True 1almaris brevis is innervated by the superficial terminal branch of the ulnar nerve in the hand. (b) 6pponens pollicis False 6pponens pollicis is innervated by the median nerve. (c) Fle$or pollicis brevis False Fle$or pollicis brevis is innervated by the median nerve. (d) >bductor pollicis brevis False >bductor pollicis brevis is innervated by the median nerve. (e) Fle$or carpi ulnaris False Fle$or carpi ulnaris is innervated by a branch of the ulnar nerve in the forearm.
MCEM Pathology MCQ ?euroanatomy
(a) The fibers of the pyramids cross inthe pons. False The fibers of the pyramids cross in the medulla.The crossing event is called the decussation of the pyramids (b) The cerebral peduncles largely contain motorfibers. True The cerebral peduncles largely contain motor fibers. (c) 4otor and somatosensory information travel through the anteriorlimb of the internal capsule. False 4otor and somatosensory information travel through the posterior limb of the internal capsule. (d) !n the motor corte$ the lateral side of the gyrus controls the hands and face.True !n the motor corte$, the body is mapped out across the e$tent of the gyrus. %ontrol of the feet lies near the midline at the top of the gyrus, whereas the lateral side of the gyrus controls the hands and face.
MCEM Pathology MCQ The following headaches usually have associated focal abnormal neurology
(a) 4igraine False 1ossible but not usual (b) %a channel blocker associated headache False (c) ?itrates associated headache False (d) %6 poisoning headache False (e) Temporal >rteritis False
6ther headaches without associated neurology include tension, and analgesic
MCEM Pathology MCQ #uring initial management of a multiply injured patient&
(a) Shock management is the first priority. False (b) %ervical spine control isusually necessary. True %ervical spine control is usually necessary. (c) 5$ternal haemorrhageshould be ignored. False (d) 1ulse o$imetry is usually unhelpful. False The results of pulse o$imetry should be interpreted with particular caution in the presence of abnormal haemoglobins(the pulse o$imetry reading represents a summation of o$yhemoglobin and carbo$yhemoglobin and in cases of carbon mono$ide poisoning or in chronic, heavy smokers, a falsely reassuring pulse o$imetry reading may mask arterial desaturation), nail polish, deeply pigmented skin, hypoperfusion, anemia, venous congestion, or when certain vital dyes (such as methylene blue, indocyanine green, fluorescein, indigo carmine, and isosulfan blue) are used for clinical purposes. (e) !schaemic limbs demand immediate attention. False
MCEM Pathology MCQ %hest drain insertion is usually indicated in patients with the following conditions&
(a) 4ediastinal traversing wounds. True (b) Flail chest. True Flail chest occurs when three or more adjacent ribs are each fractured in two places, creating one floating segment comprised of several rib sections and the soft tissues between them. This unstable section of chest wall e$hibits parado$ical motion (ie, it moves in the opposite direction of the uninjured, normal: functioning chest wall) with breathing, and is associated with significant morbidity from pulmonary contusion. >bnormal motion can be difficult to detect making the diagnosis difficult. !nitial management of flail chest consists of o$ygen and close monitoring for early signs of respiratory compromise, ideally using both pulse o$imetry and capnography in addition to clinical observation. se of noninvasive positive airway pressure by mask may obviate the need for endotracheal intubation in alert patients. 1atients with severe injuries, respiratory distress, or progressively worsening respiratory function re"uire endotracheal intubation and mechanical ventilatory support. (c) 6pen pneumothora$. True (d) 9uptured diaphragm. False (e) Surgical emphysema. False
MCEM Pathology MCQ 4ajor Trauma&
(a) 1elvic fractures in children are rare and clinically apparent, making the routine screening pelvic G 9ay obsolete. True (b) 'ypertonic saline isbeneficial in hypotensive patients with headinjury. False (c) Steroids are beneficial in patients with headnjury i and 7%S K*/ False http&< post traumatic head injury sei2ure is an indication to re"uest a %T brain scan immediately according to the ?!%5 guidelines. True http&<
6ne ?ew 3ealand study of -A children who had a pelvic G 9ay found only * fracture and this fracture was clinically apparent. The authors recommend not G 9aying. !n the %9>S' trial steroids in patients with head injury showed more harm than good. http&<
MCEM Pathology MCQ 9egarding fracture classifications&
(a) The ?eer classification refers todistal radial fractures. False The ?eer classification refers to pro$imal humeral fractures. (b) The Frykman classification refers to pro$imal humeral fractures. False The Frykman classification refers to distal radial fractures. (c) The Schat2ker classification refers to tibial plateau fractures. True The Schat2ker classification refers to tibial plateau fractures. (d) Type !! is the most common type of Salter:'arris fracture presentations.True Type !! is the most common type of Salter:'arris fracture presentations.
MCEM Pathology MCQ The glossopharyngeal nerve (%? !G)&
(a) >rises in the pons. False The glossopharyngeal nerve is mainly sensory. !t arises in the medulla. (b) eaves the skull throughthe jugular foramen True The glossopharyngeal nerve leaves the skull through the jugular foramen along with the vagus and accessory nerve. (c) !s the efferent pathway of the gag refle$ False Sensory fibers provide sensation to the tonsillar fossa and pharyn$ ( the afferent pathway of the gag refle$) and taste to the posterior +<- rd8s of the tongue. (d) Supplies taste fibersto the anterior two:thirds of thetongue False Sensory fibers provide sensation to the tonsillar fossa and pharyn$ ( the afferent pathway of the gag refle$ ) and the taste to the posterior +<- rd8s of the tongue. (e) Supplies the stylopharyngeal muscle. True 4otor fibers supply the stylopharyngeus muscle, autonomic fibers supply the parotid gland, and a sensory branch supplie the carotid sinus.
MCEM Pathology MCQ The following statements are true
(a) The median nerve supplies the interossei of thehand False lnar (b) The radial nerve supplies theabductor 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 anda half ulnar digits True (d) The e$tensor muscles of the forearm are supplied by theadial r nerve True (e) The biceps muscle is supplied by the musculocutaneous nerve True
MCEM Pathology MCQ The following are true in relation to common root compression syndromes produced by lumbar disc disease&
(a) >n S* root lesion will produce weakness of plantar fle$ion of the ankle and toes.True >n S* root lesion will produce weakness of plantar fle$ion of the ankle and toes. (b) >n S* root lesion will cause loss of the kneejerk refle$. False >n S* root lesion will cause loss of the ankle jerk refle$. (c) >n root lesion will cause sensory loss at the anteromedial shin.True >n root lesion will cause sensory loss at the anteromedial shin. (d) >n / root lesion will cause sensory loss over thesole of the foot. False >n / root lesion will cause sensory loss over the dorsum of the foot and anterolateral shin while an S* root lesion will cause sensory loss over the sole of the foot.
MCEM Pathology MCQ The 5ar
(a) The cochlea contains the auditory sensoryreceptors. True The cochlea contains the auditory sensory receptors and the vestibular labyrinth contains the balance receptors (b) The vestibular labyrinth contains the balance receptors.True The cochlea contains the auditory sensory receptors and the vestibular labyrinth contains the balance receptors (c) Blood supply to theinner ear is from the internal carotid artery. False Blood supply to the inner ear is from the vertebrobasilar system. (d) The anterior vestibular artery to thecochlea False The anterior vestibular artery provides the blood supply to the anterior and hori2ontal semicircular canals but not to the cochlea (e) The anterior vestibular artery provides the blood supply to the anterior and hori2ontal semicircular canals. True The anterior vestibular artery provides the blood supply to the anterior and hori2ontal semicircular canals but not to the cochlea
MCEM Pathology MCQ %olles Fracture
(a) !s a fracture of the radius within *cm of the wrist. False %olles fracture is a fracture of the radius within +./ cm of the wrist. (b) The distal fragment is displaced anteriorly. False The distal fragment is displaced posteriorly and with radial displacement. (c) The angulation of the distal radius normally has a / degree forward tilt on the po$imal carpal bones as seen on the lateral G 9ay (i.e in peole without a fracture ) True The angulation of the distal radius normally has a / degree forward tilt on the po$imal carpal bones as seen on the lateral G 9ay ( i.e in peole without a fracture ) (d) %olles fracture isassociated with fle$or pollicis longus rupture inthe weeks following injury. False %olles fracture is associated with e$tensor pollicis longus tendon rupture in the weeks following the injury. (e) %olles fracture usually follows afall onto a fle$ed wrist False %olles fracture usually follows a fall onto an outstretched hand. Smith8s fracture usually follows a fall onto a fle$ed wrist.
MCEM Pathology MCQ 9adiograph !nterpretation
(a) The right heart border isformed 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 formedby 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) @alve calcification is best seen on the >1 view. False @alve calcification is best seen on the lateral view as on the >1 view valve calcification cannot be visualised over the spine. (e) > large pulmonary artery will cause hilar enlargement.True > large pulmonary artery will cause hilar enlargement as will lymphadenopathy.
MCEM Pathology MCQ 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 acousticmeatus 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 thenerve at the geniculate ganglion. True The greater petrosal nerve contains taste fibers from the palate. !t 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) 1asses through the posterior fossa. True (d) 6n reaching the medial wall of the middle ear the nerve swells to form the sensory geniculate ganglion. True (e) 5merges from the temporal bone through thestylo:mastoid foramen. True
The facial nerve arises in the medulla and emerges between the pons and medulla. !t then passes through the posterior fossa and runs through the middle ear before emerging from the stylo:mastoid foramen and running through the parotid.
MCEM Pathology MCQ The Forearm&
(a) The radial artery can be palpated on the medial side of the scaphoid in the anatomical snuff bo$. False The radial artery can be palpated on the lateral side of the scaphoid in the anatomical snuff bo$. (b) The pulsations of the ulnarartery are recognised lateralto the lunate bone. False The pulsations of the ulnar artery are recognised lateral to the pisiform bone (c) The radial artery lies in a groove between the fle$or digitorum profundus and the anterior border of the radius. False The radial artery lies in a groove between the fle$or carpi radialis and the anterior border of the radius. (d) !n the area of thewrist and hand the ulnar artery is covered by the a plmer aponeurosis. True !n the area of the wrist and hand the ulnar artery is covered by the palmer aponeurosis. (e) The brachial artery divides into the radial and ulnar arteries just below the distal third of the humerus. False The brachial artery divides into the radial and ulnar arteries just below the line of the elbow joint.
MCEM Pathology MCQ 0ith regard to innervation of the scalp
(a) The frontal part of the scalp is innervated by branches of the opthalmic part of the trigeminal nerve. True
(b) The frontal part of the scalpis innervated by the supraorbital andsupratrochlear nerves. True
(c) The posterior part of the scalp is innervated by branches of the first division of the trigeminal nerve False
(d) The posterior part of the scalpis innervated by branches of thecervical ple$us. True
(e) The cervical ple$us plays a role ininnervation of the posterior and lateral scalp.True
The frontal part of the scalp is innervated by the supraorbital and supratrochlear nerves which are branches of the first division of the trigeminal nerve.The posterior part of the scalp is innervated by branches of the cervical ple$us, more specifically the greater and lesser occipital nerves. The cervical ple$us innervates the lateral scalp through the lesser occipital nerve.
MCEM Pathology MCQ 4uscles of the hand
(a) Fle$or pollicis brevis fle$es the 4%1 joint ofthe thumb. True
(b) Fle$or pollicis brevis isinnervated by median nerve True This is usually the case however may also be innervated by the deep branch of the ulnar nerve (c) Fle$or pollicis longus fle$es pro$imalphalan$ of thumb False Fle$or pollicis longus fle$es distal phalan$ of thumb (d) 5$tensor pollicis longus e$tends the !1 and4%1 joints of the thumb True (e) 5$tensor pollicis brevis forms anterior border of theanatomical snuff bo$. True 5$tensor pollicis brevis forms anterior border of the anatomical snuff bo$ and the posterior border of the snuffbo$ is the tendon of the e$tensor pollicis longus.
MCEM Pathology MCQ 1enetrating injuries of the diaphragm
(a) The arching domes of the diaphragm highest point is thelevel of the ;th rib False
(b) !f a penetrating injury is just below the level of the nipples one should not be suspicious of a penetrating injury to the diaphragm False
(c) The left dome of the diaphragm is higher than the right dome in normal e pople. False
(d) The right dome ofthe diaphragm is higher than the left dome innormal people. True (e) The right dome ofthe diaphragm is more likely to suffer a penetrating injury.False
The arching domes of the diaphragm can reach the level of the /th rib.!f a penetrating injury is just below the level of the nipples one should be suspicious of a penetrating injury to the diaphragm
MCEM Pathology MCQ 6cclusion of the anterior cerebral artery causes
(a) 1aralysis of the opposite leg True (b) 1erseveration True (c) rinary incontinence True (d) 7rasp refle$ in the opposite hand True (e) 0ernickes(receptive
MCEM Pathology MCQ !n the alert patient with evidence of blunt abdominal trauma&
(a) 1eritoneal lavage is helpful if the patient is stable. True *, 9B%ST scanning free fluid visible in the abdomen implies at least /ml of fluid.True 0ith F>ST scanning free fluid visible in the abdomen implies at least /ml of fluid. (d) %T Scanning will visualise retroperitoneal injuries w ell True %T scanning may miss diaphragmatic injury and many visceral injuries but will detect solid organ damage or intraperitoneal blood. (e) aparotomy is usually necessary in the shocked patient True The patient is likely to need a laparotomy if there has been abdominal trauma and he
MCEM Pathology MCQ 6ttawa ankle rules& The following re"uire G 9ay
(a) Tenderness at the base of the /th metatarsal. True (b) Bone tenderness along the distal ; cm of the posterior edge of the tibia or tip of the medial malleolus True (c) Bone tenderness along the distal ; cm of the posterior edge of the fibula or tip of the lateral malleolus True (d) Bone tenderness at the navicular bone (for foot injuries). True (e) 1regnancy is an e$clusion criteria. True >long with children and those with diminished ability to follow the test.
G:rays are only re"uired if there is bony pain in the malleolar or midfoot area, and any one of the following& Bone tenderness along the distal ; cm of the posterior edge of the tibia or tip of the medial malleolus Bone tenderness along the distal ; cm of the posterior edge of the fibula or tip of the lateral malleolus Bone tenderness at the base of the fifth metatarsal (for foot injuries). Bone tenderness at the navicular bone (for foot injuries). >n inability to bear weight both immediately and in the emergency department for four steps. %ertain groups are e$cluded, in particular children (under the age of *C), pregnant women, and those with diminished ability to follow the test (for e$ample due to head injury or into$ication).
MCEM Pathology MCQ 4andibular Fractures
(a) sually occur on oneside of the mandible only False (b) The most common areaof fracture is the angle of the mandible True (c) 4ay present with bony crepitus True (d) 4ay present with malocclusion True (e) 4ay present with limited 964 True
MCEM Pathology MCQ The following are true
(a) Biceps is innervated by musculocutaneous True (b) Brachioradialis is innervated by musculocutaneous False By radial nerve (c) 5lbow fle$ion is initiated by nerve roots % / and %; True (d) Triceps are innervated by %A True (e) Finger fle$ion is mediated bythe radial nerve False 4edian and ulnar
MCEM Pathology MCQ The 'and
(a) The median nerve enters the hand through the carpal tunnel, deep to the fle$or retinaculum, between the tendons of the fle$or digitorum superficialis andthe fle$or carpi radialis. True The median nerve enters the hand through the carpal tunnel, deep to the fle$or retinaculum, between the tendons of the fle$or digitorum superficialis and the fle$or carpi radialis. (b) To anaesthetise the median nerve local anaesthetic is injected between the tendon8s of the fle$pr carpi radialis and palmaris longus. True To anaesthetise the median nerve local anaesthetic is injected between the tendon8s of the fle$pr carpi radialis and palmaris longus. (c) >t the wrist the ulnar nerve is blocked by injecting local anaesthetic between the palmaris longus and the fle$or carpi ulnaris False >t the wrist the ulnar nerve is blocked by injecting local anaesthetic between the ulnar artery and the fle$or carpi ulnaris. (d) The ulnar nerve supplies cutaneuos sensation to the volarsurface 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) >bout / ml8s of +D lignocaine is re"uired toanaesthetise the ulnar nerve. False
MCEM Pathology MCQ eft common carotid artery
(a) ies postero:laterally to the left vagus nerve inthe neck. False The left common carotid artery lies antero:medial to the left vagus nerve in the neck (b) ies anteriorly to theprevertebral fascia in the neck. True The left common carotid artery lies anteriorly to the prevertebral fascia in the neck. (c) 7ives off the left inferior thyroidartery. False The left thyroid artery is a branch of the left thyrocervical trunk of subclavian (d) !s a direct branch from the aortic arch. True The left common carotid artery is a direct branch from the aortic arch.
MCEM Pathology MCQ 'aemorrhagic Shock
(a) 1ulse K* is consistent with class !shock True (b) 1ulse *:*+ is consistent with class !! shock True (c) 1ulse *+:* is consistent with class !!! shock True (d) 1ulse J* is consistent with class !@ shock True (e) 1ulse *+:* is consistent with class !@ shock False
>TS classification. K* class !, K*+ class !!, K* class !!!, J* class !@
MCEM Pathology MCQ The umbar 1le$us&
(a) The femoral nerve srcinates from the lumbar ple$us from +, and . True The femoral nerve srcinates from the lumbar ple$us from +, - and . (b) The obturator nerve srcinates from * and+ and supplies the adductor muscles of the thigh.False The obturator nerve srcinates from +, - and and supplies the adductor muscles of the thigh. (c) The femoral nerve supplies the skin onthe posterior aspect of the legand foot. False The femoral nerve supplies the skin on the medial side of the leg and foot. (d) The iliohypogastric nerve supplies the cremastermuscle. False The genitofemoral nerve supplies the cremaster muscle. (e) The femoral nerve supplies the skin on the medial surface of the thigh only. False The femoral nerve supplies the skin on the anterior surface of the thigh.The obturator nerve innervates the adductors of the thigh and the skin on the medial surface of the thigh.
MCEM Pathology MCQ ower vertebral levels&
(a) The dural sac ends at the vertebral level of S- False The dural sac ends at the vertebral level of S+ (b) The rectum starts at the vertebral level of S* False The rectum starts at the vertebral level of S(c) The bifurcation of theaorta occurs at the vertebral level of/ False The bifurcation of the aorta occurs at the vertebral level of (d) The sacral dimples are at thevertebral levels of S* False The sacral dimples are at the vertebral levels of S+ (e) The posterior superior iliac spine is at thevertebral level of S+ True The posterior superior iliac spine is at the vertebral level of S+
MCEM Pathology MCQ %ompartment syndrome&
(a) The pain is characteristically mild. False (b) The pain is characteristically well localised. False (c) 1alpation of the affected compartment will e$acerbate thepain. True 1alpation of the affected compartment will e$acerbate the pain. (d) 1assive stretching of muscles in the affected compartment will e$acerbate the pain.True 1assive stretching of muscles in the affected compartment will e$acerbate the pain. (e) 1araesthesia is a feature before pain. False
The pain is severe and poorly localised.1alpation of the affected compartment will e$acerbate the pain.1assive stretching of muscles in the affected compartment will e$acerbate the pain.1araesthesia is a feature after pain.
MCEM Pathology MCQ ymphatic drainage of the thoracic wall.
(a) The skin drains to the a$illary lymph nodes. True
(b) The intercostal spaces drain to the internal thoracic nodes.True
(c) The posterior spaces drain tothe posterior intercostal nodes. True
(d) The posterior intercostal spaces drain to the para aortic nodes True
(e) The skin on the posterior surface drains tothe para:aortic nodes False
The skin drains to the a$illary lymph nodes.The intercostal spaces drain forwards to the internal thoracic nodes and backwards to the posterior intercostal nodes and the para aortic nodes.
MCEM Pathology MCQ %haracteristic features of repetitive strain injury&
(a) 1ain felt deep in the wrist. True 1ain felt deep in the wrist radiating to forearm and shoulder is a characteristic feature of repetitive strain injury. (b) 4arked oedema of fingers and hand. False Subjective feeling of swelling but nothing to find on e$amination. (c) Symptoms worse at night False 0orsen with work and improve with rest. 1ain initially clears at night but can become constant. (d) 9aised 5S9. False ?o clinical signs. G 9ay and bloods are normal. (e) 7ood response to ?S>!#s. False ?ot of great help.
MCEM Pathology MCQ The Brachial 1le$us&
(a) The dorsal scapular nerve is abranch of %A. False The dorsal scapular nerve is a branch of %/. (b) The medial cord supplies the e$tensor structures on theposterior aspect of the limb. False The posterior cord supplies the e$tensor structures on the posterior aspect of the limb. (c) The anterior division of the lower trunk forms themedial cord. True The anterior division of the lower trunk forms the medial cord. (d) The posterior cord may contain neurons from all the spinal nerves contributing to the brachial ple$us True The posterior cord may contain neurons from all the spinal nerves contributing to the brachial ple$us. (e) !n the a$illa the posterior divisions unite to form the lateral cordFalse !n the a$illa the posterior divisions unite to form the posterior cord
MCEM Pathology MCQ The @ertebral %olumn&
(a) ateral fle$ion of thebody is restricted by the thoracic section of thevertebral column. True ateral fle$ion of the body is restricted by the thoracic section of the vertebral column because of the ribs. (b) 9otation ( twisting of the body ) of the body is least e$tensive in the lumbar region.True 9otation of the body is least e$tensive in the lumbar region. (c) Fle$ion and e$tension of the vertebral column is e$tensive in the cervical and thoracic regions but limited by the lumbar region. False Fle$ion and e$tension of the vertebral column is e$tensive in the cervical and lumbar regions but limited by the thoracic region. (d) The cervical vertebrae normally have a posterior conve$ity while the thoracic region has a posterior concavity. False The cervical vertebrae normally have a posterior concavity while the thoracic region has a posterior conve$ity. (e) There is normally A cervical vertebrae, *+ thoracic vertebrae, / lumbar vertebrae, and / sacral vertebrae, and coccygeal vertebrae. True There is normally A cervical vertebrae, *+ thoracic vertebrae, / lumbar vertebrae, and / sacral vertebrae, and coccygeal vertebrae.
MCEM Pathology MCQ The thorcic spine&
(a) 'as an increased amount of fle$ibility afforded by it8s articulation with the rib cage.False The rib cage makes the thoracic spine more infle$ible and more rigid. (b) The thorcic spine is the most commonly injured partof the spine. False The thoracic spine is among the least fre"uently injured parts of the spine. (c) The spinal canalis wider than that found in the cervical spine. False The spinal canal is narrower in the thoracic spine than that found in the cervical or lumbar spine. (d) 0hen spinal cordinjury does occur they are mostly neurologically complete. True Because of the high ratio of spinal cord to spinal canal in the thoracic spine when spinal cord injury does occur it is usually complete. (e) The thoracolumbar junction (T**:+) is considered a transitional 2one between the fi$ed thoracic and mobile lumbar regions True The thoracolumbar junction (T**:+) is considered a transitional 2one between the fi$ed thoracic and mobile lumbar regions
MCEM Pathology MCQ The following muscles and nerve root supply are correctly paired&
(a) #eltoid&%/ True %/ is the nerve root for shoulder abduction by the deltoid muscle. (b) 0rist 5$tensors&%; True %; is the nerve root for wrist e$tension. (c) %A&5lbow 5$tension True %A is the nerve root for elbow e$tension. (d) T*&>bductor #igiti 4inimi True T* is the nerve root for little finger abduction by abductor digiti minimi.
MCEM Pathology MCQ 'ip Fractures
(a) 5$tracapsular fractures are more likely to compromise blood supply to the femoral head than intracapsular fractures. False (b) !solated femoral headfractures are most commonly associated with ihp dislocations. True (c) ?on displaced neck fractures are treatedwith pin fi$ation. True (d) #isplaced fractures aretreated with open reduction or prosthesis placement. True (e) 6verall mortality for intertrochanteric hip fracturesis /D False 6verall mortality for intertrochanteric hip fractures is * to -D.
'ip fracture incidence doubles for each decade after /. 'ip fracture incidence is - to times higher in women than in men. The affected leg in a hip fracture is classically shortened and e$ternally rotated. !ntracapsular hip fractures involve the femoral head and femoral neck. 5$tracapsular hip fractures may be intertrochanteric or subtrochanteric. !ntracapsular fractures are more likely to compromise blood supply to the femoral head than e$tracapsular fractures. !solated femoral head fractures are most commonly associated with hip dislocations. ?on displaced neck fractures are treated with pin fi$ation. #isplaced fractures are treated with open reduction or prosthesis placement. !ntertrochanteric fractures are classed as stable or unstable. stable fractures are those which the medial cortices of the femoral neck and the femoral fragment abut. 6verall mortality for intertrochanteric hip fractures is * to -D.
MCEM Pathology MCQ %lassification of shock
(a) %lass ! shock is whenblood loss is K*D ofblood volume False (b) %lass !! shock is when blood loss is K+D of blood volume False (c) %lass !!! shock is when +:D of blood volume is lost False (d) %lass !@ shock is whenJD blood volume islost True (e) %lass @ shock is when J/D of blood volume is lost False
%lass ! L K*/D, %lass !! L K-D, %lass !!! L KD, %lass !@ L JD
MCEM Pathology MCQ ?!%5 7uideline& Selection of >dults for %T Brain
(a) 7%S K *- when first assessed in 5# %T brain should be re"uested immediately according to the ?!%5 guidelines after headinjury. True 7%S K *- when first assessed in 5# %T brain should be re"uested immediately (b) !f 7%S K */ when assessed + hours after presentation in 5# %T brain should bere"uested. True !f 7%S K */ when assessed + hours after presentation in 5# %T brain should be re"uested. (c) > suspected skull fracture is not an indication to re"uest a %TBrain scan. False > suspected skull fracture is an indication to re"uest a %T Brain scan. (d) 81anda8 eyes arenot an indication to re"uesta %T Brain scan False 81anda8 eyes is an indication to re"uest a %T brain scan as this is evidence of a fracture at the skull base. (e) > collection of blood in the middle ear space is not an indication to re"uest a %TBrain scan. False 'aemotympanum is an indication to re"uest a %T Brain scan as this is evidence of a fracture at the skull base.
MCEM Pathology MCQ 6penings in the diaphragm
(a) The aortic opening lies anterior to thebody of T* False The aortic opening lies anterior to the body of T*+.The aortic opening transmits the aorta,the thoracic duct and the a2ygous vein (b) The aortic opening transmits the aorta,the thoracic duct, the a2ygous vein, and the vagus nerve. False The aortic opening transmits the aorta,the thoracic duct and the a2ygous vein. The oesophageal opening transmits the vagi. (c) The esophageal opening is at thelevel of T*+ False The esophageal opening is at the level of T*. (d) The esophageal opening transmits thephrenic nerve False The esophageal opening transmits the vagi at T*. The right phrenic nerve penetrates the diaphragm with the !@% while the left phrenic nerve penetrates on it8s own. (e) The caval opening transmits the inferior vena cava at the level of TCTrue The caval opening transmits the inferior vena cava at the level of TC.
The aortic opening lies anterior to the body of T*+.The aortic opening transmits the aorta,the thoracic duct and the a2ygous vein.The esophageal opening transmits the vagus nerve
MCEM Pathology MCQ 0ith regard to the nervous system
(a) #orsal columns carryproprioception and vibration sense True #orsal columns ( 1osterior %olumns ) carry proprioception and vibration sense and decussate in the brainstem. (b) The dorsal columns decussate in the medulla True The dorsal columns decussate in the medulla (c) The sensory corte$ isin the parietal lobe True The sensory corte$ is in the parietal lobe (d) The spinothalamic tract decussates at the levelof the brainstem. False The spinothalamic tract is a sensory pathway srcinating in the spinal cord that transmits information about pain, temperature, itch and crude touch to the thalamus. The pathway decussates at the level of the spinal cord, rather than in the brainstem. The posterior column:medial lemniscus pathway and corticospinal tract decussate in the brainstem. (e) The muscles of mastication are innervatedby the facial nerve False The muscles of mastication are innervated by the trigeminal nerve ( %? @ )4ore specifically, they are innervated by the mandibular branch, or @-
The dorsal columns carry proprioception and vibration sense. From the leg they ascend in gracilis fasicles and from the arm they ascend as the cuneatus fasiciles.!n the caudal medulla they synapse and decussate in the internal arcuate fibres.They then ascend to the ventroposterolateral(@1) nucleas of the thalamus and from there to the sensory corte$ of the parietal lobe.
MCEM Pathology MCQ The sternal angle lies at the level
(a) The sternal angle lies at thelevel 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 /th and ;th thoracic vertebrae False The sternal angle lies at the level of the intervertebral disc between the th and /th 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 thejunction 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 thelevel of the bifurcation of thetrachea. 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.>s well as the above it lies at the junction of the superior and inferior mediastinum.
MCEM Pathology MCQ >bnormal @1&
(a) 7iant 8v8 waves are seen in tricuspid regurgitation. True 7iant 8v8 waves are seen in tricuspid regurgitation. (b) ?o 8a8 waves are seenin > Fib. True ?o 8a8 waves are seen in > Fib. (c) !nspiratory filling is normal. False Mussmaul8s sign is seen in pericardial constriction, tamponade and severe asthma. (d) 9enal Failure may cause an abnormal @1 . True 1ericarditis or fluid overload. (e) %annon waves are seen in ventricular tachycardia. True %annon waves are seen in ventricular tachycardia and complete heart block.
MCEM Pathology MCQ %ervical Spondylosis
(a) 0hen severe most commonly effects %/<%; True
(b) %ausing pain in the neck re"uires neck immobilisation False
(c) 4ay produce symptoms ofvertebrobasilar insufficiency. True
(d) 4yelopathy is best treated with manipulation. False
(e) 9adiculopathy rarely recovers completely. False
%ervical Spondylosis :0hen severe most commonly effects %/<%; as this is where bending the neck is greatest. 4ost episodes settle without treatment.#isc protrusion may narrow the vertebral arteries and cause vertebrobasilar insufficiency.4anipulation is contraindicated in myelopathy.
MCEM Pathology MCQ The following are causes of spinal cord compression&
(a) Spondylosis. True (b) ymphoma. True (c) >bscess. True (d) Syringomyelia. True (e) 'aematomyelia. True
Syringomyelia and 'aematomyelia are causes of intramedullary spinal cord compression. 6ther causes include trauma, prolapsed disc, and tumors.
MCEM Pathology MCQ @eins of the pper imb&
(a) >ll veins in the upper limb possess valves. True >ll veins in the upper limb possess valves. (b) The cephalic vein srcinates from the medial side of the venous network on the dorsum of the hand. False The cephalic vein srcinates from the postero:lateral aspect of the venous network on the dorsum of the hand. (c) The cephalic vein passes upwards along the lateral border of the forearm anterior to the head of the radius True The cephalic vein passes upwards along the lateral border of the forearm anterior to the head of the radius (d) !n the upper arm the cephalic vein ascends on the lateral aspect of the biceps brachii to the groove between the deltoid and pectoralis major True !n the upper arm the cephalic vein ascends on the lateral aspect of the biceps brachii to the groove between the deltoid and pectoralis major (e) The basilic vein begins on the medial side of thevenous network on the dorsum of the hand. True The basilic vein begins on the medial side of the venous network on the dorsum of the hand.
MCEM Pathology MCQ 1elvis G 9ays&
(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 (!n *1 views of the pelvis alone. False !n ID of cases a correct diagnosis can be made from only >1 views of the pelvis (d) The pelvic brim is often disrupted in onlyone place False The pelvic brim cannot be disrupted in only one place (e) ateral compression fracture causes a disruption of the ala of the sacrum and a hori2ontal fracture of the ipsilateral pubic symphysis True >nd momentary medial displacement of the hemipelvis
MCEM Pathology MCQ The following joints are often sublu$ed
(a) 1atella True The patella is often sublu$ed
MCEM Pathology MCQ #iagnostic 1eritoneal lavage is positive when
(a) 9B%8s J*, cells
>lso /ml gross blood, or e$it of lavage fluid via chest tube or bladder catheter
MCEM Pathology MCQ Brachioradialis&
(a) Fle$es arm at the elbow. True Brachioradialis fle$es the arm at the elbow. (b) Supinates the forearm. False Supination of the forearm is the action of the biceps brachii. (c) Brings forearm into midprone position. True Brachioradialis brings the forearm into the midprone position. (d) Brachioradialis isinnervated by ulnarnerve. False Brachioradialis is innervated by the radial nerve. (e) 6verlies ulnar artery. False Brachioradialis overlies the radial artery.
MCEM Pathology MCQ The 6ptic ?erve&
(a) > bitemporal hemianopia may be caused by a pituitary tumor or a sella meningioma.True > bitemporal hemianopia may be caused by a pituitary tumor or a sella meningioma (b) > homonymous hemianopia is caused by a lesion of the optic tract to the occipital corte$.True > homonymous hemianopia is caused by a lesion of the optic tract to the occipital corte$. (c) >n incomplete lesion of the optic tract isassociated with a central scotomata. False >n incomplete lesion of the optic tract is associated with macular ( central ) vision sparing (d) >n upper "uadrant homonymous hemianopia is associated with a parietal lobe lesion. False > lower "uadrant homonymous hemianopia is associated with a parietal lobe lesion. (e) > lower "uadrant homonymous hemianopia is associated with atemporal lobe lesion. False >n upper "uadrant homonymous hemianopia is associated with a temporal lobe lesion.
MCEM Pathology MCQ Thoracic vertebrae&
(a) The top of the arch of the aorta is at thelevel of T-< True The top of the arch of the aorta is at the level of T-< (b) The manubrium sterni encompasseslevels T- and T True The manubrium sterni encompasses levels T- and T (c) The a2ygous vein enters the S@% at T; False The a2ygous vein enters the S@% at T (d) The angle of louis is at the level of T
MCEM Pathology MCQ 0ound 5valuation
(a) #iffuse bleeding most often occurs from thesubdermal ple$us and superficial veins True #iffuse bleeding most often occurs from the subdermal ple$us and superficial veins (b) 1ovidone:iodine based skindisinfectant suppress bacterial growth on intact skin.True (c) 1ovidone:iodine based skin disinfectant should be used in the wound itslf to suppress bacterial growth. False 1ovidone:iodine based skin disinfectant should not be used in the wound itself as it may impair host defences and promote bacteria growth. (d) %hlorhe$idine based skin disinfectant should be used in the wound itslf to suppress bacterial growth. False %hlorhe$idine based skin disinfectant should not be used in the wound itself as it may impair host defences and promote bacteria growth. (e) !n well perfused tissues (e.g., scalp) wounds closed without prior hair removal heal with an increase in infection. False !n well perfused tissues (e.g., scalp) wounds closed without prior hair removal heal with no apparent increase in infection
MCEM Pathology MCQ The circle of willis is supplied by
(a) 5$ternal carotid arteries False The circle of willis is supplied by the internal carotid. (b) Basilar arteries True The basilar artery gives off the pontine, labyrinthine, superior and anterior inferior cerebellar arteries. (c) nion of vertebral arteries True (d) Brachial >rtery False (e) >$illary artery False
MCEM Pathology MCQ %entral @ein %annulation %omplications include&
(a) >rterial laceration. True >fter failure of placement, this is the commonest complication of central line insertion. (b) Tension pneumothora$. True (c) 'aemothora$ is increasedwith !@ cannulation whencompared to the subclavian route. False (d) %ardiac Tamponade. True %an be caused if the tip of the line lies below the pericardial reflection and it perforates the vessel wall. !t8s least likely to happen via the internal jugular vein (e) >ir 5mbolism. True
6ther complications during placement can be nerve injury. >fter placement local infection or venous thrombosis can be possible complications.
MCEM Pathology MCQ 'and !nfections
(a) The hand position of function for splinting includes the 4%1 joint being at / to I degrees fle$ion. True (b) 4idpalmer space infection occurs from spread of a fle$or tenosynovitis or from a penetrating wound to the palm causing infection in the radial or ulnar bursa of the hand. True (c) 1aronychia is an infection of the lateral nail fold. True (d) Fle$or tenosynovitis is suggested by tendernessover the fle$or tendon sheath. True (e) %losed fist injury ( human bite wound above the 4%1 joint resulting from punching an individual ) be be e$plored, irrigated andallowed to heal by secondary intention. True
MCEM Pathology MCQ 5ye Trauma&
(a) > hyphema is not a reflection on the degree of traumasustained. False > hyphema suggests significant ocular trauma. (b) 9estricted upward ga2e suggests a blowout fracture with entrapment of theinferior rectus. True 9estricted upward ga2e suggests a blow out fracture with entrapment of the inferior rectus. (c) > ruptured globe is implied by a flat anterior chamber.True > ruptured globe is implied by a flat anterior chamber. (d) The sensation of the inferior orbital nerve is tested below the eye and on the ipsilateral side of the nose. True The sensation of the inferior orbital nerve is tested below the eye and on the ipsilateral side of the nose. (e) The pupil can be constricted or dilated after sustaining trauma. True The pupil can be constricted or dilated after sustaining trauma.
Blowout fractures are the most common orbital fractures. These injuries occur when a blunt object strikes the globe, resulting in e$pansion of orbital contents and subse"uent rupture through the bony floor. 1atients may have enophthalmos, or sunken globe, when a large section is ruptured. !nfraorbital anesthesia is a more common finding and develops when the infraorbital nerve is contused by the initial trauma or when compressed by bony fragments. >nesthesia of the ma$illary teeth and upper lip is more reliable than numbness over the cheek. #iplopia, particularly on upward ga2e that usually indicates inferior rectus muscle entrapment, is another important clinical finding. > step:off deformity may be palpated over the intraorbital rim. Subcutaneous emphysema is pathognomonic for fracture into a sinus or nasal antrum.
MCEM Pathology MCQ >n ulnar nerve lesion may be represented as follows&
(a) 'ypere$tension at the 4%1 joint of the little and ring fingers accompanied by fle$ion of the interphalangeal joints. True This is claw:like hand pattern.'ypere$tension at the 4%1 joint of the little and ring fingers accompanied by fle$ion of the interphalangeal joints. (b) %lawing of the hand is more pronounced with a morepro$imal lesion. False %lawing of the hand is more pronounced with a lesion at the wrist as a lesion at or above the elbow causes loss of fle$or digitorum profundus and less fle$ion at the !1 joints. (c) Froments sign tests thumb adduction. True The patient is asked to grasp a piece of paper between the thumb and the lateral aspect of the inde$ finger. (d) The ulnar nerve supplies the sensory component to the medial half of the ring finger.True The ulnar nerve supplies the sensory component to the medial half of the ring finger.
MCEM Pathology MCQ The following are true&
(a) Mnee fle$ion is performed bythe "uadriceps. False Mnee fle$ion is performed by the hamstringsN (b) The hamstrings are innervated bythe obturator nerve. False The hamstrings are innervated by the sciatic nerve. (c) The sciatic nerve innervates the"uadriceps. False The femoral nerve(+<-<) innervates the "uadriceps. (d) The obturator nerve is composed of fibers from +,- and. True The obturator nerve is composed of fibers from +,- and . (e) The sciatic nerve is responsible forankle dorsifle$ion True The common peroneal nerve is an e$tension of the sciatic nerve.
Mnee fle$ion is performed by the hamstrings which are innervated by the sciatic nerve(S*). The sciatic nerve is responsible for ankle dorsifle$ion via the common peroneal nerve. The obturator nerve is composed of fibers from +,- and .
MCEM Pathology MCQ reters
(a) 5ach ureter measures appro$imately *cm inlength False 5ach ureter measures appro$imately +/cm ( * inches ) in length (b) 1ass into the anterior surface ofthe urinary bladder False 5ach ureter passes into the posterior surface of the urinary bladder. (c) reteric stones fre"uently arrest where the renal pelvis joins the ureter. True reteric stones fre"uently arrest where the renal pelvis joins the ureter, where the ureter is kinked as it passes the pelvic brim and where the ureter pierces the bladder wall. (d) >re supplied in the inferior end by the renal arteries. False The upper end is supplied by the renal arteries, the middle is supplied by the testicular or the ovarian artery and the inferior end is supplied by the superior vesical artery. (e) ymph drainage is to the lateral aortic and iliac nodes. True ymph drainage is to the lateral aortic and iliac nodes.
MCEM Pathology MCQ umbar 1le$us&
(a) The lumbar ple$us is formed bythe anterior rami of theupper four lumbar nerves. True The lumbar ple$us is formed by the anterior rami of the upper four lumbar nerves. (b) !t is situated within the psoasmuscle True !t is situated within the psoas muscle (c) The femoral nerve srcinates fromthe lumbar ple$us from * and +. False The femoral nerve srcinates from the lumbar ple$us from +, - and (d) The obturator nerve srcinates from * and+. False The obturator nerve srcinates from +, - and (e) The obturator nerve innervates the adductors of the thigh and the skin on the medial surface of the thigh. True The obturator nerve innervates the adductors of the thigh and the skin on the medial surface of the thigh.
MCEM Pathology MCQ The following are correct&
(a) The oesophageal opening in thediaphragm is at the level of TC False The oesophageal opening in the diaphragm is at the level of T* (b) Branches of the right gastric vessels go through the diaphragmat T* False Branches of the left gastric vessels go through the diaphragm at T* (c) The left phrenic nerve pierces the diaphragm lateral to the central tendon at the level of;TFalse The left phrenic nerve pierces the diaphragm lateral to the central tendon at the level of TC (d) The right phrenic nerve pierces the diaphragmwith the !@% at T; False The right phrenic nerve pierces the diaphragm with the !@% at TC (e) The sterno$iphisternal joint is at the level of TC
MCEM Pathology MCQ The Brachial 1le$us&
(a) The ulnar nerve is largely made up from %; and%A fibres. False The ulnar nerve is largely made up from %C and T* fibres. (b) The a$illary nerve is given off bythe posterior cord. True The a$illary nerve is given off by the posterior cord. (c) The musculocutaneous nerve is made up from %/ %; , , and %A True The musculocutaneous nerve is made up from %/ , %; , and %A (d) The medial cord andthe lateral cord form the median nerve True The medial cord and the lateral cord form the median nerve (e) The dorsal scapular nerve ( %/) supplies the serratus anterior muscle. False The dorsal scapular nerve ( %/ ) supplies the rhomboid muscles. Serratus >nterior is supplied by the long thoracic nerve.
MCEM Pathology MCQ The following are true in relation to common root compression syndromes produced by lumbar disc prolapse&
(a) >n / root lesion will cause pain from the buttock to the lateral aspect of the leg and on the dorsum of the foot. True >n / root lesion will cause pain from the buttock to the lateral aspect of the leg and on the dorsum of the foot. (b) >n root lesion will cause pain from the lateral aspect of the thigh to the medial side of the calf. True >n root lesion will cause pain from the lateral aspect of the thigh to the medial side of the calf. (c) >n S* root lesion will cause sensory loss on the sole of the foot and the osterior p calf. True >n S* root lesion will cause sensory loss on the sole of the foot and the posterior calf. (d) >n / root lesion will cause sensory loss on the dorsum of the foot and anterolateral aspect of the leg. True >n / root lesion will cause sensory loss on the dorsum of the foot and anterolateral aspect of the leg.
MCEM Pathology MCQ The Brachial 1le$us&
(a) !n the a$illa the posterior divisions unite to form the posterior cordTrue !n the a$illa the posterior divisions unite to form the posterior cord (b) The lateral cord supplies the e$tensor structures on the posterior aspect of the limb. False The posterior cord supplies the e$tensor structures on the posterior aspect of the limb. (c) The posterior division of the lower trunk forms the medialcord. False The anterior division of the lower trunk forms the medial cord. (d) The posterior cord may contain neurons from all the spinal nerves contributing to the brachial ple$us True The posterior cord may contain neurons from all the spinal nerves contributing to the brachial ple$us (e) The dorsal scapular nerve is abranch of %/. True The dorsal scapular nerve is a branch of %/
MCEM Pathology MCQ Fissure !n >no
(a) %ause painless rectal bleeding False !s a common casue of painful rectal bleeding (b) !n most cases occur in the midline anteriorly False !n most cases occur in the midline posteriorly. (c) #iscomfort is constant between bowel motions. False #iscomfort resolves between bowel motions. (d) >re associated with sentinel pile8s True >s a result of hypertrophied papillae. (e) 1atient8s should increase dietary bran True
MCEM Pathology MCQ umbar 1uncture&
(a) The plane of the iliac crest runsthrough *:+. False The plane of the iliac crest runs through -:. (b) The spinal cord in theadult ends at the level of *:+. True The spinal cord in the adult ends at the level of *:+. (c) 0hen performing a lumbar puncture the 8give8 is felt when passing through the interspinous ligament. False The 8give8 is felt when passing through the ligamentum flavum. (d) The opening pressure is usually K* cm of%SF. False The opening pressure is usually A:*Ccm of %SF. (e) The %SF protein content is usually .*/ to./g<. True 6ther important values include 0%% K/. For every * 9B%8s, subtract * 0B% and .*/ protein.
'eadache, which occurs in * to -D of patients, is one of the most common complications following lumbar puncture (1). 1ost:1 headache is caused by leakage of %SF from the dura and traction on pain: sensitive structures. 1atients characteristically present with frontal or occipital headache within + to C hours of the procedure, which is e$acerbated in an upright position and improved in the supine position. >ssociated symptoms may include nausea, vomiting, di22iness, tinnitus, and visual changes.
MCEM Pathology MCQ 'aemorrhagic shock classification
(a) %lass ! loss is usually KA/ ml True %lass ! loss is usually KA/ ml (b) %lass !! loss is usually K + ml False %lass !! loss is usually K */ ml (c) %lass !!! shock is K+./ blood loss False %lass !!! shock is K+ blood loss (d) 0ithout intervention, a classic bimodal distribution of deaths is seen in severe hemorrhagic shock. False 0ithout intervention, a classic trimodal distribution of deaths is seen in severe hemorrhagic shock. >n initial peak of mortality occurs within minutes of hemorrhage due to immediate e$sanguination. >nother peak occurs after * to several hours due to progressive decompensation. > third peak occurs days to weeks later due to sepsis and organ failure. (e) ower doses of #opamine predominantly stimulate dopaminergic receptors that in turn produce renal vasodilation and cardiac stimulation. False ower doses predominantly stimulate dopaminergic receptors that in turn produce renal and mesenteric vasodilation. 'igher doses produce cardiac stimulation and renal vasodilation http&<
%lass ! L KA/ml, %lass !! L K*./, %lass !!!L K+, %lass !@ L J+
MCEM Pathology MCQ
