ME110 SUMMATIVE SEMESTER 5: MUSCULOSKELETAL AND NERVOUS SYSTEMS

OBA
1. A 32-year old footballer jumped to head a ball into the goalpost. While landing down
on the earth, he felt his right knee seem to give way with an audible pop. He was found
in severe pain and showed abnormal forward motion of the tibia on the femur. What is
the most probably injury?

A. Medial meniscus tear

B. Tear of tibial collateral ligament
C. Tear of fibular collateral ligament
D. Anterior cruciate ligament tear
E. Posterior cruciate ligament tear

2. You are examining an adult patient who has dislocated the elbow posteriorly to note
misalignment of the bones. Which of the following would be the most likely finding?

A. Prominent medial epicondyle

B. Shortened length of the arm
C. Prominent olecranon
D. Prominent lateral epicondyle
E. Apparent lengthening of forearm

3. A 30-year-old woman with a BMI of 33 presents with a history of pain in the groin
after a minor fall. She reports a long history of intermittent pain over the hips
particularly felt after exercise for the previous few months. On examination, she is found
to have a positive Trendelenburg test. The most likely cause of this is:

A. osteoarthritic hip
B. impacted subcapital fracture
C. gluteal paralysis
D. congenital dislocation of the hip
E. L5 root lesion

4. A 50-year-old man is evaluated for complications of diabetes. A focused history is

taken about the symptoms of diabetic neuropathy. Which one of the following is the
most likely sensory abnormality seen in patients with long-term diabetes?

A. Loss of pain sensation

B. Glove and stocking paraesthesia
C. Loss of joint position sense
D. Patchy loss of touch sensation over back region
E. Loss of sensation for hot and cold
5. A middle-aged man is seen with multiple scaly skin lesions over the shin, scalp and
back. He has evidence of arthritis involving the distal interphalangeal joints and a few
larger joints. His nails show pitting. Which of the following is the most likely joint
abnormality?

A. Psoriatic arthritis
B. Juvenile rheumatoid arthritis
C. Ankylosing spondylitis
D. Reiter’s syndrome
E. Rheumatoid arthritis

6. Many chemical and mechanical factors affect the activities of osteoblasts and
osteoclasts. Which of the following increases the former and decreases the latter?

A. Mechanical load
B. Parathyroid hormone
C. 1,25-dihydroxycholecalciferol
D. Immobilisation
E. Cortisol

7. A 79-year-old man underwent coronary artery bypass graft surgery one year back
and is currently on antihypertensive and statins. He has now been diagnosed with
chronic cholecystitis for which he needs a cholecystectomy. His anaesthetist has decided
to give him general anaesthesia. He has to choose one muscle relaxant for the procedure.
Which of the following do you think he would choose?

A. Suxamethonium
B. Atracurium
C. Vecuronium
D. D-Tubocurarine
E. Pancuronium

8. Strenuous exercise can be detrimental to health and one of the most serious
conditions is known as the female athlete triad. Which of the following combination of
conditions correctly describe this triad?

A. Anorexia, vaginal bleeding and fever

B. Bulimia, osteoporosis and distorted body image
C. Muscle spasms, swelling of the joints and reduced appetite
D. Amenorrhoea, eating disorders and osteoporosis
E. Bruising, rash and depression

9. A 5-year-old child suffering from T.B. spine at T10 develops weakness of the lower
limb. Which of the following most likely describes the lesion?

A. Spinal nerve compression

B. Autonomic neuropathy
C. LMN lesion
D. Peripheral nerve lesion
E. UMN lesion
10. Selective COX-2 inhibitors are used for the control of pain and inflammation. Identify
the event with very high risk that is associated with use of COX-2 inhibitors.

A. Asthmatic attack
B. Glaucoma
C. Hepatic necrosis
D. Thrombotic events
E. GI ulceration

11. An elderly man presented with meningitis in a hospital. CSF was withdrawn by a
lumbar puncture for examination. Which of the following structures did the needle
penetrate?

A. Pia mater
B. Posterior longitudinal ligament
C. Filum terminale
D. Ligamentum flavum
E. Erector spinae

12. A 47-year-old lad complained of inability to flex the index finger at

metacarpophalangeal joint following a nerve injury caused by fracture of carpal bones.
Which of the following muscles is most likely to be affected by this nerve compression?

A. Opponens pollicis
B. Flexor digitorum superficialis
C. 1st lumbrical
D. 2nd lumbrical
E. Flexor digitorum profundus

13. After an injury during a marathon race an athlete complained of pain over the lateral
aspect of the knee while bending the knee. On examination the attending physician
found the head of the fibula avulsed. Which of the following is most likely to be affected
to produce the pain during flexion?

A. Adductor magnus
B. Biceps femoris
C. Semitendinosus
D. Semimembranosus
E. Gastrocnemius

14. A 45-year-old man was examined by a neurologist for paraesthesia of the right side
of the face. Further examination revealed a positive jaw jerk. The most likely muscle that
may be affected in this patient is

A. Buccinator
B. Masseter
C. Orbicularis oris
D. Platysma
E. Genioglossus
15. A 3-year-old child, who has restricted outdoor access, presented to the
orthopaedician with complaints of her head gradually developing a strange shape – the
front was more prominent and the back was flattened. On examination, the front of the
sternum was also pushed out prominently. These features are described medically as:

A. Harrison’s sulcus and scoliosis respectively

B. Craniotabes and Rachitic rosary respectively
C. Craniotabes and Pectus carinatum respectively
D. Rachitic rosary and caput quadratum respectively
E. Caput quadratum and scoliosis respectively

16. Muscular movement requires energy source. ATP is the energy source for muscular
contraction. Which of the following is TRUE regarding the energy cycle during muscle
contraction?

A. ADP detaches from the myosin’s head during cross bridging

B. ATP is required to move myosin’s head during power stroke
C. Cross bridge detachment occurs when ATP detaches from the myosin’s head
D. Rigor mortis occurs when ATP detaches from the myosin’s head
E. Contraction happens as long as there is supply of ATP and calcium

17. After a road accident, a motorcyclist suffered a fracture of the surgical neck of the
right humerus. The examining physician requested him to try and abduct the affected
arm away from his body to about 90 degrees. Which of the following nerves was the
doctor testing for possible injury?

A. Median nerve
B. Musculocutaneous nerve
C. Ulnar nerve
D. Radial nerve
E. Axillary nerve

18. Demyelinating diseases of the peripheral nerve can cause severe disability. This is
because demyelination results in:

A. Decreased excitability of the neuron

B. Decreased Na+-K+ pump activity in the axolemma
C. Shrinking of the axon
D. Decreased conduction velocity
E. Increased refractory period
19. At a medical museum session the facilitator asked a group of students whether they
could list the specific features of the atlas vertebra. All the students answered ‘yes’
nodding their heads. The most likely joint, which was moving in the students, is
between:

A. Inferior surface of the lateral facet of the atlas & superior facet of axis
B. Dense of the axis & anterior arch of the atlas
C. Superior & inferior articular processes of adjacent cervical vertebrae
D. The bodies of the adjacent cervical vertebrae
E. Superior articular surface of the lateral mass of the atlas with the occipital
condyle

20. A 22-year-old goalkeeper was hit hard by a football onto the front of his arm. Next
morning he found that he could not flex his elbow in supination position. It was found to
be due to the injury of:

A. Biceps brachii
B. Brachialis
C. Brachioradialis
D. Coracobrachialis
E. Supinator

21. The lateral medullary syndrome is caused by the thrombosis of which of the
following arteries?

A. Anterior spinal artery

B. Posterior spinal artery
C. Anterior cerebral artery
D. Anterior inferior cerebellar artery
E. Posterior inferior cerebellar artery

22. A 50-year-old woman comes with a superficial burn injury to her right palm. As the
woman does not complain of any pain, the doctor examines both her upper limbs for
sensory loss. The doctor finds that there is loss of pain and thermal sensations in both
hands with sparing of all the other sensations. The doctor dresses the burn wound and
refers her to a neurologist as he suspects a neurological problem. The MOST likely part
of the nervous system, which may be affected in the patient, is:

A. Cerebral aqueduct
B. Central canal
C. Posterior white column
D. Lateral corticospinal tracts
E. Anterior spinothalamic tracts
23. A 60-year-old man presents to a neurologist with loss of sensation of both hands and
legs. Further examination shows loss of proprioceptive and vibration sensations in all
four limbs. Pain and thermal sensations are not affected. The patient gives a history of
surgical resection of his distal small bowel following gunshot injury to his abdomen. The
MOST likely cause for the neurological signs and symptoms of this patient is:

A. Degeneration of the anterior horn cells

B. Degeneration of the posterior root ganglion
C. Pathological expansion of the central canal
D. Demyelination of the anterior white column
E. Demyelination of the posterior white column

24. Some ascending and descending tracts run in the spinal cord without crossing to the
opposite side. The tract which runs in the same side of the spinal cord is the

A. Lateral corticospinal tract

B. Posterior column tract
C. Anterior spinothalamic tract
D. Anterior spinocerebellar tract
E. Lateral spinothalamic tract

25. The spinocerebellum controls muscle tone and coordinates the actions of
antagonistic groups of muscles. The cortex of the spinocerebellum receives afferent
input from the spinal cord via dorsal and ventral spinocerebellar tract and
cuneocerebellar tract. Which of the following sensations are relayed by these tracts in
the cerebellum?

A. Pain and temperature

B. Fine discriminative touch
C. Proprioception from muscle spindle
D. Proprioception from the viscera
E. Sensation of size, shape and texture

26. A 70-year-old man was having a problem of falling down frequently. He was also
having some involuntary movements of his fingers. Physical examination did not reveal
any abnormality. A series of latest imaging investigations were done. Which of the
following parts of the brain was most likely to be found to be atrophied in the imaging
investigation?

A. Lentiform nucleus
B. Thalamus
C. Substantia nigra
D. Amygdaloid body
E. Ventral striatum
27. The pupil in the eye of a 43-year-old patient suffering from a brain tumour remains
small even in a dimly lit room. Which of the following structures would have been
affected to cause this lesion?

A. Trochlear nerve
B. Superior cervical ganglion
C. Ophthalmic nerve
D. Oculomotor nerve
E. Inferior cervical ganglion

28. The body temperature of a patient warded in the ICU for a cerebrovascular accident
rose alarmingly despite being in a cold air-conditioned room. Diagnostic imaging
confirmed that the clot had spread upwards. Which part of the brain is now affected?

A. Spinal cord
B. Medulla oblongata
C. Pons
D. Hypothalamus
E. Thalamus

29. Which of the following contributes the LEAST to orientation of body in space?

A. The vestibular receptors

B. The proprioceptors
C. The organ of Corti
D. The retina
E. The exteroreceptors

30. Tumours of the CNS account for 20% of all cancers of childhood. Which is the
commonest location for childhood CNS tumours?

A. Within the cerebral hemispheres above the tentorium

B. Middle cranial fossa
C. Posterior cranial fossa
D. Cerebellum
E. Anterior cranial fossa

31. An afebrile HIV positive man, not on antiretroviral therapy, was seen by a physician
a day after experiencing a generalized seizure. On physical examination, 4/5 motor
strength in the left upper extremity was detected. Diagnostic imaging shows a midline
shift and presence of multiple mass lesions, which are circumscribed and appearing
solid. Cytological examination shows large cells with large nuclei and scanty cytoplasm.
Which is the most likely diagnosis?

A. Cytomegalovirus encephalitis
B. Glioblastoma multiforme
C. Kaposi sarcoma
D. Large B-cell lymphoma
E. Meningioma
32. A patient was in status epilepticus. Select one anticonvulsant that is safe, quick in
onset and long-lasting in duration of action.

A. Diazepam
B. Phenytoin
C. Lorazepam
D. Midazolam
E. Phenobarbital

33. A 25-year-old woman was admitted to intensive care unit via her general
practitioner for weakness of the lower limbs for the last three days. She has a history of
gastroenteritis a few weeks before. On examination she was found to have bilateral
motor weakness of the legs (lower motor neuron lesion type), without sensory
involvement. The intensive care team’s provisional diagnosis was Guillain-Barre
syndrome. Which of the following is the correct explanation of the pathology?

A. Damage of the receptor on the motor end plate

B. Axonal destruction of neurons
C. Demyelination of neurons
D. Vasculitis of the vasa nervorum
E. Depletion of neurotransmitter

34. A 50-year-old emaciated man presented with fever, neck rigidity and vomiting. He
had been having a low-grade fever with night sweats for the past 10 months. Mantoux
test was positive. Which of the following is the MOST likely finding during the
examination of his cerebrospinal fluid?

A. Increase in glucose
B. Increase in protein
C. Increase in neutrophils
D. Decrease in lymphocytes
E. Xanthochromia

35. A previously health 1-year-old child was seen with fever, neck rigidity and
irritability. Examination of the cerebrospinal fluid revealed a very high increase in
neutrophils. Which of the following vaccines could be used to prevent the infection seen
in this child?

A. Hib
B. BCG
C. DT
D. OPV
E. MMR
36. A 25-year-old man falls while skateboarding and strikes the left side of his head
against a concrete retaining wall. On physical examination only a minor scalp abrasion is
present at the side of the impact, with minimal bleeding that stops in a few minutes. He
is initially alert following this accident, but then became unconscious 30 minutes later. A
head CT scan reveals a convex, lens-shaped area of haemorrhage centered over the left
parietal region. These events are most likely to be associated with damage to which of
the following parts of the intracranial vasculature?

A. Cavernous sinus
B. Bridging veins
C. Great vein of Galen
D. Inferior cerebellar artery
E. Middle meningeal artery

37. The patient is diagnosed with infectious endocarditis, and an appropriate antibiotic
regimen is started. The next day, he reports that he is experiencing some visual
difficulty, which had not been a problem for him earlier. A second evaluation reveals
that he has weakness in the left upper limb and left lower limb. He also has a right
homonymous hemianopia. What is the likely artery blocked by the infective thrombus?

A. Anterior cerebral artery

B. Middle cerebral artery
C. Posterior cerebral artery
D. Choroidal artery
E. Middle meningeal artery

38. Dr. Wong is a busy gynaecologist who does around 10-12 short surgeries per day. All
her patients get a short-acting intravenous anaesthetic agent so that they can go home
after a few hours with no hangover. The patients are also very happy as they have no
sides effects like nausea, vomiting. Which of the following drugs do you think is eing
used for Dr. Wong’s patients?

A. Thiopentone
B. Propofol
C. Diazepam
D. Ketamine
E. Etomidate

39. Slow wave sleep (SWS) is associated with

A. Vivid dreams
B. PGO spikes
C. Increased heart rate
D. Eye movements
E. Impulses arising from the forebrain
40. Choose the correct pair from the following

A. Wernicke’s aphasia; injury to forebrain

B. Reticular activating system; sleep/wakefulness rhythm
C. Associative learning; habituation
D. Classical conditioning; explicit memory
E. Broca’s area; comprehension

EMQ
For each statement described below, choose the SINGLE most appropriate choice from
the list of options. Each option may be used once, more than once, or not at all.

Options:
A: Median nerve injury
B: Ulnar nerve injury
C: Radial nerve injury
D: Axillary nerve injury
E: Lower brachial plexus injury
F: Upper brachial plexus injury
G: Carpal tunnel syndrome
H: Sciatic nerve injury
I: Peroneal nerve injury
J: Obturator nerve injury

Statements:
1. Automobile dashboard injury with flexed knee causing acetabular fracture.
(H)

2. Recurrent inferior dislocation of the shoulder.

(D)

3. Long plaster cast causing tingling and numbness over the lower part of the leg.
(I)

4. Difficult delivery of the large baby with shoulder dystocia.

(F)

5. Repetitive compression of the wrist against desk surface with pins & needles over
little finger.
(B)
Options:
A: Tentorium cerebelli
B: Horizontal fissure
C: Quadriceps femoris
D: Falx cerebelli
E: Superior cerebellar peduncle
F: Sternocleidomastoid
G: Trapezius
H: Gluteus maximus
I: Primary fissure
J: Middle cerebellar peduncle

Statements:
6. The dura mater separating the two cerebellar hemispheres.
(D)

7. The fissure demarcating anterior from middle lobe of cerebellum.

(I)

8. Anti-gravity muscle maintaining extension of the hip and knee.

(H)

9. Neck muscle helping in scanning eye movements.

(F)

10. The fibres carrying projections from neocerebellum to cerebral cortex.

(E)

Options:
A: Candida albicans
B: Cryptococcus neoformans
C: Haemophilus influenza
D: Herpes simplex virus
E: Listeria monocytogenes
F: Neisseria meningitidis
G: Pseudomonas aeruginosa
H: Poliovirus
I: Rabies virus
J: Staphylococcus epidermidis

Statements:
11. An 8-year-old child who had an intracranial shunt inserted was hospitalized with
fever, neck rigidity and headache. Cerebrospinal fluid examination of this patient
revealed numerous pus cells and Gram-positive bacteria. What is the most likely cause
of this patient’s condition?
(J)

12. A 10-month-old baby was brought to the GP as the baby was irritable, had fever and
refused to feed. The baby’s illness, which could be prevented by vaccination was caused
by Gram-negative bacilli. What is the agent responsible for the baby’s illness?
(C)
13. An AIDS patient with a decreased CD4+ cell count developed meningoencephalitis.
The protein content of the patient’s CSF was increased and it also contained budding
yeast cells with wide capsules. What is the MOST likely cause of the patient’s illness?
(B)

14. An explorer visited a cave infested with bats. Later, he was very worried that he
might have been exposed to an infectious agent transmissible through bat droppings.
What is the MOST likely infectious agent that the explorer had in mind?
(I)

15. An outbreak of meningitis occurred in a community. Examination of nasopharyngeal

swabs revealed that there was an increase in the carrier rate of Gram-negative cocci in
the community. Identify the MOST likely cause of the outbreak.
(F)

MEQ 1
Part A: 7 minutes

A 30-year-old male is seen in orthopaedic clinic with complaints of non-healing ulcer

and chronic discharging sinus over left tibial shaft for last 3 months. He gives a history of
open fracture left tibia 6 months ago.

(a) What is the most probable diagnosis?

Give two reasons for the diagnosis. (1+2=3 marks)

Answer: Chronic osteomyelitis.

Only osteomyelitis (1/2 mark).
- History of open fracture.
- Non-healing (presence of infection).
- Presence of sinus – presence of discharge (ANY TWO).

(b) List two common routes of infection reaching the bone. (2 marks)

Answer: Haematogenous spread

Extension from contiguous site
Direct implantation
Contamination (ANY TWO).

(c) The patient is having difficulty in the movement of knee joint. Name any TWO
muscles causing movements shown in the table. (0.5x4=2 marks)

Answer:

Movements Muscles
Flexion Popliteus, semimembranosus,
semitendinosus, adductor magnus,
gastrocnemius (ANY TWO).
Extension Quadriceps (Rectus femoris, vastus
medialis, vastus lateralis, vastus
intermedius) (ANY TWO).
MEQ 1
Part B: 6 minutes

Initial radiological findings were suggestive of chronic osteomyelitis with evidence of

subperiosteal bone formation and involucrum.

(a) Define involucrum. (2 marks)

Answer: Involucrum is the reactive new viable bone formed as a result of bone
infection healing process. This new bone is woven or lamellar.

(b) Briefly state what you mean by osteoid? (1 mark)

Answer: Osteoid is the organic matrix of the bone / consisting of collagen fibres,
proteoglycans and osteocalcin / it is not yet mineralized

(c) Describe how the following hormones affect bone remodeling. (3 marks)

Answer:

Hormones Action on bone remodeling

Parathyroid Increases the rate of bone remodeling by causing proliferation of
hormone osteoclasts, increasing recruitment of osteoblasts to resorption site.
Cortisol Increases the rate of bone remodeling by increasing activity of
osteoclasts.
Calcitonin Decreases the rate of bone remodeling by increasing osteoblastic
action / decreasing osteoclastogenesis.

Part C: 7 minutes

The discharge from the sinus was sent for culture and sensitivity test.

(a) Name two organisms responsible for pyogenic osteomyelitis in the following group
of patients. (4 marks)

Answer:

Group of patient Name of organism

Children Staphylococcus aureus, Haemophilus
influenzae, Group A Streptococci (ANY
TWO).
IV drug users E. coli, Pseudomonas aeruginosa,
Klebsiella group (ANY TWO).

(b) (i) State the antibiotics of choice for treating acute osteomyelitis in a child;
(ii) What would be the appropriate route of administration and duration of
therapy? (1+2=3 marks)
 Answer: (i) Cloxacillin (antibiotic sensitivity from blood and wound swab
is still needed).
(ii) Intravenous 2 weeks followed by oral capsules/tablets 4
weeks (total 6 weeks).

MEQ 2
Part A: 6 minutes

A 30-year old woman who just had a baby developed a fever, and was very troubled to
find out that she had become clumsy, knocking over chairs and stools. She was also
‘seeing double’ and experienced tingling sensations.

(a) Give THREE possible causes for her complaints. (3 marks)

Answer: optic neuritis / peripheral neuritis / subacute combined degeneration of

the spinal cord / multiple sclerosis / cerebellar lesion / lesion of nerves
supplying extraocular muscles / electrolyte imbalance.

(b) (i) Briefly state the mechanism by which diplopia occurs in binocular vision.
(2 marks)

Answer: When the movements of two eyes are not coordinated, images of the
same area of visual field are not focused on the same area of the retina,
causing a double vision or ‘diplopia’.

(ii) What could have caused diplopia in this patient? (1 mark)

Answer: It could be due to a weakness or paralysis of extraocular muscles, or also

due to a lesion of the nerves supplying this muscles.

Part B: 7 minutes

The symptoms went away for a few months, but recurred, and a friend advised her to
see a bomoh. Her husband, however, searched the internet and thought her case could
be multiple sclerosis.

(a) Would you agree with the diagnosis? Discuss. (4 marks)

Answer: Yes, young female / symptoms come on and off / visual disturbances /
clumsiness of movement / aesthesias / following an infection.

(b) Discuss the pathophysiology of multiple sclerosis. (3 marks)

Answer: autoimmune demyelinating disorder; T-cell mediated type 4

hypersensitivity reaction to myelin protein; there is also a component of
direct axonal injury and neuronal death (proposed to be due to toxic
effects of lymphocytes, macrophages, and secreted substances).
Part C: 7 minutes

She was given some drugs, but they did not seem to help. Eventually, she developed
seizures and bladder dysfunction.

(a) Discuss why drugs did not help. (2 marks)

Answer: There is no cure for multiple sclerosis. Treatment typically focuses on

combating the autoimmune response and managing the symptoms.

(b) Give TWO drugs that could help control the seizures. (2 marks)

Answer: Carbamazepine, phenytoin, gabapentin

(c) Explain why the bladder function is affected. (3 marks)

Answer: the pelvic nerve, a myelinated nerve, acting both as an afferent and
efferent nerve, mediates the micturition reflex. The multiple sclerosis
has affected the pelvic nerve.

MEQ 3
Part A: 8 minutes

A 17-year-old man complained of pain over his left upper arm that had persisted for a
month. On examination, a swelling was found over the humerus.

(a) Outline the points in history-taking you will consider in this patient.
(3 marks)

Answer: Duration of pain

Nature of pain
Onset and progression of pain/aggravating factors
Duration of the swelling
Size of the swelling, associated symptoms
Progression in the size and relationship with pain

(b) Name THREE investigations relevant to this case. (3 marks)

Answer: Plain radiograph of left shoulder joint including proximal humerus

Bone biopsy (cone needle biopsy)
Bone scan
Complete blood count

(c) After 6 months, the young man had a weight loss of 15 kg. The swelling was found to
be increased in size and fixed to the underlying muscles. What is the most probable
diagnosis? (2 marks)

Answer: Osteogenic sarcoma (malignant bone tumour)

Part B: 7 minutes

The patient was diagnosied with osteosarcoma.

(a) Cisplatin was given and painkillers were prescribed. However the pain was
becoming worse. List the nerve fibres carrying pain sensation and types of pain carried
by each fibre. (2 marks)

Answer: A-delta fibres – fast pain

C (unmyelinated) – slow pain

(b) Comment on the quality of life of the patient. (2 marks)

Answer: Affects education and social life, dissatisfaction with life, feeling of
helplessness, anxiety and distress of the family.

(c) Since the response to chemotherapy was not satisfactory, an amputation operation
was planned. Identify the ethical issues that need to be addressed before the
amputation. (3 marks)

Answer: Informed consent (Patient is 17 years, consent from the parent as well as
from the patient).
Patient autonomy
Non-maleficience – amputation should consider the preservation of
maximum functions as far as possible.

Part C: 6 minutes

The amputation was done. He still complained of pain in the arm although it was no
longer there.

(a) What is the term used to describe the complaint? Describe the law which explains
the phenomenon. (1+2=3 marks)

Answer: Phantom limb

Law of projection
It states that stimulation anywhere along the ascending tracts would
produce a sensation in the brain, which is referred to the site of the
receptor.

(b) List two classes of medications that can be used to relieve the pain.
(2 marks)

Answer: Tricyclic antidepressants (amitriptyline, nortriptyline)

Anticonvulsants (gabapentin, carbamazepine)
Narcotics/Opioids (codeine, morphine)

OSPE
1. Pott’s spine
a. X-ray
 P – sacroiliac joint, plane type synovial joint,
  Q – ischial tuberosity, attachment of hamstring,
 S – air in colon,
 R to lower border of sacrum to measure Median conjugate,
b. MRI
 compression of spinal cord, vertebra crushed
 arrow points to spinal cord
c. Picture of patient
 emaciated look, kyphosis, swelling near spine

2. Coronal section cranial cavity; name sinuses, nerves.

 A – trigeminal ganglion
 B – mandibular branch of trigeminal supplies medial pterygoid, lateral
pterygoid, etc
 C – transverse sinus
 D – sigmoid sinus
 E – optic nerve
 F – cavernous sinus

3. Brain photograph, describe lesion; related pathology.

 Description: Sulci filled with blood, haemorrhage anterior to brainstem,
brain edematous
 Diagnosis: Subdural haemorrhage
 Causes: Berry aneurysm, middle meningeal artery rupture
 Weighing of brain: Increased weight of brain
 Symptoms: Presents with headache, nausea and vomiting