GENERAL PRACTITIONER EXAM
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Question 1 of 10
1. Question
1 pointsA 41-year-old had a seat belt injury and now presents with his two week history of numbness and a burning sensation on the lateral aspect of the right upper thigh. Examination reveals sensory loss over the anterolateral thigh. Which one of the following nerve is most likely to be involved in this patient? Correct
Incorrect
Explanation:
The pure sensory loss makes the diagnosis of meralgia paraesthetica and
Is a consequence of damage to the lateral cutaneous nerve, of the thigh.
It is usually a consequence of entrapment at the lateral inguinal ligament or less likely, trauma, ischaemia or a retroperitoneal lesion. Less commonly, the nerve may be entrapped by other anatomical or abnormal structures, or damaged by diabetic or other neuropathy or trauma such as from seat belt injury in an accident. -
Question 2 of 10
2. Question
1 pointsWhich of the following statements regarding the subclavian vein and its relations is correct?
Correct
Incorrect
Explanation:
The subclavian vein is a continuation of the axillary vein, beginning at the lateral border of the first rib. It passes anterior to sclaneus anterior. The subclavian and internal jugular veins unite to form the brachiocephalic vein; subsequently the left and right brachiocephalic veins unite to form the superior vena cava. The brachiocephalic trunk is a branch of the aortic arch. which divides to form the right subclavian and right common carotid arteries.
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Question 3 of 10
3. Question
1 pointsWhich of the following statements concerning the three main structures of the hilum of the kidney is INCORRECT?
Correct
Incorrect
Explanation:
The renal vein, renal artery and renal pelvis enter and leave the kidney at the level of the hilum and are situated anatomically in relation to each other in the order mentioned above, moving in an anteroposterior direction. The anatomy of the contents of the hilum can be variable (e.g. The renal pelvis can be bifid, and the renal artery and vein may split into branches or receive tributaries, respectively, to a variable extent at the hilum). This can lead to confusion at the time of surgical dissection in this area. The renal artery divides into 3-5 segmental arteries at the hilum, which divide within the sinus into 6-10 interlobular veins – one for each pyramid and associated cortex. The renal veins follow the arterial pattern closely. The renal veins empty directly into the IVC. Since the IVC lies on the right side of the abdomen, the left renal vein is longer than the right.
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Question 4 of 10
4. Question
1 pointsThe pupil in the eye of a 43-year-old patient remains small even when room lighting is dim. Which of the following nerves would be injured?
Correct
Incorrect
Explanation:
The superior cervical ganglion is damaged. When the pupil remains small in a dimly lit room, it is an indication that postganglionic sympathetic fibers that originate from the superior cervical ganglion and innervate the dilator pupillae (radial muscles of the iris) are damaged. Other nerves contain no sympathetic fibers but the oculomotor nerve contains preganglionic parasympathetic fibers.
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Question 5 of 10
5. Question
1 pointsA diagnosis of carpal tunnel syndrome would be supported by which one of the following?
Correct
Incorrect
Explanation:
Carpal tunnel syndrome (CTS) is an entrapment neuropathy of the median nerve at the wrist, producing paresthesias and weakness of the hands. The syndrome is caused by pressure on the median nerve where it and the flexor tendons of the fingers pass through the tunnel formed by the carpal bones and the transverse carpal ligament.
It usually begins with a gradual onset of numbness, tingling, and pain in the hand and wrist. Symptoms are often present at night, during sleep, and when the wrists are flexed. The symptoms occur in the thumb rand the index and middle fingers, and occasionally in part of the fourth finger. The fifth finger is never involved- The thenar compartment is innervated by the median nerve and may atrophy as the syndrome progresses. The hypothenar musculature is not involved. ` Physical signs of CTS include a positive Phalen´s maneuver, which is a provocation of symptoms by sustained wrist flexion. Symptoms can be precipitated by activities which require repeated flexions, pronation, and supination of the wrist, e.g., sewing, driving, operating computers and cash registers, and playing golf. -
Question 6 of 10
6. Question
1 pointsWhich of the following regarding the anatomy of the heart is true?
Correct
Incorrect
Explanation:
The septomarginal trabecula (or moderator band) is a muscular band of heart tissue found in the right ventricle. It is important because it carries part of the right bundle branch of the AV bundle of the conduction system of the heart to the anterior papillary muscle.
The right branch of the pulmonary artery lies posterior to the ascending aorta.
The ascending aorta lies completely within the pericardium as does the pulmonary trunk.
The left atrium is the most posterior chamber of the heart; the right atrium is just anterior and to the right of the left atrium. The left atrial appendage is not readily seen on transthoracic echocardiography and requires transoesophageal echocardiography.
Subendocardium has a small share in coronary supply -
Question 7 of 10
7. Question
1 pointsA 36-year-old male is a struck on the lateral aspect of his left knee by the bumper of a car travelling at low velocity. On examination he is unable to dorsiflex the ankle, evert the foot and extend the toes. There is loss of sensation of the dorsum of the foot. He is most likely to have damaged which structure?
Correct
Incorrect
Explanation:
The common peroneal nerve supplies the muscles of the peroneal and anterior compartment of the leg and sensation to the dorsum of the foot.
The deep peroneal nerve is a division of the common peroneal nerve supplies only the muscles of the anterior compartment of the leg. -
Question 8 of 10
8. Question
1 pointsA patient comes in with gunshot wound and requires surgery in which his thoracoacromial trunk needs to be ligated. Which of the following arterial branches would maintain normal blood flow?
Correct
Incorrect
Explanation:
The superior thoracic artery is a direct branch of the axillary artery. The thoracoacromial trunk has four branches: the pectoral, clavicular, acromial, and deltoid.
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Question 9 of 10
9. Question
1 pointsA diagnosis of carpal tunnel syndrome would be supported by which one of the following?
Correct
Incorrect
Explanation:
Carpal tunnel syndrome (CTS) is an entrapment neuropathy of the median nerve at the wrist, producing paresthesias and weakness of the hands. The syndrome is caused by pressure on the median nerve where it and the flexor tendons of the fingers pass through the tunnel formed by the carpal bones and the transverse carpal ligament.
It usually begins with a gradual onset of numbness, tingling, and pain in the hand and wrist. Symptoms are often present at night, during sleep, and when the wrists are flexed. The symptoms occur in the thumb rand the index and middle fingers, and occasionally in part of the fourth finger. The fifth finger is never involved- The thenar compartment is innervated by the median nerve and may atrophy as the syndrome progresses. The hypothenar musculature is not involved. ` Physical signs of CTS include a positive Phalen´s maneuver, which is a provocation of symptoms by sustained wrist flexion. Symptoms can be precipitated by activities which require repeated flexions, pronation, and supination of the wrist, e.g., sewing, driving, operating computers and cash registers, and playing golf. -
Question 10 of 10
10. Question
1 pointsA 33 year old man presents with history of trauma to the right shoulder. On examination the outer aspect of the right shoulder is flattened and the shoulder cannot be moved. Skin sensation is absent over the lower part of the right deltoid muscle. Anterior dislocation of the right shoulder is seen on radiograph. The nerve most likely injured is which one of the following?
Correct
Incorrect
Explanation:
The axillary nerve innervates the teres minor and then divides into anterior and posterior branches to innervate the posterior, middle, and anterior deltoid muscle. In addition, it provides sensation to the glenohumeral joint and the skin overlying the deltoid muscle.
Injury to the axillary nerve can occur close to the inferior capsule of the glenohumeral joint, where it is susceptible to direct trauma secondary to glenohumeral dislocation, laceration during surgery, as well as to direct compression such as during the misuse of crutches.
Entrapment of this nerve can also occur at the quadrilateral space. Injuries to the axillary nerve at the quadrilateral space can occur as a result of stretching or crushing.
The axillary nerve palsy causing dysfunction of the deltoid muscle is a catastrophic event to the shoulder girdle. Forward elevation can be limited to 33 degrees (range of 0 to 75 degrees). With this degree of loss of motion, attempts at elevation and abduction will result in superior subluxation of the humeral head. The patient, however, may use “trick movements” to achieve full elevation of the arm by rotating the scapula, contracting the rotator cuff, long head of the biceps, and clavicular portion of the pectoralis major muscle.