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1 MedIS exam 2013 Course title: Nervesystemet og bevægeapparatet II – Medicine Programme: Bachelor in education Semester: 5. semester Exam date: 21-1-12 Time: 9:00 - 13:00 Evaluation form 7-point scale – External censur Important information: Remember to bring your student identification card Remember to put your student number – not your name and cpr no – on all sheets that you hand in for evaluation Remember to hand in the assignment if you leave the exam before it has ended No written aid is allowed Quicktionary pen is allowed Your paper must be handed in on paper in hand written form The study board/the university cannot be held liable if any problems should occur regarding the electronic aid during the examination It will be considered cheating or attempting to cheat if the technical equipment of the student is communicating or trying to communicate with other equipment not relevant to the exam, without an explicit permission. Before the beginning of the exam, the student should make sure that all communication devices in the equipment at the exam are turned off. Use of Latin nomenclature Communication is not allowed The exam consists of a mixture of multiple choice questions and essay questions. The total amount of questions is 60. The total amount of points is 108. This lists the grades corresponding to the points: 12 (passed): 101-108 points 10 (passed): 92-100.5 points 07 (passed): 83-91.5 points 04 (passed): 74-82.5 points 02 (passed): 65-73.5 points 00 (failed): 33-64.5 points -2 (failed): 0-32.5 points

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MedIS exam 2013

Course title: Nervesystemet og bevgeapparatet II Medicine

Programme: Bachelor in education

Semester: 5. semester

Exam date: 21-1-12

Time: 9:00 - 13:00

Evaluation form 7-point scale External censur

Important information:

Remember to bring your student identification card

Remember to put your student number not your name and cpr no on all sheets that

you hand in for evaluation

Remember to hand in the assignment if you leave the exam before it has ended

No written aid is allowed

Quicktionary pen is allowed

Your paper must be handed in on paper in hand written form

The study board/the university cannot be held liable if any problems should occur regarding

the electronic aid during the examination

It will be considered cheating or attempting to cheat if the technical equipment of the student is

communicating or trying to communicate with other equipment not relevant to the exam, without

an explicit permission. Before the beginning of the exam, the student should make sure that all

communication devices in the equipment at the exam are turned off.

Use of Latin nomenclature

Communication is not allowed

The exam consists of a mixture of multiple choice questions and essay questions.

The total amount of questions is 60.

The total amount of points is 108.

This lists the grades corresponding to the points:

12 (passed): 101-108 points

10 (passed): 92-100.5 points

07 (passed): 83-91.5 points

04 (passed): 74-82.5 points

02 (passed): 65-73.5 points

00 (failed): 33-64.5 points

-2 (failed): 0-32.5 points

2

1. Eye muscle innervations

A. M. levator palpebrae superioris

B. M. obliquus superior

C. M. rectus lateralis

D. M. obliquus inferior

E. M. rectus medialis

Lead in: From the list above, select the appropriate option.

This muscle is innervated by the N. trochlearis (cranial nerve IV). B

This muscle is innervated by the N. abducens (cranial nerve VI). C

Max point: 2 Achieved point:

2. Eye muscle functions

A. M. levator palpebrae superioris

B. M. obliquus superior

C. M. rectus lateralis

D. M. obliquus inferior

E. M. rectus medialis

F. M. rectus inferior

G. M. rectus superior

Lead in: Select the appropriate muscle function from the list above.

Eye looks laterally (abduction) C

Eye rolls, looks down, laterally B

Eye looks medially (adduction) E

Eye rolls, looks up, laterally D

Max point: 4 Achieved point:

3.

What are the three branches of the cranial nerves V (N. trigeminus)? Give

them in ascending order (V1, V2, V3)

Where do these nerves pass through?

- N. ophthalmicus/V1 (0.5); Fissura orbitalis superior (0.5)

- N. maxillaris/V2 (0.5); Foramen rotundum (0.5)

- N. mandibularis/V3 (0.5); Foramen ovale (0.5)

Max point: 3 Achieved point:

4.

Which of the following cranial nerves has no primary sensory-motor function (mixed)?

A. N. vagus

B. N. vestibulocochlearis C. N. facialis

D. N. trigeminus

E. N. glossopharyngeus

Max point: 1 Achieved point:

3

5.

Which of the following cranial nerves does not pass through the foramen

jugulare?

A. N. vagus

B. N. glossopharyngeus

C. N. hypoglossus D. N. accessorius

Max point: 1 Achieved point:

6.

Which of the following statements is not true?

A. The vitreous humor fills the space between the lens and the retina.

B. The vitreous humor enters the Canal of Schlemm that delivers the

humor to veins in the sclera.

C. The aqueous humor fills the space in front of the lens.

D. The aqueous humor is actively secreted by epithelial cells.

E. The intraocular pressure is considered normal in the range of 12 to 21

mm/Hg.

Max point: 1 Achieved point:

7

Visual information processing from the retina to the visual cortex

involves different structures. Arrange the following terms in the correct order:

Chiasma opticum, Tractus opticus, Nervus opticus, Radiatio optica,

Corpus geniculatum laterale.

Nervus opticus, Chiasma opticium, Tractus opticus, Corpus geniculatum laterale,

Radiatio optica

Max point: 2 Achieved point:

8. A left tractus opticus lesion induces which one of the following clinical

signs?

A. Medial deviation of the eyeball

B. Ptosis

C. Anosmia

D. Hemianopia E. Miosis

Max point: 1 Achieved point:

9 Which one of the following statements concerning the corneal reflex is

true?

A. The afferent nerve fibers belong to the N. occulomotorius.

B. It is a monosynaptic reflex.

C. The reflex fails in a complete peripheral palsy of the N. facialis. D. The efferent nerve fibers originate in the Mesencephalon.

E. A positive reflex is a pathological sign.

Max point: 1 Achieved point:

4

10

The pupillary light reflex mainly involves two inner eye muscles.

Give the exact latin names of these muscles and their functions.

Musculus sphincter pupillae - Miosis (1)

Musculus dilatator pupillae - Mydriasis (1)

Max point: 2 Achieved point:

11

Which one of the following statements concerning the Nervus

vestibulocochlearis is NOT true?

A. Lesions of the semicircular canals induce sensorineural deafness. B. Sensory receptors are located in the cochlea.

C. It passes through the Meatus acusticus internus.

D. Nuclei are located in the Medulla oblongata.

E. Sensory receptors are located in the semicircular canals.

Max point :1 Achieved point:

12

Which one of the following statements concerning the

Sound Pressure Level (SPL) is true?

A. The physical unit of SPL is phon.

B. A tenfold increase of the sound pressure corresponds to an increase of

SPL by 20 dB SPL.

C. The reference pressure is 0.02 Pa.

D. The auditory pain threshold is approx. 80 dB SPL.

E. The SPL of a jackhammer is 40 dB SPL.

Max point: 1 Achieved point:

13

Clinical testing of hearing impairment includes the Weber and Rinne test.

A - Describe the performance of the Weber test.

B - Give the results of the test in a patient with a conductive hearing loss

on the right side (Weber).

C briefly define the meaning of a positive and negative Rinne test

A. In the Weber test a tuning fork (either 256 or 512 Hz) is struck and the stem of the fork is placed on the top of the patient's skull - equal distance from the

patient's ears, in the middle of the forehead - equal distance from the patient's

ears or above the upper lip over the teeth. The patient is asked to report in

which ear the sound is heard louder. (2)

B. Weber: Lateralization of sound in the affected right ear. (1)

C. Conductive hearing loss: ACBC/positive Rinne test

AC: air conduction, BC: bone conduction

Max point: 4 Achieved point:

5

14 Anatomy of the ear

Lead in: Identify the appropriate name to accompany each label

Label:

A Membrana tympani

B Stapes

C Cochlea

D Tuba auditiva (Eustachii)

Max point: 4 Achieved point:

15.

When it comes to the transmission of sound waves from the inner ear,

what are the sound amplification mechanisms that involves the 3 ossicles?

The 3 ossicle are a series of levers:

Movement of the malleolus causes a greater movement of the incus which in turn

causes an even greater movement of the stapes.

Max point: 1 Achieved point:

16

Which one of the following statements is true regarding clinical signs of

N. facialis impairment?

A. Paresis of Mm. masticatorii

B. Bells sign C. Vertigo

D. Diplopia

E. Anosmia

Max point: 1 Achieved point:

6

17

Which one of the following statements is NOT a typical clinical test of

N. vagus impairment?

A. Intraoral, pharyngeal sensations

B. Uvula position

C. Speak & cough

D. Protrude & retract tongue E. Gag reflex

Max point: 1 Achieved point:

18

Which one of the following statements concerning accommodation is

true?

A. Contraction of the Musculus ciliaris decreases the refractory power of

the lens.

B. Total loss of accommodation is called Myopia.

C. Accommodation is clinically tested by the Snellen Chart.

D. Emmetropia corresponds to loss of sympathetic innervation.

E. Parasympathetic input to inner eye muscles mediates near

accommodation.

Max point: 1 Achieved point:

19

Which one of the following vessels does NOT belong to the

Circulus arteriosus cerebri?

A. Arteria subclavia B. Arteria cerebri anterior

C. Arteria cerebri media

D. Arteria cerebri posterior

E. Arteria basilaris

Max point: 1 Achieved point:

20

Which one of the following statements concerning Liquor cerebrospinalis

is true?

A. Flows from 4th ventricle to Cavitas subarachnoidalis via Apertura

lateralis and via Apertura mediana.

B. Is absorbed by Plexus choroideus in the 4th ventricle.

C. The rate of formation in adults is approx. 5 l/day.

D. Is secreted by Granulationes arachnoidales (Pacchioni).

E. Has a total volume of approx. 500 ml.

Max point: 1 Achieved point:

21

A minor head injury often causes a bump or bruise on the exterior of the

head. Give 3 other typical symptoms.

nausea, mild headache, tender bruising or mild swelling of the scalp, mild dizziness

Max point: 3 Achieved point:

7

22 Circulus arteriosus cerebri

Lead in: Identify the appropriate name to accompany each label

Label:

A Arteris communicans anterior

B Arteria cerebri anterior

C Arteria cerebri media

D Arteria cerebri posterior

E Arteria vertebralis

Max point: 5 Achieved point:

23

The concept of raised intracranial pressure is described with a specific course containing the following 3 stages due to for example

hemorrhage: Acidosis, systemic arterial vasoconstriction, CSF

displacement. Put them into an ascending order (what appears first).

Stage 1: CSF displacement

Stage 2: Arterial vasoconstriction,

Stage 3: Acidosis, systemic

Max point: 3 Achieved point:

8

24 Which neurological disorder does NOT lead to dementia?

A Myasthenia gravis X

B Parkinsons disease

C Multiple sclerosis

D Huntingtons chorea

E Alzheimers disease

Max point 1 Achieved point:

25 The typical morphological feature of dementia is NOT:

A Brain atrophy

B Inflammation around white matter tracts X

C Inflammatory cells dispersed in grey and white matter of the

telencephalon

D Loss of cholinergic neurons

E Neuronal loss

Max point 1 Achieved point:

26 Which of the following is not typically a symptom of dementia?:

A Aphasia

B Change of personality

C Apraxia

D Apathy

E Seizures X

Max point 1 Achieved point:

27 Which of the following is not considered an appropriate new treatment

method?:

A Menantine

B Sulfasalazine X

C Beta-secretase inhibitors

D Immunization with amyloid beta-peptides

Max point 1 Achieved point:

28 Mechanism of actions. Local anaesthetics work via

A blocking of calcium channels.

B binding of potassium channels.

C blocking of anionic channels.

D blocking of sodium channels. X

E binding of chloride channels.

Max point 1 Achieved point:

9

29 Minimal alveolar concentration (MAC) is defined as

A the equilibration of partial pressure of oxygen and the inhaled

anaesthetic.

B the amount of anaesthetics needed to reduce ventilation by 50%.

C the concentration of an inhaled anaesthetic that leads to

bronchoconstricition.

D the concentration of an inhaled anaesthetic, at which the response to

surgical incision is abolished in 50% of subjects.

D

E 50% of the amount of an anaesthetic for reaching the equilibrium.

Max point 1 Achieved point:

30

Briefly describe the Overton-Meyer correlation.

Anaesthetic potency is closely related to lipid solubility, not with chemical structure

Max point: 3 Achieved point:

31 Neuromuscular blocking agents.

Which of the following substance is a depolarizing neuromuscular blocking

agent?

A Gallamine

B Atracurium

C Mivacurium

D Metocurine

E Succinylcholine E

Max point 1 Achieved point:

32 Which of the following nerve fibers is most sensitive to a conduction block

via local anaesthetics?

A A-alpha

B A-beta

C A-gamma

D A-delta

E C E

Max point 1 Achieved point:

33 Choose the incorrect answer!

Osteoarthritis is a disease that involves the following factor(s):

A. Pannus Formation B. Low-grade inflammation

C. Calcification of articular cartilage

D. Genetics

E. Metabolic disorders

Max point: 1 Achieved point:

10

34 Choose the correct statement in regard to gouty arthritis (GA)!

A. The formation of Bouchard nodes is a prominent sign in GA.

B. The formation of Heberden nodes is a prominent sign in GA.

C. GA is highly correlated with chronic inflammation of bursal sacks.

D. Tophi deposits typically appear in and around joints in GA. E. Ulnar drift is one of the cardinal symptoms in GA.

Max point: 1 Achieved point:

35 Choose the correct statement in regard to septic arthritis (SA)! Lyme

arthritis is caused by

A. Borrelia burgdorferi B. H. influenza

C. Hepatitis C virus

D. Staphylococcus aureus

E. E. coli

Max point: 1 Achieved point:

36 Choose the correct answer!

Medical therapy of osteoarthritis can consist of treatment with

A. Acetaminophen

B. Corticosteroids

C. Hyaluronate

D. NSAIDS

E. All of the above Max point: 1 Achieved point:

37 An athlete has a knee injury, and the doctor performs a "drawer test" by

pulling and pushing on the leg with the knee flexed. If the leg translates

anteriorly, i. e. "gives" or moves anteriorly when the leg is pulled

anteriorly, what joint structure is most likely injured?

A. Meniscus medialis

B. Lig. collaterale fibulare

C. Ligamentum cruciatum anterius D. Lig. collaterale tibiale

E. Lig. cruciatum posterius

Max point: 1 Achieved point:

38 Which of the following statements is NOT true of the locking or

unlocking mechanism of the knee?

A. In a weight bearing position, medial rotation of the femur accompanies

final stages of knee extension to lock the knee.

B. The unlocking mechanism is brought about by action of the

Musculus popliteus.

C. In a non-weight bearing position, lateral rotation of the tibia

accompanies final stages of knee extension to lock the knee.

D. The locking mechanism of the knee tightens the collateral and cruciate

ligaments.

E. The locking mechanism of the knee accommodates the remainder of

exposed articular surface on the Condylus lateralis femoris.

Max point: 1 Achieved point:

11

39 The Ligamentum deltoideum consists of the following ligaments

EXCEPT:

A. Ligamentum talofibularis posterior B. Pars tibiocalcanea

C. Pars tibionavicularis

D. Pars tibiotalaris posterior

E. Pars tibiotalaris anterior

Max point :1 Achieved point:

40 During a basketball game, the center of the team went up for a rebound

and when coming down, her foot landed on the foot of another player,

sharply everting it. She limped off the floor, having severely sprained the

medial side of her ankle. Which ligament was injured?

A. Lig. deltoideum B. Ligamentum calcaneofibulare

C. Lig. plantare breve

D. Lig. calcaneonaviculare plantare

E. Lig. collaterale tibiale

Max point: 1 Achieved point:

41 The Arteria dorsalis pedis can be palpated lateral to the extensor hallucis

longus tendon on the dorsal surface of the foot, distal to the dorsal most

prominence of the navicular bone. The A. dorsalis pedis is usually a direct

continuation of which artery?

A. A. femoralis

B. A. poplitea

C. A. tibialis anterior D. A. fibularis

E. A. tibialis Posterior

Max point: 1 Achieved point:

42

Describe how you would perform an Anterior Drawer Test!

The patient should be supine with the knees flexed to 90 degrees and the feet

flat on table. The examiner sits on the patient's feet and grasps the patient's

tibia and pulls it forward (anterior drawer test)

Max point: 2 Achieved point:

43

Name the 4 anterior leg muscles.

What are their innervations?

M. tibialis anterior

M. extensor halluces longus

M. extensor digitorum longus

M. fibularis tertius

All innervated by the N. fibularis profundus (1 each)

Max point: 5 Achieved point:

12

44 Anatomy of the Foot and Ankle

Lead in: Identify the appropriate name to accompany each label

Label:

A Calcaneus

B Os cuboideum

C Os metatarsale IV

D Os cuneiforme intermedium

Max point: 4 Achieved point:

45

Name the posterior leg muscles from the superficial group.

What are their innervations?

M.triceps surae: M. gastrocnemius + M. soleus

M. plantaris

All innervated by the N. tibialis (1 each)

Max point: 4 Achieved point:

B

A

C

D

13

46 What is the origin of the M. gastrocnemius? Choose the correct answer.

A. Caput fibula

B. Femur (epicondylus medialis & lateralis) C. Membrana interossea

D. Tibia (fascies posterior)

E. Tuber ischiadicum

Max point: 1 Achieved point:

47 Which of the following is not part of the medial arch of the foot?

A. Os naviculare

B. Os cuboiduem C. Os talus

D. Os calcaneus

E. Os cuneiformis

Max point: 1 Achieved point:

48 A misplaced intramuscular injection into the gluteal region infiltrated the

Nervus ischiadicus (sciatic nerve) giving rise to temporary paralysis of the

muscles supplied by that nerve. All of the following muscles would be

involved EXCEPT for the:

A. Musculus tibialis anterior

B. M. soleus

C. M. gracilis D. M. peroneus brevis

E. M. popliteus

Max point: 1 Achieved point:

49 Which of the following statements is NOT true for the Nervus ischiadicus

(sciatic nerve)?

A. The sensory distribution includes the medial aspect of the leg. B. Largest and longest of all peripheral nerves.

C. Exits the pelvis through the greater sciatic Foramen infrapiriforme.

D. Divides into 2 main branches: N. tibialis, N. fibularis.

E. Receives fibers from L4-S3 spinal segments.

Max point: 1 Achieved point:

50 Dermatomes of the lower limb

A. L2

B. L3

C. L4

D. L5

E. S1

Lead in: From the list above, select the appropriate option.

Which of the above mentioned spinal nerves innervates skin over the

lower-medial part of the upper leg? B

Which of the above mentioned spinal nerves innervates skin over the

lateral sole of foot? E

Max point: 2 Achieved point:

14

51 Which of the following muscles is a lateral rotator of the shoulder?

A. Musculus subscapularis

B. Musculus latissimus dorsi

C. Musculus teres major

D. Musculus infraspinatus E. Anterior fibers of the Musculus deltoideus

Max point: 1 Achieved point:

52 Most of the muscles that act on the shoulder girdle and upper limb are

supplied by branches of the Plexus brachialis. Which of the following is

NOT?

A. Musculus trapezius B. Musculus teres minor

C. Musculus latissimus dorsi

D. Musculus rhomboideus major

E. Musculus rhomboideus minor

Max point: 1 Achieved point:

53 The Plexus brachialis

Lead in: Identify the appropriate name to accompany each label

Label:

A Truncus superior

B N. musculocutaneus

C N. ulnaris

D Fasciculus medialis (medial cord)

Max point: 4 Achieved point:

B

A

C

D

C5

T1

15

54

Topic:

Anatomy of the Hand

Lead in: Identify the appropriate name to accompany each label

Label:

A Os hamatum

B Os metacarpale V

C Processus styloideus ulnare

D Os lunatum

Max point: 4 Achieved point:

55 Which of the following statements is NOT true of the M. interossei in the

hand?

A. They are all innervated by Nervus ulnaris.

B. The Mm. interossei palmares produce flexion of the II, IV, V

Articulationes metacarpophalangeae.

C. The Mm. interossei palmares are innervated by the Nervus ulnaris and

the Mm. interossei dorsales are innervated by the Nervus medianus.

D. There are 3 Mm. interossei palmares and 4 Mm. interossei dorsales

E. The Mm. interossei dorsales originate from adjacent sides of the

Ossa metacarpalia I-V.

Max point: 1 Achieved point:

B

A

C

D

16

56 Numbness to the skin on the lateral half of the palm (thenar) of the hand

would be caused by a lesion to which nerve?

A. Nervus ulnaris

B. N. medianus C. N. radialis profundus

D. N. axillaris

E. N. interosseus anterior

Max point: 1 Achieved point:

57 If you slide a piece of paper between a patients index finger and thumb

and ask the patient to hold onto the paper when you try to pull it from

the fingers, and the patient is unable to perform this action (Froment

sign), which nerve is suspected to be nonfunctional?

A. N. radialis superficialis

B. N. musculocutaneus

C. N. medianus

D. Nervus ulnaris

E. N. radialis profundus

Max point: 1 Achieved point:

58 Which of the following statements is NOT true of the pelvis and coxal

joint?

A. The coxal joint is a ball and socket type joint.

B. The Acetabulum is positioned in a downward and outwardly direction.

C. The Acetabulum is the fossa where the femoral head articulates.

D. Hip flexion range of motion is approx. 140.

E. The Acetabulum is surrounded by a labrum which is thicker and more

substantial inferiorly than superiorly

Max point: 1 Achieved point:

59

Name 2 ligaments that help stabilizing the caput femoris!

Lig. Iliofemorale

Lig. Pubofemorale

Lig. Ischiofemorla (1 each)

Max point: 2 Achieved point:

60

Name the anterior thigh muscles and their innervations!

M sartorius

M quadriceps femoris:

- M. rectus femoris - M. vastus medialis - M. vastus lateralis - M. vastus intermedialis

N. femoralis

(1 each)

Max point: 6 Achieved point: