1

An MRI examination of the brain of a male 30 year old plasterer shows a tumour at the cerebello-pontine angle. This
is likely to be secondary to a tumour of the nerve sheath of the following cranial nerve:
Choose one answer.

a. Cranial nerve VIII


b. Cranial nerve X


c. Cranial nerve VI


d. Cranial nerve VII


e. Cranial nerve IX

Explanation
Acoustic neuromas are the most common tumours in the cerebellopontine angle. Not only do they most frequently
occur on the superior portion of the vestibular nerve but they are also tumours of the nerve sheath rather than the
nerve itself and so should really be called vestibular schwannomas. True acoustic neuromas form part of a familial
syndrome called neurofibromatosis 2, which consists of multiple cranial nerve tumours, along with neuromas on the
spinal nerve roots which can cause spinal cord compression. Running across the cerebellopontine angle from the
brain stem are the facial (VII) and acoustic and vestibular (VIII) nerves on their way to the internal auditory meatus
and hence to the muscles of facial expression and the cochlear and vestibular labyrinths respectively. At the apex of
the cerebellopontine is the trigeminal (V) nerve carrying sensation from the face and supplying the muscles of
mastication. At the base of the cerebellopontine angle are the lower cranial nerves (IX, X, and XI) on their way out of
the skull through the jugular foramen to supply a wide range of functions but most importantly, from our point of
view, to control swallowing, the airway, and the trapezius and sternomastoid muscles. Tongue movement is
controlled by the hypoglossal (XII) nerve, which leaves a little lower down.
Source: http://www.medisl.com/2010/07/plab-mcq-602an-mri-examination-of-brain.html

A 22 -year - old has a tremor that increases as the patient brings the limb toward a target. The most likely diagnosis
is
Choose one answer.

a. hyperthyroidism


b. levodopa induced tremor


c. Huntington's disease


d. Wilson's disease


e. multiple sclerosis




Explanation
A more dramatic action tremor is displayed by patients with cerebellar diseases and is characterized by progressively
increasing amplitude of the tremor as the patient brings the limb toward a target. In younger patients, this is most
frequently caused by multiple sclerosis, but similar clinical states may be produced by cerebellar infarction, by
degenerative disorders of the spinocerebellar pathways, and by chronic relapsing steroid-sensitive polyneuropathy.
This tremor is multiplanar, with large, irregular, and relatively slow (2-4 Hz) oscillations. The tremor often is
worsened by alcohol. Propranolol has no effect, and no satisfactory therapy is available
Source: http://www.medisl.com/2010/07/plab-mcq-595a-22-year-old-has-tremor.html

An 8- year - old child has a history of mouth breathing and persistent rhinitis. On examination he is found to have
adenoidal enlargement. This is likely to lead to an infection in the
Choose one answer.

a. middle ear


b. supraglottic space


c. sub-arachnoid space


d. epidural space


e. aryepiglottic space

Explanation
The eustachian tube is the pressure equalizing tube that connects the middle ear cavity behind the eardrum to the
rear of the mouth (oropharynx). The openings are hidden up behind the soft palate, to the side and just in front of
the adenoids. Chronic adenoidal enlargement can cause obstruction of the eustachian tube at its mouth and
contribute to chronic ear fluid. Chronic otitis media may be associated with infected, hypertrophied adenoids and
blockage of the eustachian tube orifices; hearing loss is often present secondary to middle ear fluid. In a child,
adenoids may fill the nasopharynx, mechanically blocking the nose and eustachian tube orifice or acting as a source
of infection that may contribute to edema and dysfunction of the eustachian tube. The eustachian tubes are
normally closed at rest and open with swallowing by action of the tensor veli palatini, which extends from the skull
base and inserts laterally into the soft palate. The eustachian tubes protect the middle ear from nasopharyngeal
secretions, provide drainage into the nasopharynx of secretions produced within the middle ear, and permit
equilibration of air pressure with atmospheric pressure in the middle ear. Mechanical or functional obstruction of
the eustachian tubes can result in negative middle-ear pressure and eustachian tube dysfunction
Source: http://www.medisl.com/2010/05/mcq-5-40-2-month-old-female-is-brought.html
A dental surgeon carries out a block of the inferior alveolar nerve by infiltrating local anaesthetic at the mandibular
foramen. Which clinical feature may result from this procedure?
Choose one answer.

a. Numbness of the lower lip on the injected side


b. Numbness of the side of the tongue


c. Ineffective block for the incisor teeth


d. Inability of the patient to clench his jaws


e. Transient weakness of the facial muscles on the injected side







Explanation
The inferior alveolar nerve, a branch of the mandibular division of the trigeminal nerve (V), traverses the inferior
alveolar, or dental, canal of the mandible to supply all the teeth of that hemimandible; all the teeth on that side are
therefore anaesthetised. The mental branch of the nerve emerges through the mental foramen to supply the lower
lip, which becomes numb in a successfully performed block. The muscles of the tongue, of mastication and of facial
expression are not affected
Source: http://www.medisl.com/2010/07/usmle-step-1-mcq-45a-dental-surgeon.htm
Main autonomic receptor types and postreceptor mechanism may vary from one tissue to another. Select the
correct match of receptor / tissue /postreceptor mechanism for the following tissues
Choose one answer.

a. Nm / skeletal muscle endplate / increased IP3 and diacylglycerol


b. Beta-2 / smooth muscle / increased cAMP


c. Dopamine-1 / smooth muscle / increased IP3 and diacylglycerol


d. Alpha-2 / smooth muscle and glands / decrease of camp


e. M2 / heart / opening of ligand-gated calcium channels

Explanation
M2 is found in the heart. But it does not work via ligand gated calcium channels. It works through the Gq protein
leading to the pathway of IP3 and diacylglycerol. Nm is found in skeletal muscle endplate. But it does not work via
increased IP3 and diacylglycerol. Its a ligand gated calcium channel. Alpha-2 is not found in smooth muscles and
glands. It works by inhibiting AMP cyclase via Gi protein. Dopamine-1 is found in smooth muscles. But it works on Gs
proteins, thus increasing cAMP instead of increasing IP3 and diacylglycerol. That leaves us with one answer, which is
D. Beta-2 is found in smooth muscles. It works on the Gs protein, increasing the cAMP levels
Source: http://www.medisl.com/2010/07/usmle-step-1-mcq-44main-autonomic.html
A man is stopped by police for over speeding in a run-down car. He is speaking very rapidly and enthusiastically in
the police station and claims to be one of the richest men in the country. His speech is rapid and virtually nonstop,
often loud and emphatic, seemingly driven, and the police find it hard to interrupt.
Choose one answer.

a. schizophrenia


b. obsessive-compulsive disorder


c. depression


d. posttraumatic stress disorder


e. hypomania






Explanation
Early hypomania can be a pleasurable state of elevated mood, elation, optimism and confidence. Treatment at this
stage is usually not desired or even necessary. For those bipolars who suffer endlessly with depression hypomania is
a desired and welcome relief. For others, a euphoric state is never reached, and even in early hypomania what they
experience may be irritability, rapid thoughts which cause confusion and quick angry outbursts. This dysphoric
hypomanic state can cause problems in relationships, not only personal, but social and work related relationships as
well. Mania is another story. Usually it begins insidiously as hypomania and becomes worse with the most striking
quality of the mood state being grandiosity. Manic people have an exaggerated sense of self confidence believing
they are more wealthy, more intelligent, more talented and more everything than anyone else. This can worsen to
the point where they become delusional - convinced of ideas that are false and impossible. In the full-blown state for
example they may believe that they have been appointed to some high political office, that they have been
appointed by God for some religious appointment, or even that they are God. They may become convinced that they
are on the verge of great scientific discoveries, or that they have solved the mysteries of the universe. Spending
sprees are common and manics sometimes borrow large sums of money or run up huge credit card debts. Judgment
is destroyed. The manic mood can be described as "expansive" as manics commonly seek out people and get
involved with organizations in what is called pressured socialization. They talk rapidly to everyone in sight in a
pressurized, driven way. Sex drive is abnormally heightened leading to loss of inhibitions and participation in sexual
activity that is unusual. In most patients the euphoric state is short lived and the mania quickly becomes very
unpleasant. Their energy level is boosted to the point where they feel pressured, driven, and in a very uncomfortable
state of mind. They can become quite irritable, enraged at the smallest perceived slight. Their thoughts race, their
thoughts come so fast they can't talk fast enough to express them and their speech can become incoherent.
Paranoia is common. Suspiciousness and the false belief that one is being persecuted are common. Mania, contrary
to popular belief is not pleasant. It is obviously an abnormal mental condition, seems to arise from nowhere, and the
person is so changed there is no mistaking the fact that something is very wrong.
Source: http://www.medisl.com/2010/06/mcqs-27-29
7
The phenomenon of cessation of breathing while sleeping is best described as
Choose one answer.

a. narcolepsy


b. insomnia


c. narcoplexy


d. sleep paralysis


e. sleep apnea

Explanation
The most common kind of sleep apnea is called Obstructive Sleep Apnea Syndrome. Sleep apnea means "cessation
of breath." It is characterized by repetitive episodes of upper airway obstruction that occur during sleep, usually
associated with a reduction in blood oxygen saturation. In other words, the airway becomes obstructed at several
possible sites. The upper airway can be obstructed by excess tissue in the airway, large tonsils, a large tongue and
usually includes the airway muscles relaxing and collapsing when asleep. Another site of obstruction can be the nasal
passages. Sometimes the structure of the jaw and airway can be a factor in sleep apnea. <br> What are the
symptoms? <br> excessive daytime sleepiness <br> frequent episodes of obstructed breathing during sleep. (The
patient may be unaware of this symptom -- usually the bed partner is extremely aware of this).
Source: http://www.medisl.com/2010/07/plab-mcq-585the-phenomenon-of-cessation.html


An elderly gentleman is being tested for possible memory impairment. It is discovered that when asked about
remote events he tends to attempt to fill in blanks in his memory with episodes that never actually occurred. This is
best described as
Choose one answer.

a. lack of insight


b. irregistration


c. amnesia


d. pretension


e. confabulation

Source:USMLE Step 2: Q - Medical E books & Applications
A 35 year old is brought into hospital after being found in the middle of the street in a comatose state. His Glasgow
scale is 5 and he has bruising behind both ears. He has no other signs of any injury. A likely cause is
Choose one answer.

a. base of skull fracture


b. meningococcemia


c. midbrain lesion


d. hepatic encephalopathy


e. meningitis

Source: MCQ 143- Medical E books and Medical Applications
Neisseria meningitides is a gram negative organism which causes meningitis in young adults. The bacteria are most
likely to gain entry into the meninges via
Choose one answer.

a. the lymphatic drainage of the meninges


b. the neural tracts of the spinal cord


c. the blood stream


d. the optic nerve and tract


e. the perineural sheath of the olfactory nerve

Source: USMLE Step 2: Q 9- Medical E books & Medical Applications
Which of the following is true of the optic disc?
Choose one answer.

a. contains a concentration of photoreceptors


b. it appears dark red on fundoscopy


c. no arteries pass through it


d. it is normally less than 1cm in diameter


e. no veins pass through it



Explanation
This is the point at which axons leave the eyeball and join the optic nerve. Also, arteries enter and veins leave the
retina at the optic disk. There are no photoreceptors here, hence it is known as the 'blind spot'. It is a pinky-yellow
oval, approximately 2mm in diameter, and situated in the nasal retina
Source: http://www.medisl.com/2010/07/usmle-step1-mcq-37
The aqueous humour of the eye may be divided into an anterior chamber and a posterior chamber. What mostly
tends to seperate these chambers?
Choose one answer.

a. lens


b. ciliary processes


c. limbus


d. iris


e. cornea

Explanation
The iris is an annular membrane dividing the aqueous humour into the anterior chamber, nearer the cornea, and the
posterior chamber, towards the lens. The inner portion of the iris, the pupillary zone, is separated from the ciliary
zone by the zig-zagging collarette.The colour of eyes is determined by the amount of pigment in the iris. With no
pigment the eyes appear blue; with increasing amounts of pigment the colour tends towards grey, brown and black.
Source: http://www.medisl.com/2010/07/usmle-step-1-mcq-33
What specific part of the eye is mainly responsible for acute vision ?
Choose one answer.

a. limbus


b. macula


c. optic disc


d. fovea


e. zonnule of Zinn

Source: USMLE Step 2: Q 8- Medical E books & Medical Applications

When our eyes attempt to focus on a close object what action is typically required?
Choose one answer.

a. the zonnules of zinn contract


b. the lens becomes less convex


c. the sympathetic system is stimulated


d. the ciliary muscles contract


e. increase in the tension of the lens capsule







Explanation:
The smooth muscle of the ciliary body consists of both radial and circular fibres. When we wish to focus on some
close object we must increase the power of our optics. This process is called accommodation.The out of focus retinal
image triggers the parasympathetic system which contracts the ciliary muscle. The muscle moves forward and
inwards; consequently the zonnules of zinn relax, decreasing the tension in the lens capsule which becomes more
convex, increasing the lens' power.This is an important junction where the iris and the sclera meet. Close by is the
circular canal of Schlemm, which runs around the eye just below the limbus. Aqueous humour is exuded from
secretory cells just below the pigment epithelium in the cauliflower-like ciliary processes. The aqueous humour
drains through the Zonnules of Zinn to the posterior chamber and through the pupil to the anterior chamber. The
fibrous Zonnules of Zinn, which support the lens, are attached to the valleys between the ciliary processes
[USMLE Step 2: Q 49- Medical E books & Medical Applications]
A 6 year- old with a two day history of a severe headache develops fever and a spreading purplish rash. On
examination the child is noted to be lethargic and confused and to have nuchal rigidity. The change in mental status
is likely to be secondary to
Choose one answer.

a. child abuse


b. disseminated gonorrhea


c. aneurysmally dilated great vein of Galen


d. encephalitis


e. meningitis

Source: http://www.medisl.com/2010/09/usmle-step-2-mcq-113

A 7- year-old boy is taken to his pediatrician by his father. The father noticed that the child awoke jerking his limbs
during his sleep. When he called out to him the child was muttering to himself, seemed agitated, and failed to notice
his father was in the room. On examination, the boy was alert and well. Neurologic examination was entirely normal
and the child's motor skills, language, and social interaction seemed normal for his age. The most likely diagnosis in
this case is
Choose one answer.

a. breath holding spell


b. febrile convulsion


c. nightmares


d. night terrors


e. epilepsy




A 45- year-old man diabetic and smoker complains of dizziness and loss of balance. On examination it is noted that
he has a mild bilateral sensorineural hearing loss. In the history it is noted that his sister had a demyelinating disease.
He is on long term gentamycin and aspirin. A likely diagnosis is
Choose one answer.

a. Multiple sclerosis


b. Acoustic neuroma


c. Aminoglycoside toxicity


d. Meniere's disease


e. Presbycusis


Explanation:
The most probable answer is aminoglycoside toxicity (although it is not explained why he is on long term
gentamicin). Presbycusis is hearing loss and does not cause balance problems ( anyway he is a bit young for this).
Meniere's has vertigo and this is not the presentation for multiple sclerosis.
Source: http://www.medisl.com/2010/09/usmle-step-2-mcq-70
18. A 38 year old farmer is seen with severe headache and fever. He has a history of a ten day cough with bloody
sputum and consolidation on a chest x-ray showed for which he was given erythromycin by his physician. Physical
examination was unremarkable except for bilateral is inspiratory crackles and a lumbar puncture was performed.
This demonstrated a highly pleomorphic coccobacillii with gram-negative cell wall. These features are characteristic
of
Choose one answer.

a. Coxiella burnetii


b. Bacteroides fragilis


c. Streptococcus pneumoniae


d. Escherichia coli


e. Haemophilus influenzae

Source: http://www.medisl.com/2010/09/usmle-step-2-mcq-142
A physician is explaining to his student that the process of hearing requires that amplified mechanical energy is
transmitted from the middle ear to the cochlea. He claims that the process of amplification is necessary in order to
amplify weak vibrations in the air before reaching the inner ear. Which of the following factors has the greatest
amplifying influence on sound?
Choose one answer.

a. the shape of the middle ear


b. the bone lever system


c. the pressure gradient between middle ear and the nasopharynx


d. the physician is wrong, amplification does not occur within the middle ear


e. the ratio of the size of the oval window to the size of the eardrum


Explanation
The amplified mechanical energy transmitted from the middle ear to the cochlea is transferred into hydraulic
pressure. This hydraulic pressure creates movement to the cochlear duct and to the organ of Corti (the seat of
hearing) The oval window is the interface between middle and inner ear. The stirrup passes on the vibrations to the
oval window, a small thin membrane covering an opening in the bony case of the cochlea. The size of the window
,(15-30 times smaller than the eardrum), produces critical amplification needed to match the vibrations in the air
and the fluid in the cochlea. The sound is amplified at the window another 15 to 30 times. Amplification from outer
to inner ear. There are three distinct areas where the incoming sound vibrations are amplified on the way to the
inner ear. The reason for this is to magnify weak vibrations in air so that they can establish pressure waves in liquid.
The shape of the ear canal may increase pressure times 10. The stirrup, anvil, and hammer bones of the middle ear
may nearly triple the pressure. The arrangement between the eardrum and oval window provide up to another 30
times magnification. The results in amplification is 800 times before the sound wave sets the liquid of the inner ear
into motion.
Source: http://www.medisl.com/2010/07/usmle-step-1-mcq-63
Which receptor is innervated by a branch of the glossopharyngeal nerve?
Choose one answer.

a. pulmonary artery receptors


b. carotid sinus receptors


c. aortic arch receptors


d. atrial receptors


e. central chemoreceptors

Explanation
The aortic arch baroreceptors are innervated by the aortic nerve, which then combines with the vagus nerve (X
cranial nerve) traveling to the brainstem; bilateral vagotomy, therefore, denervates the aortic arch baroreceptors.
Source: http://www.medisl.com/2010/07/usmle-step-1-mcq-62
Which receptor is innervated by nerves that combine with the vagus nerve ?
Choose one answer.

a. pulmonary artery receptors


b. Carotid sinus receptors


c. Atrial receptors


d. Central chemoreceptors


e. Aortic arch receptors

Explanation
The aortic arch baroreceptors are innervated by the aortic nerve, which then combines with the vagus nerve (X
cranial nerve) traveling to the brainstem; bilateral vagotomy, therefore, denervates the aortic arch baroreceptors.
Source: http://www.medisl.com/2010/07/usmle-step-1-mcq-54
Match the following mechanism or pattern with the appropriate disease: - progressive degeneration of anterior horn
cells resulting in progressive muscle weakness, wasting and fasciculations
Choose one answer.

a. Amyotrophic lateral sclerosis


b. Duchenne muscular dystrophy


c. Myasthenia gravis (MG)


d. Guillain-Barr syndrome


e. Myotonic dystrophy

Explanation
Amyotrophic lateral sclerosis is a progressive neuromuscular condition characterized by weakness, muscle wasting,
fasciculations and increased reflexes. The disease is most commonly diagnosed in middle age and affects more men
than women. It usually presents with problems in dexterity or gait resulting from muscle weakness. Difficulty in
speaking or swallowing is the initial symptom in the bulbar form of the disease. Over a period of months or years,
patients with ALS develop severe, progressive muscular weakness and other symptoms caused by loss of function in
both upper and lower motor neurons. Sphincter control, sensory function, intellectual abilities and skin integrity are
preserved. Patients become completely disabled, often requiring ventilatory support and gastrostomy. Death usually
occurs within five years of diagnosis and is attributed to respiratory failure or cachexia.
Source: http://www.medisl.com/2010/06/mcqs-137-139
A history of episodic vertigo and hearing symptoms with audiometric documentation of a fluctuating low-tone
sensorineural hearing loss is characteristic of
Choose one answer.

a. cervical spondylosis


b. benign positional vertigo


c. acoustic neuroma


d. ototoxic drugs


e. Meniere's disease

Explanation
The diagnosis of classic Meniere's disease can be made purely by history, but most commonly it is made by
combining a history of episodic vertigo and hearing symptoms with audiometric documentation of a fluctuating low-
tone sensorineural hearing loss
Source: http://www.medisl.com/2010/06/mcqs-103
You ask a medical student to examine a diabetic patient with Horner's syndrome. You would expect the student to
describe the patients's pupils as
Choose one answer.

a. constricted pupils


b. dilated pupils


c. Hutchinson pupil


d. Argyll- Robertson pupil


e. tonic pupil

Explanation
In diabetic patients sympathetic nerve damage may result in Horner's syndrome which includes a constricted pupil.
Source: http://www.medisl.com/2010/06/mcqs-49
A 66 year old male presents with acute progressive headache and neck and back pain. He has a history of multiple
cerebral infarcts assumed secondary to embolization of a left ventricular clot for which he is treated with coumadin
to prevent further left ventricular thromboemboli. On examination he has mild nuchal rigidity, confusion and
disorientation, slow incomprehensible speech, but no localizing neurologic deficit. His hemoglobin and electrolytes
are normal but his INR is 6.0. A likely diagnosis is
Choose one answer.

a. cluster headache


b. sub-arachnoid hemorrhage


c. trigeminal neuralgia


d. tension headache


e. migraine



Explanation:
Since the onset is sudden and the patient's INR is very high the main diagnosis to consider is sub-arachnoid
hemorrhage. Alternative diagnoses include Meningitis, thromboembolitic infarcts, ischemic acidosis. Since the onset
was sudden vascular causes including other causes of hemorrhage are important. Perform a CT and expect to see
blood diffusely present in sub-arachnoid space. LP- expect to see blood- tinged CSF
Source: http://www.medisl.com/2010/06/mcqs-51
A woman is to have her second caesarean section and is keen to have adequate pain relief. Her first caesarean
section was uneventful. The anaesthetist is consulted. Appropriate anaesthetic management is likely to include
Choose one answer.

a. non-steroidal anti-inflammatories


b. opiods by spinal injection


c. opiods by intramuscular injection


d. nitrous oxide mixed with oxygen


e. opiods by epidural injection

Explanation:
Appropriate anaesthetic management is likely to include d) opiods by epidural injection. Appropriate anaesthetic
management of a caesarean section usually involves epidural or spinal anaesthesia. GA (which can cause neonatal
depression) is very rarely indicated.
Source: http://www.medisl.com/2010/06/mcqs-46


A 2-month -old female is brought to the Casualty Department with acute onset of loss of consciousness. On
examination the child is unresponsive. A noncontrast CT of the head demonstrates an extensive area of edema
involving the right cerebral hemisphere as well as the ACA territory of the left cerebral hemisphere. The bone
windows also demonstrate a subdural hematoma. These features are suspicious of






Choose one answer.

a. thrombosis of a major dural sinus


b. meningitis


c. encephalitis


d. child abuse


e. medulloblastoma

Explanation
Cerebral infarction without an underlying condition or trauma in childhood is rare. The finding of an associated
subdural hematoma suggests trauma or child abuse. The battered child syndrome is the most common cause of
serious intracranial injuries in children less than 1 year of age, and it is the 3rd most common cause of death in
children after SIDS and true accidents. CNS findings include the following: impact injury; skull fracture; subdural
hematoma ;brain contusion ;cerebral hemorrhage ;infarction or generalized edema.
Source: http://www.medisl.com/2010/05/mcq-5
A 70 year old known hypertensive man presents to the general practitioner complaining of sudden onset of a
drooping right eyelid and slurred speech. Examination revealed the tongue deviated to the right. A Horner's
syndrome on the right was diagnosed. Further examination showed a loss of pain sensation of the left side. The
physician also noted a poor visual acuity from both eyes. Which area of the brain is involved in ischaemia?
Choose one answer.

a. left side of midbrain


b. spinal cord at the level of C2


c. right side of midbrain


d. dorsolateral medulla


e. anterior pons

Explanation
This patient's clinical condition suggests ischemia of the dorsolateral medulla. Involvement of the ninth and tenth
cranial nerve nuclei result in ipsilateral tongue deviation to the right and ipsilateral palatal weakness, respectively.
Involvement of the central sympathetic pathway results in an ipsilateral Horner's syndrome. Damage to the lateral
spinothalamic tract results in contralateral loss of pain and temperature sensation The poor visual acuity in this case
was irrelevant and an incidental finding- this was corrected .
Source: http://www.medisl.com/2010/07/usmle-step-1-mcq-68
A 12- year- old boy ran into a glass door receiving a puncture wound .A very sharp piece of glass had lodged into the
side of his face. He did not require sutures and the wound healed well. However, 6 months later, his mother noted
that he would sweat profusely on the skin of his face at the site of the old injury. He was diagnosed to be suffering
from Frey's syndrome. It was decided that the best treatment would be to avulse the nerve carrying the
parasympathetic nerve fibres to the region. Which nerve was to be avulsed?








Choose one answer.

a. Trigeminal nerve


b. Great auricular nerve


c. Auriculotemporal nerve


d. Facial nerve


e. Oculomotor nerve

Explanation
The glass had damaged the parasympathetic secretomotor fibres to the parotid gland and also branches of the great
auricular nerve which supply the overlying skin. On regeneration some of the parasympathetic fibres had crossed
over and joined the distal end of the great auricular nerve. A stimulus normally producing salivation stimulated the
sweat glands instead. The best method of treatment is avulsion of the auriculotemporal nerve which carries the
parasympathetic fibres.
Source: http://www.medisl.com/2010/06/mcqs-178
An eight year old has episodes of 'staring' in which she may stop talking for a few seconds and stares into space. A
couple of seconds later she recovers fully and keeps on talking. These features are characteristic of a
Choose one answer.

a. Jacksonian seizure


b. petit mal seizure


c. atonic seizure


d. simple partial seizure


e. grand mal seizure

Explanation
Petit mal seizures occur in 2 out of 1,000 people. They are most common under age 20, usually in children ages 6 to
12. They may occur in combination with other types of seizures. Typical petit mal seizures last only a few seconds,
with full recovery and no confusion They manifest themselves as staring episodes or 'absence spells' during which
the child's activity or speech ceases. The child may stop talking in mid sentence or cease walking. One to several
seconds later speech or activity resume. If standing or walking a child seldom falls during one of these episodes.
'Spells' can be infrequent or very frequent occurring many times per hour. They can interfere with school function
and learning. Teachers may interpret these seizures as lack of attention or other misbehavior. Atypical petit mal
seizures begin slower, last longer, and may have more noticeable muscle activity than typical petit mal seizures.
There is usually no memory of the seizure. Up to hundreds of seizures can occur in a person in a single day. They may
occur for weeks to months before they are noticed because symptoms commonly occur during quiet rest periods
rather that periods of activity. Transmission of information from nerve cell to nerve cell occurs by an electrochemical
process. This process can be detected as electrical activity by an electroencephalograph (EEG ). Abnormal patterns of
electrical activity are associated with seizures. Petit mal seizures generally present a very characteristic appearance
on the EEG. No cause can usually be found for typical petit mal seizures. No neurologic or other disorders are usually
discovered. Atypical seizures may or may not be associated with other neurologic disorders. Causes may be
unidentifiable, or identified as congenital brain abnormalities, complications of kidney or liver disease or brain
injuries from trauma or birth complications.

Source: http://www.medisl.com/2010/06/mcqs-128




1
Marks: 0/1
What is the diagnosis for this patient?


http://health-pictures.com/bell-palsy-picture.htm
Choose one answer.

a. Left VI nerve palsy


b. Ptosis due to lesion of III nerve


c. Right medial rectus palsy


d. Lesion of right XII nerve


e. Lesion of left XLL nerve


f. Left medial rectus palsy


g. VII nerve palsy


h. Right VI nerve palsy

What is the diagnosis for this patient?

The patient was asked to look to the right
Choose one answer.

a. Lesion of right XII nerve


b. VII nerve palsy


c. Left VI nerve palsy


d. Left medial rectus palsy


e. Right VI nerve palsy


f. Right medial rectus palsy


g. Ptosis due to lesion of III nerve


h. Lesion of left XLL nerve


What is the diagnosis for this patient?

Choose one answer.

a. Left medial rectus palsy


b. Right VI nerve palsy


c. Lesion of right XII nerve


d. Lesion of left XLL nerve


e. Right medial rectus palsy


f. Ptosis due to lesion of III nerve


g. VII nerve palsy


h. Left VI nerve palsy


What is the diagnosis for this patient?

Choose one answer.

a. Right medial rectus palsy


b. Left VI nerve palsy


c. Left medial rectus palsy


d. Lesion of right XII nerve


e. VII nerve palsy


f. Lesion of left XLL nerve


g. Right VI nerve palsy


h. Ptosis due to lesion of III nerve



What is the diagnosis for this patient?

Choose one answer.

a. Lesion of left XLL nerve


b. VII nerve palsy


c. Ptosis due to lesion of III nerve


d. Left medial rectus palsy


e. Lesion of right XII nerve


f. Right medial rectus palsy


g. Right VI nerve palsy (INTERNAL STRABISMUS)


h. Left VI nerve palsy


This is a drawing of the middle ear. Identify the letters (A to E) which represent the structures listed below .


Malleus [A]
Tensor tympani muscle

[B]
Incus [C]

Stapedius muscle [D]

Stapes [E]






Which cranial nerve is the largest?
Answer:
trigeminal, V


Correct Answer: CN V (Trigeminal)
Which cranial nerve is the only one that exits the "posterior" side of the brainstem?
Answer:
trochlear, IV

Correct Answer:CN IV (Trochlear)

How many cranial nerves are responsible for eye movements?
Answer:
three (III, IV,VI)

Correct Answer: Three: CN III (Oculomotor), IV (Trochlear), and VI (Abducens).

What does "abducens" refer to?
Answer:
crania. nerve 6

Correct Answer: The abducens nerve carries motor impulses to the lateral rectus eye muscle which moves the eye
laterally causing abduction of the eye

Which cranial nerves carry gustatory (taste) information?
Answer:
facial, glossopharyngeal

Correct Answer: CN VII (Facial), CN IX (Glossopharyngeal) and CN X (Vagus).