HNNS Important Questions II Flashcards by 888 😉

[Old PP]
State motor supply to stylopharyngeus.

Glossopharyngeal nerve

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[Old PP]

State sensory supply to nasopharyngeal recess (fossa of Rosenmüller) .

Maxillary nerve (CN V2)

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[Old PP]
State the sensory supply to piriform fossa.

Internal laryngeal nerve (CN X)

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[Old PP]
State the motor supply to middle pharyngeal constrictor.

Pharyngeal plexus (CN X)

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[Old PP]
Which of following statements regarding nasopharynx is INCORRECT?

A. At roof of nasopharynx lies a collection of adenoid tissue called pharyngeal tonsils.
B. Pharyngeal recess is a common site for nasopharyngeal carcinoma.
C. Sensory nerve supply to nasopharynx is by mandibular division of trigeminal nerve.
D. Opening of auditory tube is found at lateral region of nasopharynx.
E. Nasopharynx is located behind posterior aperture of nasal cavity.

Maxillary nerve (CN V2)

Posterior apertures of nasal cavity: choanae

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[PP]
Mid-shaft clavicular fracture.
Which muscle is responsible for the upward displacement of the proximal fragment?
A. Pectoralis major
B. Sternocleidomastoid
C. Subclavius
D. Trapezius

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[PP]

The vestibule of the larynx is located above the true vocal cords. What is the sensory innervation of this region?

A. External laryngeal nerve
B. Inferior laryngeal nerve
C. Internal laryngeal nerve
D. Recurrent laryngeal nerve

Supraglottic region: internal laryngeal nerve (branch of superior laryngeal nerve)
Subglottic region: recurrent laryngeal nerve

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[PP]
Miss Wong underwent left hemithyroidectomy 2 weeks ago and has recovered well. However, when she returned to work as a singing teacher, she found that she had difficulty in singing the soprano range. Other than that, she is able to speak normally and eat normally. What structure is MOST LIKELY to be damaged during the operation leading to the present symptom? A. External branch of left superior laryngeal nerve
B. Left recurrent laryngeal nerve
C. Left true vocal cord
D. Left vagus nerve

Superior laryngeal nerve
1. External laryngeal nerve
-> cricothyroid (lengthen vocal cord)
-> damage: X high-pitched voice

Internal laryngeal nerve
-> sensory Innervation to supraglottic region

Recurrent laryngeal nerve
-> all intrinsic muscles of larynx except cricothyroid
-> unilateral damage: hoarseness of voice (vocal cord palsy), choking
-> bilateral damage: airway obstruction
-> sensory innervation to subglottic region

Damaged vagus nerve -> hoarseness of voice, choking

Damaged vocal cord -> hoarseness of voice

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[PP]
A patient has Horner syndrome, with ptosis and miosis. The presynaptic sympathetic fibres that are affected MOST LIKELY travel through the white ramus of which spinal nerve?
A. C2
B. L1
C. L5
D. T1

T1-T3

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[PP]
Acoustic startle reflex is a defensive response triggered by a sudden loud noise of > 80 dB. Which neural area plays an important role in generating the startle response?
A. Inferior colliculus
B. Inferior olive
C. Lateral lemniscus nucleus
D. Trapezoid body

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[PP]
Vestibular apparatus in the inner ear senses head movements. What is the stimulus that excites sensory hair cells underneath the otoconia crystals?
A. Endolymph motion
B. Optokinetic input
C. Perilymph motion
D. Rotational motion
E. Translational motion

Otoconia crystals: translational motion
Cupula: endolymph motion

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[PP]
To test the language ability of a patient, a neurologist asks the patient to describe the picture. Which brain region is involved in the comprehension of language?
A. Amygdala
B. Broca area
C. Putamen
D. Wernicke area

Broca’s area (44, 45): motor, produce language
Wernicke’s area (22): comprehension of language

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[PP]
A 55-year-old man had trouble reading the newspaper. The visual field examination showed a right homonymous inferior quadrantic hemianopia/quadrantanopia. Lesion at which location would MOST LIKELY correlate with his visual problem?
A. Left Meyer’s loop
B. Left superior bank of primary visual cortex
C. Right lateral geniculate nucleus
D. Right parietal optic radiation

A: right homonymous superior quadrantanopia
D: left homonymous inferior quadrantanopia

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[PP]
A patient has dementia from Alzheimer disease. Which brain region is MOST LIKELY to show early neuronal loss?
A. Entorhinal cortex
B. Insula
C. Pineal gland
D. Putamen

In hippocampal formation

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[PP]

A patient suffered from Parkinson disease for 10 years and later developed cognitive dysfunction and sleep disturbance.
List two structures of the brain which display neurodegeneration at the early stage of Parkinson disease. (2 marks)

Caudate nucleus
Putamen
Globus pallidus
Subthalamic nucleus

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[PP]
A patient suffered from Parkinson disease for 10 years and later developed cognitive dysfunction and sleep disturbance.
Which degenerated region of the brain caused his cognitive dysfunction? (1 mark)

Frontal cortex

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[PP]

A patient suffered from Parkinson disease for 10 years and later developed cognitive dysfunction and sleep disturbance.
Which region of his brainstem caused his sleep disturbance? (1 mark)

Reticular formation

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[PP]
A patient suffered from Parkinson disease for 10 years and later developed cognitive dysfunction and sleep disturbance.
What is the name of patient’s current neurodegenerative disease? (1 mark)

Parkinson’s Disease Dementia (PDD)

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[PP]
A motorcyclist was sent to the Accident and Emergency Department after a traumatic injury to the left side of the head. The mandible and temporal bone were fractured. Epidural haematoma was suspected.
Injury to which nerve might cause sensory disturbances to his lower lip and chin? (1 mark)

Inferior alveolar nerve

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Which two nerves might be damaged if the salivary secretion was affected? (2 marks)

Lingual nerve (chorda tympani)
Auriculotemporal nerve

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[PP]
Which damaged artery lead to epidural haematoma? Which foramen transmits this artery? (2 marks)

Middle meningeal artery
Foramen spinosum

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[PP]

Which blood vessel relates to the anterior wall of structure Y? (1 mark)

Internal carotid artery

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[PP]
Which blood vessel relates to the inferior wall of structure Y? (1 mark)

Internal jugular vein

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[PP]

What are the two main histopathological hallmarks in AD brain? (2 marks)

(Extracellular) amyloid plaques
(Intracellular) neurofibrillary tangles
- abnormal form of microtubule-associated protein tau

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[PP] The rare forms of Alzheimer's disease (AD) with onset before the age of 60 are heritable. Name two genes in which mutations have been found to cause onset of AD before the age of 60. (2 marks)

APP PSEN1 PSEN2

[PP] Name one type of cognitive deficit in AD patients. (1 mark)

Impaired memory Attentional and executive deficits Language and knowledge deficits Visuospatial and perceptual abilities deficits

[PP] What is the predominant inflammatory cell type that is recruited into the cerebrospinal fluid or abscess cavity that is involved in the defense against acute bacterial infection? (1 mark)

Neutrophils

[PP] Name at least two bacterial organisms that can commonly cross the barrier to enter the brain to set up acute infection in the leptomeninges in a previously healthy child. (2 marks)

Neisseria meningitidis Haemophilis influenzae Streptococcus pneumoniae

[PP] Bacteria can set up acute infection in the central nervous system in form of diffuse infection of the subarachnoid space, or forming abscesses within the cerebral cortical grey and white matter, morphologically characterised by pus formation. Name two predisposing factors that can facilitate entry of bacteria into the cerebral cortical grey or white matter to set up abscess cavity. (2 marks)

Haematogenous (e.g. bacterial endocarditis, lung abscess) Direct penetrating injury breaching the skull bone Adjacent sepsis spreading into the brain (e.g. otitis media)

[PP] Explain why the hand usually has shorter discrimination distance than the forearm. (2 marks)

Compared to the forearm, the hand has - higher density of tactile receptors - smaller receptor field of tactile sensation

[Old PP] Name three areas in motor cortex that are involved in control of voluntary movement. (3 marks)

Primary motor cortex (M1) Pre-motor area (PMA) Supplementary motor area (SMA / M2)

[Old PP] Describe briefly the anatomical locations of the three areas in motor cortex in control of voluntary movements.

Primary motor cortex (M1): in area 4, covers precentral gyrus, from longitudinal fissure to lateral sulcus Supplementary motor area (SMA / M2): medial and superolateral surface of area 6, buried in longitudinal fissure Pre-motor area (PMA): area 6, lateral side of brain, immediately anterior to M1

[Old PP] Name one cortical parietal area that is involved in voluntary movement. Briefly state its function. (2 marks)

Posterior parietal cortex Integrate sensory inputs by constructing a map of immediate extrapersonal space to facilitate sensorimotor guidance

[Old PP] Name two subcortical brain structures that are important in control of voluntary movement. (2 marks)

Basal ganglia (nuclei) Cerebellum

[Old PP] Briefly describe the function of primary motor cortex.

Execute the movement by generating signals to brainstem / spinal cord

[Old PP] Briefly describe the function of premotor area.

Integrate sensory information from posterior parietal cortex and motor information Control proximal and axial muscles via 1. Medial descending systems in brainstem and 2. Spinal cord

[Old PP] Briefly describe the function of supplementary motor area.

Planning, sequencing and programming of complex movements based on memorised space of movements Coordination of bilateral movements

[Old PP] Which neural pathway is responsible for the fine control of fingers? (1 mark)

Corticospinal tract

[Old PP, ALW] Where do upper motor neurons of corticospinal tract decussate?

Lateral corticospinal tract (majority): lower medulla (motor decussation of pyramids) -> continue in lateral funiculus Anterior / ventral corticospinal tract: spinal cord (anterior white commissure)

[Old PP, ALW] Origin of corticospinal tract

Cell body of UMN in cortex (mostly Primary motor cortex) + some immediately rostral to primary motor cortex (e.g. area 6, most from SMA, some from PMA)

[Old PP] Destination of corticospinal tract

Spinal (alpha) motor neurons In anterior horn of spinal cord

[Old PP] Which muscles groups are supplied by corticospinal tract?

Lateral corticospinal tract: contralateral upper and lower limb muscles Anterior corticospinal tract: bilateral axial and proximal limb girdle muscles

[ALW] How many neurons form the pyramidal tracts?

2 (UMN, LMN)

[ALW] Where is the cell body of LMN of pyramidal tracts?

Corticospinal: anterior horn of spinal cord Corticobulbar: motor nucleus of cranial nerve

[ALW] Tweezers and forks are used to test which tract?

Dorsal column-medial lemniscus tract

[ALW] Pin-prick test and temperature are used to test which tract?

Spinothalamic tract

[ALW] Describe the response in positive Babinski sign.

Dorsiflexion of big toe

[ALW] The isolated lesion of which pathway results in Babinski sign in adult? A. Extrapyramidal tract B. Spinocerebellar tract C. Pyramidal tract D. Spinothalamic tract

C UMN lesion

[ALW] Which symptom can be found in a patient with right hemisection of the spinal cord at the level of T7? A. Loss of pain sensation of left lower limb B. Spastic paralysis of left lower limb C. Loss of vibration sensation of right upper limb D. Flaccid paralysis of right upper limb

[ALW] The vestibulospinal tract is an extrapyramidal pathway that subcortically (and therefore subconsciously) activates muscles to promote the maintenance of balance. Where is the origin of this pathway?

Vestibular nuclei in medulla oblongata

[ALW] Which modalities are conveyed by dorsal column-medial lemniscus tract?

Fine touch and pressure Two-point discrimination Vibration Proprioception

[ALW] Where are the beginning and end of DCML tract?

Beginning: receptors in skin, proprioceptors in joints End: primary somatosensory cortex in postcentral gyrus (conscious level)

[ALW] Where are the first, second and third-order neurons of DCML tract?

First: dorsal root ganglion Second: gracile (lower limbs) / cuneate (upper limbs) nucleus in medulla oblongata Third: VPL nucleus of thalamus

[ALW] Where does DCML tract decussate?

Level of lower medulla oblongata

[ALW] Name 3 receptors in DCML tract.

Pacinian corpuscle - vibration Meissner corpuscle - fine touch Muscle spindle - proprioception

[ALW] Which modalities are conveyed by spinothalamic tract?

Pain, temperature, light / crude touch

[ALW] Where are the first, second and third order neurons of spinothalamic tract?

First: DRG Second: dorsal horn of grey matter, SC Third: VPL nucleus of thalamus

[ALW] Where does spinothalamic tract decussate?

SC via anterior white commissure

[PP] A 25-year-old man arrived at the hospital with a severe left periorbital haematoma. Computed tomography examination revealed a fracture of the inferior wall (floor) of the orbit and a related hemosinus (hemorrhage in a paranasal sinus). Two weeks after discharge, the patient could not yet gaze his eye laterally. Which paranasal sinus(es) contained the hemorrhage? (1 mark)

Maxillary sinus

Ethmoidal cells

[PP] A 25-year-old man arrived at the hospital with a severe left periorbital haematoma. Computed tomography examination revealed a fracture of the inferior wall (floor) of the orbit and a related hemosinus (hemorrhage in a paranasal sinus). Two weeks after discharge, the patient could not yet gaze his eye laterally. Rupture of which artery resulted in the hemosinus? (1 mark)

Infraorbital artery

[PP] A 25-year-old man arrived at the hospital with a severe left periorbital haematoma. Computed tomography examination revealed a fracture of the inferior wall (floor) of the orbit and a related hemosinus (hemorrhage in a paranasal sinus). Two weeks after discharge, the patient could not yet gaze his eye laterally. Which venous sinus drains MOST of the blood from the orbits? (1 mark)

Cavernous sinus

Abducens nerve / CN VI

[PP] Schirmer’s test shows severe eye dryness in a woman two weeks after a middle skull base surgery. Which nerve was likely injured?

Greater petrosal nerve (CN VII) Via foramen lacerum

[PP] Long bones ossify via endochondral process. In which zone of the growth plate do the chondrocytes undergo rapid duplication, become flattened and arranged into characteristic columns? A. Zone of calcification B. Zone of hypertrophy C. Zone of ossification D. Zone of proliferation

[PP] There are two types of ossification: intramembranous and endochondral. During fetal development, which bone is formed mainly by intramembranous ossification? A. 5th metacarpal bone B. Parietal bone C. Patella D. Tibia E. Ulna

B Intramembranous ossification: most flat bones of skull Endochondral ossification: most long, short and irregular bones

[PP] COMMUNICATIONS BETWEEN INFRATEMPORAL FOSSA AND OTHER REGIONS OF THE HEAD A. Carotid canal B. Foramen ovale C. Foramen spinosum D. Inferior orbital fissure E. Jugular foramen F. Mandibular foramen G. Petrotympanic fissure H. Pterygomaxillary fissure I. Stylomastoid foramen J. Superior orbital fissure Match the options with blood vessels/nerves that course through them. The option may be used once, more than once, or not at all. (i) The branch of the mandibular nerve that provides sensory innervation to the lower lip.

F Inferior alveolar nerve / Mental nerve

[PP] COMMUNICATIONS BETWEEN INFRATEMPORAL FOSSA AND OTHER REGIONS OF THE HEAD A. Carotid canal B. Foramen ovale C. Foramen spinosum D. Inferior orbital fissure E. Jugular foramen F. Mandibular foramen G. Petrotympanic fissure H. Pterygomaxillary fissure I. Stylomastoid foramen J. Superior orbital fissure Match the options with blood vessels/nerves that course through them. The option may be used once, more than once, or not at all. The branch of the maxillary artery that supplies the upper incisor and canine teeth.

D Infraorbital artery (via inferior orbital fissure) -> anterior superior alveolar artery Posterior superior alveolar artery (via pterygomaxillary fissure)

[PP] COMMUNICATIONS BETWEEN INFRATEMPORAL FOSSA AND OTHER REGIONS OF THE HEAD A. Carotid canal B. Foramen ovale C. Foramen spinosum D. Inferior orbital fissure E. Jugular foramen F. Mandibular foramen G. Petrotympanic fissure H. Pterygomaxillary fissure I. Stylomastoid foramen J. Superior orbital fissure Match the options with blood vessels/nerves that course through them. The option may be used once, more than once, or not at all. The nerve that gives off the branch to supply the intrinsic muscles of the auricle.

I Facial nerve

[PP, formative] THERE ARE DIFFERENT TYPES OF GANGLIA IN THE PERIPHERAL NERVOUS SYSTEM. A. Celiac ganglion B. Ciliary ganglion C. Dorsal root ganglia C1-C4 D. Dorsal root ganglia T1-T4 E. Ganglion of impar F. Inferior mesenteric ganglion G. Pterygopalatine ganglion H. Stellate ganglion I. Submandibular ganglion J. Superior mesenteric ganglion Match the ganglion(ganglia) to the description. The option may be used once, more than once, or not at all. he nerve fibres carry referred pain sensation of angina travel towards the central nervous system through the white rami attached it (them).

[PP, formative] THERE ARE DIFFERENT TYPES OF GANGLIA IN THE PERIPHERAL NERVOUS SYSTEM. A. Celiac ganglion B. Ciliary ganglion C. Dorsal root ganglia C1-C4 D. Dorsal root ganglia T1-T4 E. Ganglion of impar F. Inferior mesenteric ganglion G. Pterygopalatine ganglion H. Stellate ganglion I. Submandibular ganglion J. Superior mesenteric ganglion Match the ganglion(ganglia) to the description. The option may be used once, more than once, or not at all. Contain(s) the primary sensory neurones for the referred pain sensation of angina.

[PP, formative] THERE ARE DIFFERENT TYPES OF GANGLIA IN THE PERIPHERAL NERVOUS SYSTEM. A. Celiac ganglion B. Ciliary ganglion C. Dorsal root ganglia C1-C4 D. Dorsal root ganglia T1-T4 E. Ganglion of impar F. Inferior mesenteric ganglion G. Pterygopalatine ganglion H. Stellate ganglion I. Submandibular ganglion J. Superior mesenteric ganglion Match the ganglion(ganglia) to the description. The option may be used once, more than once, or not at all. Nerve block of this ganglion can be used for managing refractory ventricular tachycardia.

[PP] There are intrinsic and extrinsic muscles of the tongue. Contraction of which of the following elongates the tongue? A. Genioglossus B. Superior longitudinal fibres of intrinsic tongue muscles C. Transverse fibres of intrinsic tongue muscles D. Transverse together with vertical fibres of intrinsic tongue muscles

D Transverse: narrowed, heaped up into convexity Transverse + vertical: flattened, elongated Traverse + vertical + genioglossus (lowest fibres): protruded

[PP] Musculus uvulae is one of the five pairs of muscles that act on the palatine aponeurosis. Which nerve innervates this muscle? A. CNV B. CNIX C. CNX D. CNXII

C Pharyngeal plexus

[Old PP] Name the structures that pass through foramen ovale.

Otic ganglion V: CN V3 (mandibular nerve) Accessory meningeal artery Lesser petrosal nerve (CN IX) Emissary veins

[Old PP] Name the structures that pass through foramen spinosum.

Middle meningeal artery (branch of maxillary artery) Middle meningeal vein Meningeal branch of mandibular nerve

[Old PP] Mr Lee, 35-year-old was struck on lower jaw during basketball game and resulted in dislocated TMJ. Condyle of mandible moved beyond articular eminence, held in dislocation due to spasm. What is origin and insertion of main protruder of lower jaw? A. Maxillary tuberosity and adjacent pyramidal process of palatine bone; medial angle of mandible B. Lateral surface of lateral pterygoid plate; condylar process of mandible C. Bony surface superiorly to inferior temporal line; anterior surface of coronoid process and along anterior margin of ramus of mandible D. Maxilla and zygomatic arch; lateral surface of ramus/angle of mandible and coronoid process E. Digastric fossa of mandible process and mastoid process of temporal bone; hyoid bone via intermediate tendon

B Lateral pterygoid

[Old PP] Motor supply of masticatory muscles

CN V3 (mandibular nerve)

[Old PP] A 20-year-old male had prolonged and extensive facial acne problem. He also complained of headache and fever upon examination. His left eye was unable to abduct and was associated with severe conjunctival congestion. His left eye seems to be bulging out. What is most likely diagnosis? A. Infection and thrombosis of cavernous sinus with paralysis of abducent nerve B. Infection and thrombosis of facial vein with paralysis of ophthalmic nerve C. Infection and thrombosis of maxillary vein with paralysis of abducent nerve D. Infection and thrombosis of ophthalmic vein with paralysis of oculomotor nerve E. Infection and thrombosis of pterygoid plexus with paralysis of trochlear nerve

A Infection of face can spread to cavernous sinus (septic thrombosis) via 1. Pterygoid plexus -> emissary veins 2. Superior ophthalmic artery * facial veins are valveless

[PP] List three branches of the anterior division of mandibular nerve. (3 marks).

Buccal nerve Nerve to lateral pterygoid Masseteric nerve Deep temporal nerves Posterior division: auriculotemporal, lingual, inferior alveolar Trunk branches (medial): meningeal nerve, nerve to medial pterygoid (also give branches to tensor veli palatini & tensor tympani)

[PP] Name one muscle in the middle ear supplied by mandibular nerve.

Tensor tympani

[PP] Name one muscle at the floor of the mouth supplied by mandibular nerve.

Mylohyoid Anterior belly of digastric muscle

[Self-assessment] Which artery supplies the medial pterygoid muscle? A. Lingual artery B. Facial artery C. Maxillary artery D. Superficial temporal artery

C Lingual artery: tongue, adjacent salivary glands and muscles B: superficial face C: all four muscles of mastication D: temple and scalp

[Self-assessment] During a dental procedure, the patient felt numbness at the front of the chin. Which nerve is most likely anesthetized during the procedure? A. Lingual nerve B. Inferior alveolar nerve C. Facial nerve D. Zygomatic nerve

B Inferior alveolar nerve: lower teeth and chin Lingual nerve: sensory to anterior 2/3 of tongue Facial nerve: muscles of facial expression, special sensory and presynaptic parasympathetic to anterior 2/3 of tongue Zygomatic nerve: sensory to skin over zygomatic and temporal bones

[Old PP] Parasympathetic supply of parotid gland. Which opening does nerve go through to enter infratemporal fossa? A. Foramen ovale B. Foramen spinosum C. Jugular foramen D. Petrotympanic fissure E. Stylomastoid foramen

A Auriculotemporal nerve

[Old PP] A. Mylohyoid nerve B. Deep temporal nerve C. Nerve to medial pterygoid D. Nerve to lateral pterygoid E. Lingual nerve F. Masseteric nerve G. Buccal nerve H. Greater petrosal nerve I. Auriculotemporal nerve J. Meningeal nerve Motor supply to anterior belly of digastric

[Old PP] Mumps in parotid, pain in parotid region and ear when chewing, which nerve for pain A. Auriculotemporal nerve B. Buccal nerve C. Facial nerve D. Greater auricular E. Lesser occipital

A Auriculotemporal nerve - two roots wrap around Middle Meningeal Artery - Motor: postsynaptic parasympathetic fibres of CN IX from otic ganglion to parotid gland - Sensory: temple, external ear, external acoustic meatus, tympanic membrane, TMJ

[Old PP] Infratemporal fossa B. Auriculotemporal nerve D. Meningeal branch of mandibular nerve F. Buccal nerve H. Nasopalatine nerve J. Nerve to medial pterygoid 41 A. Inferior alveolar nerve C. Lingual nerve E. Masseteric nerve G. Deep temporal nerve I. Nerve to lateral pterygoid This nerve is anaesthetised in operation on mandibular molar teeth.

[Old PP] Through which opening does infratemporal fossa communicate with pterygopalatine fossa? A. Foramen ovale B. Foramen spinosum C. Inferior orbital fissure D. Pterygoid canal E. Pterygomaxillary fissure

[Old PP] Patient suffers from loss of taste and loss of sensation at his right half of tongue after having dental surgery to remove right lower wisdom tooth. Which nerve is damaged? A. Glossopharyngeal nerve B. Hypoglossal nerve C. Inferior alveolar nerve D. Lingual nerve E. Mandibular nerve

[Old PP] A 23-year-old female had a dental procedure that required injection of local anaesthetic agent around left inferior alveolar nerve (inferior alveolar nerve block). After effects of local anaesthetic agent had worn off, patient complained of persistent numbness and pain on left side of anterior part of tongue. Which of following structures (on left side) had probably been injured? A. Buccal nerve B. Glossopharyngeal nerve C. Hypoglossal nerve D. Lingual nerve E. Submandibular duct

[Old PP] Match following cranial nerves responsible for described actions: A. Olfactory nerve (I) B. Optic nerve (II) C. Oculomotor nerve (III) D. Trochlear nerve (IV) E. Trigeminal nerve (V) F. Abducens nerve (VI) G. Facial nerve (VII) H. Vestibulocochlear nerve I. Glossopharyngeal nerve (IX) (VIII) J. Vagus nerve (X) K. Accessory nerve (XI) L. Hypoglossal nerve (XII) Autonomic supply to major salivary gland

I Parotid: auriculotemporal Submandibular and sublingual: chorda tympani

[Old PP] Which of following regarding parotid gland is INCORRECT? A. It contains facial nerve. B. Duct crosses masseter muscle. C. Duct opens across 2nd mandibular molar. D. It is postsynaptic to otic ganglion. E. It is innervated by auriculotemporal nerve.

C Contents: external carotid artery, retromandibular vein, CN VII Duct traverses Buccal fat pad and buccinator opposite 3rd upper molar -> open into mucosa opposite 2nd upper molar

[Old PP] Which of following is correct about parotid gland? A. Innervated by facial nerve B. It lies in oral cavity. C. It is tightly bound by fascia. D. It produces mixed (serous and mucinous) fluid. E. Its duct is opened in palate.

C Motor: CN IX via otic ganglion Sensory: CN V3 via auriculotemporal nerve Serous fluid only Duct opens opposite 2nd upper molar

[Old PP] Name the 4 extrinsic muscles of tongue and their nerve supply.

Palatoglossus Styloglossus Hyoglossus Genioglossus Palatoglossus: pharyngeal plexus (CN X) Others: CN XII

[Old PP] Describe the actions of the 4 extrinsic muscles of tongue.

Palatoglossus: retract and elevate back of tongue Styloglossus: retract tongue -> push food into esophagus Hyoglossus: draw the side of tongue downwards Genioglossus: lower fibres protrude tongue (together with transverse and vertical intrinsic fibres)

[Old PP] Locations of anterior 2/3 and posterior 1/3 of tongue

Anterior 2/3: oral cavity Posterior 1/3: oropharynx Jian Yang: boundary demarcated by palatoglossal arch (anterior pillar of fauces) Tipoe: boundary demarcated by sulcus terminalis

[Old PP] Functions of anterior 2/3 and posterior 1/3 of tongue

Anterior 2/3: prehensile on food, mastication Posterior 1/3: anterior wall of oropharynx

[Old PP] General sensory supply to tongue

Anterior 2/3: lingual nerve (CN V3) except vallate papillae Posterior 1/3: CN IX including vallate papillae

[Old PP] Taste fibres to tongue

Anterior 2/3: chorda tympani (CN VII) Posterior 1/3: CN IX

[Old PP] Secretomotor fibres to tongue

Chorda tympani (CN VII) which synapses at submandibular ganglion and tongue BV

[Old PP] A patient underwent partial unilateral thyroidectomy involving lower lobe. Post-operatively, he experienced ‘hoarseness of voice’. What nerve was most likely damaged during surgery? (1 mark)

Recurrent laryngeal nerbe

[Old PP] What vessel accompanies recurrent laryngeal nerve? (1 mark)

Inferior thyroid artery

[Old PP] What is action of lateral cricoarytenoid muscles? (1 mark)

Adduct vocal cord Adductors (close) vocal cord: lateral cricoarytenoid, transverse arytenoid, oblique arytenoid Abductors (open) vocal cord: posterior cricoarytenoid

[Old PP] List two functions of brainstem.

1. Ascending and descending tracts 2. Nuclei of most cranial nerves 3. Life center (HR, BP, breath), ascending activating system e.g. Reticular Formation

[Old PP] List the five divisions of brain.

Telencephalon: cerebral cortex, white matter tracts, basal ganglia Diencephalon: thalamus, hypothalamus, epithalamus, subthalamus Mesencephalon (Midbrain) Metencephalon: pons, cerebellum Myelencephalon: medulla Telencephalon + Diencephalon = Prosencephalon (forebrain) Metencephalon + Myelencephalon = Rhombencephalon (hindbrain)

[Old PP] List five structures formed from dura mater.

Dural folds: falx cerebri, falx cerebelli, tentorium cerebelli, diaphragma sellae Dural sinuses

[Old PP] In stroke, it is believed that neuronal damages are caused by glutamate neurotoxicity that results in over-production of nitric oxide (NO). This free radical can subsequently combine with superoxide anion to form more reactive and highly toxic substances and free radicals that kill neurons. What glutamate receptor has been implicated in stroke? (2 marks)

NMDA receptor (ionotropic iGluR)

[Old PP] Write the equation of an enzymatic reaction by which glutamate can be converted into GABA in neurons. (1 mark)

Glutamate -> GABA + CO2 Enzyme: glutamate decarboxylase

[Old PP] State three main criteria that qualify chemical signals as neurotransmitters. (3 marks)

1. Present at presynaptic neuron: precursor, enzyme, transmitter (e.g. synaptic vesicle) - insufficient alone E.g. glycine, glutamate (a.a.): needed for protein synthesis 2. Release: in response to presynaptic depolarisation, Ca2+ dependent 3. Specific receptors at postsynaptic neuron: exogenous transmitter should mimic endogenous postsynaptic effect (e.g. under agonist and antagonist)

[Old PP] Which of GABA and glutamate function as an excitatory / inhibitory neurotransmitter?

GABA: inhibitory Glutamate: excitatory

[Old PP] In neurons, glutamate can be derived from α-ketoglutarate, an intermediate of tricarboxylic acid cycle (TCA cycle). Write an equation for one such enzymatic reaction and name enzyme involved. (2 marks)

Alpha-keroglutarate + aspartate -> oxaloacetic acid + glutamate Enzyme: glutamate-oxaloacetate transaminase

[Old PP] Certain amino acids are classified as neurotransmitters. Name one example of such neurotransmitter. (1 mark)

Glutamate / glycine

[Old PP] Name two major classes of receptors that can bind glutamate but mediate very different intracellular signal transduction cascades. (2 marks)

Ionotropic (iGluR): AMPA-R, NMDA-R, Kainate-R Metabotropic (mGluR)

[PP] Magnetic resonance imaging (MRI) can assess structural atrophy in the early state of Alzheimer disease. Which of the following brain structures displays atrophy in the mild cognitive impairment of Alzheimer disease by MRI assessment? A. Inferior frontal gyrus B. Lingual gyrus C. Parahippocampal gyrus D. Supramarginal gyrus

[PP] One observable change in the brain of Parkinson disease patients is the loss of neuromelanin (depigmentation) in substantia nigra. From which of the following is neuromelanin derived? A. Alpha-synuclein B. Dopamine C. Melatonin D. Parkin

[PP] Neurotransmitter-gated ion channels, also known as ionotropic receptors, at the post-synapses are responsible for fast synaptic transmission. What neurotransmitter mediates increased flux of cations through the channels, directly causing excitatory transmission? A. Gamma-aminobutyric acid B. Glutamic acid C. Glycine D. Kainic acid E. N-methyl-D-aspartic acid

B GABA = inhibitory neurotransmitter in CNS Glutamic acid = glutamate Glycine = inhibitory neurotransmitter in brainstem and spinal cord Kainic acid, NMDA = agonists of iGluR

[PP] A constant supply of oxygenated blood is essential for brain functioning and survival. Which of the following would MOST LIKELY be present in acute severe brain ischaemia? A. Calcium efflux from neurons B. Increased cell membrane Na+/K+-ATPase activity C. Increased release of glutamate by neurons D. Intracellular alkalosis of neurons

C Hallmark of ischemic neuronal injury: increased release of excitatory neurotransmitters e.g. glutamate Increased calcium influx into neurons (mechanism causing ischemic neuronal injury) Reduced ATPase activity Increased pyruvate -> lactate -> lactic acidosis

[PP] A patient has experienced a sudden and complete interruption of his cerebral blood supply. Which of the following changes are MOST LIKELY present? A. Increased number of rapid waves on electroencephalography (EEG) B. Increased release of excitatory neurotransmitters C. Reduced calcium influx into neurons D. Reduced lactate level within neurons

B EEG slows down

[PP] A young man has recently started to use illicit drugs. Which brain area is MOST RESPONSIBLE for the reinforcement of his drug taking behaviour? A. Dorsal striatum B. Periaqueductal grey C. Prefrontal cortex D. Ventral striatum

D Drugs that increase dopamine release initially activate ventral striatum -> activate reward system and reinforce further drug use -> increase frequency of drug use -> external stimuli associated with drug use further increase dopamine release and elicit craving -> drug use becomes less pleasurable and more compulsive -> behaviour becomes driven by dopamine release in dorsal striatum

[PP] A young woman has recently developed compulsive use of an addictive substance. Dopamine release in which brain region is MOST RESPONSIBLE for driving her compulsive substance use? A. Dorsal striatum B. Hippocampus C. Hypothalamus D. Ventral striatum

[PP] Incentive salience is thought to be signalled by which of the following neurotransmitter systems? A. Acetylcholine B. Dopamine C. Noradrenaline D. Serotonin

[PP] A student presents with the conviction of being followed by random strangers. Dysregulation of which neurotransmitter pathway is the MOST LIKELY cause? A. Basal forebrain cholinergic projection to the hippocampus B. Brainstem noradrenergic projection to the prefrontal cortex C. Brainstem serotonergic projection to the cingulate gyrus D. Midbrain dopamine projection to the striatum

D Delusions are results of aberrant processing of salient stimuli by dopamine pathways

[PP] Activity of which brain centre responsible for a depressed mood? A. Dorsolateral prefrontal cortex B. Lateral entorhinal cortex C. Parahippocampal gyrus D. Subgenual anterior cingulate cortex E. Ventromedial nucleus of the hypothalamus

[PP] A 68-year-old woman with a history of hypertension had a sudden onset of weakness of the right side. On examination, she had a global aphasia, left gaze preference, right homonymous hemianopia, right facial droop and right hemiplegia. After treatment, she only had a very mild expressive aphasia. Which specific cerebral artery is MOST LIKELY blocked? (2 marks)

Left middle cerebral artery

[PP] A 68-year-old woman with a history of hypertension had a sudden onset of weakness of the right side. On examination, she had a global aphasia, left gaze preference, right homonymous hemianopia, right facial droop and right hemiplegia. After treatment, she only had a very mild expressive aphasia. What part of the visual pathway is affected that correlates with right homonymous hemianopia in this case? (2 marks)

Left optic radiation

[PP] A 68-year-old woman with a history of hypertension had a sudden onset of weakness of the right side. On examination, she had a global aphasia, left gaze preference, right homonymous hemianopia, right facial droop and right hemiplegia. After treatment, she only had a very mild expressive aphasia. Lesion of which area in the brain leads to expressive aphasia? (1 mark)

Broca’s area / Brodmann area 44/45 / (Left) Inferior frontal gyrus

[PP] Mr. Lee has been a butcher for 15 years. Recently he complained about discomfort and numbness on his hands. Two-point discrimination was conducted to investigate the underlying problem. Discrimination distances in right thumb and index finger are higher than normal. Explain which nerve in his upper limb might be damaged. (3 marks)

Median nerve at the wrist is responsible for the sensation of right thumb and right index finger So median nerve in right hand may be damaged

[PP] Memory is the storage of acquired knowledge and it consists of short-term and long term memory. What is the difference between retrograde and anterograde amnesia? (2 marks)

Retrograde amnesia: pathological loss of previously stored information, e.g. loss of memory prior to trauma Anterograde amnesia: inability to form new memory after trauma

[Self-assessment] The limbic system includes which of the following regions? A. Amygdala, cerebellum, hippocampus B. Amygdala, pon, hippocampus C. Amygdala, hippocampus, hypothalamus

[Self-assessment] Which region of the limbic system deals with the emotion of fear? A. Nucleus accumbens B. Amygdala C. Septal nuclei

B Nucleus accumbens, septal nuclei: reward, reinforcement

[Self-assessment] Which of the following memory is explicit memory? A. Procedural memory B. Fear conditioning C. Autobiographical memory

C Explicit (declarative) memory: fade quickly Implicit (non-declarative) memory: take much time and effort to build up, more robust and long-lasting

[PP] Name two general functions of Limbic system.

Emotion, behaviour, memory, motivation and olfaction

[PP] Name one psychiatric disorder characterised by a highly disruptive emotional disorder.

Major depressive disorders Post-traumatic stress disorders (PTSD)

[PP] Describe the structure of the Limbic system.

Interconnected cortical areas (cingulate gyrus, parahippocampal gyrus, hippocampal formation, subcallosal area, paraterminal gyrus) and subcortical nuclei (mamillary bodies, amygdala, septal nuclei, anterior nuclei of thalamus) E.g. mammillothalamic tract, fornix, fimbria, stria terminalis, indusium griseum

[PP] Damage to basal ganglia. Name one memory domain that would be severely impaired.

Skill memory (caudate nucleus)

[PP] Damage to hippocampus. Name one memory domain that would be severely impaired.

Spatial memory

[PP] You are examining a 20-year-old man who sustained a penetrating injury to the right side of his T10 thoracic spinal cord two weeks ago. Describe the distribution of his lower limb weaknesses. (1 mark) Describe the nature of the motor weakness. (1 mark)

Right LL abnormal Left LL normal

[PP] You are examining a 20-year-old man who sustained a penetrating injury to the right side of his T10 thoracic spinal cord two weeks ago. Describe the nature of the motor weakness. (1 mark)

Spastic paralysis

[PP] You are examining a 20-year-old man who sustained a penetrating injury to the right side of his T10 thoracic spinal cord two weeks ago. Describe the MOST LIKELY distribution and modality of sensory deficits in his lower limbs. (2 marks)

Left lower limb loss of pain and temperature sensation Right lower limb loss of proprioception and fine touch

[PP] You are examining a 20-year-old man who sustained a penetrating injury to the right side of his T10 thoracic spinal cord two weeks ago. Where would you expect to find a 'cut-off' between normal and abnormal sensory functions (i.e., the sensory level)? (1 mark)

Around the level of the umbilicus

[PP] A patient who suffered a facial trauma presented to the hospital with a left periorbital haematoma and epistaxis. A CT reconstruction of the head of the patient was obtained. Two weeks after the accident, the patient could not gaze his eye laterally. (a) Which two specific borders of the left orbital rim were fractured? (2 marks) (b) Which paranasal sinus was damaged? (1 mark) (c) Which muscle and nerve were still impaired two weeks after the accident? (2 marks)

(a) Lateral border / Zygomaticofacial suture Inferior border / Infraorbital foramen (b) Maxillary sinus (c) Lateral rectus Abducens nerve

[PP] What are two histological findings that may be seen if the lesion is removed? (2 marks)

Squamous metaplasia (Stromal) oedema Inflammation, congestion, fibrosis

[PP] Mr. Chan is a young adult who was in a coma after cardiac arrest. For evaluating the somatosensory function, somatosensory evoked potentials (SEPs) with median nerve stimulation were investigated. The SEPs were recorded at the Erb's points of shoulders, 5th cervical vertebra, CP3 and CP4 of scalp. Explain the purposes to measure latency of SEP at the Erb's points of shoulders and 5th cervical vertebra, respectively. (2 marks)

Erb’s point: evaluate electrical conduction of sensory signals in brachial plexus 5th cervical vertebra: evaluate electrical conduction of sensory signals in cervical spinal cord

[PP] Mr. Chan is a young adult who was in a coma after cardiac arrest. For evaluating the somatosensory function, somatosensory evoked potentials (SEPs) with median nerve stimulation were investigated. The SEPs were recorded at the Erb's points of shoulders, 5th cervical vertebra, CP3 and CP4 of scalp. These are the results of SEPs: Explain if the function of his primary somatosensory cortices is impaired when he is awake. (3 marks) [Latency of SEP at CP3 is beyond normal limit Latency of SEP at CP4 is not beyond normal limit]

As CP3 is located in left primary somatosensory cortex, his primary somatosensory cortex only in left cerebral hemisphere is impaired in function

[PP] Which nerve innervates ischiocavernosus muscle?

(Perineal branch of) pudendal nerve Superficial perineal pouch muscles: ischiocavernosus, bulbospongiosus, superficial transverse perineal muscle -> all innervated by perineal branch of pudendal nerve

[PP] Name one nerve that is innervated by inferior rectal nerve.

External anal sphincter Part of levator ani muscle

[PP] A 30-year-old pregnant woman gave birth vaginally to a full-term baby and sustained laceration of the perineum. Six months later, she complained of "something out of the vagina" when she stood upright and carried heavy load. What muscular structure was severely damaged during the delivery? (1 mark)

Pelvic diaphragm / levator ani / pubococcygeus / iliococcygeus

[PP] A 30-year-old pregnant woman gave birth vaginally to a full-term baby and sustained laceration of the perineum. Six months later, she complained of "something out of the vagina" when she stood upright and carried heavy load. What is the nerve supply of this damaged muscular structure? (2 marks)

S4-S5 Pudendal nerve

[PP] A 30-year-old pregnant woman gave birth vaginally to a full-term baby and sustained laceration of the perineum. Six months later, she complained of "something out of the vagina" when she stood upright and carried heavy load. Which connective tissue structure was severely damaged during the delivery? (1 mark)

Perineal body

Uterine prolapse

[PP] A 26-year-old woman with a history of multiple sclerosis presented to the ophthalmologist complaining of diplopia when looking towards the left. Her visual acuities were 6/6 in both eyes. On right gaze, the conjugate eye movements were normal. However, on left gaze, her right eye fails to adduct past the midline and her left eye abducts with nystagmus. Where is the lesion that causes her symptoms? A. Left medial longitudinal fasciculus B. Left paramedian pontine reticular formation C. Right medial longitudinal fasciculus D. Right paramedian pontine reticular formation

C MLF lesion -> ipsilateral failure to adduct across midline, contralateral nystagmus upon abduction PPRF lesion -> ipsilateral horizontal gaze palsy (both eyes)

[PP] Alzheimer disease is characterised by the presence of extracellular amyloid plaques and the accumulation of intracellular neurofibrillary tangles. Amyloid plaques are derived from cleavage products of amyloid precursor protein (APP) while neurofibrillary tangles are derived from aggregation of tau proteins. (a) In addition to alpha-secretase and beta-secretase, which protease is required for processing of APP to form amyloid plaques? (1 mark) (b) What is the effect on the formation of amyloid plaques if APP is preferentially cleaved by alpha-secretase? (1 mark) (c) Explain your answer in question (b). (2 marks) (d) What aberrant protein modification in tau protein results in its aggregation? (1 mark)

(a) Gamma-secretase (b) Reduced formation of beta-amyloid plaques (c) Normally, APP is cleaved by alpha-secretase and beta-secretase in balance, followed by gamma-secretase (PSEN1). If APP is preferentially cleaved by alpha-secretase -> less cleavage by beta-secretase -> reduced formation of beta-amyloid plaques Cleavage by alpha-secretase -> non-toxic peptide Cleavage by beta-secretase -> toxic, longer amyloidogenic peptide (42/43 amino acids) OR non-toxic peptide (d) Hyperphosphorylation

[Self-assessment] Which of the following circumstances can induce neuroinflammation? Sleeping Periodontitis Exercise regularly

Periodontitis Systemic inflammation -> neuroinflammation

[Self-assessment] Which pathological condition reduces glymphatic flow? Sleeping Neuroinflammation Exercise

Neuroinflammation

[Self-assessment] Amyloid plaques is a hallmark in brains of Alzheimer’s disease patients. Which mutant protein forms amyloid plaques? Alpha-synuclein Parkin Amyloid precursor protein (APP)

Amyloid precursor protein (APP) Alpha-synuclein: intracellular eosinophilic masses made of alpha synuclein and other proteins Parkin - E3 protein ubiquitin ligase in Parkinson’s disease

[Old PP] A 65-year-old gentleman presents with progressive onset of worsening resting tremor, bradykinesia and limb rigidity. There is no muscle weakness, no sensory loss and no cerebellar sign. Computed tomography scans of brain are normal. (a) What is most likely site of pathological lesion? (1 mark) (b) Name three major anatomical structures that are functionally closely related to your answer in (a) in this condition. (3 marks) (c) What is most commonly used class of pharmacological agent for this condition? (1 mark)

(a) Substantia nigra pars compacta (SNc / SNpc), ventral tegmental area: sites of dopaminergic neurons (b) Caudate nucleus, putamen, globus pallidus (c) Levodopa (dopamine precursor)

[Old PP] A patient was diagnosed with Parkinson’s disease 10 years ago. Recently he develops progressive cognitive dysfunction and complains of sleep disturbances. (a) In early stages of Parkinson’s disease, which regions of brain and which type of neurones are most likely to degenerate? (3 marks) (b) Name three distinctive cortical nuclei that comprise basal ganglia. (3 marks) (c) Which type of neurones in frontal cortex is mainly responsible for cognitive function? (1 mark) (d) Which nucleus projects cholinergic neurones to frontal cortex? (1 mark) (e) Name disease in which patients develop cognitive dysfunction with neurodegeneration initiated in hippocampus. (1 mark) (f) Name region of brainstem that regulated sleep and alertness. (1 mark)

(a) Substantia nigra pars compacta, dopaminergic neurons (b) Caudate nucleus, putamen, Globus pallidus (c) Cholinergic neurons (d) Basal nucleus of Meynert (e) Alzheimer’s disease (f) Reticular formation

[Self-assessment] Which of the following is a unique feature of the basilar membrane? Vibrates more strongly when the incoming sound is of a higher sound frequency Broader at base than apex. More stiff at base than apex

More stiff at base than apex HBLA High frequency at base (stiffer) Low frequency at apex (broader)

[PP] A 25-year-old woman presented with an enlargement of the right parotid gland. There was no evidence of facial nerve damage. The gland was removed and histology showed cytologically benign spindle cells in a myxoid and chondroid stroma plus small duct like spaces. What is the MOST LIKELY diagnosis? A. Adenoid cystic carcinoma B. Mucoepidermoid carcinoma C. Pleomorphic adenoma D. Warthin tumour

[PP] Tensor veli palatini is one of the muscles of the soft palate. What is the innervation of this muscle? A. Mandibular nerve B. Maxillary nerve C. Ophthalmic nerve D. Vagus nerve

[PP] Extracellular amyloid plaques and intracellular neurofibrillary tangles are the two pathological hallmarks in brains of Alzheimer disease patients. Which abnormal protein forms intracellular neurofibrillary tangles? A. Alpha-synuclein B. Apolipoprotein E C. Hyperphosphorylated tau ~D. Parkin

[PP] Acute pyogenic meningitis has different bacterial causes in different patient groups. What is the MOST IMPORTANT bacterial group causing bacterial meningitis in neonates? A. Encapsulated bacteria including Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus suis B. Group B Streptococcus, Escherichia coli and Listeria monocytogenes C. Gut flora including Escherichia coli, Klebsiella pneumoniae and Salmonella Typhi D. Hospital-acquired flora including Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia

[PP] The cricopharyngeus muscle is one of the components of the pharyngeal constrictor muscles. What is the main action of this muscle? A. Acts as a sphincter at the lower end of pharynx B. Aids soft palate in closing nasopharynx C. Elevates the walls of pharynx D. Propels bolus downward

[PP] The posterior cricoarytenoid muscle is one of the intrinsic muscles of the larynx. What is the main action of this muscle? A. Abducts the vocal cords B. Adducts the vocal cords C. Relaxes the vocal cords D. Tenses the vocal cords

A Larynx intrinsic muscles Adductors of vocal cord: lateral cricoarytenoid, transverse arytenoid, oblique arytenoid Abductor: only one = posterior cricoarytenoid

[PP] Antiretroviral drugs target different steps of the human immunodeficiency virus (HIV) life cycle. Which of the following steps in the viral life cycle is present in HIV but NOT in SARS-CoV-2? A. Protein synthesis B. Reverse transcription C. RNA replication D. Virus release

[PP] When you have acute onset of headache, neck pain and fever. What is the MOST DANGEROUS group of infectious disease which you must consider? A. Acute keratitis, facial cellulitis and rhinosinusitis B. Acute meningitis, encephalitis and brain abscess C. Acute osteomyelitis and discitis of neck vertebral spine D. Acute retropharyngeal cellulitis and abscess

[PP] A 36-year-old motor cycle driver sustained a road traffic accident. Upon admission to Accident and Emergency Department, an urgent CT scan showed a large epidural haematoma compressing on his right cerebral hemisphere. Which of the following sequelae can lead to the rapid death of the patient? A. Compression of the right motor cortex B. Compression of the right occipital lobe C. Subfalcine herniation D. Transtentorial herniation

[PP] A 78-year-old woman developed sudden onset of left hemiplegia. An urgent CT scan showed an acute cerebral infarct involving the right cerebral hemisphere. What is the MOST COMMON underlying cause? A. A meningioma in the right cerebral hemisphere that compressed the meningeal blood vessel B. Atrial fibrillation with thrombi formation that developed embolism to the brain C. Congophilic angiopathy D. Ruptured berry aneurysm in the basilar artery that led to vasospasm

B Cerebrovascular accident (Stroke) 1. Infarction - Atherosclerosis, thrombi - Embolism … 2. Haemorrhage - Hypertension - Berry aneurysm …

[PP] An 80-year-old woman has long standing history of hypertension. She developed sudden onset of left hemiplegia. Apart from the motor dysfunction, she is otherwise conscious and well. An urgent CT scan showed a 1 x 1 x 0.5 cm lesion in the right basal ganglia encroaching on the right internal capsule suggestive of acute cerebral infarct. What is the MOST COMMON and LIKELY underlying pathological change in the blood vessel that cause this lesion? A. Lipohyalinosis of the deep penetrating arteries that originate from the right middle cerebral artery B. Obstruction of the lumen of the right posterior cerebral artery by fat embolism C. Rupturing of a berry aneurysm located at the bifurcation of the right internal carotid artery D. Severe atherosclerotic narrowing of the right anterior cerebral artery

[PP] A 65-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) presents with symptoms of anxiety associated with dyspnoea. The physician decides to prescribe an anxiolytic medication. Which of the following anxiolytic drugs should be avoided in this patient due to his potential respiratory depressant effects? A. Buspirone B. Diazepam C. Hydroxyzine D. Propranolol

[PP] Dopamine plays a key role in the drug addiction process. Dopaminergic neurons of which brain region project to nucleus accumbens involved in addiction and its associated behaviours? A. Locus coeruleus B. Raphe nucleus C. Substantia nigra D. Ventral tegmental area

[PP] Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Which region in the brain stem plays a role in noradrenergic descending pain modulation pathway? A. Locus coeruleus B. Mesencephalic nucleus C. Periaqueductal grey D. Raphe nucleus

A Noradrenergic locus coerulus neurons in upper / rostral pons -> descend through medulla and project to dorsal horn

[PP] STRUCTURES RELATED TO THE MIDDLE EAR A. Chorda tympani B. Fenestra cochlea C. Greater petrosal nerve D. Pharyngotympanic tube E. Processus cochleariformis F. Promontory G. Pyramid H. Tensor tympani I. Tympanic canaliculus J. Stapedius muscle For each of the following descroptions, select the MOST RELEVANT structure from the list of options above. Each option may be used once, more than once, or not at all. (i) Carries parasympathetic secretory fibres to the nasal glands (ii) Passes medial to the malleus (iii) Is innervated by the mandibular nerve (iv) Neutralises the pressure between the middle ear and nasopharynx (v) Forms the origin of the stapedius muscle

CAHDG

[PP] MUSCLES OF THE EYE A. Ciliary B. Dilatator pupillae C. Inferior oblique D. Inferior rectus E. Lateral rectus F. Levator palpebrae superioris G. Medial rectus H. Sphincter pupillae I. Superior oblique J. Superior rectus For each of the following descriptions, match the corresponding muscle from the list of options above. Each option may be used once, more than once, or not at all. (i) Depresses the eye from a starting adducted position (ii) Adjacent to the frontal nerve (branch of CN V1) (iii) Adjacent to the ciliary ganglion

I F E

[PP] ARTERIES AND VEINS OF HEAD AND NECK A. Anterior jugular vein B. Costocervical trunk C. Facial artery D. Lingual vein E. Maxillary vein F. Occipital artery G. Ophthalmic artery H. Posterior auricular vein I. Superficial temporal artery J. Superior thyroid artery Match the descriptions with the vessels. The option may be used once, more than once, or not at all. (i) It gives rise to the inferior thyroid artery. (ii) It anastomoses with the angular artery.

B (better: thyrocervical trunk) G

[PP] CENTRAL NERVOUS SYSTEM INFECTIONS A. Candida tropicalis B. Cryptococcus neoformans C. Cytomegalovirus D. Enterovirus A71 E. Listeria monocytogenes F. Mycobacterium tuberculosis G. Streptococcus agalactiae H. Streptococcus pneumoniae I. Streptococcus pyogenes J. Varicella zoster virus What is the MOST LIKELY causative organism of the central nervous system infection in each of the following patients? The option may be used once, more than once, or not at all. (ii) A 4-year-old boy presented with 3 days of vesicular rash over the hands, feet, and mouth, followed by fever, headache, and neck stiffness. Cerebrospinal fluid examination showed raised leukocyte count with lymphocyte predominance. Cerebrospinal fluid and blood culture were negative for bacteria and fungi.

[PP] INFECTION IN THE CENTRAL NERVOUS SYSTEM A. Amoebiasis B. Brain abscess C. Creutzfeldt-Jakob disease D. Cysticercosis E. Group B streptococcal meningitis F. Meningococcal meningitis G. Neurosyphilis H. Post-infectious encephalitis I. Tuberculous meningitis J. Viral meningoencephalitis Choose the MOST LIKELY disease for the following patients. The option may be used once, more than once, or not at all. (ii) A 24-year-old woman who was healthy all along, developed fever, decrease in consciousness and died. Postmortem examination of the brain showed perivascular lymphocytic infiltrate, with activated macrophages and microglia attacking and ingesting neurons. (iii) A 60-year-old woman had chronic rheumatic heart disease with recent development of subacute bacterial endocarditis after a tooth extraction. She developed multiple space occupying lesions in both cerebral hemispheres.

J B

[PP] ASSESSMENT OF SOMATOSENSORY FUNCTIONS A. Facial nerve B. Ilioinguinal nerve C. Median nerve D. Obturator nerve E. Olfactory nerve F. Radial nerve G. Subcostal nerve H. Tibial nerve I. Trigeminal nerve J. Ulnar nerve For each patient below, select which nerve is MOST LIKELY damaged or affected. The option may be used once, more than once, or not at all. (i) Mr. Chan is a stroke survivor. A facial sensation test found that he lost sensation to cold and warm objects. (ii) Mr. Lee is a diabetic patient. He was tested with two-point discrimination on the plantar region of his left foot. The test results showed the discrimination distance was longer than normal range. (iii) Mr. Mo suffered from brain trauma earlier in a traffic accident. He was tested with gustatory sense with a piece of sugar. The test discovered he lost the sensation to sweetness. (iv) Ms. Wong had her right elbow injured by hitting a hard object and she complained of numbness in her right little finger.

I H A J

[PP] You are examining a 20-year-old man who sustained a penetrating injury to the right side of his T10 thoracic spinal cord two weeks ago. (a) Describe the distribution of his lower limb weaknesses. (1 mark) (b) Describe the nature of the motor weakness. (1 mark) (c) Describe the MOST LIKELY distribution and modality of sensory deficits in his lower limbs. (2 marks) (d) Where would you expect to find a 'cut-off' between normal and abnormal sensory functions (i.e., the sensory level)? (1 mark)

(a) Right LL abnormal, left LL normal (b) Spastic paralysis (c) Left lower limb loss of pain and temperature sensation Right lower limb loss of proprioception and fine touch (s) Around the level of umbilicus

[PP] A 5-year-old girl developed acute fever, headache, and neck stiffness. Analyses of the cerebrospinal fluid sample obtained before the use of intravenous antibiotics and acyclovir were as follows: - White cells: 620/mm3 count (polymorph 6%, lymphocyte 94%) - Protein: 0.80 g/l (normal: 0.15-0.45 g/l) - Glucose: 3.1 mmol/l (normal: 2.8-3.9 mmol/l); serum glucose: 5.4 mmol/l - Gram-stained, Ziehl-Neelsen-stained, and India ink-stained smears: negative Which of the following is the LEAST LIKELY cause? A. Enterovirus A71 B. Herpes simplex virus 2 C. Human coronavirus HKU1 D. Varicella zoster virus

[PP] A 59-year-old woman suffered from Broca's aphasia due to ischemic stroke. Which cerebral artery is MOST LIKELY blocked in this patient? A. Left anterior cerebral artery B. Left middle cerebral artery C. Right anterior cerebral artery D. Right middle cerebral artery

[PP] A patient has dementia from Alzheimer disease. Which brain region is MOST LIKELY to show early neuronal loss? A. Entorhinal cortex B. Insula C. Pineal gland D. Putamen

[PP] Thalamocortical projections play an important role in cortical functions. A lesion of which thalamic nucleus would lead to personality changes and apathy? A. Medial geniculate nucleus B. Mediodorsal nucleus C. Ventral lateral nucleus D. Ventral posterolateral nucleus

B Medial geniculate nucleus: project to primary auditory cortex Mediodorsal nucleus: input from amygdala, olfactory cortex, etc., project to prefrontal cortex and limbic system -> for cognition, memory, executive functions, personality, emotion Ventral lateral nucleus: input from basal ganglia, project to primary motor cortex Ventral posterolateral nucleus: input from spinothalamic tract and DCML tract, project to primary somatosensory cortex

[PP] A 1-month-old baby was diagnosed with congenital torticollis (twisted neck) due to muscle rupture during childbirth. When relaxed, his neck rotated towards the left side. Which muscle is MOST LIKELY injured? A. Left levator scapulae muscle B. Left sternocleidomastoid muscle C. Right levator scapulae muscle D. Right sternocleidomastoid muscle

HNNS Important Questions II Flashcards

(188 cards)